National Assembly for Wales

I move to item 4 as we go now into public session with the Health and Social Care Committee this morning. I'd like to welcome Members and witnesses, who are already in the meeting. This morning's meeting will be a combination—a hybrid—with Members and witnesses attending this morning, and as always, we operate bilingually as well. I move on to item 4. We have apologies this morning from Jack Sargeant, and Vikki Howells is substituting. If there are any declarations of interest, please say now. Sarah Murphy. 

Thank you, Chair. I'm a member of Unison Cymru and also GMB.

Lovely. Thank you very much. Thank you, Sarah, for that. 

Item 5, we have a general scrutiny session this morning with the Minister for Health and Social Services, the Deputy Minister for Social Services and the Deputy Minister for Mental Health and Well-being. So, I'd like to welcome the Ministers to the committee this morning, along with officials as well. So, perhaps, Ministers, you could introduce yourselves then followed by the officials in the meeting this morning. Minister.

Thanks. I'm Eluned Morgan, Minister for Health and Social Services in the Welsh Government. 

Morning. I'm Lynne Neagle. I'm Deputy Minister for Mental Health and Well-being. 

Bore da. Julie Morgan, Deputy Minister for Social Services. 

And now the officials. 

Good morning. Nick Wood, deputy chief executive of NHS Wales.

Bore da. Good morning. Albert Heaney, chief social care officer for Wales.

Good morning. I'm Matt Downton. I'm head of the mental health and vulnerable groups team in Welsh Government. 

Bore da. Irfon Rees, director of health and well-being at Welsh Government. 

Lovely. That's everyone, I think, from looking at my screen. Thank you. Diolch yn fawr iawn. Thank you very much for introducing yourselves and welcome, all, to the meeting this morning. What I would say at the start of our meeting is that, during the summer period, we asked members of the public if they had any questions to put to you as Ministers. So, we've incorporated a number of those questions into the session today. Some members of the public were happy to be named, others were just happy that their questions were put. I don't think we're going to be able to ask every question that was put to us, but we've certainly tried to group the questions accordingly and will incorporate questions from members of the public as we can. But, I would like to thank all the members of the public who did contribute to putting questions to us to put to the Ministers for today's session. One of those questions, Minister, and I'll perhaps look at you, Minister, Eluned Morgan, put to us was: what steps are you taking to address staffing shortages in social care? I wonder if you would like to take that, or direct one of the Deputy Ministers to answer that point. 

Well, if you don't mind, I'd like to ask Julie Morgan, who is responsible for social care, to take that. 

Julie Morgan. 

Yes, thank you very much, and it's very welcome, I think, that you're incorporating what members of the public are asking.

So, in terms of what steps we are taking and have taken to address the shortage in social care, this year, we provided £43 million-worth of funding to deliver our commitment to uplift salaries to the real living wage, and that has been achieved. We also made additional payments of £1,498 to 63,000 social care workers across Wales this summer, and we did that along with paying them the real living wage. And that, again, has all been paid out. And we're looking with our partners—that's the unions, the employers and local authorities—to look at what further steps we can take in order to improve conditions in the sector, because we know that it is a struggle to manage to recruit new staff to the sector.

We have had a national recruitment campaign over the summer, using the WeCare.Wales brand to encourage more people to join the sector, and I think they are having a real impact, these campaigns, in terms of people getting information about social care work and people feeling more positive about working in the sector. And, as you know, we've set up the social care fair work forum, which advised us on bringing in the real living wage and is also now moving on to look at terms and conditions in the sector. We want there to be a clear career route in social care and, of course, Social Care Wales does have a social work workforce plan for social workers. We've also put in £10 million to uplift the social work bursary, and that's going to be increased financial support for social work students over the next three years. So, those are some of the things that we've done, but it is difficult to recruit staff and we're trying to make the jobs as attractive as we can.

What's the scale of the vacancies, Minister—what's your estimate, and what's your forecast for the winter?

Well, Social Care Wales collects information on the social care workforce annually and, according to the last report in 2021, there are approximately 5,500 vacant posts, which represents about 6 per cent of the workforce. And work is ongoing at the moment to review the position with regard to winter vacancies, and that's being done at a regional level by health boards and local authorities. 

I think it's important to say that nearly all parts of the economy are facing challenges recruiting and retaining staff and social care is definitely facing those challenges, but we are competing with retail, hospitality and other sectors and it is a challenging situation. But we have got the community care capacity building initiative, which is work between local authorities and health boards, to try to deliver additional system capacity this winter, and I hope that we'll be able to tell you more about that as it progresses.

So, how do you overcome some of those challenges in terms of competing against other sectors, such as supermarkets? How do you compete in that area? And you talked about the forecast—that there's a 5,500 vacancy gap at the moment, according to figures you quoted: what are your estimations for the winter period into next year?

Well, those were the last figures that we had available and we don't have the figures to say what we estimate they will be now in the autumn. But what we have to do is to make people realise how attractive the job is, because it is a very rewarding job and people who are really involved and have done it for some years absolutely love the job. So, what we need to do is make people realise how attractive the job is, and the WeCare.Wales adverts do do that and they have had an influence in doing that. But we still need to do a lot more. Obviously, we are paying the real living wage now, but it's not really enough and we want social care workers to have parity of esteem with healthcare workers and that certainly does not exist at the moment.

We are registering the workforce. We've registered the domiciliary care workforce and we are registering the residential care workforce—we're in the process of doing that, and that is a part of trying to professionalise the workforce. There's a lot of work to do. We are making steps towards doing it, but I think we'd have to accept that this competitive market for workforce is throughout the UK, basically, and lots of sectors are struggling and we've just got to do all we can to attract people to the social care workforce.

Thank you, Minister. I've got to say, I'm having difficulty—I was trying to politely interrupt, but it's difficult when you're having a virtual meeting sometimes to do that, which is why I do hope that Ministers will be able to be here physically for future meetings; it does cause some technical issues sometimes.

Minister, what I was going to ask you is why you don't have a forecast for vacancies in social care, because to understand the scale of the issue, surely you do need to have that forecast.

Yes. Well, it is very difficult to make a forecast about the vacancies, and the reason it's difficult to make a forecast is because we're dealing with more than 1,000 employers. So, the vast majority of the sector is in the private sector with independent people running the sector, so it's very difficult to link that and to make an overall forecast. But we are working at this to try—. We're working with Social Care Wales to try to get to a position where we are able to get more grasp of what's happening in the social care workforce. But the real reason is that it's a very disparate employment field with very small domiciliary care private employers, care homes, and as I say, it's over 1,000.

Thank you. Okay. I think other Members may want to perhaps dig into that a bit later. Vikki Howells.

Thanks, Chair. Good morning, Ministers. I've got some further questions on social care, specifically around both retention and recruitment. So, firstly, I'm wondering, Deputy Minister, what you can tell us about the trends in the retention of care staff, and whether the number of people leaving the sector is starting to stabilise at all.

Well, again, it is difficult to say exactly about that, for the very reasons that I've explained. We await the next figures that come forward, and as I said, the original figures that I gave you earlier were 5,500 vacant posts, which represented about 6 per cent of the workforce. That's the last report that we've got, and that was in 2021, from Social Care Wales. They collect those figures annually, so we'll have that next figure in 2022, but we haven't got it at the moment. But it's all linked to the way that the set-up is with these 1,000 different employers, and so it is very difficult to make any accurate predictions. But obviously, we are aware of the shortages, because we're aware via the local authorities when they tell us that they're not able to provide the domiciliary care to people who are living at home and who need it. That is reported regularly from all the local authorities in Wales, that they are nearly all having difficulties in providing help and support to people who are living in their own home.

And then, of course, we have the people in hospital who are not able to be discharged, and a significant number of those people who are waiting, again, for packages of care. So, we know that the shortage is there, and we are doing our utmost to try to tackle this, and that's why we're having this community care capacity building initiative, which we will be able to tell you more about, but we're not really at a stage to measure that yet. I don't know if Albert Heaney wants to come in on this.

Yes, thank you. I would be pleased to come in, Minister, and thank you very much for the question. I think it was really just to add a couple of comments to the Minister's already very helpful statement. The first thing is that a lot of the work that we've been putting in is to try to retain staff, a lot of focus is on career pathways, trying to work with Social Care Wales in the sector and the different employers, so that our valuable staff members can see progression, can see the opportunities that social care offers. Alongside that, there have been a number—as Ministers have mentioned—of payments that have been supporting staff financially, the latest being the £1,498 which is really appreciated by staff who are on the front line, and that adds great value.

The Minister, of course, added the community care capacity building work. The Minister for Health and Social Services has led on that work, and there's a great deal of co-operation taking place across health and social care. As part of that, on a regional basis, they have been working through in detail issues around vacancies in critical parts of the sector, whether that be reablement, or social care, domiciliary care front-line staff. They're putting a range of measures in place now over the winter both to look to recruit staff into those very specialist posts and deliver and protect, but also to work on a whole-system response around step-down facilities so that the system flows and the hospital has admission avoidance, but also so that the people who are in hospital have a healthy route out of hospital as well. So, just a few additional comments, Chair. Diolch yn fawr.

Thank you. Vikki Howells, do you have any further questions?

[Inaudible.]

I'm ever so sorry, Vikki. We can't hear you, I'm sorry. I'll come back to you if we can perhaps get the technicians to check the line, but we just couldn't hear you at that point. I'll come back to you. Sarah Murphy.

Thank you, Chair. Thank you, all, for being here today. I wanted to ask some questions around the impact of the cost-of-living crisis, which, obviously, is very much at the forefront of everybody's minds at the moment. So, there's evidence that rising fuel costs are causing more domiciliary care workers to leave the sector, making staff shortages even worse. What action will the Welsh Government take to help domiciliary care workers with their fuel costs?

Thank you very much for that question, Sarah. We've provided £10 million of additional funding to local authorities through the supplementary budget in April. This was intended to allow local authorities to fund domiciliary care staff to learn to drive and for local authorities to buy electric vehicles for use by domiciliary care staff. We were trying to get increased capacity in the sector, and, obviously, to support care workers. But since April, as fuel prices have increased, and there is evidence to suggest that staff mileage rates set by the independent sector, on the whole, have not kept pace, some local authorities then asked if they could use this funding, this £10 million, within their commissioning arrangements where they can be satisfied that this will lead to an increase in staff mileage. We confirmed in a letter to directors of social services in August that they could use the funding in this way. So, we have put £10 million in that we have told directors of social services that they can use in order to help with fuel. But I absolutely accept that it is a real problem, the cost of fuel, and that, particularly, domiciliary care workers were travelling often between different houses around a local authority area, and they couldn't really manage without using a car. So, the fuel issue is a big issue, but we have put that £10 million in.

Sarah Murphy.

I was just waiting to be unmuted, thank you. Thank you, Deputy Minister. I also wanted to ask if the Welsh Government is planning to provide any further financial assistance to care providers such as Tŷ Hafan hospice for soaring energy bills. I've had a constituent get in touch with me from Porthcawl who oversees a number of care homes there, and they again are saying that they're on a fixed term at the moment, but the tariff that they've been offered for their next plan is far more than they could possibly afford, and they're very, very worried.

I absolutely understand that they are worried, and it is a huge issue. In terms of hospices, we have delivered on our programme for government commitment, which was to review hospice funding and we provided an extra £2.2 million for hospices on a recurrent basis from April 2021, so we are upping our contribution to hospices. But we do recognise the huge importance of the service that the hospices do, and we're working with Tŷ Hafan and with other hospices to better understand the challenges that they're facing through the current cost-of-living crisis. So, we know that hospices across the country are struggling and, obviously, the UK Government—we do hope that there would be more action taken over energy costs, but we are working with the hospices now to see what we can do. But we have given additional funding this year.

Thank you, Deputy Minister. And now I have the pleasure of asking a question from a member of the public. They've asked: what further action will the Welsh Government take to urgently address the financial hardship that unpaid carers and people with disabilities are currently facing, exacerbated by the cost-of-living crisis?

Thank you very much, again, to the member of the public who put that important question in, and raised the issue of unpaid carers who are often looking after people with disabilities, and so the two go hand in hand, basically. We know that during the pandemic unpaid carers did a fantastic job, because often they had no help at all because of the safety of the person they were looking after. They weren't having other people in their homes, and we know that they did, as I say, an absolutely fantastic job, and so we have tried to help them with payment schemes.

In April 2022, we announced £29 million to provide 57,000 unpaid carers in Wales who were in receipt of carers allowance with a £500 carer grant. And we're very pleased about the way that has been taken up, and the latest returns from the local authorities show that 75 per cent had actually registered for the payment, which is a very high take-up and very urgently needed. The Welsh Government has, obviously, put £90 million into another Welsh Government fuel support scheme, which is being extended, and that will, obviously, help people as well. That means even more households, including people who are on carers allowance, will have help with their fuel costs from the Welsh Government's fuel support scheme.

I'm aware that it's only people who are on carers allowance who are receiving the £500, so we're really committed to finding other ways to help unpaid carers. We have launched the carers support fund. This fund is £4.5 million over the next three years, and that's administered by Carers Trust Wales. And since we started that in 2020, it's helped over 10,000 carers on low incomes. And what you can do is have up to £300 to buy basic essentials, really. And it has been very successful, but in order to apply for that fund, you don't have to have carers allowance, so it is a much more flexible fund, and it's not linked to benefit entitlement. So, we have done a number of financial initiatives to help unpaid carers.

Thank you very much, Deputy Minister, and thank you, Chair.

Thank you, Sarah. Vikki Howells, I'll just try you again. Hopefully we can hear you this time. Vikki Howells.

Hello, Chair. I'm just checking if you can hear me.

We can hear you well. Thank you.

Great. Thank you. It was a follow-up question to Mr Heaney regarding the Welsh Government's recruitment campaign. I understand the committee was rather surprised to hear that the Welsh Government was unable to evaluate the success of the recruitment campaign beyond simply—[Inaudible.]

Sorry, Vikki. We've lost you again. We'll try and take you out of the meeting to try and get some technical support. But I think the question you asked was heard, so I don't know if Mr Heaney wants to address that point.

Certainly, Chair. And thank you for the question. I did hear the beginning of the question, but I didn't catch all of it, so I'll endeavour to cover it. As a Welsh Government, we clearly value the work that Social Care Wales are doing, the work that they're leading on around the WeCare.Wales campaign—we fund that. The committee's absolutely correct, and the Member's correct, to raise that there were challenges in terms of how you demonstrate the cause and effect—so, the relationship between a recruitment campaign activity, such as tv advertising, and then how you actually demonstrate that there's been an increase in people taking up jobs across such a diverse workforce of over 1,000 employers across Wales. So, following the last meeting, I had agreed to take that away, as Members will recall. I've had conversations with the chair and the chief executive, for example, of Social Care Wales, and I'm very aware now, for Members, that they're taking forward work to look at deploying enhanced measures.

Just a couple of things to say on that: they're redeveloping their website, which is really important, to be able to—. They're seeking to track the outcomes more effectively for those seeking jobs through its portal, and I think that will have valuable information for us. And they're hoping that will be available, Chair, by February of next year. And then, to help us get more accurate information, and help reassure members of the committee today as well, Social Care Wales have been conducting surveys. One of the surveys that they have done was across—. So, they surveyed 500 new social care workers. What was interesting, and what they found was, that over half of the 500 recalled seeing the adverts and actually indicated that the WeCare.Wales adverts made them interested in working in social care, which is a really positive outcome in terms of generating public interest, and actually, for almost two thirds of them, it really made them more positive about applying for social care posts. So, again, I think we're seeing, from some of the survey work, and from the design, that we have more information coming forward that, hopefully, will reassure the committee as well.

Thank you, Mr Heaney. Joyce Watson.

Good morning, everybody. Again, I'm going to ask a question that was put to us from a member of the public, an unpaid carer, asking if the Minister recognises that unpaid carers are struggling both physically and mentally, and what is being done by the Welsh Government to ensure they get proper support before they reach breaking point. Of course, one aspect of that support will be respite, so that those people can have some time to themselves. 

Thank you very much, Joyce, for that question. And, yes, I absolutely recognise that many unpaid carers are struggling physically and mentally, and we've already said in this committee how magnificent they've been all the way through the pandemic, supporting their loved ones. And it is a huge strain, and we have been told by unpaid carers that having a break, in whatever form that takes, is really important, and it's really important that we make those opportunities available. 

In 2021-22, we allocated £3 million to local authorities to increase the availability of respite services across Wales. And from this financial year, we've allocated £9 million over three years to establish an innovative short breaks scheme for unpaid carers on low incomes who are struggling to cope with their caring responsibilities. And this scheme will increase opportunities for unpaid carers to take a break away from their caring role. And what we want for unpaid carers is to have a life alongside caring. And, so, a short break can provide a service, support or any experience that the carer would like. Maybe it would be a very short thing, like wanting to go to a class every week, or it could be something a bit longer. So, one of our programme for government commitments was to deliver an unpaid carers short break scheme.

So, Carers Trust has been appointed as the national co-ordinating body, and they're going to oversee the scheme and work with regional partnership boards, local authorities and the third sector across Wales to encourage innovation and good practice. So, we've put in this £9 million and we're trying to get a new respite scheme available for unpaid carers.

I thank you for that. And, of course, we've heard that carers are still reeling. You've mentioned the effects of the pandemic, and it's put on additional care that they've been asked to provide during that pandemic. But, because services haven't recovered, they are still experiencing continued disruption to the services that they were relying on to provide and support them in their care. So, have you any idea when those same carers can expect a reprieve on those pressures that they're bearing every single day of the year?

Well, Joyce is absolutely right to draw attention to the services that have not fully resumed since the pandemic. Many day-care services, for example, are not back at full strength, as they were before the pandemic. And I know, from speaking to many unpaid carers and the people they care for, that this is a real problem for those families.

We are talking to local authorities regularly. Albert Heaney meets with the directors of social services and I know has said how urgent we feel it is that the day centres in particular should resume. And there is action being taken to resume day services, as the effects of the pandemic are being reduced. Although many services are reopening, there are still challenges, I know, in fulfilling all the opportunities, and to make sure that the services that are delivered have got a person-centred focus.

Now, for example, a couple of weeks ago, I visited an excellent day service provided by Mencap in Chepstow, and I was so impressed with the activities that go on there. It's used as a base for young adults with learning disabilities to go out into the community—a very impressive place. But I had parents waiting there to see me to raise their concerns about the fact that their children may have been going five days a week before the pandemic but now they were only going three days a week. I am very concerned about this, and I've asked the Association of Directors of Social Services to take an in-depth look to see what is happening with day services and how they're being delivered post COVID, to try to understand what are the challenges that are stopping them opening up. I am aware that many people who ran day services were diverted during COVID to other areas of work in order to keep things going, basically. But day opportunities are crucial. They're a lifeline for parents and carers, and we are doing out utmost to encourage the local authorities to move ahead in reopening them.

Thank you. We've also heard evidence from unpaid carers that they're not being recognised or compensated for the care they provide, and one particular carer said that the cost of his provision should be recompensed at £15 an hour. I know you've given extra money for unpaid carers, and I think that's been extremely well received, but is there a wider issue here about the amount of care that people are providing, which is saving significant money? If those people were unable to offer that care, the recipients of care would have to be paid for out of the public purse.

Thank you for that question. Now, some carers have told me that they do not wish to be seen as professional carers and paid by the hour for what they're doing. And I think there are a significant number of carers who do feel like that—that they're caring for their loved ones within the family, and they just want to get as much help and support as they can, but they don't see it as a professional job. I've had a lot of carers telling me that. However, the point made by the member of the public, as you said, is obviously something that some carers do feel—that they should be paid by the hour—but I have to say that I have a lot of carers saying that what they want is the support and access to benefits and things in a fair way. 

We do feel that all carers should be able to have access to financial and practical support at the time that they need it, and that's why I've mentioned the carers support fund and the short break schemes, which are all new initiatives. Now, we don't have responsibility for welfare benefits. We do lobby the Westminster Government. I know there's a general feeling about the carers allowance—many people feel that is not sufficient, and we have lobbied the Westminster Government about that. And, of course, welfare benefits, as a whole, are with the Westminster Government, So, whether they go up or down, as we know very well by recent publicity, or whether they keep pace with inflation is in the gift of the Westminster Government. So, all we can do is try to make representations about people who are dependent on benefits who, in many cases, are unpaid carers. But what we've got to do is make sure that we maximise the money that people are actually entitled to, because I think that, whenever you look at welfare benefit take-up, it's always much lower than it should be. So, the Welsh Government has had a number of welfare benefit take-up schemes that have been very successful in terms of maximising the amount of money that can be brought in.

Thank you. Carers Wales did tell us that legal obligations under the Social Services and Well-being (Wales) Act 2014 are being undermined, because the pressures around hospital discharge are forcing carers to go above and beyond being, and I quote in inverted commas, 'willing and able' to provide care. 

Yes. The times that we are in are exceptional, and we acknowledge the stress on local authorities. We have talked already this morning about the stress on staff and the fact that we can't get social care staff in some cases, and that means that we do need more help from families to extend their care for their loved ones, beyond what they would normally do. We have also used volunteers to try to help with the situation, because it's an exceptional time, and I just think that we've got to understand this in light of the difficulties that are all around. But we do expect local authorities to ensure that people's needs are being met and to try to address any situations where people have had to go beyond what they would really feel able to do as soon as they possibly can. One million pounds has been allocated in this financial year to health boards to focus on supporting unpaid carers when the person they care for is admitted or discharged from hospital. I know that there are often complaints from unpaid carers that they haven't been drawn in enough to a hospital discharge, for example, and there are examples of people being sent home without much preparation. So, we have put in this money in order to do that, and I think that there are now good practice examples of activity, with action taking place to improve communications with unpaid carers in the hospital setting and to engage them in the discharge process, which of course they should be in any case. It is good practice. But we have put that extra money in to do that.

We have also funded Carers Wales to produce best practice guidance for social care workers on how to engage with unpaid carers, and a lot of that, again, is related to hospital discharge, which is where we have had an awful lot of issues raised. When unpaid carers have eligible needs for support, direct payments can sometimes aid timely discharge, and we have given money towards helping with that.

Thank you, Joyce. Do you have any further questions, Joyce? No. Deputy Minister, can I just ask you: you mentioned at some length the short breaks scheme in your response, but, earlier in the session, you also talked about the thousands of vacancies within the sector as well, so is it the case that the short breaks scheme isn't going to work, with the level of vacancies, or at least be hampered?

Well, the short breaks scheme, in some cases, would need a carer in to help with the person who was being cared for while the person took a break. So, obviously, in a situation where there is a shortage of carers, it will be more difficult, but I have no doubt that we will be able to make an impact with the short breaks scheme. I think we mentioned that there was a 6 per cent shortage of care workers at the last reckoning, and I have no doubt that that will make some impact, but I'm sure we will be able to make an impact with the scheme. 

I think that my point is—what you outlined on the short breaks scheme all seemed very welcome and positive—it isn't going to work if you haven't got the carers to stand in while the breaks are taking place, surely. 

No. We need the carers, but, although we have got 6 per cent vacancies, we have got carers and we’re hoping to improve the numbers as they come along. So, that’s a very important point, but this all depends on us getting more carers. But in the situation as it is at the moment, we certainly would be able to provide some short breaks, yes.

Sure. And then also, just to pick up on another point, I’ve got a note here that states that, by the end of last winter, six of seven health boards had put out a call to carers and families asking for their help to take more care to ease pressures on services, and I’m wondering whether you’re expecting that to happen this year.

Those were very exceptional circumstances, as I’ve said. I think we are anxious about what’s going to happen in the winter, and we feel very strongly that we don’t want to ask unpaid carers to go beyond what they feel able to do, but we were forced to do that in order to try to keep the system moving, because, obviously, to a certain extent, being able to enable people to leave hospital, for example, does then keep the system flowing.

But the other thing is we have tried to get more volunteers involved because there are some very well-established volunteer schemes working with hospital discharge, for example, such as the Red Cross, who do a huge amount in terms of helping with hospital discharge, and we would really like to do more of that. I think it’s great to get involved with the voluntary sector as well, because there are people who are willing and eager to help as volunteers, but it’s become much more of a critical aspect in view of the fact that we are under such pressure.

So, are you expecting the same to happen this year?

I don’t know.

Okay. Thank you. Sarah Murphy.

Thank you, Chair. I’m going to ask some questions now about social care pay and terms and conditions, specifically looking at sickness pay, because, as we know, the majority of social care staff only receive statutory sick pay, and some aren’t entitled to that. So, my first question is whether the Welsh Government carried out a risk assessment before they made the decision to end the COVID-19 sick pay enhancement scheme last week, ahead of this winter, and it would also be helpful to know in particular how this may have impacted NHS support carers who have long COVID as well, please.

Yes, thank you very much for that, again, very important question. We were very concerned about having to end the support for sick pay for social care workers, and we certainly considered it very carefully. That payment scheme was brought in as a result of COVID, and as we didn’t want people to be under stress and feeling that they had to carry on at work, causing any further infection and things like that, we did feel that it was very important to pay that, but now the pandemic is over we’ve had to revert back to the situation as it was before. But that doesn’t say that there isn’t a problem, because this has been a long-standing problem in the sector, and it’s been something that I think we’ve all known about. The fragility of the social care sector has been there for many, many years. There aren’t good terms and conditions, and that’s why we’ve got the social care fair work forum, which is looking at all these issues, and sick pay would be one of the things that we look at.

So, we did stop paying, and that was recognising the end of the pandemic. We also ceased to have any consequentials from the Westminster Government for the pandemic, which this had been paid out of. But there is an issue, and we do want to see better terms and conditions, including sick pay, for people in the sector, and that’s what the social care fair work forum is looking at now.

Thank you. And in relation to people who’ve got long COVID, what is the case with them?

The situation with long COVID is obviously—and it's a very difficult situation, isn't it—that they will be—. Some of them, I know, are continuing to work with long COVID, and others are not able because of how it varies, but it obviously is a situation where they are not satisfactorily covered by sick pay and, again, something that we have to address with the fair work forum.

Okay, thank you. In terms of ending the scheme, trade unions like Unison Cymru have warned that they think this decision will cause impossible dilemmas for many care workers this winter, and could provoke a deepening crisis in care. What is the Welsh Government's response to this?

Well, as I said, we don't have any more consequentials so we don't have the money to continue the scheme. It wasn't intended as a long-term scheme in any case—it's a much deeper, deeper issue to address. I think that what the social care staff have to do, really, and we have to do as a Government, is to encourage mass use of vaccination, to take up all the precautions that we can. It is very important for social care workers to have the booster that they are eligible for, and, of course, the flu vaccine. For people who are in care homes, for example, to make sure that they all get the flu vaccine so that people and social care workers are protected against illness as much as we possibly can. I think that's an important strand in terms of addressing this. 

Sarah, I think Mr Rees wanted to come in on this point or the previous point. Mr Rees. 

Thank you, Chair. I was just going to add to the Minister's comments on the support around long COVID to make the point that, of course, the workforce can benefit from the Adferiad programme, the investment of £10 million, should they need specialist care and rehabilitation to support them and to get them back into work. But, as the Minister said, that is a small proportion of those with long COVID; many can continue to work with relatively mild symptoms, just to make that broader point. Thank you. 

Thank you very much. Thank you for the point. 

And my last question on this: Unison says that proper sick pay, in line with health service and council workers, must be placed at the top of the agenda. Trade unions are calling for immediate action to enable care workers to receive decent sick pay before the winter pressures hit. So, is this something that the Welsh Government willing to commit to take action on, on sick pay as a priority? 

I can't say that we can commit on sick pay now before the winter pressures come. We don't have the money to do it. We are in a difficult financial situation. It's going to be a really difficult budget, so I have to be honest that I can't commit that we would do that, although we want to do it. But, in any case, we want to do all these changes that we're making. We want them done in a discussion between employers, trade unions and interested bodies, and we've got the set up for social care of the fair work forum. That is where these decisions must be thrashed out, so that everybody is part of the decision. So, we're waiting for them to work on these issues. But I can't make spending promises that I can't commit to, really. 

Of course. Thank you, Deputy Minister, and you've mentioned the social care fair work forum a few times. I just had a couple of questions on that as well. So, following on from the previous question, can you confirm whether improving sickness pay and terms and conditions for social care workers are initial priorities for the forum, and whether or not it will be reported on by the end of the year?

We're asking the social care fair work forum to come forward with their programme, and what we're urging them to do now is to look at terms and conditions, particularly sick pay. So, I hope we will have—. Well, we will get that programme before the end of the year; obviously, I don't know whether the deliberations will happen before the end of the year. But it's an important forum to have those discussions. 

Wonderful, thank you. And my final question, then, is: the care sector told us that a national pay structure is desperately needed for social care. The Welsh Government’s evidence paper says the forum is developing a pay structure framework that will provide a model of good practice and could be applied across Wales. So, what's the reasoning for why it won’t be a national, mandatory pay structure? How will this improve consistency across Wales if it's only a model of good practice?

Well, I think it's a model of good practice because collective bargaining will always take place on a local level, so we don't want to interfere with good relationships that are already there. But, as well as the forum, we are setting up a national social care office, and we're going to have standards, a national structure, a framework, and this framework will be looking at all aspects of social care work and payments, et cetera. I hope we'll be able to come up with much more standardised proposals for throughout Wales, and that is some of the work that is being done as part of the reform of social care. So, that's happening as well, at the same time as the social care fair work forum, with the employers and the trade unions there also looking at these things.

Lovely. Mr Heaney wanted to come in, I think, on this point.

Yes, thank you. Thank you very much, Chair. Thank you for your question. Just to add some comments in relation to the Minister's, I think for the first time that employers, whether they be local authority or in the private sector, are seeing the need for that national approach to pay, terms and conditions. What we hope, by the good work the Minister is taking forward and the social care work forum, is that, actually, we would seek to broker with the local authorities an agreement that they would all work to the same pay scale. So, although at this moment in time, we're not saying we will develop a national pay scale, what we're looking to do is develop that good practice and also, alongside that, reach agreement with the employers as partners so that we can move forward. So, hopefully, that's helpful. Thank you.

Thank you.

Thank you, all, very much. Thank you, Chair.

Thank you, Sarah. Minister, just to go back to the sick pay for care workers, there are a couple of challenges here. We've talked about the vacancies that run into the thousands in terms of care workers, so there's a big issue in terms of retention and working conditions and pay, but also, the other element of this is about care workers testing positive for COVID—I assume that they have to regularly test—and then being told, effectively, by their employer, 'You can't go into work, but you're not going to have the same level of pay, not in comparison with others that work within the NHS.' I appreciate, Minister, you've talked about the resource challenges that you've got, but surely this is a key priority above, perhaps, other priorities.

I think, as I said, the payment that we were making—the additional payment we were making—to the social care workers was out of the consequential, the money that was given to us from the Westminster Government, and was a key part of the pandemic. We don't have the resources to continue with it, because the consequentials have stopped. But we are looking at it as a very important, fundamental part of trying to improve the workforce as a whole. Again, there are so many of these things that are absolutely key things and we regretfully ended it and did, in fact, see if there was any other possible way of finding some money to keep it going. But we couldn't do it, and we do accept that it was part of the pandemic response, and we want to look at it now in the social care fair work forum.

Okay. When will the social care work forum report? When will we know—

I don't know whether anybody here's got any details. Albert, have you got any details of the timetable for the fair work forum?

Yes, Minister. The fair work forum are due to report, Chair, later this year, so the Minister will have the opportunity of receiving their thinking and their advice.

Okay. So, Minister, do you think that you will be able to respond to that by the end of the year?

We're in a very difficult financial situation. I have to repeat that. Certainly, I'll be able to respond, but when we'll be able to take action—. But, certainly, we acknowledge it's a very important area.

Yes. Okay. Thank you. Rhun ap Iorwerth.

Yes, we can hear you, Minister.

Thank you, Minister. Thank you, Chair. So, as the Minister has alluded to, what we identified when we set out the plan was the cohort of patients that we knew would come on to the waiting list as waiting over a year or over two years for treatment, because obviously they were already on the waiting list. The Minister has alluded to the fact that there were 244,000 over-52-week patients to be seen by the end of this year. We currently see around 90,000 out-patients every month in Wales through the NHS. So, if we were to see 50 per cent of those as from the cohort, between now and the end of the year, that gives us the opportunity to see 135,000 patients from the cohort. As you've alluded to, there is still 155,000 on that list to be seen, so it would get us much closer to achieving the ambition that was laid out in the plan in the first instance. And as the Minister has alluded to, there are 44 different specialties that deal with out-patients and 29 of those are highly likely to achieve the 52-week out-patient target. We've got particular challenges in five specialties, which are ophthalmology; ear, nose and throat; trauma and orthopaedics; general surgery; and urology. So, we've made progress on those, but not the progress that we need, and it is, as the Minister said, the treat-in-turn issue, which is being driven by urgency and by cancer referrals, that currently is causing the problem.

Thank you very much for that. You list there a few specialisms where there are problems, and you might be lagging behind a bit there, but, Minister, the issue is that trauma and orthopaedics can't be just one on a throwaway list; that is the longest list. And if you're not hitting your targets on trauma and orthopaedics, you are missing the biggest target that you have, and the trajectory—. I must say, the statistics that I have in front of me suggest that you're going to miss that ambition 2 target by more than a year, on the current trajectory.

I don't think that's what the outcome will be. I called an orthopaedic summit in the summer, where we pulled together all of the heads of orthopaedic surgery in each health board and the chief executives, just to make sure they understood what we required from them. One of the things that we've asked them to do is not just to treat in turn, because they weren't doing that, and they are now responding to that, but also they need to follow what the Getting It Right First Time review has suggested, and that is to do a lot more in terms of out-patients and day surgery. If they were to do that, which is a clinically very acceptable practice, then they would come a lot nearer to hitting those targets.

Okay. I appreciate that that's your idea, but actually I have in front of me here—and I know you have it in front of you, whether it's on your desk this second, but you have it as a Minister in front of you—'The National Blueprint for Orthopaedic Surgical Delivery in Wales', published this year by the Welsh Orthopaedic Board National Clinical Strategy for Orthopaedics. You are fortunate, you have a team that have engaged with this and have given you a blueprint, which includes the establishment of three orthopaedic elective surgery hubs. You've rejected that blueprint. They tell me that you will see the doubling, potentially, of patients on waiting lists within a relatively short period of time, unless you put that report, which has the NHS's logo on it—it's yours—into action.

You can't snap your fingers and create orthopaedic hubs, but what we do have now is systems, for example, in Swansea, where we do have the majority of routine orthopaedic care being done now in Neath. In Cwm Taf they are centralising their practice. In Betsi, we are having active discussions with them about additional planned capacity in Abergele. In Hywel Dda, there are two new day theatres where we will see 4,600 new procedures per year, and that's going to be starting in the next week or two. It is important, I think, for us to understand that there is a short-term issue that we've got to address here and then there's a longer term strategic plan where we, of course, need to think about restructuring how we do orthopaedic surgery in Wales.

And of course any positive moves are to be welcomed, and I know, speaking to the authors of this report, that they will work positively and look at how to make the most of your plan B, but this is their plan A, and you're quite right to say that you can't snap your fingers; what you can do is conduct a feasibility study, for example, into how to implement this three-hub plan. It doesn't have to be three new shiny buildings; it's not about that. Have you conducted that feasibility study to measure how this could actually be done?

What we're doing is something where we're responding directly to what the orthopaedic surgeons are telling us, for example in Betsi, where they have requested that we develop a more comprehensive hub in Abergele and—

Can I just interrupt you? I know about that hub in Abergele doing some excellent work, but if we could just broaden our focus to the Wales-wide model, where you have the National Clinical Strategy for Orthopaedics saying that you need these three hubs and, together, that's the kind of model that will give us the kind of progress that we need on a national level. Have you conducted a feasibility study into how to implement that? Did you do so before rejecting this model, which they are adamant is absolutely necessary or we're going to see, potentially, a doubling of people on waiting lists?

It's not that we are rejecting what they are suggesting, it's just that, frankly, there is no money in the system—

Have you conducted—? Sorry, just a simple question: have you conducted a feasibility study into how this could be delivered?

Rhun, at some point, there will be more money in the system. At the moment—

But you've already rejected—

At the moment, there is no money for anything in the system, Rhun. Nothing. So, to start to raise expectations that you'll be able to deliver something when we've seen an inflationary impact on the NHS hitting us in a way that we hadn't foreseen at the beginning of the year—. But, what we are doing and what I have asked our team to prioritise is to look again at how we're spending our capital, so that we can start to work up some of the suggestions that are in those proposals.

I absolutely recognise the tightness of the financial situation, but in the words of the people behind this report, the cost of not doing this is such that we cannot afford not to do it now. So, again, I—

There's work to do now, though, Rhun. There's work to do now that could get them much, much closer to the targets that we've set, and one of those is to do a hell of a lot more day surgery. So, of course they can come to us and ask for x, y, z, and that's the ideal, but actually there are things that they can be getting on with today where they would be helping themselves. 

As I understand you, there hasn't been a feasibility study to see how much this would cost, but we'll leave that there. If I could move on, Chair—

Can Nick Wood just come in? He wants to come in on another point. 

Yes, of course. 

Nick Wood. 

Thanks, Chair. It's just to pick up around the question of regional solutions, which are alluded to in the report. Each of the three regions of Wales, the health boards' collaborative regions, are already moving ahead with plans, particularly in the south-east, to utilise existing capacity and existing hospital sites to, in effect, create some of that green orthopaedic capacity that is described in the plan. I think the plan was specific in its nature, in some respects, that it was looking at new facilities, whereas actually what—. So, the south-east of Wales has a regional planning group, which has already established a regional diagnostics footprint, potentially a regional ophthalmology footprint and is moving ahead with a regional orthopaedic footprint, in conjunction with the three groups of surgeons from those three health boards. In the north, as the Minister has alluded to, with the Abergele project, we have requested a business case from them to try to utilise what available capital we have to support the surgeons in north Wales around Abergele. I think we're slightly behind in south-west Wales, although there is work ongoing in Neath and there is a business case to better utilise the theatres at Singleton Hospital in Swansea and Prince Philip in Llanelli, to be shared by both health boards to resolve some of the orthopaedic issues. So, I think in some respects, we are working locally with each of the different health boards' groups of orthopaedic surgeons to try and put in place some of the recommendations that were in that strategy. 

Thank you, yes.

And as the Minister has alluded to—

That's fine.

—I think it was very clear though that the need to implement the GIRFT review has been the first phase of that strategy, if you like, before we got on to the next part of it. But I absolutely recognise the need for further facilities for orthopaedics as we move forward.

Thank you.

And it really is worth reminding ourselves what that blueprint tells us:

'elective orthopaedics and trauma services in Wales are in a perilous state of near collapse'.

It doesn't come much clearer than that. And if I could go on to cancer, we have today Professor Tom Crosby, national cancer clinical director, saying:

'Demand is outstripping capacity and that means patients are being diagnosed and treated later than we would like.'

Sorry, my computer has its own mind today.

'Demand is outstripping capacity and that means patients are being diagnosed and treated later than we would like. We are going to see a deterioration in cancer outcomes as measured in survival, quality of life and patient experience.'

Minister, there are concerns there that your ambition 5 on cancer is in trouble too.

I'm really worried about cancer. What's happening is that we've seen a massive increase in the number of referrals for cancer diagnostic testing, and one of the reasons why we’re not hitting out targets is because we have to go to the people beyond 62 days—we have to go to the longest waiters when it comes to cancer and to treat them first. You will also have seen on the BBC today that we were the first part of the UK to roll out rapid diagnostic centres, so we are hoping that that will have an impact and will speed up the system.

So, there is a bit of a bottleneck when it comes to diagnostics. Once they've got through that bit—. And of course, don't forget that about 96 per cent of people are told very early on that they don't have cancer; it's a great relief to them, so we need to get that done very early. But once we know that they need treatment, actually that treatment does happen quite quickly, so the bottleneck is in the diagnostic part.

We have a question that came through our consultation. Trevor Hughes-Morris, a member of the public—if I'm right, a constituent of mine—says that the First Minister promised that there would be a new cancer strategy for Wales, and of whatever title, that would be published in September. Where are we with that announcement?

We asked the Wales Cancer Network to help us to write that cancer services action plan. We have received a draft copy, but what we've found is that it's incomplete in terms of the local planning response. So, the whole point of this is it's supposed to respond to what was the expectation in terms of the quality statement for cancer, and it's not doing that at a local level, so we've asked them to go away, come back with that, and I am hoping that we will have a final version, hopefully by the end of this month, but I certainly wouldn't want it to go beyond the end of November.

Cancer survival rates are going down, aren't they? But people are waiting longer and longer. We need this last month as promised, not in a few weeks' time. That's the problem.

I would rather publish a report that is complete and that is accurate and is correct, than to publish something at speed.

Diolch, Gadeirydd.

Thank you, Rhun. Before I come to Gareth Davies, just in terms of the ambitions in terms of the targets, especially by the end of 2022, what happens if your ambitions for the targets are not met? What happens then? Are you going to revise the targets? Are you going to move the target dates?

I'm not giving up. I'm trying to put pressure on the health boards to make sure that they don't give up. I think that this is still doable. They need to cleanse their data, they need to look at who is waiting—do they still need the treatment? So, there's a lot of admin work that can be done. There's also a huge amount of work that I think that they can be doing on this 'treat in turn' that would get us very close to where we need to be.

So, no plans to revise the target dates as it stands at the moment.

I'm not changing the target dates. I want them to hit these targets. These people matter. These things matter to people, they're affecting people's lives, and I think it would be absolutely wrong for us to throw in the towel at this point. I'm not throwing in the towel, and I'm not expecting health boards to throw in the towel. In fact, I'm having very robust conversations with them on a regular basis, and I know Nick is as well.

I appreciate that. We want these targets to be met. It seems like, Minister, you believe those targets will be met. I appreciate that answer. I think Sarah Murphy wanted to come in as well before I come to Gareth Davies, and Joyce as well, actually. 

Thank you, Chair. Speaking of cancer diagnostics and waiting times, I did just want to draw attention to, particularly, the gynaecological cancers. We've heard that they seem to be quite up there when it comes to waiting times. Also, quite worryingly, there seems to be evidence that suggests that it's disproportionately impacting minority ethnic women as well. I wanted to know if you had any idea why that is, why it is disproportionately impacting them, and what is being done about that, please.

Just before you come in, Minister, can I ask Joyce to come in with her supplementary as well? Oh, it's not on cancer. Okay. Do you want to ask your question anyway, Joyce? We're just short on time.

It's on waiting lists. The Minister won't be surprised that I'm going to ask about wet macular degeneration and ophthalmic more generally, because it doesn't seem to be one of the targets often talked about, but if those targets aren't met, particularly with wet macular degeneration, those people will go blind. There is no second chance. So, I'd like to hear more about that.

We're really short of time, but they're both important questions. If you could just be as focused as you can, Minister, on the reply.

First of all, I have organised a cancer summit for next week where I'll be calling in all of the leads of the health boards and the leaders of those cancer services in the health boards just to run through what exactly can we do to help to drive increased productivity when it comes to cancer services. When it comes to gynaecology, we had a really good debate, I thought, on that last week, and thank you to members of the committee for contributing to that. Certainly, that will be something that we will put on the agenda too to focus on next week. As you know, Sarah, I'm very keen to focus on women's health as an issue in the coming few years, and so that question of, 'Are women paying the price more than men?' is a question worth asking. Certainly, we've got to bear in mind the implications for ethnic minorities as well.

When it comes to ophthalmology, this is one of the areas where we have the longest waiting lists. I'm sure you'll be aware that, when it comes to ophthalmology, what we do is categorise people in terms of urgency, so those people who are likely to go blind go straight to the heads of the list. Cataracts are going to take a bit longer, but what we do have is some health boards going much faster than others. Hywel Dda, for example, are doing very well in relation to getting through some of these. Cardiff has got a new centre that is really ploughing through numbers at a very fast pace, and what we need is for other health boards to look at those examples and to speed up their activity as well.

Mr Rees, I think you wanted to come in. If you could just be brief, because we're very short of time.

Thank you, Chair. Very quickly, just on the preventative element of the gynaecological cancers, just to add that we know uptake on screening can be lower among minority ethnic groups, so there's targeted activity from Public Health Wales to try and increase uptake, working with community groups. There's some piloting work in England of self-testing that we're staying close to to see if that's something that could increase uptake in Wales too, if it's recommended. 

Thank you. I appreciate it. Rhun.

Not to take up time, because it's a bit specific, but if I could ask the Minister's team to provide just a written response to this, maybe. My understanding is that, with cataract operations, which we just mentioned there, it is good practice to provide follow-up appointments for people who've had cataract operations. I understand that, at least in some parts of Wales, those follow-up operations are not currently happening as a matter of course, and that that is causing an increase in problems—development of scar tissue and so on. If we could get a response about what is actually best practice and what is happening on the ground, I'd be very grateful, and I'm sure the committee would be too.

That's a concern raised by a couple of Members. If anybody wants to briefly address that, with a bit more detail in written form, then I'm happy to do that. Minister.

We are trying to move to a system where people refer themselves, or 'see on symptoms'. I don't know if Nick would like to handle that a little bit.

We'll take that up in written form, if that's all right. 

Okay. We can write to you.

Thank you. We appreciate that. I will come to Gareth, but I've got Vikki first.

Thank you, Chair. It's a question on COVID. COVID certainly hasn't gone away. Is the Welsh Government confident that it's got the necessary data now, and understands the extent of the potential pressures from COVID, including the number of cases, excess deaths and long COVID?

Thanks. It is more difficult now to predict where the potential pressures are going to come from, and that's partly because of the success of our vaccination programme in terms of fewer people going to hospital. What we're not sure about this year is the complexity that may occur if we see a resurgence of flu or other respiratory illnesses at the same time. That means that there may be a different dynamic this year. There are lots of things that are variables here: what the vaccine take-up will look like, waning immunity. We don't know if there's going to, obviously, be another variant. Also, a lot of this depends on how people behave—to what extent people will be mixing. So much of this modelling is out of our control, it's very difficult to predict, but what I can assure you is that we are trying to model as much as we can. We, obviously, are testing much less than we used to, but we do have the ONS survey that we rely on quite a lot. We match that up against the water monitoring. But we are preparing for a worst-case scenario. That's what we do constantly—what is the worst-case scenario, what would that look like and what would the pressure be on the NHS?

Thank you, Minister. Thank you, Chair.

Thank you. Gareth Davies.

Thank you very much, Chair, and good afternoon, Ministers and officials. We've had a large number of requests from the public to ask you about pay in the NHS, particularly around nurses. In my experience, working in the NHS and as a Member of the Senedd, a lot of nurses feel overworked, underpaid, underappreciated and, quite frankly, sick to the back teeth of not being supported through pay. So, what can the Welsh Government do to address the concerns around NHS pay, with a particular view on the nursing sector? 

Thanks very much. First of all, I want to be absolutely clear that we are massively appreciative of all the work that all of our health workers have undertaken, not just over the past two years under COVID, but over decades. They have been on the front line and we are appreciative of it.

The system we have is a system that is agreed, and agreed by the unions as well, where we have an independent body that assesses what the pay should be for NHS workers. Unions feed into that as well. They came up with their recommendation of an increase of, generally speaking on a flat rate, about £1,400 for workers in the NHS this financial year. So, we agreed to that. Obviously, that feels very different when you've got inflation at 10 per cent. That feels very, very hard, and obviously, we are completely understanding of the fact that there are lots of frustrations in the system. The problem that we have—

Just on that, Minister—. Sorry, if I may. In that case, then, do you believe that the 'Agenda for Change' pay scales are fit for purpose at the moment? Because they were introduced back in 2004, so 18 years ago. Do you think that model is still appropriate for the modern day, considering those pressures?

'Agenda for Change' is not the issue here. I think the issue is the timing of when the proposals were made by the independent pay review body, and the fact that inflation has gone way above what they had predicted. And if you think there's an issue this year, then I think we've got to think very seriously about next year. I would, Gareth, with respect, ask—. I need people to understand that actually, the inflationary pressures are not just inflationary pressures on the workers in the NHS. We only have a set pot of money that we can spend. This year, I have to find an extra £207 million to pay for energy bills in the NHS. That's money that's not in my budget, so the question for me is: even if I wanted to, where on earth would I get that money from? So, that is a problem for us. We will get a little bit of a discount from the UK Government, but there's no way it will come anywhere near covering that £207 million additional funding that we're going to have to find this financial year. And as I say, next year looks even more challenging.

With due respect, Gareth, I actually think that this is a question that you need to ask your political masters in London, because if they are serious about cutting taxation for the richest, and then expecting public services to take the strain, there is a consequence to that, and the consequence is that it's going to be very, very difficult for us to increase the pay of people in the public sector. It's not where we want to be; we are really, really upset about this. And you need to take some accountability for that as well, I'm afraid, Gareth.

Thanks for the political tinge at the end of your answer there, Minister, but my question was about nurses, not energy. I will move on to agency staff.

The money comes from the same pot.

I'm talking about agency staff now, Minister. We've seen an increase of NHS workers moving to agencies, so what are you doing to reduce NHS reliance on spending on agency staff, considering that it's very costly for the health service, especially in nursing and medicine? What are you going to do to stop people moving to agencies, and the NHS having to rely on agency nursing?

I am a bit upset about exactly how much we're spending on agency staff. Let's just be clear that agency staff are currently used to fill unfilled vacancies, to cover people who are on sick or maternity leave, and to address increases in demand. You'll be aware about the numbers of staff in the NHS who've gone off sick, because of COVID amongst other things, so we needed to plug those gaps. That has been an additional cost that's gone beyond what we expected. I've now asked for a piece of work to be done, working with our unions, to see what can be done to reduce this bill, because this is not an acceptable situation.

The other thing, of course, we need to do is to recruit more nurses. We have seen a 72 per cent increase in nurse training in the past five years; we've recruited an extra 400 international nurses. Of course, there's still a gap, so we are very keen to see what we can do to retain nurses so that we don't have to rely on agency nurses in future.

Thanks. I just wanted to highlight staff retention as there's a significant amount of evidence that suggests that healthcare staff are contemplating leaving the NHS, particularly those people over 40. So, do you know why that's the case, then, Minister? Can you just expand a little bit more on some of that plan around staff retention, so that people aren't feeling the need to leave the NHS and seek other careers or training?

Yes, thanks very much. I can only imagine the stress that people on the front line have been going through over the past two years, and obviously that is going to take a toll on people. That's why we have continued to recruit, so we now have 105,000 people working in the NHS in Wales. That's a record level, and what we're trying to do also is to make sure that we've got support in place for them when it comes to well-being, to make sure that they can recuperate and that they can support recovery of the wider system. We're also making sure that we're putting measures in place to train the future workforce and upskill the current workforce, spending around £0.25 billion on that, which is not an insignificant amount of money. And we're also making sure that people can work flexibly, can work part-time, and again, trying to recruit additionally from overseas where we can to take the pressure off people. 

And do you recognise as well the amount of vacancies? I can only speak for Betsi Cadwaladr in terms of my knowledge of current vacancies; I think the last time I checked there were about seven pages on the website of vacancies. Do you recognise that issue, Minister? And what steps are you taking to make sure that vacancies are being filled and that people are being adequately trained for these jobs?

Yes, we do recognise that vacancies are an issue in the NHS, which is why we are spending £0.25 billion, as I say, on training. I spoke at the midwives' annual conference that came to Wales last week, and I think they were quite surprised at the fact that we are training about 97 per cent, I think, more people than we've had in the past five years in terms of midwifery. So, all of these things are trying to plug the gap. The bigger issue we have is retention. So, that's where I'm trying to focus our attention now—what can we do to relieve pressure on people, how can we maintain people and make sure that they don't leave the system?

Thanks, Minister. Finally, I just want to ask you on the workforce plan, it was originally promised for summer this year, but it's currently still in development. Do you believe that, if that was implemented more swiftly and sooner than now, then we'd be in a better position in that respect, then?

I'm a little bit frustrated, as you are, in terms of the workforce plan. I did receive a copy that wasn't where I needed it to be, so there's a lot of work being done, and once again, I'd rather get something right than get it done fast. So, there's a huge amount of work being done on that. I'm expecting to see a new iteration of that report by the end of October, and I will seek to get that published as soon as we can, working with Health Education and Improvement Wales, who really are the people who should be leading in this space. 

Thank you, Minister. Thank you, Chair. 

Joyce Watson. 

I just want to first of all put on the record a declaration of interest—a close family member being a member of the Royal College of Midwives. So, I wanted to do that. And I want to focus here on two things. The vacancies are around 6,000, I believe, in the care sector, which is knocking on. That was predicted by a report when we went into Brexit, and guess what? That's exactly the number we now see. So, nobody wants to talk about Brexit, but I will. So, that is having an impact on it. But in terms of the agency staff, if we conflate that with the people, particularly over the age of 40, leaving the profession—and I know you're looking at this, Minister, and I thank you for that—it would be worth examining what the real cause is here. Is it timetabling? Is it the fact that people can't work flexibly, and those people have their own families and their own caring responsibilities that are driving them towards a more flexible working solution, which, of course, becomes costly to the NHS? So, I particularly would ask if you'd look at that.

And when we look at the over-40s, I just wonder whether it's worth examining that some of those people have been in that profession perhaps for over 20 years by the age of 40, and, again, find themselves in caring positions with elderly relatives or family members. So, it's just a plea, really, to look at those two figures to see what we can do to support those people that we're not doing already to keep them in the workforce.

Thanks, Joyce. That's absolutely what we're trying to do. I have regular meetings with the Royal College of Nursing, and one of the things that they're very keen to do is to make sure that they are working with Health Education and Improvement Wales to identify exactly what it would be that would be helpful in terms of retention. So, the chief nursing officer is on this; I know that she's really trying to do as much work as possible. 

In relation to caring responsibilities, you'll be aware, Joyce, that we have the most generous childcare offer in the United Kingdom. It was interesting to have a meeting yesterday with the General Medical Council that identified exactly how many people are looking to leave medicine in the next 10 or so years. So, obviously, we need to start preparing to plug that gap, and things like the north Wales medical school will hopefully help us with those kinds of challenges. 

Thank you. 

Thank you, Joyce. Minister, the NHS executive was due to be in place by 2018, is there an underlying reason why there's a lack of urgency in this area? 

Yes, we've had two little things that have come in the way; one was Brexit and the other was COVID. When you're firefighting, you need to put out the fire first before you start looking at structural issues. Look, a huge amount of work has been done on this. What I want is as little disruption to the healthcare system as possible. The NHS executive will be a small team in Government, but it will oversee and direct a much bigger national resource base within the NHS. And the whole point of this is to drive improvements in the quality and safety of care, and to make sure that we see a lot more consistency in terms of our approach. So, I'm expecting significant work to be done on this between now and Christmas. We've got programmes in place—a formal implementation programme, including a steering group. That is going to be in place by the end of this year. 

Okay. Thank you for the timescale as well—that's helpful. A coalition of 34 organisations have written to us, unhappy with the proposed hybrid model. In their opinion, it doesn't meet the parliamentary review's recommendations on the separation of functions. What's your response? 

I've done lots of reading over the summer, just refreshing my understanding of what the parliamentary review was saying and understanding what the 'A Healthier Wales' programme was saying. And I've got to say that that was the one bit that I didn't agree with the parliamentary review on, and the reason for that is a political one. And that is, whatever happens, if I have an NHS executive sitting independently and apart from Government, that will not stop you from holding me to account. So, I want a system where I can hold the system to account, because I'm the one who's going to get the blame. And so, I was very, very clear that that was not a path that I was prepared to take because, Russell, I've got no doubt that your committee would not not be holding the NHS executive to account and they would be holding me to account, and I think that's probably how it should be. 

Is a stronger national executive for NHS Wales an essential part for making our system fit for the future? 

I think it is. I'm very keen to see a more centralised system that will drive standards. That's not to say that we're not going to allow health boards to maintain their independence, but we will be giving much clearer ideas of our expectations of them. I'm in the process of tightening up the whole accountability system, setting out much clearer targets, and measurable targets for chairs, for example, to meet, but also getting the integrated medium-term plans into a different place, where I can get a better sense of what's happening across the whole piece, because, at the moment, it's very difficult to compare what is happening in each health board. So, the systems are being tightened, and I'll expect the NHS executive to be driving those changes forward.

Thank you. The last section, I think, we'll come to, Minister—we can't go without discussing winter preparedness as well. I know that we've got two Members who have got questions on this particular area. Vikki Howells.

Thank you, Chair. [Inaudible.] 

I'm ever so sorry, Vikki, your line isn't so good. I'll come to Sarah first, and come back to you—we'll try and then come back to you. Sarah Murphy.

I'm so sorry, I didn't realise I was asking questions in this section, Chair.

I think you wanted to come in on a particular point you mentioned, Sarah. But, no problem—no? No problem.

Sorry. Thank you.

No problem at all. I'll come back to winter preparedness in a moment. Did you want to come in with a question on a separate issue, Rhun? 

Yes, I wanted to ask on winter preparedness as well actually, but there was one particular issue; it's on escalation measures within the NHS in Wales. I think, other than Powys and Aneurin Bevan, all of Wales's health boards are in some level of targeted intervention or escalation measures. Yesterday, we heard of two escalations: one in Hywel Dda and one in Cardiff and Vale. For us to be able to hold you to account, give us a timescale in which you believe that you can move us to a point where the NHS in Wales is functioning without the need for special intervention by Government. Because I think patients and staff are fed up of this lack of sustainability and a chaotic situation for the NHS in Wales. 

Look, I understand why people would feel like that, but I've also got to make it absolutely clear that, when you get a £207 million bill that you weren't expecting, you can expect your plans to be blown out of the water. Now, none of us, in any walk of life, saw that coming, and so, clearly, for me to be able to say, 'This is when I expect this to be finished', is very difficult. Because I don't know when the war in Ukraine's going to be finished, and that will have an impact. So, I need to know what the budget for the NHS looks like going forward and, frankly, the noises I'm hearing from central Government don't fill me with a lot of hope. What we will have to do is to ask health boards to think very seriously about what their plans might look like in future, and those are going to be very, very challenging, and there will be consequences, I'm afraid, for the public.

Very briefly, you seem to blame the war in Ukraine, and, clearly, that has an impact on public spending, perhaps; you've blamed UK Government, and, clearly, I would agree with you politically on the need to make sure that we have a good level of public spending. I'm talking about effective, well-running NHS organisations that Welsh Government doesn't seem to have a handle on, because all the time, we're having escalation measures, it's right across the NHS in Wales. When can we expect to have an NHS that doesn't need that kind of intervention, which takes up time and effort and is a symptom of a system that isn't operating as it should? 

I think we can have that when we've got a more stable situation, when we know where inflation will be, so that people can plan for that inflation rate and how it's going to impact on their services, and until we get more stability in the system, that's going to be difficult. So, if we write that in next year, that 10 per cent increase in inflation costs, for example, if we don't get any additional money, that's going to cause us massive problems. So, until I've got a better sense of what the budget looks like next year, I think it's very difficult for me to say how we expect this to be worked out. But what we can't put up with is a situation—. Where we do set out a budget framework, we expect people to come in in line with what they themselves have set out, and that's the problem here, that they set out what their plans were and they haven't complied with their own plans. I don't know if Nick can add to this as well.

Before you bring in the official, if I could make a point. This is not just about budgets, is it? This is about the effective running of health boards. It's not just about money; it's how they are run. Look at Betsi, look at mental health, look at Ysbyty Glan Clwyd—these are not just budget issues.

I accept that they're not just budget issues, but the two that have gone into the targeted intervention that you mentioned are mostly budget issues, so that's why I focused on those. But, listen, we do have a challenge in relation to Betsi. We're on it. We're spending a lot of time giving them the support that they need, and it was very heartening, once again, to speak to people in the General Medical Council yesterday, talking about how they are going to be standing by and working with people, for example, in the vascular department at Ysbyty Glan Clwyd.

Thank you.

Perhaps if Nick can—

Oh, sorry. Nick, did you want to come in? Just briefly, if you can, Nick.

Yes. To pick up on the general escalation and intervention mechanism, in some respects it's more about the support that we can offer health boards and trusts in terms of ensuring that all of the services, whether it be linked to the money or the quality of services, it gives it a standard. I think the work we've done assisting Betsi Cadwaladr is hopefully going to start to make some impression on the service quality that is received in the north of Wales. The two, as the Minister has alluded to, that have gone into escalation this week are mainly driven by the financial positions. I think we're hopeful that one of them will be a very short intervention. The other one is probably slightly more challenging.

Thanks, Nick. We'll have to move on, because I do want to just cover, very briefly in the time—I know we're a little bit over; I hope Ministers don't mind—winter preparedness. Gareth Davies.

Thank you, Chair. It's a simple question, really, just to ask around: are we prepared for winter now? Nights are drawing in, temperatures are dropping now. To be frank, I get a little bit anxious at this time of year, because we see the stories across the winter of the ambulances waiting eight to 10 hours outside of A&E and the horror stories that we tend to see during the winter, more than in summer months. So, can you provide an update to the committee this afternoon, just to tell us how the winter plan is going? The Minister talked a lot in her last contribution about energy prices and factors such as the UK Government, the war in Ukraine, but what can the Welsh Government do in its remit to help NHS Wales with those rising energy costs, within your gift?

Thanks very much. First of all, we have been preparing for winter. What we've done this year is not to give an additional slug of money in September or October, which is what usually happens. We actually gave that additional money, as was requested by health boards and local authorities, so that they could build it into their year-round planning. So, you'll have seen that there's not been much let-up over the summer months, but everybody recognises that the pressure this winter could be significant, which is why we've asked them to build in resilience right from the beginning, which is why, for example, we had the WeCare.Wales campaign over the summer, so that people are in place ready for September. You can't start recruiting in September and get people in place by December—it's too late. So, all of those things have been built in much earlier than usual.

The other thing we've been doing is building our community care capacity. So, working with local authorities on creating additional means of relieving that pressure. And, as the Deputy Minister said, we'll be giving you more information on that very shortly. We've also issued new guidance to support improvement and resilience plans. That's to health boards, local authorities and through the regional partnership boards. And the other thing we've done is that the care action committee has recommenced meeting regularly now just to make sure that we're monitoring the delivery of what we've all agreed.

And then the other thing is on the urgent care side of things. So, we've put in £25 million of additional funding to relieve pressure on urgent and emergency care. You'll have seen that we now have SDEC facilities in each health board—same-day emergency care systems that take the pressure off our accident and emergency services. We've got new urgent care centres across the country, but also our 111 service is diverting people to where they need to go and trying to make sure we take the pressure, again, off our accident and emergency centres. So, all of those things are in place, but we recognise that things are going to get hotter.

Thank you, Minister.

Any other questions from Members on winter preparedness? No. Thank you, Ministers, and officials. We're grateful to you for being with us this morning. So, diolch yn fawr iawn. 

Diolch.

We move to item 6, and there are a number of papers to note: a letter from the Westminster Joint Committee on the Draft Mental Health Bill, one from Oxfam Cymru and the Women's Equality Network, and also various correspondence with the Welsh Government. That's all detailed in the papers and the agenda pack. Are Members content to note the papers? Diolch yn fawr. 

I move to item 7, and I propose in accordance with Standing Order 17.42 that the committee resolves to exclude the public from the remainder of the meeting. Are Members content? Thank you very much. That ends our public session this afternoon.