National Assembly for Wales

Good afternoon and welcome to this Plenary meeting. The first item will be questions to the Cabinet Secretary for Finance, Constitution and Cabinet Office, and the first question is from Mark Isherwood.

Having listened carefully to people’s views from our consultation, there was a clear appetite for reform but delivered over a slower time frame. I'll deliver some improvements to make council tax fairer this term, and continue engaging on the right structural reforms for 2028. I have issued a statement today setting out the plans.

Thank you. Well, the 182-day rule means that legitimate, well-established, local self-catering businesses have become liable to pay council tax, sometimes at a premium rate. When the secondary legislation introducing this threshold was proposed, the sector warned that this would harm legitimate Welsh businesses and damage the fragile ecosystem that is the visitor economy. Over 1,500 self-catering businesses have now responded to a new survey commissioned by Wales Tourism Alliance, UKHospitality Cymru and the Professional Association of Self Caterers UK. Only 25 per cent said they would hit 182 days this year, 70 per cent are discounting to try to hit 182 days, and 42 per cent are either putting their property on the market, or considering it, with the likelihood that they'll be purchased as second homes. How do you therefore respond to the request made by the Wales Tourism Alliance in their letter to the First Minister for a commitment to a date for a review of the 182-day policy, and to discuss what further exemptions from council tax premiums are needed in order for a balanced Welsh visitor economy to survive and thrive?

Well, I'm grateful for the opportunity just to restate the purpose behind the 182 days that was introduced, and that is very much because the Welsh Government believes that owners of properties and residents of properties, be they domestic or business, should pay a fair contribution to the communities in which they are based. I have seen a previous survey, which was undertaken by the tourism sector, and, actually, that survey did suggests that our aims through the policy were actually starting to achieve what we have set out to do. So, I'm not sure if this is a new survey that provides different evidence. If it is, I'd be very, very keen to look at that. 

I just want to be really clear, though, in terms of a review: we have no plans to undertake a review. The rules have only recently come in. I think it's important that they do bed in. I don't want the sector to be falsely labouring under the assumption that there is going to be an immediate review when, actually, the efforts of the sector should be looking to either meeting those 182 days or considering the options that are available to them, and options are available to them. 

Council tax was not meant to be fair. It was brought in to replace the hated poll tax. As it currently exists, it's regressive, but also very difficult to avoid, compared to income tax, which is progressive, but which is very easy to avoid, especially by the rich. The problem with council tax is that the bands are too wide and that very expensive houses are in the top band, no matter how valuable they are, above the minimum for band I. Will the Minister consider more bands above the current band I and increasing the number of lower bands by splitting the current bands in two?

I'm very grateful for that question and that clear recognition that property taxes are stable taxes but also taxes that are much more difficult to avoid in many ways. For that reason, we think that council tax absolutely plays an important part in our local tax structure and has been stable for a very long time. But, that said, we are undertaking huge efforts to make council tax fairer for the future. So, I've made a statement today that reflects on the phase 2 consultation. The phase 2 consultation looked at two things: it looked at the pace of reform and the scale of reform. In relation to the pace of reform, today I've made an announcement that we will be looking to introduce that revaluation from 2028, and the Valuation Office Agency will be undertaking the necessary work for that.

In terms, then, of the scale of change, and that includes things such as introducing new bands, those were included in our consultation, and there was definitely some support for doing that, both in terms of additional bands at the higher end, but then also, potentially, an additional band at the lower end to help those people in the least expensive properties. And absolutely, that will be part of our thinking as we move forward. I do want to be clear, though, that there would have to be a further consultation closer to the 2028 date, which would look again at those issues in relation to the scale of reform.

Yes. The fiscal framework is subject to regular internal review. In the main, it is operating well. However, there are elements relating to fiscal flexibilities where I have been making the case for improvements with UK Government Ministers.

I thank the Cabinet Secretary for that, Llywydd. By the end of this Senedd term, it will be nearly 10 years since the fiscal framework was first negotiated, yet the figures in it, as we have heard, remain stuck at the level that they were agreed back then. In the meantime, budgets have risen, inflation has eroded the real value of those figures. In the meantime, as well, agreement has been reached in both Scotland and Northern Ireland to have greater flexibilities in managing what is, after all, money that belongs to this Senedd. Does the Cabinet Secretary see any prospect of putting this right for Wales in the dying months of the current UK Government, or must we wait for the election of a different administration in London to treat Wales fairly and sensibly, so that public money can be managed here in the most effective way and in ways already available to every other part of the United Kingdom?

Yes, it's absolutely the case that the value of the flexibilities that we have has been eroded since the point at which they were set. So, in this financial year, our reserve capacity and also our borrowing powers will be worth 23 per cent less than at the time they were originally agreed. So, we absolutely think there is a very strong case for the powers and the flexibilities that have been given to Scotland recently to be given to us in terms of the indexation of the borrowing and the reserve. I will absolutely continue to make that case at the Finance: Interministerial Standing Committee. I'm very pleased to tell colleagues that I do still have the support of my counterparts in Scotland, and also now in Northern Ireland, for these measures. Despite the fact that they have had improvements, they're still very keen to support us in making the case, because they know it makes sense for all parts of the United Kingdom in terms of the devolved Governments.

I again find it rather amusing that, as the ex-First Minister, you are asking questions that are drawing attention to your own fiscal chaos, and yet it was never raised during your own tenure. These have not just sprung up now since you—[Interruption.] According to the Office for National Statistics, the figure in 2022 for the Welsh deficit between public spending and revenue was estimated to be an eye-watering £20.3 billion. Wales has the highest net fiscal balance per head in Great Britain, with a staggering £6,500 per person. For comparison, where do we think England comes in that chart? Roughly the same? Half? No. It was six times lower, at £1,100 per person—a country that has faced the same challenges as Wales, yet clearly is far better at balancing their public finances. I wonder what the difference is. Councils across Wales are facing more than £5 billion of debt. Why is it always Labour Governments that make a mockery of taxpayers' money and public finances? Will the Cabinet Secretary agree with me that the Welsh Government's own frivolous spending has wrecked the fiscal framework of Wales, and that, clearly, the socialist economic strategy of tax and spend is not only exacerbating the problem, but is drowning the Welsh dragon entirely? Diolch.

I'm afraid I don't recognise any part of that contribution at all because it mixes up a whole load of different matters, including the way in which the UK Government is responsible for pensions here in Wales, the way in which the UK Government is responsible for benefits here in Wales. Colleagues will know, of course, that we have a generally much older population here in Wales than other parts of the United Kingdom, and that is reflected through then in terms of the amount of money that is spent on people here in Wales. I think the important point to recognise, though, about the fiscal framework is that, thanks to the agreement made by the former First Minister, and finance Minister, as he was at that point, as well as providing the additional policy tools—and we've had a debate about how those need to be improved—the devolved taxes negotiated by Mark Drakeford have so far made a positive net contribution to the Welsh Government budget. Over the years for which outturn is available, this amounts to over £400 million in total, which we've been able to invest in public services here in Wales. And the Barnett needs factor, which, again, was introduced by part of the fiscal framework agreement, led by Mark Drakeford, has also provided additional funding, and is contributing around an extra £300 million to the Welsh Government settlement in 2024-25. So, there are certainly areas of the fiscal framework that are working for us; it is, really, that matter of the fiscal flexibilities that we need to see updated.

The former First Minister has made the case very eloquently in favour of a review. Now, the automatic mechanism for a review under the agreement—the periodic review—is some years off. But the agreement does have within it the ability, the power, for the Welsh Government to ask for a review now. So, have you asked for a review, or will you, given what we've heard?

So, I've just set out the ways in which the fiscal framework is working very much to our advantage at the moment, and particularly in terms of the Barnett needs factor, whereby we have an additional £300 million in the settlement. So, I think that's important to recognise. There are things that absolutely aren't working for us, but let's remember that we're dealing, at the moment, with a UK Government that sees everything as a zero-sum game—everything as a negotiation where they have to take something from that table as well. This isn't a UK Government that is interested in working with the Welsh Government for the benefit of the people of Wales. So, when you look at the way in which the Scottish framework was reviewed, certainly, the Scots gained a number of things, but then they also had to put on the table a number of things to lose. Their framework is different to ours. Now, if the UK Government wants us to put anything on the table, all we really have to put on the table in those negotiations is the Barnett needs factor, and we've heard time and time again from the benches over there how the Conservatives think that we're overfunded in Wales. So, I don't think that this is the right Government to go into those negotiations with. However, there could be a case for a future review with a Government that is more disposed to devolution and one that respects this Government and this Senedd.

Questions now from the party spokespeople. The Welsh Conservative spokesperson, Peter Fox. 

Diolch, Llywydd. Cabinet Secretary, this is the first formal opportunity to say congratulations on retaining your position in the Cabinet and in the Government, and I look forward to constructively working with you over the coming period. So, today, I had to change tack a little, because your statement came out this morning, and I was disappointed that it came out as a written statement and wasn't presented, perhaps, to the Senedd yesterday so that we could have debated it. And, of course, it came after topical questions time as well, so that didn't give an opportunity for us to debate. But I've got an opportunity now to put some questions to you, Cabinet Secretary. In your written statement, you highlighted the need for a transition fund to support people through changes to council tax—well, that's what I assume that's what it's meant for—and that comes to the crux of my question. Can you, Cabinet Secretary, explain what the transition fund looks like and who will be eligible for it?

So, I'm not able to set out those details today because, whilst the announcement has said that the revaluation will take place in 2028, and we'll be amending the Local Government Finance (Wales) Bill to reflect that, what we don't have now, at this point, is that decision in terms of the scale of reform. So, we don't have, at this point, the bands. We don't have, at this point, the rates. Those will be subject to further work and further consultation closer to the date. When those decisions are made, it's at that point, then, that you understand the impact on households and so on, and it's at that point, then, that you would consider what a transitional scheme might look like. But we've been very clear from the outset that that absolutely has to be part of the work before any scheme is introduced, so that households have certainty. When there was a previous revaluation, I think that the consensus now is that, perhaps, those transitional arrangements came too late, which is why we're very keen to at least reassure people that that will be part of our thinking when we get to that point. But we're not at the point yet where we can start putting a figure on it, because we are some years off.

Thank you for that, Cabinet Secretary. That transition fund will be absolutely fundamental to so many people when whatever happens, I'm sure, because there will always be winners and losers when you change something as profound as the council tax structure.

Some cynics might say, with the announcement today—and, yes, the announcement around the single farm payment moved off to 2026— that there must be some elections on the way that might be driving some of the Government's decisions here, but I'm not necessarily one of those cynics. Cabinet Secretary, in your written statement, you highlight the use of new technology used for valuation methods resulting in systems in place that provide comprehensive and robust information about up-to-date property values. Minister, I'm sure you will be aware of the report last week across lots of national press that the Welsh Government will be using satellites to access changes to house values. Cabinet Secretary, can you elaborate as to the technology used and whether this will include the use of satellites?

The first thing to say is there's been an awful lot of misreporting. I'm aware that the Conservatives have had their wrists slapped somewhat in relation to their use of the phrase 'a blanket ban' in terms of the 20 mph and so on. So, I would urge the Conservatives to reflect on that and try to stick to the facts in terms of council tax reform, and then we will all stay out of hot water. 

What I will say is that the article in The Daily Telegraph I think was poorly informed, to be generous. The fact is that property valuations for council tax purposes are undertaken independently of the Welsh Government. They're undertaken by the VOA. It uses the same technology for Wales as it would for England, and it's important to recognise it's entirely separate from Government, where we take those decisions about the overall design of the tax. It's important that there is that separation.

The VOA is an executive body of HMRC and the range of ways in which they use technology is a matter for them, but we are assured that the methods are internationally recognised as best practice and they are based on freely available information. It is important for council tax bills to be based on accurate and robust information. We do have a service level agreement with the VOA, which provides that level of accountability on the work.

I just don't understand this clutching of pearls that we're using publicly available information and the latest technology to accurately ensure that households are paying the right council tax. Technology has always been used, but technology is evolving.

The question was driven from your statement within your statement where you were quite excited about the new technologies that were being used by the VOA to do this, so I think it's quite right that we challenge it, especially in light of the public discourse over recent weeks where some might argue that Wales is going down this Big Brother type of situation where George Orwell's Nineteen Eighty-Four is playing out, perhaps. That's what some people are leading us to believe. I'm sure that isn't the case.

But this isn't the only concern many of us in Wales will have with the statement. Another concern is the fact that these revaluations will have a massive impact on families that are very much cash poor. They may live in larger, rural houses, perhaps, perhaps in quite poor disrepair, but still triggering a higher council tax band. Those are very vulnerable and worried people.

So, whilst I welcome—and I absolutely do welcome—the fact, hopefully, that the 25 per cent discount will remain place, I'm concerned that your explanatory memorandum for the upcoming Local Government Finance (Wales) Bill highlights the fact that Ministers have the powers to allow councils in certain circumstances to disapply or reduce discounts in their area. If you are committed, Cabinet Secretary, to the 25 per cent council tax reduction, why are you giving local councils the power to disapply these discounts?

I recognise the concerns about the impact on households during the cost-of-living crisis, and that was very central to our considerations as we looked at the pace of reform. The slower pace was the favoured response in terms of the consultation, so we listened very carefully to that. Some of those arguments that were made to support that request for a slower pace were about the cost of living and the way in which council tax rises might affect families and so on. So, we have, I think, responded well to that. 

What we also recognise is that there are people living in properties that might be high value but they might have a lower income, and it's for that reason that we're undertaking our review of the discounts, disregards and exemptions. That's going on at the moment, and that won't have to wait until 2028; that's work that we're doing at the moment to look at that. It is the case that councils are able to disapply council tax bills for certain properties. So, if there is a reason why they're able to do that, they do have a good level, I think, of flexibility to be able to do that locally. But, as I say, we are currently undergoing that quite significant work, looking at the 53 different categories of discounts and exemptions and so on to make sure that they are fit for purpose. Our working group has suggested that many of them are, but some might need some further work, and then we also need to look at the other groups who should benefit from a discount or an exemption. 

Plaid Cymru spokesperson, Peredur Owen Griffiths. 

Diolch, Llywydd. Cabinet Secretary, since your reappointment to the Welsh Government, we've heard a number of commitments from your colleagues relating to their portfolios. These announcements have a bearing on budgets and on the bottom lines of each department. My first question today, therefore, relates to the recent Cabinet reshuffle and the transferring of responsibilities between ministerial portfolios. We have seen, for example, the responsibility for the national museums and galleries of Wales, which we know are facing a financial crisis, transferred from the economy portfolio to a new culture and social justice portfolio. Likewise, responsibility for the Welsh language is now part of the reconfigured economy, energy and Welsh language portfolio. These are just two examples of high-level changes. Can I ask what assessments you have undertaken as to the impact of the changes in ministerial responsibilities on the Welsh budget? How has that impacted on the make-up of the Welsh Government's main expenditure groups? Are there knock-on consequences for the quantum of funds made available through particular portfolios? And can I ask when any such assessment will be published? For example, will it be published alongside the supplementary budget to give this Senedd the opportunity to scrutinise those decisions? 

Yes, certainly. I think that what you've set out is very much our approach to the first supplementary budget, which we will be publishing in June, as normal. Officials have been working through the implications of the changes in responsibilities in terms of MEGs, but then also looking to see if there are any budget expenditure lines that need to be looked at again if, for example, there are things that might be undertaken now in different parts of Government. That's quite a complex piece of work in terms of resetting the MEGs against the new portfolio structures. But it is ongoing at the moment, and the intention is to publish that detail in full at the first supplementary budget. 

Thank you for that answer. It would be very useful to see that tracked through in terms of where it's moved to and from. I'm hoping that level of detail will be available in that. As you've said, as June approaches, we do anticipate the imminent publication of the first supplementary budget. This time last year, we were invited to scrutinise and approve the first supplementary budget, which alleged to have accounted appropriately for the impact of inflation, including through the increased draw-down on the Welsh reserve. However, only a couple of months after the supplementary budget was passed, we were told that the Welsh Government was facing £900 million shortfall in its budget, and that Ministers across all departments had been asked to make substantial cuts in funding to public services. I think it's reasonable to expect a supplementary budget to survive first contact with fiscal reality and that it accurately reflects Wales's real financial position. Can I ask you to confirm, Cabinet Secretary, that we will not be blindsided again this year by a similar financial bombshell over the summer recess, and that the work being undertaken to prepare this year's first supplementary budget is more robust and durable? And what changes have you made to the process to ensure that that's the case? 

I wouldn't say that the Senedd or anybody else was blindsided by the work that we did to respond to the impacts of inflation on our budgets, because we were really clear. We did have some debates about it in Government and we decided at the end to make a statement in August of that year, whereas the work, actually, was only completed in October. So, we felt it was important to be transparent about the level of pressure that the Welsh Government was under at the time, and also, then, the work that we would undertake, which culminated in the changes that we made to the budget in October. You'll have seen then that the budget for this financial year baselined some of those changes. So, those things, if you like, have been dealt with and we've moved on from that. But pressures, of course, still remain on the budget, and colleagues are managing their budgets very carefully in order to deliver on their commitments.

What you can see, I think, from the first supplementary budget will be that kind of recasting of the MEGs and so on. We have to manage things as we go through the year. You'll know that our levels of reserves are very minimal as we start this financial year because of the choices that we've taken to allocate as much as we possibly could. There may be things that come forward in the financial year that we need to respond to, so we'll have to maintain a level of ability to respond in that agile way if necessary. But I think that we've dealt, in the main now, with the massive impact of inflation that we saw last year, bearing in mind that those budgets were originally set back in 2021, when we weren't aware of the challenges that were coming our way in terms of inflation and also the war on Ukraine, the high prices of energy and so on.

I was informed of the Barnett consequentials for Wales as a result of the childcare funding in England in a call with the Chief Secretary to the Treasury on the morning of the UK spring budget 2023.

Thank you very much. The cost of childcare in Wales for a child aged two is 63 per cent of a parent's average take-home pay, and as the parent of a daughter who is under two years old, I know from first-hand experience that it costs nearly £1,000 a month for her to be in full-time nursery, and many other parents in the Vale of Clwyd feel the same. With close links between the north-east of Wales and England, people are seeing, particularly in border areas, the positive news coming from the UK Government in terms of childcare funding being in place from nine months and the clear disparity of that being not the case in Wales, with that being two years. I've got many constituents who are desperate to get back to work, they enjoy working, they're young, they're ambitious, they want to do things in life and they want to get back to work, knowing that there's a robust nursery system in place to support their ambitions. So, what would your message be to my constituents who are desperate to get back to work and see the obvious and ever-growing disparity between the systems in England and Wales?

We're focusing on a roll-out of our childcare measures in a way that is focused, structured and budgeted for, and a way in which the sector is there ready, if you like, to deliver on, which isn't the case in England, which I think we can all agree has been quite chaotic in terms of its attempts to roll out the policy. In Wales, we're investing more than £100 million in childcare provision across Wales. That's through our Flying Start offer, and also our childcare offer, but alongside that, £70 million capital in the sector, and also providing support for the workforce directly through training, skills and development and so on.

Also, I know the Conservatives are always very interested in non-domestic rates relief. We're providing 100 per cent business rates relief for registered childcare premises here in Wales, and that goes through until March of next year. That will save registered childcare providers around £10 million in their overhead costs. And also, we're working with Social Care Wales to respond to the challenges of recruitment in the sector, which I think is also really important.

But in terms of our roll-out of our programme here in Wales, we're very much focusing resources on our most disadvantaged communities in the first instance, ensuring that that support reaches the families who are in greatest need at the earliest opportunity. Ultimately, our ambition is for Flying Start childcare services to be available for all two-year-olds in Wales, and we're working with the sector to build capacity to deliver that.

Decisions about the funding available for bus franchising will be a matter for the budget-setting process in the appropriate years, noting the challenging fiscal outlook that we're facing.

Many of us in north Wales look jealously at the investment going into the south Wales metro, the £1 billion plus upgrade of services, which, of course, is welcome, but, by contrast, we have a rather ambiguous candy floss concoction that's been branded a north Wales metro that merely links up existing rail and bus services. Bus services, as we know, have long been a poor relative of rail, with services in decline since before COVID, actually. I welcome Government proposals around bus franchising and ending the grip that private bus firms have on those services, but for it to work properly, it obviously has to be funded properly. So, can you assure us today that you will be investing more money in bus services to ensure that the proposed bus legislation is as effective as we all hope it to be? And can you also assure us that north Wales will get its fair slice of the cake?

I can't say anything about the budgets for the years that we don't have a settlement for at this point. I think something that needs to be recognised is that we provide significant funding already to support bus services across Wales. But what franchising will allow us to do is to make better use of the funding that we provide and give us more control over the risk and also the power to control the funding that we invest, making sure that it can be spent where it has the greatest impact, reducing inefficiency and improving the integration of the services to make that funding go as far as possible. You will, I'm sure, be very familiar with the bus reform road map that was published; that really does, I think, recognise that future funding will be challenging, so it matters how we spend the limited resources that we have.

Unfortunately, I'm not able to say more in terms of the future funding for the bus franchising, purely because we haven't yet had those discussions, we haven't yet had our settlement from the UK Government. We haven't entered into a spending review period of that sort yet. But we absolutely will be considering the importance of bus services, as we enter those discussions.

North Wales relies on buses, certainly in Aberconwy, they do—one in five households do not have access to a car, with four in every five bus users not having access. Clearly, maintaining our bus system is crucial. However, I am concerned about the financials for the franchising model, which, I know, are still under development, and, indeed, we took evidence last week in our climate change committee. Indeed, there are suggestions that London-style franchising will cost at least £300 million a year. You propose to adopt an incentive-based gross cost model, for which Transport for Wales will pay operators a fixed sum to run specific services, and this will keep the revenue in-house. However, it will also mean that TfW is obliged to run services that are at risk of decreasing passenger numbers and thus fund non-financially viable services. 

Now, TfW is known well to this Chamber for its performance in the rail system. As the chief executive of TfW, James Price, has outlined, future funding will be a challenge. Now, again, last week, as we were in the climate change committee with those actually working on the franchise model in England, several concerns were raised as to whether TfW even has the capacity, the resources or the ability to carry out the franchising model in Wales, but also within the timescales set. So, how will you, Minister, work with Transport for Wales to ensure that it does have the resources to make the franchise scheme a success? And what additional funding are you planning to transfer in order to ensure that this is not a failed exercise? Diolch.

The first thing to say is that we haven't yet developed the contracts that we will use for the franchising, but our existing contracts for TrawsCymru services will be used as a starting point because they have, already, some of the features that we would expect to see in franchising contracts. This work is being led by the Cabinet Secretary for transport, so he would be much better placed to provide you with detailed answers. But on the financing of it, as I said in my previous answer, we don't yet have budgets for these financial years, so I'm not able to provide any level of certainty to colleagues at this point. But I know, when it does come to the point of scrutinising the budget for those years, this will be a focus for colleagues.

Procurement is one of the most important levers we have to support a more equal, more sustainable and more prosperous Wales. Implementing robust procurement policies can help us achieve our ambitious net-zero aspirations, support a green recovery and contribute to our shared ambition for a Wales of fair work.

Cabinet Secretary, I believe that the Welsh public sector should be procuring Welsh goods and services as much as possible. And so when a constituent contacted me with concerns about Cadw's procurement of goods, I was really disappointed to learn recently that only around 60 per cent of suppliers who provide products sold at Cadw sites are actually based here in Wales.

Now, for many years, the Welsh Government has talked about the need to support Welsh businesses, and it's vital that we see organisations such as Cadw—which, after all, is a Welsh Government funded organsiation—doing everything it can to support Welsh suppliers. So, Cabinet Secretary, can you tell us what action the Welsh Government is taking to ensure that all Welsh Government funded organisations and sites are supporting Welsh businesses as much as they can?

I'm very grateful for the question, and it leads me to think of some work that we've been doing through the co-operation agreement with Plaid Cymru in relation to better understanding Welsh spend in terms of procurement. So, we've been looking at how we can map out spend more accurately in Wales, and there are lots of questions, even fundamentally, that we have to answer. So, how do you go about defining a Welsh company? Is it a company that has a business here in Wales, or a postcode here in Wales? Some businesses that contribute an awful lot to the Welsh economy aren’t Welsh businesses, if you like. So, what credence do we give to the number of Welsh employees? That kind of thing. So, we've been looking very closely at how we go about defining that work, and we hope to say a bit more about that in due course.

But then we're also considering how we can establish a kind of ‘made in Wales’ mark that businesses can use themselves to identify themselves, looking at the ‘made in Ireland’ mark that has been given to businesses over there. That does help businesses, as we understand it, to be able to market themselves in Ireland as Irish products. We're looking to see what more we can be doing here.

We do have a great deal of public policy advice notices that are provided to the public sector to enable them to better support businesses that are here in Wales, and also to deliver on some of our other priorities, such as supporting small and medium-sized enterprises in particular. So, there are a number of things going on in procurement at the moment, not least our new procurement legislation.

Following the exit from the European Union, we have had to look fundamentally at the way in which we procure, so we're able, through that legislation, to put a greater focus on procurement in that kind of local context. Equally, we have the work that we've been doing with the UK Government on this as well, and our own social services—. I always say social services, but it is our our social partnership Bill, which again seeks to drive those public goods, if you like, from our procurement.

Along the same lines as Paul Davies, one of the things that is most frustrating for me, certainly, in terms of public bodies in Wales is the fact that many of them are outsourcing their work to other companies—companies that are very often not located here in Wales, and that don't even have a workforce working here. It's even more frustrating when you consider that that work doesn't have to be outsourced. There are skills within those public bodies that could do it, but for whatever reason, the public body decides that the best decision is to outsource to an external company. So, what steps are you taking in order to ensure that not too many of these projects and plans are outsourced to external companies, and if things do have to be outsourced, that they are outsourced to companies that bring economic benefit to those communities that are being worked upon? 

We know that this is a concern to a number of public bodies, which is why we've worked to develop an insourcing toolkit. We know that a number of local authorities are very interested—local authorities, but you could read across to other parts of the public sector—in what more they could insource. So, we worked hard with, I think it was—. The organisation's name escapes me now, but perhaps I will write to the Member with more information. But we did develop an insourcing toolkit that we felt met the needs that public bodies were telling us that they wanted, in terms of understanding the arguments for insourcing and then testing how they would compare one contract against another, and how you can demonstrate value for money in a different way and so on. So, I think that that toolkit has been well received, and I'd be happy to send you a copy.FootnoteLink

We remain on track to deliver the programme of reforms that I set out for this Senedd term. Several improvements have already been made, including delivering the 2023 revaluation. Through the Local Government Finance (Wales) Bill, we will deliver on the range of specific proposals that we consulted on in 2022.

Thank you for your answer, Cabinet Secretary. With regard to business rates, amongst the issues most frequently raised with me by constituents is concern at what can feel like an unresponsive system, with there being too long a gap between revaluations. So, could you expand on how the Welsh Government will address this in the Local Government Finance (Wales) Bill, and what mechanisms would you like to introduce to ensure a more flexible, responsive system that supports our small businesses on our high streets?

I'm really grateful to Vikki Howells for raising that, and I know that she's been talking to businesses in her local area a great deal, and they have been expressing concerns about those gaps between revaluations. That's one of the reasons why we're introducing, through our local government finance Bill, three-yearly rolling revaluations now for businesses for non-domestic rates. We think that three years does give that balance between certainty for business, but then also reflecting more up-to-date and current market conditions. So, three years is the number that businesses and their representative bodies have been telling us that they would welcome. I think that that's a particularly positive part of our reforms that we're undertaking.

The 2023 revaluation was surprisingly smooth, so I think that we can take some comfort from how well that revaluation went. We were able to provide, of course, some transitional support for businesses that saw an increase in their bills, but when we do have this cycle of more frequent revaluations, we should see a little less churn.

Cabinet Secretary, unfortunately, for many hospitality businesses, these reforms will be far too late. The sector is facing a perfect hurricane, in the words of UKHospitality Cymru. By the time the business rates system is reformed, we will have lost many businesses, and many town centres across the country will become ghost towns. Cabinet Secretary, the industry is on its knees. Will you, therefore, take urgent action to support the sector by eliminating non-domestic rates for hospitality businesses until a new fairer system is introduced? Thank you.

I'm afraid I can't eliminate non-domestic rates for a very large sector of our economy here in Wales, just because non-domestic rates—. Let's remember the purpose of those non-domestic rates—they are there to provide vital funding for our public services. So, unless colleagues want to tell me where I need to find the money from elsewhere, or what I need to cut as a response to that, I'm afraid that's not something that I can commit to today.

Up to the end of 2024-25, Wales will have missed out on around £350 million as a result of the incorrect classification of HS2 as an England-and-Wales project.

Thank you. Cabinet Secretary, in a written answer to me yesterday, the First Minister stated that the Welsh Government budget is worth £700 million less than when it was agreed. So, if you add to this the clearly disgraceful decision by the UK Government to class HS2 as an England-and-Wales-only project, even though not an inch of track—or centimetre, even—will be built on Welsh soil, any fair and objective person can ascertain how Wales is being short-changed by the Tory UK Government, whilst the party opposite do nothing to stand up for Wales and Welsh interests. So, Cabinet Secretary, what practical differences, then, would it make to Welsh public life and the tough financial decisions being made every day by the Welsh Government, and our hard-working and hard-stretched local authorities, if the money Wales rightly should have and deserves was actually honourably given to us, or is this simply another great train robbery?

Well, £350 million could have made a significant difference to us here in Wales in terms of the investment that we're able to make in public services. I think that the UK Government should return that money to Wales. There's absolutely no argument now that the HS2 project, which is basically a London-to-Birmingham railway, has any benefit to us here in Wales. Those kind of flimsy arguments that we would benefit in the past I think have been completely washed away now, so that money I think does need to be returned to us. We're being short-changed in so many ways. When you think about replacement EU funding, for example, that’s a classic example of the UK Government short-changing the Welsh Government, and when you look at the ways in which the UK Government has provided specific funding for Northern Ireland to help Northern Ireland to meet its challenges in terms of public services, but not providing the same for us here in Wales, I think again that’s an example of where we’ve been short-changed. As I’ve said to the Minister in Northern Ireland, we don’t begrudge a penny. We recognise the pressures on public services there, but what we want is fair treatment and fair play right across the United Kingdom.

So, what I would like to see as we start our discussions in terms of the next spending review period is absolutely for this project to be categorised now as an England-only project, as it should have been all along.

Finally, question 8, Adam Price.

I'm continuing to work with the Finance Committee to agree improvements to our budget processes. Further discussions are planned over the summer with a view to agreeing an updated budget business protocol.

Under systems based on processes in Westminister, there is a tendency for the Executive, the Government, to keep a very tight hold of the ability to set the budget. We in this Senedd, and, truth be told, in the Scottish Parliament as well, have inherited that stance. In the Scottish Parliament they have a Finance Bill, but it's only the Government that can bring forward amendments.

But this is not the only way of doing things, of course, and, as we now reform the Senedd, we are moving towards a European system in terms of the electoral system, and when we look at Parliaments in those nations—Scandinavian countries, for example—because of the negotiation between parties, very often where the Government doesn't have a majority, they provide for more powers in the hands of, for example, committees—the finance committees of those Parliaments—to table specific amendments to the budgets. And not just in Europe. Also, there are some Parliaments that do operate on a Westminster basis—Canada, India, South Africa—that also give that ability to committees to bring forward specific amendments. Why don't we emulate that here?

I'm always interested in finding out what’s happening in other countries. I think that the way in which we can operate in a collaborative and co-operative way here in Wales is demonstrated through the co-operation agreement that we have with Plaid Cymru. I think I’ve had, over the years, some really excellent discussions with Siân Gwenllian as the designated Member there in terms of our preparations for the budget. I hope that those discussions have gone on in a respectful way, where Plaid Cymru is able to see the influence that it has had on our wider budget. So, I think that the way in which we’ve approached things here has been on that kind of party political, if you like, approach to budget setting.

Of course, I’m interested in what’s happening elsewhere. Ultimately, we have to make things balance, if you like, so you could conceivably find yourself in a situation where you have amendments on different tax matters, for example, which mean that the outcome of those amendments leads you then to have to go back and look at your whole budget again to make it balance. But of course I’m happy to consider good examples of what’s happening elsewhere.

I think the budget protocol has been really important in terms of trying to find those additional points through the budget year where we can have that engagement. So, the debate that we have is really important. If we’re not able to publish an early budget because of choices made in Westminster, I go to the Finance Committee to have those discussions, and I know that the sessions with the chief economist have been well received as well. So, we’ve managed to agree quite a number, I think, of things in terms of the changes to the budget protocol, but there are some areas where we’ve yet to come to an agreement, and I know that we’ll have some more discussions over the summer on that.

I thank the Cabinet Secretary.

The next set of questions will be to the Cabinet Secretary for Climate Change and Rural Affairs. The first question is from Siân Gwenllian.

Thank you, Siân. I cannot make comments on specific cases. But, as the First Minister made clear yesterday, our general policy does not support the construction of new power plants that are fossil-fuel powered. We must reduce fossil fuel emissions and increase generation from renewable sources to meet our ambitious climate targets.

Thank you very much for restating the Government's stance, and I was very pleased to hear the First Minister also saying this during questions to the First Minister yesterday. 

Siân Gwenllian's connection seems to have frozen. We will move on to Mark Isherwood's supplementary question at this point in the hope that Siân Gwenllian will have reconnected. So, Mark Isherwood. 

Diolch, Llywydd. Also questioning the First Minister about this yesterday, I noted that the International Energy Agency defines energy security as the uninterrupted availability of energy sources at an affordable price, that current levels of energy technology and infrastructure necessitate back-up for intermittent renewable energy, which remains dependent upon fossil fuels, predominantly gas, for rapid response and to balance demand, particularly when wind and solar outputs are low, and that it's likely to remain the case for much of the transition period to a carbon-neutral future, and it would be a disservice to the public to pretend otherwise. I then asked him how the Welsh Government proposes to ensure energy security during the years of transition to a carbon-neutral future. In his response, and as you indicate, the First Minister said there is a presumption against new fossil-fuel-powered production in Wales. How do you therefore propose in your new role to address the technological and scientific reality that this is not an either/or choice, and that failure to accept and plan for the risks risks leaving people cold, hungry, thirsty and exposed to life-threatening instability?

Thank you, Mark, for that supplementary, and this isn't an either/or because climate justice and social justice are our twin economic missions and achieving both of them requires collaboration. For our part, the just transition to net zero is at the very heart of this Government; it's embedded throughout everything we do. We will ensure workers and consumers are front and centre in the net-zero transition and that the people of Wales benefit. But, to be absolutely clear, we do need a secure, affordable energy supply and a sustainable industry in Wales.

The climate crisis and our current dependance on expensive globally sourced fossil fuels underlines the importance of an affordable clean energy that is generated in Wales. We need sustainable industries that support the well-being of our economy and citizens and contribute towards decarbonisation. Our programme for government requires that we embed our response to the climate and nature emergency in everything we do, so we do uphold our policy of opposing the extraction of fossil fuels in Wales, both on land and in Welsh waters, using the powers available.

And just to remind the Senedd and colleagues—I'm sure nobody needs reminding—our statutory commitments are to reduce greenhouse gas emissions by 63 per cent by 2030, 89 per cent by 2040, and at least 100 per cent by 2050, based on 1990 levels. This is not mutually exclusive. We need to deliver climate justice and social justice at the same time. 

I will, Tom, and thank you. On 25 April, a joint statement on the deposit-return scheme was published, outlining the interoperability positions agreed by all four nations. Having worked closely with England and Northern Ireland on the development of their legislation, it forms the basis for our legislation, which is now being drafted.

Can I thank the Cabinet Secretary for the response? I know the Welsh Government in its new iteration is keen to create the impression that it is in listening mode. We've heard that from the Cabinet Secretary for North Wales and Transport as regards 20 mph, the Cabinet Secretary for Education as regards additional learning needs reforms and from yourself yesterday regarding the sustainable farming scheme. So, I wonder whether you'd be willing to listen to those breweries across Wales who are concerned about the impact that the inclusion of glass in the deposit-return scheme would have on their businesses. Last year, with the Secretary of State for Wales, I visited Bang-On Brewery in Bridgend—I know you're familiar with it; I meant more from a geographical perspective than a familiarity with the product, Cabinet Secretary, but I'm sure you're familiar with Bang-On Brewery, nonetheless. [Laughter.] And they informed me that they thought the impact of the deposit-return scheme meant a bottle of beer there could cost as much as £12.50 or more. So, I wonder whether you've taken time to reflect on the fact that England, Scotland and Northern Ireland are not progressing with glass in the deposit-return scheme in the initial instance, and whether Wales now, under your tenure as Cabinet Secretary, might want to follow suit.

Well, a couple of points to make in response, Tom. First of all, not only are we keen to engage, but we have been engaging, and I've had two or three round-tables, including with the supply chain, including with brewers, the retail and hospitality sector, over the last few weeks that I've been in post. I'm keen to engage with them, keen to work through how we take this forward.

But just a reminder of why we see glass as being so critical: it is, for a variety of reasons, not least our trajectory to zero carbon, touched on in the previous question—. The fact that we have to, to recycle glass, heat it to 1,500 degrees before we turn it into a recyclate product is significant. Reuse of glass is a major breakthrough in our zero-carbon trajectory, and Wales is far ahead of many others on the recycling of plastics, what we're doing on single-use plastics, what we're doing on aluminium and so on already. We are already third in the world and possibly moving upwards in terms of our recycling, because of bold measures we've taken. But glass needs to be in there; it needs to be an all-in scheme. It's not a question of 'if' but 'when'—it is not a question of 'if' but 'when'. Because this is not only to do with zero carbon, it's to do with litter and the effects of litter on communities, and litter and the links with deprivation, and litter and the links with deprivation and then with criminality, if it's not tackled. It is to do with animal welfare as well. So, there are a number of reasons.

But we will continue to work with all businesses, Tom, very closely indeed, as we seek not only to take forward the four-nation statement on DRS, which we have signed on, but also our fundamental principled position on glass. There are reasons—very good reasons—why glass should be in, and reasons, by the way, why leaving glass out for too long or at an early stage will lead to additional costs for businesses as well. Look at the increase in some of the landfill costs in England at the moment—that's what we're trying to protect against.

It's very typical that we have three Members from Bridgend contributing to this question and we all want to talk about Bang-On Brewery. But Bang-On Brewery is a good example, as are other small breweries across Wales, of some of that concern that is there around glass being included in the DRS, particularly the administrative burden that'll be placed on these smaller producers, who, more often than not, are more like passion projects, staffed by one, two or even three people. So, my question to you, Cabinet Secretary, is: how do we actually ensure, then, that those smaller producers, who, to be fair, aren't the ones that are contributing the most to the litter on the streets, how do we ensure that that administrative burden on them isn't so much to the point where they then start considering what actually their future trading in Wales is actually going to look like?

Thank you, Luke, and I get a feeling I'm going to get some invitation from Bang-On Brewery at some time to go down and visit their premises. I'll clearly be hugely reluctant to take up that invitation—no, I'll definitely accept it, if it does come.

But just to say that working with businesses has already been extensively under way. Can I just remind all colleagues who are contributing to this, that there was a position, only a couple of years off, where there was a UK-wide sign-off on everything, including glass? It's not that Wales has changed its position or Scotland has changed its position; it's that England has changed its position. [Interruption.] Sorry, there are some comments behind saying Scotland has changed its position. Scotland were confronted by a UK administration that said that they would use UKIMA, the United Kingdom Internal Market Act 2020, to thwart their ambitions to move ahead. But, actually, there was sign-off across all the nations on that consultation only as recently as two years ago.

Can I just say, in terms of small breweries, there are ways in which we can deal with this, and small producers as well? So, for example, recognising the potential impact on small producers, producers may choose to register product lines with less than 5,000 units placed on the market across the UK per annum as a low-volume product. Now, this exemption is designed to support those producers with low-volume sales products or specialist sales products who would find DRS requirements disproportionately burdensome. We actually want to work in Wales with our small producers, so that we can support them to make the most of the opportunities, from more resilient supply chains to decreased material costs, and particularly through our plans on reuse in Wales. So, we will continue to work with all of our small producers.

Can I welcome this question being put forward and the Cabinet Secretary's answers already? I note the Cabinet Secretary's ambition around the importance of the four-nation approach. I also note his comments around glass being included in a scheme. Very similar to the comments we've heard from Tom Giffard and Luke Fletcher, in my role as chair of the Senedd cross-party group on beer and pubs, I've spoken to a number of small and microbreweries who do have those concerns that have been raised this afternoon, particularly around glass, and when that would be introduced.

Your commitment is really welcome to the industry. I think you're demonstrating that already by meeting a number of times, through round-tables and other avenues, with the industry and stakeholders of the industry. Can I ask you therefore: will you carry on engaging and speaking to the industry—perhaps through the cross-party group as a vehicle to engage with many small and microbreweries across Wales—to make sure that any scheme doesn't disadvantage small and microbreweries across Wales, which play an incredibly important role in our Welsh economy? Diolch.

Jack, we will, of course, continue that engagement. My thanks for your engagement in this role, with your chairmanship of that group as well, which is a very well-loved cross-party group, I have to say, here in the Senedd.

We'll continue that engagement, but just to reiterate: this is not Wales being the odd one out here. This is Wales trying to do the right thing for our planet, for recyclate as well, and also for a resilient industry. There are real costs, I have to say, to phasing glass in at a later stage, or blocking it from being phased in. It has considerable issues. So, for example, it excludes the material with the greatest carbon footprint and what has the greatest potential in sustainability, but it also means that we could be into the 2030s at the earliest before we introduce glass. Bear in mind that there are over 50 countries that currently have this and the majority actually with glass as well. If we have an initial roll-out without glass, imagine the costs of the redeployment of the equipment that would then take glass subsequently. So, there are a number of reasons why—. And also there wouldn't be a level playing field. So, between aluminiums and plastics and steel and glass, there wouldn't be a level playing field.

But we will, Jack, continue to work in partnership with you, the group, but also with those wider, small-and-medium-scale businesses, which are so important to food and drink within Wales, on whatever proposals we take forward.

Questions now from the party spokespeople. Conservative spokesperson, Janet Finch-Saunders.

Diolch, Llywydd. Only last year, we in the Climate Change, Environment and Infrastructure Committee branded the Welsh Government's efforts on environmental governance as inadequate. Over several months, we've actually, or I certainly said it was woefully inadequate. The crisis here in Wales is now worse. Wales still remains the sole region in the UK without a permanent body dedicated to scrutinising its Government's environmental performance. Welsh Water has breached regulations more than 200 times since 2018, but was only fined twice. The Wales environment network also agreed that current arrangements for the interim do not constitute a route to good environmental governance.

Enforcement by Natural Resources Wales has resulted in only 50 fines across 880 breaches in recent years. And even after NRW undertook a year-long investigation into the illegal dumping of waste in a site of special scientific interest on the Gwent levels, and David John Neal was given a three-month suspended sentence, the First Minister deemed it acceptable to accept a £200,000 donation. Called out in this Senedd by Paul Davies and Andrew Davies, our leader, Vaughan Gething MS, otherwise known as the First Minister, has sold any credibility on the nature crisis down at the Gwent levels just to ultimately become First Minister. Would you, Minister, have accepted this donation? Should it be returned? And how do you mitigate the embarrassment felt by, I'm sure, other Members of the Welsh Government, backbenchers and indeed, us, as Senedd Members?

Well, Janet, can I deal with the substance of your question rather than the political points that you're making? The substance of your question is to do with the environmental governance within Wales, and it is a factor of our withdrawal from the EU that we lost that framework, and we now have to put in place—. And I give credit, I have to say, to the interim assessor, and a very small unit, for the work that they've done already. But I'm glad, I think, taking it from the comments that you've made, that we have your support for the work that we will bring forward on the environmental governance and biodiversity targets Bill, which will actually fill those gaps that we have now lost. That will put in place not only a permanent environmental governance body, which is important—we need that—but it will drop down those environmental principles. We always made clear in Wales that we will not take a step back, and I would ask for consistency from all Members of this Chamber, then, when we come to difficult decisions on environmental matters, that we stand steadfast with it, in line with the well-being of future generations approach as well. And we will also put in place, following the COP on biodiversity last year, which my predecessor Julie James attended, all those targets that drop down from the United Nations high targets into Welsh domestic targets as well. That it is the way to proceed. If you don't mind, I'll ignore the politics that you're trying to make of what is actually a very serious and substantive issue, but thank you for your support.

That was not an answer to the questions I raised with you. Referring to the case against Mr Neal, NRW said:

'The outcome of this case shows that companies and individuals who seek to exploit the regulatory framework...will not be tolerated by Natural Resources Wales.'

NRW has actually drawn a clear red line that they do not tolerate those who seek to exploit regulations that protect the public and our environment. However, as reported in March, the First Minister shockingly asked NRW, allegedly, to ease restrictions on one of Mr Neal's companies, Atlantic Recycling. If only it ended there. The First Minister then accepted £100,000 in December 2023, £100,000 in January 2024. Shockingly, this coincided with Mr Neal pleading guilty to another offence in January—not once, not twice, but three times a charm. This absolutely stinks. Jeremy Miles MS and Mick Antoniw MS have both said that they would not have accepted this money.

Do you, Cabinet Secretary, not believe that the First Minister has crossed his own red line and that he's undermined his Welsh Government by not only tolerating, but supporting an individual and companies that have fundamentally undermined our environment, and have caused misery to so many people?

Well, Llywydd, today on the Senedd floor, the privilege we have to be here, there are 101 important environmental matters that could have been brought to my attention by Janet as the frontbench spokesman. Rather than that, she's focused on issues that the First Minister has already addressed repeatedly. And let me just say in terms of the red lines on this as well: there is a Cabinet Secretary for Climate Change and Rural Affairs—that's me. My responsibilities are there. In the same way that NRW has those very firm lines on what they do, without influence, and so on, so do I. That is my role. So, unless, Janet, you are directly questioning my integrity, then I say to you, let's talk about matters of substantial interest to Wales and the people of Wales and the quality of our natural environment, and let's get back to doing the day job.

Thank you, Cabinet Secretary. I wouldn't dream of questioning your integrity because you didn't accept the money. But that the leader of Welsh Labour has publicly accepted money from an environmental law-breaker is unacceptable, and we should not be accepting this. I find it quite appalling that there appears to be no redress on ethical and moral standards by the First Minister.

Just look at the suffering in Pembrokeshire: Public Health Wales feeling the need to tell residents that they should keep their windows closed, and doors, during what is now—hopefully and thankfully—warm weather, because the emissions may be harmful to health, and to contact any health provider if there are any concerns. This week, the head of south-west operations for NRW said:

'We fully understand the strength of feeling and growing impatience amongst people living and working in the surrounding communities.'

Do you acknowledge that the First Minister's refusal to return the donation is causing him now, and your Government, to be perceived as backing a donor instead of the local community, which is now clearly suffering from this environmental disaster? What pressure will you now put on NRW to ensure that these breaches end now? And also, are you looking, with NRW, at the permit that this operator is actually using to carry on with this shocking situation that is affecting so many people's lives? Diolch.

Thank you, Janet, for moving on to the particular matter that is causing high concern around the Withyhedge landfill site. If you'll excuse me, I'll choose not to conflate it with, again, the wider political points that you're making, because, on the ground, there is a situation where I have the most enormous amount of empathy with those individuals, and we heard earlier, actually, and at First Minister's questions yesterday as well, Llywydd, some of the concerns there. 

Public Health Wales, and of course NRW, are on the ground. I know we have a further question coming on this very soon as well. But I've made clear, when asked about this in previous questions—and so has the First Minister—that NRW, as the regulatory and enforcement body on the ground, are not only there, and also engaging with residents, but have put in place the measures that they require of the operator, and if those measures do not take place and are not made effective, and if the concerns of residents are not addressed, they have enforcement powers to use. And one of those deadlines passed yesterday. So, on that basis, rather than take—. I think we'll come back to this question with another Member, which I'll address in further detail. 

Plaid Cymru spokesperson now, Delyth Jewell.

Thank you, Llywydd. I'd like to ask you about global mapping trends in terms of climate change, please, and how that impacts on our work here in Wales. There is now a consensus amongst some of the most prominent climate scientists that the world is on a very damaging course. Global temperatures will rise by at least 2.5 degrees C, and with that, there will be more floods, fires, heating and storms—a nightmarish scenario. 

So, first, what impact will this have on Wales? But also, at the same time, there is another crisis when it comes to communicating that challenge. Westminster politics increasingly downplays the importance of reaching net zero. The Conservatives, of course, have led on this in Westminster, but Labour on a UK level are retreating from the ambition that we need to see. So, what effect is that distance or that gap between what needs to happen as a matter of urgency, and the way that Westminster politicians discuss these issues—? What impact is that having on public confidence, and on that feeling of perseverance?

Delyth, thank you very much for that question. The global trends are incredibly worrying, and we're not immune from this. We can see this in the recent mapping that was done in Wales in terms of flood and coastal inundation, which was the latest set of mapping. It's no surprise to us now, and we need to put in place, then, the toolkit of how we respond to that. We saw it over, not just this winter, but in the trends that we've seen over the last decade and more in the farming community, and to do that, we need to put in place the toolkit. Part of that is, by the way, the sustainable farming scheme that we debated yesterday, about how we can deliver resilience into our farming as well, recognising they're going to have extreme wet weather for prolonged periods, and then drought as well within Wales. So, it's really impacting us directly. And, sometimes, we as policy makers, and as parliamentarians, need to do all we can to explain in very direct terms what this means.

So, if we do not deal with this, it will mean more expensive food on our plates. If we do not deal with this, it will be more people exposed within their homes to risk to property, but also to life and limb as well. It's that scale of it. That's why we need to do it. It's now, as well as our children and grandchildren. Because that way, we can then bring the public with us. But it isn't a question of scaring the public, or making them so pessimistic that they think we can do nothing. It's being realistic about the incredible challenges that we now face, because the projections on where we are with the climate heating, as many people refer to it, rather than global warming, are stark and clear. And that's why the sooner—as Lord Stern warned us all those years ago—the sooner we invest in the multiple ways to deal with this, across my Cabinet colleagues, in housing, in transport, in farming, et cetera, et cetera, then the sooner we start to turn the tide again. And we have to give people that optimism to bring people with us, but not run away from hard choices. 

Thank you for that. Would you agree that, at the same time—and I agree with you, we must not scare people—playing it down is equally damaging, and damaging not just for the climate, but for politics, trust in politics, and all sorts?

Thank you for that. We've heard your agreement with those points.

A number of us, the majority in the Senedd, want to see more powers being devolved, such as powers over the Crown Estate, over the grid, and over sustainable energy generation on a larger scale. What are you doing to ensure that these powers do come to Wales? How will you be working with the Cabinet Secretary for energy, the General Counsel and the First Minister to secure these powers? There's a great deal of talk and there are very warm words spoken about why we should have these powers, but will you outline a strategy about how you will be ensuring that these powers do come to Wales—a strategy to respond to the Westminster Government, but also to a prospective future Labour UK Government after the next election?

A very good point to end on. I think the way that we do this is—I know it wasn't meant in the question—rather than write out a strategy, it's a plan we're already involved in. It does mean consistently arguing the case, whether it's in letter or in bilateral meetings with the current Government or with any future potential Government as well. It does also mean working this across Government, so doing it hand in hand with other Cabinet Members, including my colleague Jeremy Miles as well, so that we are saying exactly the same thing in whichever meeting we go into and repeating and repeating ad nauseam until it actually happens.

Meanwhile, on issues like the Crown Estate, we still need—and the Cabinet Secretary, my colleague, would agree with me as well—to continue to work with them very closely prior to any devolution of those powers to actually make sure that the benefits in Wales that we can get are retained here within Wales. But, the point is well made. We have a clear position stated not only in the programme of government, but also as part of the co-operation agreement, on devolution of the Crown Estate and we look forward to either this or a future Government of a different colour, perhaps, helping us make that happen.

Indeed. Thank you, Adam. The difference in payment rates reflects the costs incurred and the income forgone for undertaking organic farming practices in the four different land use categories. The scheme offers higher payment rates on land where the greatest environmental benefit can be achieved through organic management practices.

I understand that response, but the backdrop to all of this is that payment rates have fallen across the board. If you happen to be in one of the lower categories—in the sheep sector, for example—the situation is very fragile indeed. From the conversations that I've been having with farmers in those categories, they've farmed organically successfully for decades under the various schemes that have been in place, and now they're facing a situation where they are either having to leave farming entirely, or they are having to intensify their farming for the first time in decades, which is entirely contrary to the Government's policy direction.

The Cynefin programme will now have to continue for another year. It was supposed to be a stopgap, wasn't it? I, of course, welcome the opportunity to have more discussion on the SFS, but could I ask the Cabinet Secretary to look as a matter of urgency at the impact of the Cynefin scheme on farmers in these vulnerable areas and the impact that that will have on organic, where there's been a good news story for Wales over many years?

Indeed, Adam, we're very, very keen to continue our support for the organic sector and will keep on talking to those who want to continue farming organically as well. You rightly draw attention to the fact that, outside of the support that we provide to those four different land categories, there are other things that can threaten the sustainability of particular farms within that. That can be, as you say, prices for lamb on the hills, or it could be a drop in prices, for example, for dairy organic support as well, which many would argue doesn't reward with the premium price that organic farmers need for their investment within organic schemes. So, there are things outwith the support that we can put as a Government as well. But we will continue, not least as we take it forward over the next year in this preparatory phase with the SFS, before we transition forward, to make sure that organic is firmly in there as part of that consideration. And we will keep talking as well directly to those farmers, because we know that some have left the market, because they are not getting rewarded in the way that they feel is commanded by the added investment that they put in. Some of this, though, is outwith the actual fee structure payment; it's actually those wider market forces, but we need to be alive to that as well.

During the Economy, Trade and Rural Affairs Committee's evidence session on the sustainable farming scheme last week, Soil Association Cymru, representing the Welsh organic forum, stated that 

'it's only recently that there's been this sort of recognition that organic systems need something specific within the SFS.' 

There were similar comments made by the Tenant Farmers Association too, who stated that there were just too many people on the round-tables in previous years for the needs of tenant farmers to be heard. Yesterday, you made your announcement on the delay to the sustainable farming scheme and the round-table work that's going to be undertaken to right the wrongs of the current policy. So, I hope that these round-tables will be far smaller than previous ones so that no specific points relating to tenant farmers and organic farmers, for example, are lost. But, sticking to the theme of payment rates, have you, as a Cabinet Secretary, made any calculations to determine what it will cost to deliver the sustainable farming scheme, and, if so, have you made any representations to HM Treasury of that cost? Diolch, Llywydd. 

Sam, in answer to your closing question there, 'No, we haven't', because we'll determine the cost of it when we've done the final design, as I mentioned yesterday. I'm very keen to keep engaging with you and all Members on this as we take this forward, but the final design will determine the cost. At this moment, I repeat the ask I made of you and colleagues—and all colleagues here—in any engagement they have with the UK Government at the moment. The envelope that we have for support of primary food production in Wales is less than we were promised. It's not a political point; it's a factual statement. Now, on that basis, many farmers in England as well are saying, 'Can we have the quantum of funding that we were promised when we left the EU?' I would welcome that, because, at the time, some people were saying to them, 'Don't you worry, when we've left the EU—this isn't refighting, by they way, the Brexit thing, but I remember being at farmers' platforms, hearing it said—'When we leave the EU, you will have more funding'. And people wiser than me, at the time, said, 'When you're confronted with the choice between social services, and health, and education and many other things, the idea then that farmers would—'. Sam, I know I'm in some ways preaching to you things that you are already aware of. But, if the UK Government were to say that they were to put a greater quantum of funding in, and this is where I do ask for your help, then we're all in a better place. For the moment, however, we will design the SFS, and then we will actually say, 'Here is how the payments within it will line up and it's within the cost envelope we currently have', unless there is suddenly a switch thrown and the UK Government say, 'We're going to make good that promise that we made all those years ago'. But, for now, we are where we are. And I think the farming unions and others are realistic about that as well. They know that's the envelope we're currently working within. 

Thank you, Paul. Protecting and improving our environment in Pembrokeshire and across Wales is a priority for this Government. We have provided Natural Resources Wales with powers to take strong action to regulate and enforce environmental controls at polluting activities. Additionally, an interim environmental protection assessor for Wales has been appointed to oversee the functioning of environmental law.

Cabinet Secretary, as you've just said, one of the Welsh Government's environmental priorities for Preseli Pembrokeshire must surely be to keep people from harm, and yet, as we've just heard, residents living around the Withyhedge landfill site are still living in fear of the potentially toxic stench and stink coming from this site. Now, as was said, on Friday, Public Health Wales issued advice saying that the odours and emissions coming from the site could be harmful to people's health, and they urged people with symptoms to seek medical advice. Now, I'm surprised that we've not heard more from Public Health Wales. But, this morning, I've written to them, asking them what action they've been taking to resolve this unacceptable issue. But it's quite clear to me that this matter has been handled very badly, and I believe there now needs to be an independent public inquiry into the handling of all this, given it's been ongoing for around nine months, and how it's badly affected so many of my constituents. However, in the short term, given these huge environmental and public health concerns, can you tell us what discussions the Cabinet Secretary for Health and Social Care has had with you about this issue, and can you also tell us just how bad the side effects have to get before the Welsh Government will intervene to remove this operator from the site permanently?

Thank you, Paul. First of all, at the outset, can I just reiterate my empathy with those residents who have been having to suffer what they've had to suffer for the past weeks and months there? This needs a resolution, I absolutely, entirely agree with you. Just to reassure you, both the Cabinet Secretary for Health and Social Care and I, and our officials, are in close liaison on this because the two organisations that are critical to resolving this include Public Health Wales, who, of course, have issued advice to local residents and people on the ground. They're also taking forward, I'm informed, work to obtain monitoring data to inform a full health risk assessment. They have given advice to the public at the moment. From my perspective as the Cabinet Secretary for Climate Change and Rural Affairs, NRW are very clear what our steer is and what our priority is: that the enforcement orders that have been put in place to do the work on the ground and to resolve the problem need to be done for the benefit of local residents. There are deadlines with this, as you're fully aware as well, and NRW are aware that they have a range of enforcement powers that they can take if those measures to benefit local people are not adhered to, and that's what I would say. I don't think this is a question of an inquiry; this is a question, I have to say, for you and also for residents, of seeing the enforcement bodies on the ground, NRW, but also Public Health Wales, doing the work that they should do in order to resolve these issues very promptly and speedily now, because it's been going on too long for those local residents.

I also want to support Paul Davies in saying that some action has to be taken on the Withyhedge site. I do feel that anybody shouldn't be subjected to the fumes that may or may not be toxic and the sheer stress that has been imposed on people. I'm not, at this stage, supporting any public inquiry, but what I will ask, Cabinet Secretary, is that we are seen to support, where that's appropriate, the actions that should be taken on the ground. I know that several actions have been taken and several of them have been met to date. There are a number of outstanding actions that are causing real concern to those residents that need to be fulfilled. So, my question to you will be what conversations you're having with NRW and the local authority to help support those people who so desperately do need that support that we can give them.

Thank you very much, Joyce. I'm glad to see there's real support from all Members of the Senedd here to alleviate these problems for local residents. It is unacceptable and it has to be dealt with. Can I just be as absolutely clear here as I possibly can be? NRW are on the ground—they've increased their presence because of the matters ongoing. They will continue to update the community as well. I understand that there's been a lot of communications, including newsletters. They've served enforcement notices on the landfill operator as well, who is required to cover all the exposed waste, complete the landfill engineering works, and to contain and collect the landfill gas. That's pretty explicit, pretty clear. If the operator fails to comply with the final deadline of the notice, NRW will be looking to take enforcement action in line with their enforcement and prosecution policy. So, NRW are responding as a priority to resolve this issue. I would encourage, however, both you and Paul to tell all residents to continue to report, as they have been doing, any instances of odour to NRW, as this will help, actually, NRW in terms of informing the effectiveness of their enforcement.

Thank you, Gareth. The Environment (Wales) Act 2016 requires robust monitoring and reporting of our environment through the 'State of Natural Resources Report'. Our environment and rural affairs monitoring and modelling programme provides further evidence at an all-Wales level and on a scheme basis on the efficacy of our projects.

Thank you very much. Biodiversity is still declining in Wales. The number of bird species in Wales categorised as 'declining' has increased by 122 per cent in the last 20 years, for example. The 'State of Natural Resources Report' in 2020 also highlights that Wales has not met any of its four aims on the sustainable management of natural resources approach. The new 'State of Nature Wales' 2023 report reveals the devastating scale of the nature loss across the country and the risk of extinction for many species. Welsh wildlife has decreased on average by 20 per cent since 1994, and one in six species are threatened with extinction. In my constituency, the protection of little terns has been successful, and we see some projects yielding results. But, overall, despite the money being invested into biodiversity projects, we are not seeing the results. The EU has been placing more emphasis on nature-based solutions, and the London School of Economics and Political Science recently published a report on incorporating nature into finance, placing more financial incentives on biodiversity, and attracting more private investment towards ecological projects. So, has the Cabinet Secretary reviewed the efficacy of the Welsh Government's biodiversity projects in north Wales? And what efforts have been made to work with private enterprise in addition to local authorities and other stakeholders? Thank you.

Thank you. Gareth. You raise some important points. I mentioned how we do the monitoring of the efficacy in my initial response, but that wider question about how we go beyond public resource to actually attract ethical green investment with real integrity behind it is an interesting one. What we don't want to do, and we discussed this briefly in the debate on the sustainable farming scheme yesterday, is open up a market to, if you like, commodity trading that just simply takes all the value out of Wales and perhaps has negative consequences. But there is something within that space that needs to be looked at with careful consideration, which is to do with how we lever in additional funding for the right reasons, into biodiversity gain, biodiversity restoration, but also wider land use management as well.

Some of this falls within the work we're doing, for example, with the nature networks programme, where we've just announced £17 million of additional funding throughout Wales for those schemes, and you'll see these in your local area as well. But some of it does go to that thing of, 'Well, is everything we're doing sufficient, or could there be an additional quantum that we could lever in somehow?' But if we were to do that, it has to be absolutely gold standard of ethical investment within Wales so that local places actually benefit, local people actually benefit, rather than sucking the value out of Wales entirely for international investors and so on. But it's an interesting thought, and I'd be interested to see, over time, where the views of those in the wider Chamber rest on this as well.

Thank you, John. I was honoured to announce last week a newfound partnership between Water Safety Wales and the Royal Society for the Prevention of Accidents. This partnership enhances our combined efforts in reducing water-related accidents, and the Welsh Government has allocated up to £150,000 for 2024-25 to support these endeavours.

I was very pleased to sponsor the water safety coalition event in the Pierhead building the other week, and it was very good to have you there to speak, Cabinet Secretary. You will know that the mother of Mark Allen, who tragically drowned in a reservoir in Wales, was there to speak about the importance of having throwlines at reservoirs, lakes and canals as part of improving our water safety. And we also heard that too few children are learning to swim now as part of the primary school swimming programmes.

As well as perhaps addressing those two sets of issues, Cabinet Secretary, might I also mention SARA, which is a volunteer-led lifeboat service operating in and around the Severn estuary and includes the River Usk? As part of improving water safety, they would like to have a new base on the River Usk near the city centre in Newport so they could get into that river more quickly if people were in difficulties in the water. I just wonder if you could tell us how the policies that you're taking forward and the investment that you've mentioned might help them establish that new base, which would be very important in improving safety on the River Usk in the centre of Newport.

Thank you, John, and thank you for hosting that event last week, because it was truly excellent. It was a real pleasure and a privilege to speak with Leeanne. She, of course, addressed from the main stage in the Pierhead those who were gathered there. I think her work and her campaigning that went to, indeed, the Petitions Committee, as well, has been instrumental in pushing us along and encouraging us to go further and faster. I think we both want to use the floor of this Senedd to thank her for all the work she has done, and she continues to do, because there is no better legacy to Mark Allen's memory than that. This will actually save lives, what has been already achieved.

Part of that is, within this partnership, really practical measures such as enhancing safety measures at high-risk locations with open water and on the coast, improved signage to get the message across, life-saving equipment installation, regular risk assessments at those big water bodies as well, and so on. These are simple but exceptionally important steps in reducing water-related incidents and fatalities. We have too many fatalities. And the other aspects, of course, are what we can do in schools, not just on swimming but on water safety awareness, and also engagement with the local communities themselves, who know these water bodies, to get the message through there about how to look after themselves properly as well.

In respect of SARA and what they can contribute, it's amazing to see how many organisations out there can be part of this. I'd be interested in learning more, John, if you were to drop me a line or have a further conversation with me, and let's talk about how they and others can get involved with this important piece of work. We're approaching that time of year now where many people of all different ages will want to go out. The approach, now, to open-water swimming is interesting, but do it safety and so on. Youngsters, particularly, will want to go out and enjoy themselves in our great outdoors. That's fantastic, but do it safely. Be aware. Know what your limits are and know what you should be doing in the right place and so on. So, I think, working with organisations such as the one you've highlighted today is the way forward, and working with local communities. There's a big job of work to do, but if we save lives over this summer—. We know there are too many fatalities out there, but let's do the very best we can, and this partnership approach is key to it.

Thank you, Heledd. We will provide more than £75 million to flood risk management authorities across Wales this financial year. This includes £5,706 million to risk management authorities in South Wales Central, which will be used for improvement works to flood risk management infrastructure, benefiting approximately 5,706 properties.FootnoteLink

Thank you very much. Clearly, some of that work emerged from the co-operation agreement.

I'd like to ask you specifically, though, about the practical support for communities at risk of flooding. You'll be aware of the trauma felt by many for years after a serious flooding event, the trauma that they feel every time it rains heavily. The Welsh Government has funded some flood forum work, to develop flood action groups, but this is quite inconsistent across Wales. We don't have a national flood forum here in Wales. There is one in Scotland and one that operates in England, which sometimes is funded to work here in Wales. Do you think there is merit in exploring a Welsh flood forum specifically to support flood action groups? And how can we empower communities? Because I think some of the advice about raising your plug sockets and so on is all very well, but for people who have this continuous risk and may not be equipped to fill in forms or know how to form a committee, how can we provide that practical support so that they feel empowered when the worst may happen again?

We often look outside the boundaries of Wales, and we should sometimes, to look at what other areas are doing to see if it works, but there are different approaches as well that we can do, bespoke to Wales. A national flood forum isn't an approach we take currently in Wales. It wasn't considered as an option, as NRW are being funded to undertake this work, but actually, in my own communities, I've faced exactly the same challenge. We haven't had the sheer scale of devastation as some others, but we have had now properties that haven't been flooded for decades that have now been having street-level flash flooding incidents on a more regular basis. So, we've tried to work with them to say, 'We have the expertise out there', and actually we have brought in, then, the various agencies that we have in Wales to sit down with them, including local partners, the local authority, as well as NRW, to say, 'This is how we can actually establish your localised response to it.'

But we are putting funding into this. We fund Natural Resources Wales and local authorities to engage in flood awareness and resilience activities through the year. NRW have provided guidance as well on what to do before, during and after a flood on their website. We fund community groups and individual members of the public to work with advice and guidance. And, of course, NRW, with our support, work in close partnership with other organisations to provide support and to signpost groups to others who can help them. That includes, for example, Public Health Wales, Flood Re, the National Flood Forum, the Met Office and the Association of British Insurers. Indeed, this is what we did in our local context as well. There's also, of course, a flood warning service that we operate now from rivers in Wales that NRW operates, and there's more.

We'll always keep an open mind to how we can improve this, because what we do want are resilient communities who know what to do, who know, when they can, how they can play a part, both for themselves as individual householders or property owners, but also for their wider community. And when this works well, it works very well indeed. We always keep an open mind, but at the moment, what we want to roll out is that signposting, advice and best practice so that any community that needs it can have it.  

Field trials to collect data for the use of TB cattle are continuing. In tandem with this research and development work, we are considering strategies for incorporating cattle vaccination into our TB eradication programme. The future scale of use would be informed by the analysis of effects following the initial authorisation.

Thank you for the answer, Cabinet Secretary. As we all learned through COVID, breaking chains of infection is important, and vaccination, as well as hygiene, is a key part of this. Studies have shown a reduction in transmission in vaccinated cattle, with a total vaccine efficacy of 89 per cent. These suggest that vaccination could represent an important tool for bTB control. As of 2024, the UK has culled 330,000 cattle, with around £150 million paid to support farmers' losses each year, and this is added to the 210,000 badgers culled at a cost of £58.8 million. These figures don't sound very effective and are still heavily pursued in England. Cabinet Secretary, please could you outline a time frame for a cattle vaccine roll-out, how you anticipate this will help us tackle bovine TB going forwards, and how this should be the most effective strategy, along with hygiene? Thank you.

Carolyn, thank you very much. You are right that this could be something of a step change in the way that we deal with bTB, which is such a devastating illness for cattle but also for the farmers who see so many of their cattle then destroyed as a result of this. We have reason to be optimistic, but what we can't do is put a timeline on it, because we have to test and prove the efficacy of this. So, in order for cattle BCG to be used, we first of all have to have a diagnostic test that is capable of differentiating infected from vaccinated animals. That is needed. Once such a test is available and validated, then the use of cattle BCG, combined with a DIVA test, could indeed be approved. But we don't have a timeline on that. The work has got to be done and carried out. 

The field trials to collect the safety data for the use of TB cattle vaccine and the companion DIVA skin test and to gather additional data on the DIVA test specificity—I always have a problem with that word—and to explore options to optimise the performance of the new test are ongoing. We continue to work at pace, but to make it clear, we, and I suspect other nations within the UK as well, will only deploy the vaccine and the companion DIVA skin test when we've got all the right evidence and the right steps in place. So, our aim is to deliver an effective cattle TB vaccination strategy within the next few years to accelerate our continued progress towards eradicating bovine TB in Wales. Thank you.

As you're still a keen new Minister, I'm going to take you back to question 1 [OQ61091] and the supplementary that Siân Gwenllian had attempted to ask. I’m going to allow her just to ask the supplementary again and for it to be answered. 

Thank you for your patience, Llywydd. I was pleased to hear the First Minister yesterday, and yourself, Cabinet Secretary, this afternoon, restating the Government’s stance, namely a presumption against new gas-fired power stations in Arfon and elsewhere, and I was also very pleased to hear your emphasis on creating an affordable clean energy supply. But, unfortunately, that isn’t the view of the Conservatives, and constituents in Arfon will be very disappointed and very concerned to hear that the Tories do support the building of a gas-powered fire station in an old quarry in Caernarfon, which would emit toxic fumes and endanger the health of local people, given that homes, a hospital and a school are all nearby. In addition to the health problems, do you agree with me that the impact of new fossil fuel developments is very damaging to biodiversity and is entirely contrary to this Senedd’s legislation, including the future generations Act, the environment Act and the clean air Act?

Thank you, Siân, and it's nice to have you back.

Nice to have you back. Llywydd, it’s helpful if I can restate our approach here and in Net Zero Wales—it’s how we increase renewable energy in Wales whilst also committing to phasing out unabated gas-fired generation, and it’s for the reasons that you outline. Where the Welsh Government is called to decide on future proposals, and I cannot, as I said in my response to you earlier, Siân, comment on individual proposals that might come forward, but in general, where we’re called to decide on future proposals to build unabated power generation in Wales, it would be the intent of Welsh Ministers to maintain that strong presumption against new fossil-fuelled power plant, and also to avoid, I have to say, replacing our current fleet of plant with alternatives that may themselves have the impact of becoming a source of greenhouse gas emissions or even, I have to say, a costly stranded fleet of generators as well. So, this presumption may well have the effect of discouraging local decision makers from consenting to new small-scale fossil-fuelled plant. But, Siân, those comments are in the generality of our approach in Welsh Government, which I’m happy to restate, rather than in respect of one individual proposal, Llywydd.

I thank the Cabinet Secretary.

The topical question today is to be answered by the Cabinet Secretary for Culture and Social Justice, and is to be asked by Luke Fletcher.

Thank you. I send my sincere condolences to all those affected by the recent deaths at HMP Parc prison. The operational running of prisons is reserved, however Welsh Government is liaising with the UK Government and other partners to ensure action is being taken following the deaths. As with all deaths in custody, the Prisons and Probation Ombudsman will investigate.

 Thank you for the response, Cabinet Secretary.

And, of course, it’s good to hear that liaison is happening, but what direct conversations is Welsh Government having with the G4S officials at Parc prison? The stories coming out of Parc prison are very concerning: two deaths within hours of each other, those being the eighth and ninth deaths in the space of two months, as well as alleged open drug use, neglect of inmates’ health—I could go on. Would she also support the calls of her colleague Beth Winter that Parc should ultimately be brought back under Government control, and would she also agree that the long-awaited devolution of justice would help us actually deal with the situation ourselves?

Thank you. As I say, there is that partnership approach going forward. Whilst the running of prisons is a reserved matter, of course, the health of prisoners here in Wales is devolved to the Welsh Government. I’ve already met with the Minister of State for Prisons, Parole and Probation, Edward Argar, last month. I’ve also written to him this week. As you mentioned, there have been two further deaths this month. I think it’s really important that we recognise we don’t know the cause of death of the individuals. That’s a matter obviously for the coroner, and the Prisons and Probation Ombudsman is looking into these and will publish reports in due course, but, of course, the police did confirm in March that they believed some of the deaths were linked to substance misuse.

I heard the call, I think it was yesterday, in Parliament by Beth Winter to have the Ministry of Justice replace G4S in running the prison. At the current time, what's really important is we all come together to work together to ensure the safety of both prisoners and staff at Parc, but that's certainly something that I will be speaking to the Minister in the UK Government about, and, as you know, the Government supports the devolution of justice.

Sarah Murphy.

Thank you, Llywydd, for granting this topical question today. As the Member for Bridgend, I'm obviously getting a lot of constituents who are getting in touch with me, and I also want to refer to Chris Elmore, the MP for Ogmore, who put in an urgent question in Westminster as well this week. My thoughts are, of course, with the inmates who are no longer with us and with their families. Every death is a tragedy, regardless of the circumstances, and I would also like to thank Heather Whitehead, the governor of Parc, for engaging with me over the recent months as the deaths have, sadly, increased.

The UK Minister made reference in his speech to the spice in the prison and questions around naloxone, which is needed, obviously, in those very desperate circumstances to prevent tragedy. There are also concerns within the Bridgend community that the prison is a catalyst for spice, because it is being transferred in and out of the prison. So, Cabinet Secretary, can you expand on the work that is being done with the MoJ, Public Health Wales officials and Bridgend County Borough Council intervention teams to bring some sort of control of the drug abuse taking place inside and outside the prison?

I also want to pay tribute to the prison staff. They are working in what are extremely difficult circumstances. Issues around staff-to-prisoner ratios have still not been dealt with, and it is vital that we ensure that prison officers who are having to deal with the deaths over the past nine to 10 weeks are receiving the mental health support that they so desperately need. I would just like to say that there is a lot of speculation, accusations and abuse of those prison staff online. They are unable to comment or say anything back, but I believe that it is really making things very difficult for them.

Finally, can the Cabinet Secretary expand on any work that is being done with our health board, Cwm Taf Morgannwg? I have had some constructive meetings with the health providers over recent weeks, but there does appear to be a disconnect between the reality on the ground in the prison and what the Ministry of Justice seems to be saying. I would be grateful for any update that you can give, really, to bring some calm to the situation, as my colleague Chris Elmore MP also asked for in Westminster, to the prison estate and also to the wider Bridgend community. Diolch.

Thank you. I think you raise some very important points, and I too want to pay tribute to the staff at the prison who are having to deal with a very difficult situation, and I suppose that's what I was trying to say in my answer to Luke Fletcher—a lot of this is around speculation. It's really important people do not speculate and we wait for the reports to be published by the ombudsman, and also for the causes of death to come forward from the coroner.

As I say, there's a huge amount of work being done. I think it's really important that the UK Government focus on ensuring that they gather intelligence on the drug entry points. I think that's a really important piece of work that needs to be done. Movements within the prison—there have been extensive searches, I know, undertaken of prisoners and staff, and they've run drug amnesties, for instance, and they've expanded the use of naloxone at the prison. As a Government, obviously, we are looking at what we can do to support the health board in the delivery of that healthcare in our prisons. As you know, as a Government, we're doing work around mental health and substance misuse strategies, we've also got a new substance misuse treatment framework coming forward for our prisons here in Wales. So, I'll be very happy to update Members as we go through this process at the current time.

Thank you for the update, Cabinet Secretary. I know colleagues at Westminster, as you said, have raised concerns with the MoJ and the prisons Minister. The number of deaths at Parc is deeply concerning, and I sought to raise a topical question on this subject last week. My thoughts are with the families of those who have passed. Although we don't know the whole picture at present, it does appear that many of these deaths are drug-related, and while the running of the prison estate is a matter for the UK Government, the Welsh Government has a role to play in ensuring the health and well-being of those on the estate. Therefore, Cabinet Secretary, what discussions have you had with the Cabinet Secretary for health about ensuring that sufficient drug rehabilitation services are available to Parc inmates and the number of inmates on substance misuse registers?

Thank you. I repeat that I really do not want to hear any speculation, but I absolutely accept Welsh Government's part in the delivery of healthcare at HMP Parc. I haven't had a specific meeting with the Cabinet Secretary for Health and Social Services, but, obviously, our officials are working very closely together, along with other partners—Public Health Wales, for instance—in ensuring that the staff at the prison are able to access the healthcare for the prisoners that is required. I think, once we have the reports published by the ombudsman, once we have the coroner's reports as well, we really will need to look at learning lessons, not just us, but the UK Government as well, and we really will need to draw on the expertise of the ombudsman.

I thank the Cabinet Secretary for those responses.

Item 4 is the 90-second statements. The first statement is from Jack Sargeant.

Diolch yn fawr, Llywydd. This week is Mental Health Awareness Week. It is a crucial time for us to focus on our own well-being. The theme this year, set by the Mental Health Foundation, is 'Movement: moving more for our mental health'. Llywydd, it's all about finding something that both moves your body and your mind, whether that's football, walking or any other activity you may enjoy. It can significantly boost your mood and overall well-being.

I am not a particular fan of running, nor am I an avid gym-goer, but as the Presiding Officer knows, I do have a love of football and recently started playing for the Senedd parliamentary team. Presiding Officer, our recent 5-4 victory over the BBC at Cardiff City Stadium, the home of the red wall, certainly raised my spirits over the bank holiday weekend. It was a great team effort from both sides, but, importantly, raising money for a great cause, in the mental health charity Mind Cymru. Can I thank everybody for supporting that important cause? And can I thank the Mental Health Foundation and everyone involved in organising this week's important awareness event, but also thank those involved in daily work to support people with mental health issues? 

Presiding Officer, a reminder to all who may be struggling or know someone who is struggling with their own mental health: please do reach out, there is support out there for you. Diolch.

Thank you very much. Delyth Jewell.

Diolch, Llywydd. Congratulations are due to Ystrad Mynach's Lauren Price for becoming the world boxing champion. Lauren has created history by becoming the first Welsh woman to do this. After winning the world title, she dedicated it to her grandmother, Linda, and her late grandfather, Derek, who recognised and nurtured her sporting talent from a young age. They raised her from when she was three days old and she has paid tribute to the love and support they gave her. And the community in Ystrad Mynach have shown their support too, by welcoming her back last Sunday in style.

Lauren has managed to fit a lot into her 29 years, from playing international football for Wales, representing her nation at the Commonwealth Games and, of course, winning the gold medal at the Olympic Games. And she always shows her pride in being a woman from Wales. She told the Caerphilly Observer recently:

'Being Welsh, we’re a small country but when it comes to supporting our own we’re a very proud nation.'

What an important message for other young people in Wales to hear. So, congratulations, Lauren, from all of us at the Senedd.

I'm sure the best for you is still to come.

Congratulations to Ysgol Pentrecelyn school, which is celebrating its one hundred and fiftieth anniversary this week. As a former parent and current governor of the school, I want to mark such a major milestone for this small rural school in the beautiful Vale of Clwyd.

Now, the school was opened on 11 May 1874, with 34 children on the register, and Mr Owen Henry Owen, Gaerwen, as head. Sarah Ann Winter from Siop Pentrecelyn was the first name on the register and many hundreds of pupils have followed in her footsteps on that register since then. People such as the actors Rhys Ifans and his brother, Llyr Ifans, the actor Victoria Pugh, the internationally renowned pianist Teleri Siân and the well-known singers Sera Baines and Elis Jones, and Elis, by the way, is also a world champion clay-pigeon shooter, and that's just to name a few of the former pupils.

And the school of course continues to go from strength to strength, with a glowing report from Estyn last year demonstrating that Ysgol Pentrecelyn is an outstanding school that provides high-quality education and learning experiences for its pupils. 

Several hundreds of people attended a celebratory concert a few weeks ago, and there will be a day of celebration and a big birthday party at the school this Saturday. Gareth Neigwl wrote in his wonderful englyn:

'Its teaching was my mooring—all my days, / I belong to its playground; / Wherever I may roam, / All roads lead home to Pentrecelyn.'

Happy birthday to Ysgol Pentrecelyn from all of us here at Senedd Cymru.

Thank you for those statements.

The next item is the motions to elect Members to committees, and, in accordance with Standing Orders 12.24 and 12.40, unless there are any objections, I propose that the motions to elect Members to committees are grouped for debate and for voting. Does any Member object? No. There is no objection.

I call on a Member of the Business Committee to move the motions formally. Heledd Fychan.

Formally move.

They have been formally moved. Is there any objection? No. Those motions are therefore agreed.

The next item will be a Member debate under Standing Order 11.21 on the control of tobacco and nicotine products, and I call on Mabon ap Gwynfor to move the motion.

Diolch yn fawr iawn, Llywydd. Since 2017, more than 20,000 children in Wales have smoked their first cigarette. By now, 15,000 of those children will be well on their way to becoming long-term smokers. And in a future none of them can yet see, 10,000 of these children will eventually die from their deadly addiction. 

As shocking as they are, these numbers represent just a fraction of the young Welsh lives affected by the cruel consequences of smoking. I reference 2017, because, on the 16 May of that year, the Senedd passed legislation that could have, and would have, reduced some of this harm and saved some of these lives. Heralded by the Minister at the time as a landmark day for public health in Wales, almost seven years to the day on and the law to introduce a tobacco and nicotine register has never been implemented. We have wasted time at a huge cost to children’s health. We must now put that right.

Smoking is an addiction of childhood. The majority of people who smoke in Wales had their first cigarette when they were children or teenagers. When surveyed by ASH Cymru, 71 per cent of these smokers say they wish they’d never started in the first place, and, although more than half want to quit, many are trapped by their childhood addiction.

Smoking remains the No. 1 cause of preventable death—5,600 people die from smoking every single year. Cigarettes are the only consumer product, which, when used as directed by the manufacturer, will kill two in three long-term users. If tobacco was brought to the market today, it would never be approved for sale.

As well as cancer, heart disease and lung disease, smoking is also a major contributing factor in still birth, stroke and dementia. Smoking continues to drive devastating discrepancies in health outcomes. The tobacco industry tend to airbrush over the fact that they’ve made people addicted to their uniquely dangerous products, and, sadly, they have had the most success in the areas of Wales that are most disadvantaged.

New data published this week by ASH Cymru shows that, while 9 per cent of homeowners smoke, when we look at those who live in social housing, that figure rises to 30 per cent. But we have a huge opportunity within our grasp to do something about all of this—to close existing loopholes, reduce health harms, save lives and protect our future generations. We can use existing legislation to implement a tobacco and nicotine retail register here in Wales. A register would require all businesses and retailers who sell either tobacco products or nicotine products in Wales who sell either tobacco products or nicotine products in Wales to sign up, and it would be an offence to sell tobacco or nicotine products from premises, including mobile units and pop-up shops, if those businesses were not on the national register.

The legislative mechanism for a tobacco and nicotine retail register is already contained in the Public Health (Wales) Act 2017. If implemented, it would benefit everyone, from retailers to consumers and enforcement teams. Most importantly, it would reduce health harms and save lives. It could offer support, advice and training to the vast majority of retailers, who would only ever sell tax-paid products to adults. And rather than subcontracting this responsibility to future generations, the implementation of the retail register would show that this Senedd used its powers, did what it could, when it could, and acted on its commitment to a smoke-free Wales by 2030.

Over the years, regulation and laws on cigarette promotion and price have played a huge part in tobacco control. But, in today's market, with the explosion in unregistered retail outlets and a surge in youth vaping, a fresh approach is needed, and we must meet the scale of this growing challenge. Until now, tackling the availability of cigarettes and vapes in our communities has been very much a poor relation. A retail register for Wales will help address that gap. At the moment, we don't know for sure if the most disadvantaged areas of Wales have the highest density of tobacco retailers and vape shops. We can guess, because of what we see in our communities, but we lack true evidence.

Local availability of cigarettes matters enormously to health. Research by Dr Jamie Pearce of the University of Edinburgh shows that adolescents in areas with a high density of tobacco retailers are more likely to have ever smoked. Adults in high-density areas are more likely to be current smokers and less likely to quit, and pregnant women in high-density areas more likely to smoke in their first pregnancy and less likely to quit. As part of his research, Dr Pearce also used GPS to track 700 volunteers aged 10 and 11 for a week. It showed that children from income-deprived areas were seven times more likely to be exposed to tobacco retailing than those from affluent areas.

Knowing exactly where these products are being sold, and by whom, is also important for public health teams, to make sure that precious resources are being used in areas of greatest need. A retail register would give us new and previously unavailable data for where the most nicotine is being sold, allowing smoking cessation efforts to be targeted in those communities. And for every Member who has been approached by a constituent concerned about an explosion in vape shops in their area, imagine how a retail register, had it been implemented in 2017, would have helped us monitor, manage and mitigate what has happened on every high street in Wales.

I wanted to reassure you on one other important point too. When surveyed by ASH Cymru, 86 per cent of people questioned said they're already on board with a retail scheme for tobacco products, and supported it. This includes 65 per cent of current smokers in Wales and 74 per cent of current vapers. Not only that; support for tobacco control more widely is growing in Wales. If I can take you back to 2015, when ASH Cymru conducted its annual YouGov survey, almost four in 10 people thought that the Welsh Government wasn't doing enough. Fast forward to 2024, and, when they asked that exact same question again, the proportion of people in Wales saying that the Government isn't doing enough had increased to 52 per cent.

The retail register is also supported in the recently published recommendations of Public Health Wales's incident response group report on youth vaping, by leading health charities, including ASH Cymru, Cancer Research UK, British Heart Foundation Cymru, and Asthma and Lung UK Cymru, and also by trading standards and medical professionals. It also has cross-party support here in the Senedd. So, we urge Welsh Government to implement the existing legislation for the tobacco and nicotine retail register without further delay, and use the enormous opportunity that we have within our grasp to protect our most vulnerable.

I very much support what we've heard from Mabon ap Gwynfor, which I think makes a very clear and strong case for that retail register. I know from my own constituency—I'm sure this applies to other Members—just how prevalent the problems caused by tobacco and vaping are at the current time. Vaping, for example, is increasingly a problem even in primary schools, where headteachers are very concerned about the health and well-being and keeping good order in the school aspects of vaping and the problems that vaping brings to those concerns. And parents, of course, are very concerned as well. And, as I say, that's at a primary school level, let alone what's happening in our secondary schools. 

As we've heard from Mabon, tobacco use is still such a huge problem to our health and well-being in Wales, isn't it? And, again, we're all very familiar with the statistics, and just what a cause of preventable death and injury smoking is, the fact that it affects our more deprived communities to a greater extent and it's a very strong driver of health inequalities and that gap in life expectancy and healthy life expectancy between our most and least deprived communities. So, there's an awful lot to be done on tobacco still.

Illegal tobacco is a very big problem, and those illegal operators are very much concerned with selling illegal vapes, as well as illegal tobacco. And very often, it goes together as a package, as it were. So, there's a great deal for trading standards to do in terms of enforcement. And recently, in the cross-party group on smoking, we brought some of the key players together—the deputy future generations commissioner, academics, trading standards, ASH Cymru, of course, the health sector—and looked at some of these problems, and we reflected on some of the statistics that Mabon has already rehearsed in terms of the survey and the key statistics that ASH Cymru put before us.

It is a very, very clear case, and it does have very strong public support. And that does give a very fair wind, I think, in terms of what Welsh Government might do with key partners to establish that retail register and have that licensing scheme. And that cross-party group, I think, with all the key partners involved, was very clear in terms of the need for that register, that licensing scheme, and the benefits that it would bring.

As I said in beginning my remarks, Dirprwy Lywydd, I do think that, at the beginning of this important debate, Mabon has very clearly outlined a very strong case for this action—this retail register and this licensing scheme. Much of what I was going to say Mabon has already said. And I would just like very much to support this proposal, these proposals, and hope that Welsh Government—which I'm pretty confident it does—sees the sense of having this approach and will do all it can to bring about that register, that licensing scheme.

I was delighted to be asked to co-sponsor this motion today. Sadly, smoking remains one of the biggest killers in Wales. Despite years of public health interventions, we are still seeing thousands of people each year losing their lives needlessly, which is why I support a tobacco and nicotine register in order to target our stop-smoking initiatives in Wales and link it with the UK Government's tobacco and vapes Bill. We have to stop the deaths, and that means stopping people from getting addicted to nicotine in the first place. I believe a retail register would help aid the fight against young people getting hooked.

Colleagues will no doubt address the issues with cigarettes, as Mabon has done, and John has also said about it. So, I want to focus my contribution on shisha smoking. More and more young people are getting hooked on hookah. Since the ban on smoking in public places, there has been a 210 per cent increase in shisha bars and cafes. Shisha, also known as hookah, narghile, water pipe, hubble bubble or jajeer in Kashmir, is a method of smoking tobacco invented in the sixteenth century by a physician named Hakim—'hakim' means physician, homeopath—Abdul Fateh Gilani. He was a physician in the Mughal durbar, or you can say 'court'. The purpose of the device was to pass smoke through water in an attempt to purify the smoke, a myth that has since been disproven by medical science, but sadly one that persists to this day.

Shisha utilises specially prepared tobacco that is heated to produce smoke with bubbles through a bowl of water and into a long hose-like pipe to be breathed in. The tobacco can come in different flavours, and sometimes it's mixed with molasses or sugar, often making the smoke smell sweet. It is usually heated by burning wood, coal or charcoal. Shisha smoking is popular in south-east Asia, the middle east and north African communities, especially among young people. It is becoming increasingly popular here in the United Kingdom. A shisha session typically lasts for about 45 minutes. Research conducted by the New South Wales Government suggested that each session is the equivalent of smoking 100 cigarettes. Shisha smoke is toxic, it contains chemicals including carbon monoxide and tar, which are bad for health—your health, my health and those around us—yet many young people still think it is safe.

In the short term, shisha can increase your heart rate and your blood pressure, reduce your lung capacity, impact your physical fitness, and has been known to cause carbon monoxide poisoning. In the long term, shisha smoking can cause head, neck, lung and other cancers, heart diseases, lung diseases, and lead to early ageing. Shisha smoking, far from being a safe alternative, is as dangerous if not more so than cigarettes. Its flavour and ceremony appeals to young people and it gets them hooked on nicotine incredibly fast. Ensuring that shisha cafes and bars need a tobacco licence can help regulate the growing industry and prevent under-age users. Taken alongside the Tobacco and Vapes Bill, we can ensure future generations will be free of smoking-related harms and death. I urge Members to support our motion. Diolch yn fawr.

Thank you, Mabon, for bringing this important debate before us today. It is a problem, and we have to recognise it as a major problem. As Plaid Cymru's education spokesperson, I often have teachers, but also pupils, approaching me telling me how concerned they are specifically about vaping, but also smoking among young people is still a problem. 

I was brought up in the 1980s, I'm now 43, and the norm at that time was that almost every adult around me smoked. You could smoke anywhere, and that was the norm. But, there was an excellent campaign in our primary schools, and secondary schools, which did highlight those dangers. Because, by that point, they were well known. They saw the impact on previous generations, a number of people who had been smoking from a very young age. And I have to say, I found these campaigns very effective. I was one of those who would go home and preach to the adults around me about the dangers of smoking. Certainly, those campaigns had an influence on me. 

We've seen huge changes too in terms of all the changes there have been in not being allowed to smoke in cars with children, not being allowed to smoke in parks and school playgrounds and so on, and also that we ensure that when we go out—. Who remembers being in a pub late at night and your clothes stinking the next day, and your hair and everything else smelling too? There have been major changes made, but I think, by seeing those changes, it is easy to rest on our laurels. And what we have seen is that companies, who can financially benefit from this, will always find a way to take advantage. And what we are seeing now is this targeting of young people specifically. I would like to say, and I think it's important to emphasise this point, that there is support for vaping for those trying to quit smoking. There is an important role for vapes in our society, but they must be regulated. And I think a national register is crucial. 

If we look at the Wales youth vaping survey from ASH Cymru, those statistics are frightening, in that 24 per cent of all children between years 7 and 11 have tried vaping, 7 per cent vape regularly, and 37 per cent of the 7 per cent also smoke. Ninety two per cent of those who are using vapes use those that contain nicotine, and 45 per cent can't get through the school day without vaping. Well, this creates huge problems in our schools. It means that pupils can't get through a lesson, they have to leave the classroom to vape, and schools then don't know how to deal with that situation, often choosing to lock toilets to try to deal with this, which isn't fair when we think about those learners who need to access those toilets. It does have a major impact on all levels. 

If we also look at the statistics from ASH Cymru, 55 per cent of all pupils who have vaped have used vape products that are likely to be illegal vapes. Well, this is also extremely worrying. We know, from trading standards statistics, that some illegal vapes correspond to smoking 20 cigarettes in one session. And, as has already been mentioned, they do target children. There is no doubt about that. You see the shops, and they are very attractive to children—very colourful. We know that vapes themselves are so attractive, aren't they? Why else would you produce vapes that look like a Prime bottle, for example, or have incredible flavours, or bright colours, if you're not actively targeting children? A national register would respond to some of those challenges. 

But we must also look at the online element, and that many children and young people do buy these vapes online. Primary school pupils were entirely honest with me, telling me that Tiktok Shop is the best way to access them. Many children can buy these things online themselves with debit cards. We must get these messages across. So, the register is one important element, but we must also improve resources within our schools to get the message out there about the dangers of these vapes, and how we stop children and young people from being exploited. There is a place for vapes to help those quitting smoking, but no young person should be vaping in our schools. 

I'm grateful for the opportunity to participate in this debate this afternoon. I've been quite excited to speak on it, actually, because I did a study into smoking for my foundation degree back in 2018, and gave a presentation to Bangor University. Do you know that one of the first places that brought in an indoor smoking ban was the Houses of Parliament in Westminster, back in the 1800s, I think? They banned it in committee rooms, initially. It was really groundbreaking at the time. And, I think, it was up until 2006—. It was as late at 2006, when they brought in a ban for cigarette advertising in Formula 1, and it ran all the way up to only, gosh, less than 20 years ago. I remember the cigarette brands on the back of Schumacher's car, and Mika Häkkinen and Damon Hill and all of them. So, it shows how far we've come in a relatively short space of time, really.

There has been a real resurgence in the attention being paid to smoking and nicotine cessation in recent years, and I think perhaps brought about by the explosion in young people using vapes and e-cigarette devices. And I absolutely share these concerns regarding under-18s using disposable vapes and e-cigarettes, and the action taken by the UK Government with the smoking and vaping ban has been quite extensive. The debate on nicotine and tobacco, however, does seem to be increasingly coercive, and is indicative of some of the worst rhetoric of nanny statism. And I think there are better ways that we can handle public health issues than we currently are. We know that the harms of smoking are very well understood at this point. Smoking is devastating for one’s health. It also places a huge burden on the NHS. But I sometimes get the impression that we are simply flogging a dead horse, continuing to fight a battle that we have already won, and that there are more important public health battles to fight. I’m not sure if this is due to the influence of the anti-smoking lobby, or an attempt to demonstrate that we are on the right side of history.

Anti-smoking rules in the UK are the second strictest in Europe. Data from 2022 shows that only 14 per cent of adults in Wales smoke, and this number is decreasing. Data from 2021 shows that 12 per cent of 11 to 15-year-olds have tried a cigarette at least once, and the vast majority of these are not regular users of tobacco. This is also down from 50 per cent in 1996. We have done more than other countries in the world to reduce smoking, and often at great cost to individual liberty and personal choice, which instinctively makes me feel very uneasy.

Will you take an intervention, Gareth?

Yes, of course.

Thank you very much. This argument about personal liberty and freedom is rehearsed quite often in this debate. Would you see that there is an inherent contradiction in the idea of giving someone freedom to become addicted? That's an oxymoron. It contradicts itself. As well as that—if I may, briefly, Dirprwy Lywydd—when you said that the risks of smoking are well known, and so it is up to people, presumably, to make that choice, the logical extension of that argument would be the same for heroin, wouldn't it? So, would you want to legalise heroin as well? 

Delyth, I think that's not a fair comparison to be honest. Heroin is not a fair comparison at all. Heroin wrecks people's lives, and the addiction level between tobacco and heroin—that is not a fair comparison at all, and I don't accept that at all.

I believe that this issue does not always require ever-increasing legislation, which often isn’t intended to garner results, but to show that our hearts are in the right place. We instead need to better enforce the laws already on our statute books. It’s already a crime to sell products containing nicotine to people under the age of 18, but adequate resources are not lent by the state to ensure that these laws and regulations are abided by.

We have seen that it is incredibly easy for young people to buy vape and e-cigarette products on the high street, and we need to do more than legislate to get these devices out of the hands of children. I understand how a national register for retailers, which Mabon is advocating, could be advantageous for that, and I am broadly supportive. Despite laying out my unease with some of the more coercive, paternalistic actions taken by the state, I care about getting nicotine products out of the hands of children, I care about reducing rates of alcoholism and obesity, and I care about removing ultra-processed foods from children’s diets, which Jenny Rathbone has raised many times before.

The Welsh NHS has published itself that our diet and being overweight or obese have far more impact than tobacco use. As rates of smoking are falling, the number of overweight and, particularly, obese people is increasing. We should shift our attention to these more pressing issues, as our health will continue to deteriorate unless we treat other issues with the same concern. Thank you.

I call on the Minister for Mental Health and Early Years, Jayne Bryant.

Diolch, Deputy Llywydd. I'd like to thank Mabon ap Gwynfor, John Griffiths and Altaf Hussain for tabling this Member debate today, and for the points made about tobacco and nicotine. Members will recall the statement that the Cabinet Secretary for Health and Social Care made just over two weeks ago, in which she set out the measures in the UK Tobacco and Vapes Bill that will apply to Wales.

Before I turn to the Bill, I want to reiterate some of the startling facts about smoking. Mabon raised that in his opening statement, and I think it's always important to remember those stark facts. They should always stick with us. Smoking remains the leading cause of avoidable harm and death in Wales. Smoking harms nearly every organ of the body and, uniquely, it harms not just the smoker, but the people around them. It has a devastating effect on our health, whatever our age, and I'm pleased that Altaf was able to mention shisha in his contribution.

The Bill continues to make its way through the UK Parliament, and the Chief Medical Officer for Wales gave evidence during the Committee Stage about the importance of the proposals for Wales. It provides a unique opportunity to take decisive action to free a generation from nicotine and tobacco addiction. The Bill also includes provisions to strengthen the enforcement system by introducing on-the-spot fines for under-age sales of tobacco and vaping products in England and Wales, which will enable trading standards officers to take swifter action when needed.

I'm clear that the measures in the Bill are not the only actions we need to take in our continued battle to protect public health. As discussed today, there are provisions in the Public Health (Wales) Act 2017 that have come into force. These were hard won and provide us with important tools to use. But it's important to recognise that we have made progress in bringing other provisions in this wide-ranging Act into force, such as protecting young people from inappropriate cosmetic piercings, pharmaceutical needs assessments and the provision of local toilet strategies. As part of our efforts to denormalise smoking, we made school grounds, playgrounds and hospital grounds smoke free in 2021, and we're currently developing regulations to reduce health inequality in Wales by embedding the use of health impact assessments.

There are other areas of the Act where powers are available to strengthen our approach to tobacco and vapes, particularly the introduction of a retail register, that have yet to come into force. As we know, this industry moves rapidly. We have kept this policy under review and we regularly discuss with stakeholders what they require. We have provided funding to Trading Standards Wales to undertake enforcement action on illegal vapes, trained officers and raised awareness about the impact illegal products have on our communities. But the introduction of the UK Tobacco and Vapes Bill changes the landscape that we are working in.

We'll also need to consider—[Interruption.] Yes.

Thank you. I'm curious to know the answer to the question—because I was up in the office before thinking to myself—if the matters that Mabon's proposing to the Senedd do get agreed, then with the UK Government's legislation, does that then create a duplicate system in Wales, and we'll see a difference in smoking legislation and a disparity across UK nations? Because if we're looking at significant public health legislation, then surely we've got to adopt pretty much a universal approach to stop any wriggle room, if you like, within those systems, so that whatever is agreed can be delivered on a universal basis, where everybody knows where they stand and the information's quite universal and easy to understand.

Thank you, Gareth. As a Government, we're clear that we must consider all our options to support our ambition to be a smoke-free Wales, and this includes whether we look to develop a licensing system, or if we move ahead with the implementation of the retail register. As you know, the Tobacco and Vapes Bill is currently progressing through the UK Parliament and is expected to change the landscape considerably. It's also important to recognise the difference in views at the moment, and what will be needed in future. This is something that we are looking at.

We will need to consider any amendments to the Bill, one of which proposed the introduction of that licensing scheme, and reflect on the recommendations in the independent Khan review to support a smoke-free society. If the Bill passes, whether amended or not, it will give us even more tools to support our ambition to make Wales smoke free. Because of this changing legislative landscape, we have decided to pause implementation of the outstanding areas of the public health Act in relation to tobacco. However, we will undertake a full review of our legislative tools in our next tobacco control delivery plan, which is currently in development. The retail register may well be an effective enforcement tool, and my officials are currently discussing and learning from the approaches taken elsewhere, including Scotland, where a retail register is in place.

In relation to the other part of the motion on a communications campaign, I do agree that it's a crucial part of our approach and an area my officials continue to work with other UK nations on. We want consumers and retailers in Wales to be aware of any changes to the law in relation to tobacco and vapes, and as the Cabinet Secretary said last month, we will continue to update Members about our work to control the sale and use of tobacco and vapes, which is so important for the protection of young people and public health. Diolch yn fawr. 

I call on Mabon ap Gwynfor to reply to the debate.

Thank you very much, Dirprwy Lywydd, and thank you very much to everyone who has participated in this discussion. It has been very interesting, and on the whole the Senedd seems to be supportive. I look forward to seeing the Senedd and the Siambr supporting the motion.

I'll start with Gareth's point. He put forward the libertarian arguments about smoking. First of all, during your contribution you said that you wanted to see, for instance, ultra-processed foods being controlled. That doesn't tally with your libertarian arguments when it comes to smoking. If you want people to have that access to smoking of their own free will, then they should be able to use that free will to consume ultra-processed food. 

There is clearly a difference between smoking and ultra-processed food. The difference is that cigarettes and smoking products have been significantly taxed with price rises over an incremental period, over many, many years, but ultra-processed food is very, very cheap. I'm not calling for price rises, but just better quality food that's more accessible to people, so that anybody, no matter what their background, can access good quality food, no matter what their budget.

So maybe we should aim to get better quality cigarettes, or better quality vapes. The argument doesn't hold, I'm afraid. You've also said that the battle is already won, but say that to the 5,600 people who die in Wales every year as a consequence of smoking. Say that to their families—tens of thousands of people who are suffering from bereavement because of smoking.

Thanks, Mabon. We've got to keep remembering that smoking is legal. It's not illegal, and like I said in my remarks, it's an informed choice, because if you're over a certain age, you've learned from quite a young age in school that smoking's pretty bad for your health. Everybody accepts that. I get that. I worked in the NHS for 11 years. I fully understand the health implications of smoking. So, it's an informed choice, because they have been aware of the health implications from quite a young age at this point in time.

Thanks, Gareth. I'm afraid it seems to be a confused argument, but nevertheless, I am concerned that you've misunderstood the proposal in any case, the motion. The motion isn't to do with impacting on people's right to smoke. It's to do with bringing in a retail register so that we can control who sells tobacco and nicotine products. People will still be able to buy those products. So, hopefully that will convince you that the motion is the right way to go, because it doesn't impact on your libertarian concerns.

As I said, smoking kills 5,600 people in Wales every year. John Griffiths and Altaf Hussain made a point of explaining how smoking still impacts on people's lives, and they made that very strongly. We also know that it costs in excess of £300 million to the NHS every year. And smoking accounts for 5 per cent of all hospital admissions. That's the impact of smoking, and that's what this motion aims to try to decrease and help. 

Also, thanks to John Griffiths, who referred to the work of the cross-party group. The cross-party group has been doing some excellent work, and I thank the cross-party group. You mentioned in your contribution, John, as did Heledd, schools, and the impact on schools, and the fact that a lot of young children are now starting to vape—vape especially, which leads them on to smoking cigarettes. Coincidentally, I had two schools from my constituency here yesterday, Treferthyr and Llanystumdwy. I spoke with them about the proposed motion, and they were 100 per cent in agreement on needing a retail register. They said that they knew children and their siblings who were vaping, and they saw the benefit that this motion might bring. 

The Minister was right in thanking Altaf for referencing shisha. I've seen people smoke shisha and think that because it goes through water, it makes it better somehow, without realising the impact on their health. And as you say, the impact of one shisha session is the equivalent of dozens of cigarettes. This proposal would help license those cafes and bars as well, so thank you, Altaf, for your support. 

Minister, thank you for the response. Overall, I think there's general support for the principle. The Cabinet Secretary did mention about three weeks ago that, as a principle, she very much would be willing to look at whether this is something they could look at as a Government. That seems to have been diluted since then, because in your response, Minister, you did say that things have changed now—the landscape, I think you said, has changed because of the proposed new Bill.

I know you mentioned that the Bill would allow for on-the-spot fines, which is good, but having a retail register would be even better. You wouldn't necessarily need those on-the-spot fines. You wouldn't need to chase people down the street. You wouldn't need to look after people. You'd know where the products were being sold. You'd know which people were licensed to sell these products. 

And isn't it ironic that we have a system in place that licenses the sale of alcohol, amongst other things, but not tobacco and nicotine, which are just as dangerous if not more so in some cases? I'm also concerned that you said that you've funded Trading Standards Wales for enforcement. Again, you wouldn't need to fund those elements if you had a retail register, because trading standards could monitor exactly who sells tobacco and nicotine products.  

You also then went on to say that you're pausing implementation because of the new Bill. I'm afraid I don't buy that, because we've had the ability to introduce a retail register since 2017, long before Westminster's proposed vape Bill. So, there's still a strong argument here to get the Government to introduce a retail register. I think the argument has been well put by everybody here this evening, so I'd urge every Member to support the motion tonight. Diolch yn fawr iawn, Dirprwy Lywydd. 

The proposal is to agree the motion. Does any Member object? [Objection.] There is objection. Therefore, I'll defer voting under this item until voting time. 

Item 6 today is the debate on the Health and Social Care Committee Report, 'Unheard: Women's journey through gynaecological cancer'. I call on the Chair of the committee, Russell George, to move the motion. 

Diolch, Deputy Presiding Officer. I move the motion tabled in my name. Each year, around 1,200 people are diagnosed with a gynaecological cancer in Wales. The incidence rate for gynaecological cancer in Wales is higher than the UK average and so is the mortality rate. Sadly, around 470 people die from a gynaecological cancer in Wales each year. As a Health and Social Care Committee, we agreed that women's health should be one of our priorities, and this is why we decided to carry out an inquiry into gynaecological cancers and the experiences of women with symptoms of gynae cancers. 

The committee was fortunate to be assisted in its work by some incredibly brave women, some I know are in the gallery today, who wanted to share their stories and be heard. And you can see some of their evidence in videos in the supporting documents attached to today's agenda. I would urge Members who have not seen those videos to make time to watch them, but I would warn you they are certainly difficult viewing. I really want to take the opportunity, though, to pay tribute to their honesty, their bravery and their determination to see changes made to the way that women's health is treated. 

Speaking personally, I've been a Member for 13 years and sat on several different committees and been involved in dozens of inquiries, but I would say that the evidence that I heard through the brave women who spoke to us was the most powerful and emotional evidence that I have come across in my 13 years as being a Member here.

Now, the evidence we heard during the course of this inquiry was pretty shocking. The women who shared their stories with us told us how they felt that their health concerns were not being taken seriously by health professionals and how they dealt with them. The women knew that something was wrong with their bodies, but they struggled to get any health professionals to listen to them. Their symptoms were often dismissed or downplayed and they were made to feel, sometimes, that they were being a nuisance, and this was described to us most memorably as medical gaslighting.

Now, our report made 26 recommendations to the Cabinet Secretary. In addition to this, the committee took the opportunity to share the Cabinet Secretary's response to our committee's report with our stakeholders, and I'd like to share some of their feedback with you.

The Cabinet Secretary said that she is ambitious for change on women's and girls' health. However, her response to our report, I would suggest, is light on detail in prioritising the distinct needs of women. She outlines actions to support improvements in cancer care in general, including initiatives like rapid diagnostic centres and waiting-time recovery programmes, but there is an absence of targeted actions addressing the specific challenges faced by women with gynaecological cancers. And Claire O'Shea, a cancer patient who has experienced gynaecological cancer services in Wales, who some of us met just before this debate today, once again—she documented her experiences on video and she told us this: she told us that she had been deeply disappointed by the tone and lack of concrete commitments by any transformative change that can meet the challenges and needs of women in Wales now and in the future. And significantly, although the Cabinet Secretary accepted 24 of our recommendations, either in full or in part, her response does not commit to any additional funding for implementing the committee's recommendations, or to reprioritise existing funding for this purpose. Indeed, the recommendations she has accepted will be implemented within existing resources. Now, Tenovus Cancer Care told us that this sends a regrettable signal to women affected by gynaecological cancers, that investment in resolving the issues uncovered by the inquiry is not forthcoming, despite that it is a priority for Welsh Government and the NHS. Similarly, Claire O'Shea said that the rhetoric that women's health in Wales is a priority doesn't appear to be met with the ambition and resources that it demands.

Now, I'd like to draw your attention to the opening comments of the Cabinet Secretary's response to our committee's report, which stated:

'the vast majority of those receiving cancer care for gynaecological cancer consistently report high levels of patient satisfaction with NHS services.'

This particular statement was met with real surprise and disappointment by a number of our stakeholders who felt this did not represent their or their families' experiences. Claire O'Shea told us this: 'As a patient, at no point have I been asked about my satisfaction levels with the services I have received'. And Sioned Cash, whose mother Judith Rowlands passed away shortly after her video evidence was shown in committee, said that making this claim at the start of her response sets the tone for the rest of the report to be one that is quite dismissive of there being any issues. So, I hope, Cabinet Secretary, you will reflect on these comments and offer some reassurance to the women who shared their experiences with us, that the much-needed changes recommended in our report will become a reality.

I'll now talk to some of the points and recommendations in our report. In 2019 the Royal College of Obstetricians and Gynaecologists recommended that the four UK nations published a women's health plan to address areas of unmet need for women's health. The Scottish Government published its plan in August 2021, the UK Government published its women's health strategy for England in August 2022. Wales still does not have a women's health plan, and in the Cabinet Secretary's response, she says that this plan will be published by the end of the calendar year, but that's still some seven months away, so I'd ask the Cabinet Secretary, perhaps, in her remarks today, to set out why—why is it that we are so behind the curve in Wales?

In our report we recommended that the women's health plan includes a specific focus on gynaecological cancers, and the aim of this was to help improve women's health inequalities by raising awareness around the issues, improving access to healthcare and improving cancer outcomes for women diagnosed with a gynaecological cancer. So, it is disappointing that the Minister has chosen not to fully commit to including a specific focus on gynaecological cancers within the plan. I hope the Minister might be able to explain the rationale behind her decision in that regard.

The committee's report discusses the importance of funding for gynaecological cancer research, and during our inquiry we heard that research in this area has not been adequately prioritised under the current arrangements, and that the specific needs of women are being overlooked in favour of funding research into other types of cancer. So, it's hard to see from the Cabinet Secretary's response just how gynae cancer research will be prioritised in the future, especially when the Cabinet Secretary says that no specific funding will be made available in this area. Needless to say, this response, of course, was met with disappointment and concern by our stakeholders, who felt that this was a missed opportunity.

Now, we understand there will always be a certain number of cancer cases that are diagnosed through emergency admissions. However, in Wales this figure is unacceptably high, and during our inquiry we heard that receiving a cancer diagnosis in an emergency setting can be overwhelming for patients and their families, with accident and emergency departments not equipped to support patients to cope with the diagnosis. The number of women being diagnosed with a gynae cancer following an A&E admission suggests that something is wrong in primary care, and it really is crucial, I think, for health bodies to priortise efforts to understand and address the factors contributing to emergency presentations with a gynae cancer. This is why the committee recommended that the Welsh Government should commission an urgent review of these presentations. But, Cabinet Secretary, you did reject also this recommendation, saying that there is insufficient resource to undertake a formal review. Now, as you say in your response, emergency presentations of cancers can often lead to an inferior outcome for patients, so with this in mind, I hope you can commit to exploring other options for conducting such a review within the resources that are available.

Finally, I want to talk about the lasting impact of the pandemic and the need for those gynaecological cancer-related services that were lost during that time to be reinstated. Cabinet Secretary, you rejected our recommendation in this area also. From the evidence we heard, it is clear that there were long-standing issues in gynaecological cancer services that predated COVID-19. Waiting times for treatment are long, and compliance with single cancer pathway targets is one of the lowest for all reported cancers. We also heard of significant capacity issues, including a lack of resource, facilities and workforce, so surely, therefore, returning services to the pre-COVID level is a bare minimum we should be looking to achieve.

Cabinet Secretary, your response outlines a policy intention to transform how patient pathways and clinics are arranged and delivered to meet cancer waiting time targets. You say that the pre-pandemic clinical service model may not be suitable, given the increasing complexity of service delivery and limited capacity. So, can you then provide us with more detail of what this transformation will look like and how it will help improve gynaecological cancer waiting times and how will this transformation address the points made by the British Gynaecological Cancer Society about the need for services to be uniformly accessible and delivered across Wales?

I'm going to leave my comments there, and I'll make some other comments in the time I've got left for closing remarks, but I do look forward to Members' contributions in this debate this afternoon.

Well, I want to begin my contribution to this debate by echoing what the Chair, Russell George, said, saying that this inquiry is amongst the most heart-rending and powerful and emotional inquires that I have been part of during my three years at the Senedd. For me and everyone that was part of the inquiry, and hopefully to everyone present today, it's clear that we are letting the women of Wales down. From the awareness, diagnosis, treatment and every step along the journey, we're letting far too many of our sisters down and we have to change the situation. I want to echo what Russell has said and express my sincere thanks to everyone who took part in the inquiry, and extend my sincerest condolences and thanks to the family of Judith Rowlands, who passed away after giving her evidence.

The evidence was heartbreaking—from the constant battle that women had to go through to be heard, being ignored, and being made to feel that they were hypochondriacs or neurotic, even though they lived knowing there was a problem, the way they were disregarded and were having to receive a diagnosis far too late, and how their lives, as a result, have been cut short, and families losing their anchors. As Tenovus told the committee, these are structural problems, and we need structural solutions to them.

I welcome that the Welsh Government has accepted many of the committee's recommendations, but might I suggest that it is a little short of scandalous that the recommendations of this report, which, as I have suggested, are underpinned by the real, lived experience of women who have been failed by our health system, have not been accepted in full? These are the minimum required to affect the kind of structural change we need to see.

As is so often the case, it seems to me that there is a failure here on the part of the Welsh Government to acknowledge the scale of the problem—the necessary first step on any journey to resolving it. The fact that the instinctive response of the Government is to claim that the majority of people are happy with the service means that these women are being gaslit twice. Not only are they being told that they don't understand what's wrong with them by the health specialists, but to compound things, they're now being told the same thing by this Government. It's an insult in the extreme, and the Government should be ashamed of itself for issuing such a response.

It bears repeating that compliance with a single cancer pathway target is the lowest for gynaecological cancers; the facts speak for themselves. I'd like, for instance, a clearer justification as to why the Welsh Government is not prepared to work with the health boards to ensure that services lost during the COVID pandemic are reinstated as a matter of urgency. In her evidence to the inquiry, Dr Louise Hanna of the Wales Cancer Network’s gynaecological cancer site group was perfectly clear on the need to survey within Wales what services where lost due to COVID, and that the reinstatement of those services would be an absolute minimum requirement.

More specifically, I am frankly little short of appalled by the Welsh Government's continued foot dragging on the women’s health plan. The need for such a plan was flagged by the Royal College of Obstetricians and Gynaecologists in 2019. Scotland’s was published in August 2021, and the UK Government published its women’s health strategy for England in August 2022. Despite persistent promises from the Cabinet Secretary for health, in Wales we are still waiting for a women's health plan. Latterly, the Cabinet Secretary has also tried to absolve the Government of responsibility for delivering the plan by insisting that this sits with the NHS, and I quote:

'I can't determine what they're going to do, because it's their plan—it's the NHS plan. I do the quality statement, they do the delivery.'

This is, unfortunately, part of a repeating pattern, whereby Welsh health Ministers have consistently sought to avoid taking responsibility for problems that fall precisely under their brief. And we also have been told that if and when it does finally emerge, the women’s health plan for Wales will not include a specific focus on gynaecological cancers. None of this is good enough.

I want to conclude by asking the Cabinet Secretary to look again at the recommendations that have been made and that she has rejected, and to reconsider this decision, and I ask the Cabinet Secretary when the women's health plan for Wales will be published, and to ensure that gynaecological cancers receive the attention that they deserve in that plan. Thank you.

I'd like to thank the Chair, fellow committee members and clerks for undertaking this inquiry. I am proud of the thorough and vital report that we have produced. I also want to pay tribute to Judith Rowlands, who is no longer with us. Judith's testimony of her lived experience was heartbreaking and powerful and was key to us producing our report. I pay condolences to her daughter, Sioned Cash, as well as Judith's family and friends, and thank you, Sioned, for responding to the Welsh Government response on your mother's behalf.

Claire O'Shea is here in the gallery today with us, Dirprwy Lywydd. Claire is my friend, known to many of us in the Chamber, and is now undergoing life-extending chemotherapy treatment, despite doing everything right, as they say—'everything right'—including looking after her health, presenting early with symptoms, pursuing appointments when she was dismissed and obtaining her own medical records to review the standards of care. Along with Tenovus Cancer Care, she has launched Claire's Campaign to amplify the voices of women who have felt ignored by healthcare professionals, leading to misdiagnosis, inadequate care and tragic outcomes. That is why we called the report, 'Unheard: Women's journey through gynaecological cancer', because, as Claire has summarised, women with cancer are often dismissed, downplayed, unheard and misdiagnosed by GPs.

Gender bias has seen many women's concerns attributed to emotional or psychological issues, because, crucially, the suspected cancer pathway target that the Welsh Government points to, to ensure the majority of their patients receive cancer diagnostic tests in a timely manner and start their treatment within 62 days from the very first point where cancer might be suspected, is not being met. Only 34 per cent of gynaecological cancers meet the suspected cancer pathway target, and I know for a fact that it is not being met for women in Bridgend, for example, because they are currently being sent to Swansea Bay health board, and I have had assurances that they will be brought over to Cwm Taf Morgannwg as soon as possible, but this is taking time that many of them won't have. I urge the Cabinet Secretary to work with my health board and others to prioritise this. I understand that this may be due to workforce, recruitment, resources, but that is why there is merit to the stakeholders asking for a comprehensive review of the gynacological cancer workforce in Wales, as set out in recommendation 19. Please can the Cabinet Secretary explain why this wasn't accepted?

I know that our Cabinet Secretary is committed to improving women's health. Only last month, a new clinical lead to help drive improvements in women's health was appointed, with Welsh Government allocating £750,000 to commission research focused entirely on women's health. But why won't the Welsh Government commit then to that going towards gynaecological cancer research specifically? Why wasn't that recommendation accepted? And also, it just doesn't make sense to many of us, as well as stakeholders, not to commit to including gynaecological cancer in the women's health plan that is due at the end of the year. I know that health boards are developing the plan, and also that there is a need not to duplicate work, so can't the suspected cancer pathway target just be incorporated—not duplicated but part of the women's health plan, so that it is part of that shared goal to address late diagnosis across women's health, and also really change that narrative that gynaeocological cancer needs to be siloed and is seen as too difficult or too rare to diagnose? Because, on the contrary, every year there are nearly 1,000 cases of gynaecological cancers in Wales, and these cancers are the fourth most common cause of cancer death amongst women here in Wales. But many are being diagnosed when they reach the emergency department, as Russell George mentioned, often after months—even years—of trying to get a GP to refer them for tests.

So, recommendation 15 was really crucial to call for Welsh Government to work with the Wales Cancer Network to commission an urgent review of the incidence, trends and high-risk populations in relation to emergency presentations with gynaecological cancer. The Welsh Government has said there are insufficient resources available to undertake a formal review within the requested time frame. If the issue was the requested time frame, then I take it back. We put six months on there because we wanted to make it clear that it was really urgent. If that's what the barrier is, then we take it back, because the British Gynaecological Cancer Society, Sioned Cash and Tenovus have said it just needs to be done—set a different time frame, but please do it.

And then, Dirprwy Lywydd, I want to end by quoting Claire O'Shea about the use of the term 'vague symptoms', because I don't think that anyone can say it better:

'I have an additional plea to stop using the term ‘vague symptoms’—we must move away from this language.... The use of ‘vague’ is loaded with connotations and it breeds doubt. It is clear that often, the symptoms grouped together as ‘vague’ are simply symptoms of Gynaecological or other cancers. If we were to use language that reflected that, the symptoms might be treated with seriousness and urgency.'

Claire, from me, I am so sorry that you and many women have been let down, and I urge all of us, and Welsh Government, to ensure that your Claire's Campaign will be a lasting legacy and change the outcomes for future generations of women. Diolch.

I'm certainly grateful to colleagues for contributions in this important debate so far. Thank you to the committee, including the clerks and the Chairman, Russell George, for the hard work that's gone into the report, but I certainly want to join colleagues in thanking the women who contributed with their own experiences for this report as well. I'm very conscious that I've only joined the health committee in the last two or three weeks, but I just wanted to contribute today and recognise what an important report this is. I'm hopeful that the report and its contents will have a positive impact on the way in which gynaecological cancer is addressed in Wales.

And perhaps, before I go on to the substantive points that I want to raise, I just want to acknowledge what colleagues have mentioned in terms of the title of this report. It struck me when I read this that the first word in that title is the word 'unheard'. And I think that's the basis of much of what we're talking about here today, that people need to be listened to, that, when people present with symptoms—not vague symptoms, but clear symptoms, symptoms that need to be spoken of properly—people are listened to. And we've heard already colleagues mention the word 'gaslighting', of people being told to doubt what it is that they're feeling. That needs to be removed completely from people's experience when they visit their GPs or other health professionals.

And the other side of listening, of course, is the listening from Welsh Government, which colleagues have also raised here today. We're sick and tired of a tone-deaf response, quite frankly, what we're seeing here today. And I really hope that the Cabinet Secretary, in being here today, is hearing, and not just hearing but listening, to the words that are being said, and I look forward to the response, on the back of these contributions, from the Cabinet Secretary here today. But I would just like to focus on a couple of the recommendations that struck me when I read the report, and the recommendations that either haven't been agreed at all by the Welsh Government or not agreed in full. I'll also address why I think they should be accepted, and, for me, they're recommendations that struck me as fairly basic, fairly simple recommendations for a Government to accept.

The first one that struck me was recommendation 4, which was outright rejected, and this was mentioned by Russell George as well in his contribution. This asked Welsh Government to work with health boards to ensure that an assessment is made of gynaecological cancer related services lost during the pandemic and ensure that those services are reinstated quickly. It strikes me that that's not the toughest recommendation for a Government to accept. We know that the pandemic had a brutal effect on health provision in Wales and beyond. There's no denying that at all. That's not the issue that we're talking about. The context around the clinical services model has changed, but the need for reinstating that clinical capacity is still there. We heard from Russell George earlier on the number of people who are diagnosed with gynaecological cancers, and, sadly, around 470 of those are dying in Wales each year. I'll quote Dr Louise Hanna of the Wales Cancer Network, who called for immediate action on this survey to know what services were lost due to COVID and to reinstate those immediately. And Dr Hanna also made the point that, in actuality, we need to go above and beyond that, but at least a starting point is to do that analysis to understand what has been lost and what needs to be reinstated.

The second recommendation that struck me, Deputy Presiding Officer, was one that wants Welsh Government to work with different groups, including Public Health Wales, on a series of campaigns to raise awareness about the symptoms of gynaecological cancer, and that's recommendation 12. Now, this was accepted in part, to be fair, but there are concerns that previous campaigns haven't been as effective as they should have been, and, to quote Tenovus Cancer Care, they say that there is little or no consistency and co-ordination on these campaigns, and they've also said that for

'relatively small amounts of funding, Welsh Government, through the Wales Cancer Network, Public Health Wales and others could develop a range of campaigns, online and offline, targeted at at-risk audiences.'

So, again, there is a fairly straightforward recommendation there that would make a huge difference to the lives of women up and down Wales, and I'm baffled as to why Welsh Government didn't feel that they could accept that recommendation as well, because we know that raising awareness is half the battle for illnesses like this, and effective campaigns mean that more people are aware of potential symptoms and can, crucially, get checked out before the cancer becomes too pervasive, and this is a relatively straightforward way to help save lives, and a relatively low-cost way of helping to save those lives as well.

So, Cabinet Secretary, I would urge you to revisit the partial rejection of recommendation 12 that I mentioned there and the recommendation 4 rejection. Again, I just want to thank the committee for its work and I’m grateful to be able to join the committee at this stage and hope the Cabinet Secretary will think on these recommendations as I’ve outlined here today. Diolch yn fawr iawn.

Thank you to the committee; thank you to all of those who brought your experiences so bravely. It’s a sad place when, in Wales, we are seeing women being pushed back again, being told to get back, get in their box, don’t moan, don’t complain, because putting it and leaving it in the dark means that it just gets worse and worse. This report has shone a light on a much-concerning area, and I do thank the committee, but most of all I do thank those brave experiences brought to the committee by the women who gave evidence.

The situation is that it’s so challenging that too many women endure gynaecological cancer. From the casual dismissal of their symptoms to the unacceptable delays in receiving treatment, this report exposes the systemic failings that no longer can be ignored. It is, though, so disheartening that the Welsh Government’s response seems to be half-hearted. By accepting the majority of recommendations only when they are cost neutral, we seem to be turning a blind eye to the urgent need for robust investment and research, support services and comprehensive reforms. Above all, we must reiterate the paramount importance of completing and publishing the long-overdue women’s health plan for Wales. Two years ago, the Cabinet Secretary herself acknowledged the pressing need for such a plan. Yet, since then, women’s distinct healthcare needs have languished in limbo, with Wales falling far behind Scotland and England, who have both released their plans. How can we actually hope to tackle the entrenched inequalities that plague women and their health if we can’t co-ordinate our efforts? I do urge the Cabinet Secretary to not only commit to publishing the plan at the earliest possibility, but to listening to the voices of the women it aims to serve and to include a clear, comprehensive focus on the threat of gynaecological cancers.

Beyond this, I just wish to highlight three areas. Firstly, the report highlights the alarming lack of awareness surrounding the symptoms of gynaecological cancer. With early diagnosis, as we all know, being crucial to saving lives, I have to concur with Public Health Wales that multiple ongoing recurrent campaigns are absolutely essential. We have to work with community organisations, ensuring that that information is available to all our communities in whatever language and ensuring that it reaches those women that are hard to reach at times. Occasional social media posts on Government accounts aren’t going to cut it. The Welsh Government’s response to recommendation 12 implies that existing efforts are sufficient. However, there is a lack of consistent, co-ordinated and well-funded national campaigns to raise awareness, so I would urge the Cabinet Secretary to take that away.

Secondly, the Welsh Government must confront declining cervical cancer screening coverage in Wales. It currently stands at a disheartening 69.5 per cent. This downward trend poses a grave threat to our efforts in early detection and prevention, and we can’t continue to allow it to go unchecked.

Finally, I would like to see priority given to palliative and end-of-life care for women with gynaecological cancers. The stark reality that these patients endure over 13 interactions with unscheduled care in the final year of their life, nearly double the population average, is a sobering testament to the insufficiencies in available community care. I would welcome your clarification, Cabinet Secretary, about what efforts you are taking to close the implementation gap with palliative care and how you intend to fully implement and empower the programme to oversee delivery of that statement.

Ultimately and finally, the Welsh Government must demonstrate the determination to rise to the challenge outlined in this report and strive towards a future where no woman in Wales faces the agonising experience of gynaecological cancer alone, uninformed and unsupported. Diolch yn fawr iawn.

I am truly grateful to Russell and his committee for looking at this, and I would pay tribute to all of the women and their families who have given evidence. I also think that it is really powerful that the report is called 'Unheard', because gynaecological cancers steal the lives of too many women, too often, as we've heard already, because their symptoms went unnoticed until it was too late or the women's own concerns were unheeded by doctors. Women don't get listened to when it comes to healthcare, not anywhere near enough, and that has to change.

I'm going to focus my remarks on ovarian cancer, but I know that cancers of the womb, the cervix, the vulva, the vagina have to be talked about too. Part of the issue here is that some of those words are considered a taboo, not quite polite. If even the words for those body parts are thought of as unmentionable, how can we be surprised that some women find it difficult to find those words to talk to their doctor about what's going wrong in those places? But as we've heard as well, many women are shouting about their symptoms, they have found those words, but they're not being heard, they're not being believed.

Only 31 per cent of women in the Aneurin Bevan health board area are diagnosed with ovarian cancer early, that is at stages 1 or 2. Sixty-nine per cent are diagnosed at a late stage, when the disease is far more difficult to treat. More than 300 women across Wales are diagnosed with this type of cancer every year, and roughly half of that number die from ovarian cancer each year. Those figures are stark. I'm quoting from Target Ovarian Cancer, who have provided me with a briefing for this debate.

I agree with what's been said: we have to raise awareness about the symptoms of ovarian cancer alongside all these other cancers. That's patently the case when 27 per cent of women, only 27 per cent, were able to recognise bloating as a symptom of ovarian cancer. Now, I agree with campaigners that if the Welsh Government has to wait for more money to become available to fund a symptom-awareness campaign, women will die. What more can be done to encourage more women to be aware and feel that they can talk about their symptoms? So many women downplay how they're feeling. They tolerate too much pain. They're frightened of going to the doctor. We've got to change that, or, again, more women will die.

There are an awful lot of changes about how we go about cervical screening, particularly, again, around accepting women's pain. I know the committee's report argued for improving the information that's given to women when they have their smear. Again, according to Target Ovarian Cancer, 42 per cent of women in Wales wrongly believe that a smear test can detect ovarian cancer. That confusion could cost lives, and I'm glad that the Government has agreed to amend the information given to patients, because having that information is empowering. If ovarian cancer is diagnosed early at stages 1 or 2, 93 per cent of women survive for five years or more, and that falls to 13 per cent of those diagnosed at stage 4.

Not all GPs realise that symptoms can be detected early with the disease. A quarter of women diagnosed will have visited their GP three times or more before they are referred for tests. Now, this isn't GP bashing, they do a fantastic job, but we need to make sure that they have the support and the training they need to change those statistics. Let's empower GPs more by rolling out education and training on these symptoms. Cabinet Secretary, could we lessen the amount of time that it takes? Why not undertake blood tests and an ultrasound at the same time, because this is an aggressive cancer? Time lags in between those tests can make a devastating difference.

So much of what I've said about ovarian cancer can be said for those other gynaecological cancers, those other cancers of the parts of the body that we don't talk about, the parts of our bodies that we're more likely to ignore pain from, the bits of our bodies it's more awkward to mention. The proverb talks about how, for want of a nail, a shoe was lost. Please let's stop a situation where, for want of words, for want of words that are listened to, the lives of loved ones are lost too.

I'm very pleased to be taking part in this debate. My own sister died of ovarian cancer, and this was after three separate primary incidents of breast cancer. Ovarian cancer is much more difficult to diagnose than the single job of self-examination of your breasts. There's plenty of cultural misappropriation of breasts, but discussion of what a healthy vulva or vagina looks like is hidebound by much more embarrassment and ignorance, as Delyth has already referred to. Many people, for example, fail to attend cervical cancer screening appointments for similar reasons, and this is particularly prevalent amongst ethnic minority communities, and these are serious issues that we all need to bear in mind.

The cross-party group on women's health discussed the issue of these five cancers in December 2022. We heard from two very, very powerful witnesses, which provoked a really useful discussion. Firstly, Athena Lamnisos, who is the chief executive of the Eve Appeal, which is focused on prevention, risk prediction and early diagnosis. Across England and Wales, 60 people are diagnosed every day of the year with one of these five gynae cancers and 21 of them will die. So, early diagnosis, we know, increases hugely the chances of survival, which is why the Eve Appeal is campaigning for women to be made more aware of their own risk factors and pay attention to what their bodies are telling them, which is when they're then able to go and confront the clinical issues that many people have already spoken about.

Our second witness was a man called Jim Sweet—an extraordinary man—whose wife, Sian, had died of ovarian cancer, aged 48. She had been advised that the pain in her stomach was irritable bowel syndrome. However, after she was admitted to the accident and emergency gastroenterology ward, she was diagnosed with ovarian cancer and given six weeks to live. Tragically, she died a fortnight after her diagnosis.

Jim is really an exceptional man, because, as a widower, he has dedicated his time to learning everything there is to know, that he can, about ovarian cancer, and he began researching the risk factors. His research found that there are 23 factors that indicate that a woman could go on to develop ovarian cancer, however, there was no research that considered these risk factors holistically and balanced the probability of one or other of them being more important. So, as a mathematician, he developed a formula for the consideration of all these risk factors, and has been working with medical professionals and researchers at Cardiff University to develop an algorithm based on this mathematical algorithm. It's 88 per cent accurate, 81 per cent sensitive and 95 per cent specific and is currently going through the process of clinical evaluation, with the hope that it will help clinicians with diagnostics in the future.

But, given that extraordinary contribution, I have to say that the most powerful thing that Jim Sweet told us was that he, himself, was a survivor of prostate cancer and he reflected on the fact that he'd been given a Rolls-Royce service with a dedicated ward and a clear clinical pathway, and how different it was for his wife.

So, I just want to echo the concerns that other people have said about this medical gaslighting, because I think, given the really challenging financial situation that we have in the health service, we're not about to get new services, but we absolutely can work on the culture of listening to women, of ensuring that women understand their own bodies, but also, when they present and say, 'This is not normal; I know I've got something wrong', that they are listened to and taken seriously, and not simply sent away and told to come back later, or if the problem changes. That is the one thing that we can really do something about now, and that will help women's voices to be heard, and then to get earlier attention for obviously being able to combat this cancer.

Can I start by genuinely thanking the Health and Social Care Committee for undertaking this inquiry and producing this report? Your findings and recommendations, I hope, over time, will save lives. It’s not often that I read a report that brings me to tears, but this one did, and I thank all of those who gave evidence to that committee. It was such an important piece of work.

It was heartbreaking to learn that so many women don’t feel that they are listened to, and sadly, many are losing their lives to cancer as a result. That shouldn’t be happening in this day and age. People know their bodies. They know when things aren’t right and, as such, they should always be listened to and given the time needed by health professionals to identify and treat conditions in a timely manner, because clearly, as we have heard, timing is so crucial with gynaecological cancers.

I want to thank all of the organisations and constituents who have contacted me recently to voice their concerns, including Target Ovarian Cancer and the Women’s Institute. Since being elected, I have met some wonderful people. Jim Sweet, a constituent, is one of those whom I have met many times and heard harrowing stories of suffering and sad loss.

The report says that, too often, women’s concerns are dismissed as a result of preconceptions about their emotions or pain tolerance. Sadly there has been a gross lack of medical research on female subjects, which can lead to misdiagnosis or inadequate care being provided. And yes, while not every woman who visits their GP with symptoms of gynaecological cancer has a bad experience, when things do go wrong, the consequences are dire, as we’ve heard.

As the report highlighted, and Russell shared, about 1,200 women a year are diagnosed with gynaecological cancer in Wales. It’s also sadly a fact that Wales has some of the worst survival rates for ovarian cancer in Wales. We heard from Delyth earlier that 300 women are diagnosed with ovarian cancer each year in Wales and, tragically, up to 150 of those lose their lives.

I applaud charities such as Ovarian Cancer Action, and many others, that are working towards early diagnosis of ovarian cancer, and the crucial work, as we’ve heard, that Jim Sweet is doing along with Cardiff University, which is so important. This is crucial work. Too often, women are suffering with a critical disease, and their loved ones don’t even know it.

Again, this is largely down to the fact that women are diagnosed far too late. So, it follows that early diagnosis is fundamental to improving outcomes. The report recognises that innovation and investment in early diagnosis will be key. I know that there are early diagnostic tools, as we have heard from Jenny, that the likes of Jim Sweet are bringing together, which will be revolutionary in helping to identify those at risk of gynaecological cancers.

We need these innovations to come forward as soon as possible, and I certainly hope that the Government will embrace them and will invest in ways to help those most at risk. As this report says, there will always be a certain number of cancer cases that are diagnosed through emergency admissions. However, this figure is unacceptably high in Wales, and diagnosis through admission to A&E suggests that something is going fundamentally wrong within our primary care.

As with all cancers, early diagnosis is vital for increasing the chance of survival, but sadly only a third of women in Wales are diagnosed at stages 1 or 2. Clearly, we need to ensure that the system is listening to women. We also need to ensure that GPs and healthcare professionals have access to medical education focusing on gynaecological cancers, and they also need support from secondary care to assist them in the assessment and referral of patients with potential gynaecological cancer symptoms.

Gynaecological cancer diagnosis pathways should be prioritised to ensure that more people are able to start treatment as soon as possible. The current situation of only 34 per cent of women getting cancer treatment within that 62-day target is just not acceptable. I listened to Claire O'Shea on the radio coming in this morning. It was very moving, and I wish you well in your campaign as you go forward. The Welsh Government must put more resources into working with universities and undertaking more research into women's health to ensure that our healthcare professionals learn more about these gynaecological cancers and how to diagnose sooner.

I'm glad that the Welsh Government has accepted 18 of the 26 recommendations in this report. However, there is, as we've heard, wider concern that the Welsh Government is clearly in denial about the scale of the problem here. It is only through meaningful change that Wales can become a nation where women have the confidence to speak to their GP with the full knowledge they will be supported and receive the care they deserve. I sincerely hope we will see that change soon. Diolch.

I could spend my time asking to be listened to; I could spend the whole five minutes saying, 'Listen to me, listen to me, listen to me.' And that would somehow reflect what these women have done, asked and spent their time with the health professionals doing. But that would do an injustice, because there are other things that have to happen. They have been ignored, they have been brushed aside, and they were ridiculed—we've seen that—and that evidence is there in the video. It's an important and it's a moving report, but it underscores the urgency of addressing disparities in access to care, enhancing support services and promoting awareness and education across Wales.

I want to pay tribute to the honesty and the bravery of the women who gave evidence. Their stories are poignant and they're telling. Judith was repeatedly told that her severe pain couldn't be caused by the return of her endometrial cancer. By the time she finally had a scan, the cancer had returned but was uncurable. Claire's rare and aggressive cancer was diagnosed two years after she first raised the symptoms with her GP. It took a Turkish masseur to spot what her GP had misdiagnosed as IBS. Linda told of how her ovarian cancer was also misdiagnosed as IBS and urinary tract infections. Unfortunately, it happens too often, and we've heard many stories here today.

It's called the silent killer, and it is a silent killer, because by the time the symptoms are diagnosed, it is very often too late, which brings me back to where I started: you have to listen to women. We can all play our part by being aware ourselves of the potential symptoms, by not ignoring those symptoms, but also by doing all the tests that are available to us. But unless GPs or health professionals are aware of those symptoms, and have the willingness to listen to women when they do present with those symptoms, nothing's going to change.

I'm pleased that the Welsh Government has largely accepted the recommendations of the report, but gynaecological cancer should be, in my opinion, in the women's health plan. I will pay recognition here to the Cabinet Secretary for health, because she has taken seriously the issue of women's health. She is driving forward a women's health plan. That is the first of its kind in all of the time and the numerous Ministers for health that preceded her. So, I will thank her for that.

The report must lead to people like Judith, Claire and Linda being listened to and taken seriously, because we all know the subsequent outcomes if people aren't listened to. This will require cultural change within the health service and within society at large. Since the beginning of time, women have been called 'hysterical' and 'emotional'. Those are words that were used to some of these women when they were describing their own symptoms. It’s very easy to attribute those words to women rather than look and listen.

We must have targeted change. It is needed urgently, and part of that has been mentioned already. We need research. We do need a return to service levels pre pandemic, but we’ll accept that maybe some of those pathways are different, and I think that is fair. But we owe it to the women who stood before us, to the women who stood before us and are no longer here, and to their families, and also to help the professionals to help those women as well.

I call the Cabinet Secretary for Health and Social Care, Eluned Morgan.

Diolch, Dirprwy Lywydd. I'd like to thank all Members of the Senedd Health and Social Care Committee for their work on this important report about gynaecological cancer, and all the Members who've contributed to the debate today. But most of all I'd like to thank all the women who gave evidence to the committee's inquiry. Thank you for coming forward and for sharing your personal experiences. I know it had a profound effect on members of the committee, as the Chair set out.

I want to start by apologising to you on behalf of the NHS for where we got your care wrong and where we let you down. In no way am I dismissive of the conclusions of the report. I hope you’ve noted that we’ve accepted almost all of the recommendations, and I absolutely accept the scale of the challenge ahead of us. We all want and expect the NHS to provide the highest possible standards of care and to treat people with the dignity and respect that they deserve. Unfortunately, there are occasions where this doesn’t happen, and the NHS doesn’t always get it right. Despite people’s hard work and dedication, sometimes things go wrong. When things do go wrong, I expect the NHS to be open and honest about what happened, to put things right, and, most importantly, to learn from its mistakes. That’s why we introduced a duty of candour, so we and the NHS can do exactly that.

Healthcare and health services for women are not the same as men’s. All women should feel confident that their specific health needs will be met and their concerns will be taken seriously. This is something I was able to discuss in terms of training with representatives from the GMC this morning. That’s why we introduced the quality statement for women’s and girls’ health in 2022, and that’s why the NHS is developing a women’s health plan. It must be owned by the NHS so they have this sense of ownership, so that they have this need to deliver it, and I am pleased that we have got a very good woman to lead that clinical approach that we’re looking for.

This will be ready at the end of this calendar year, and within this, I shall ask them to be particularly careful with the use of language that I know offends some women, like the reference to vague symptoms. Also, we need to make sure that staff are trained to speak in accessible language that helps people to understand what clinicians are saying. I know lots of women don’t feel listened to, and we’ve heard this once again in the report that was published earlier this week in England on birth trauma.

I want to turn now to the issues highlighted by this inquiry and the committee’s recommendations. As I set out in my evidence to the committee and in my subsequent response to the committee’s report, improving cancer care has been and continues to be one of my priorities for the NHS in Wales. It is why I was pleased to accept the vast majority of the committee’s recommendations. We’re working hard to improve cancer waiting times and ensure people get faster access to diagnosis and treatment. We know that where we’re at at the moment is not good enough.

In March this year, more than 14,000 people were given the good news that they didn’t have cancer. I’m absolutely clear that health boards still have a lot more work to do to improve their performance against the 62-day cancer target, and this is particularly true when it comes to gynaecological cancer. It’s not an excuse, but it’s a fact that we are facing, year on year, increases in demand for cancer investigation and treatment that we can't meet in the way that services were delivered in the past. To give you a sense of the scale of the increase in demand, it's worth noting that there's been a 34 per cent increase in the number of women referred for suspected gynaecological cancers between 2019 and 2023.

With the best will in the world, it is difficult for us to switch on this kind of capacity in such a short space of time. Going to pre-pandemic pathways and systems in the face of that increase is simply setting ourselves up for failure, so getting new pathways in place is the right and proper way to do things. But we have to make changes to meet that increase in the number of referrals, and I will be holding a national summit in July to focus NHS attention on gynaecological services, including cancer. 

We cannot return to the services of the past and how things were pre pandemic. I have already announced a national recovery programme worth £2 million through the NHS executive, and this will focus on three kinds of cancer, including gynaecological cancer. The NHS executive has agreed on the steps that they will take in order to tackle cancer, which will change how services are planned and provided to women in possible cases of gynaecological cancers. 

I want to explain why we can't accept a recommendation to review data and activity on gynaecological cancers within six months of the publication of the committee's report. In order to do this, we would need to shift resources away from efforts to improve waiting times and cancer services. The data that we already hold shows what needs to be done. We are taking steps in terms of GP awareness of symptoms and referral practice. Swift diagnosis centres are operational across the country. We have national pathways and smart data equipment that helps us plan improved services, and this includes a new clinical inspection of ovarian cancer. 

We are developing new ways of delivering services and accelerating care pathways. We are looking at improving the rates of those who participate in screening activities in areas and groups of the population that are less likely to take up the screening opportunities. We are investing in new radiotherapy and diagnostic equipment, and the new treatments fund ensures that drugs that have just been approved do start to be used earlier. We will also invest in new research capabilities as part of the women's health plan, and I hope that you will have noted that since I responded to the report I have redirected over £700,000 to women's health research. 

This is a comprehensive package of steps that will help us to improve services. Put simply, at the moment the performance of health boards in this area is not good enough. There's a great deal of work to be done by the NHS executive too in supporting them, and in ensuring that clear care pathways that are set out are followed. I will be more than willing to update you on the progress of this work during the rest of this Senedd term. Thank you to the committee for the report, and a particular thanks to those women who provided evidence. Thank you.    

I call on Russell George to reply to the debate. 

Thank you, Deputy Presiding Officer. I would like to reiterate my thanks particularly to the incredible women who helped us with our work. I'd also like to pay tribute to Judith Rowlands, who sadly passed away on 21 May last year. Judith gave really powerful evidence to our committee through video last year, and I really want to extend the committee's thanks to her husband, Gwilym, and daughter, Sioned, for their continued support for our work. I'd also like to thank the support that we've had from the clerking team and the wider integrated team, and especially the Senedd engagement team as well, who really helped us in our work on this inquiry in encapsulating the evidence from the women who gave us such powerful evidence. 

Just to comment on some of what's been said today, Mabon pointed out the failure of Welsh Government to acknowledge the scale of the problem, and that was really the issue here that was a theme across our report, as Peter Fox also pointed out as well. Tenovus Cancer Care pointed out that the number of women starting their cancer treatment within 62 days—the 62-day target—is at an all-time low, and Sarah Murphy commented on that in her own contribution. And that's why, as a committee, we were baffled by the fact that the Government didn't accept some of the recommendations around reinstating services, following the COVID pandemic, and Sam Rowlands referred to that in his contribution, about the disappointment that our recommendation 4 in that area had not been accepted.

I thank Jane Dodds for her contribution as well. Of course the women's health plan really is well overdue; we really are behind the curve in Wales. We've seen that plan in Scotland, in England, and we haven't yet got that plan in Wales, and that is so disappointing, as Delyth pointed out as well in her contribution. And thank you, Jane Dodds, as well, for pointing out that the cervical cancer screening coverage also needs to be addressed.

Thank you, Delyth, for your contribution as well in pointing out the taboo subject, which is often an issue, which Jenny referred to in her contribution as well. And, Jenny, thank you for talking about your own family experience. But women do know their bodies best. That was a recurring theme that we heard in our evidence session and how health professionals just don't listen, ignoring women knowing and understanding their own bodies, as you pointed out in your contribution. And Jenny and Peter, you also referred as well to Jim Sweet, and I believe Jim is in the gallery today, actually, I've been told, so thank you, Jim, as well, for your work and support in this area.

And Peter, you hope that lives will be saved, but as a result of our report—. Our report is just that, it's a report with recommendations, and we as a committee want to see the Government reflect, perhaps, again on its response. And, of course, Joyce, I agree with your comments in terms of the need for a wider culture change and the inappropriate words that are often attributed to women by some health professionals is also something that needs to be tackled as well.

Minister, I thank you for your response. Your tone, I think, was right, in offering that apology—the NHS not always getting things right. And I understand, Cabinet Secretary, you say that you've responded positively to most of the recommendations in the report, but when we actually look at the response to the recommendations, we felt that you've accepted them, but we felt, as committee members and stakeholders as well, that your response that followed seems to suggest that some of the things that we're suggesting you do, you're already doing, and we don't think that's the case. But, no, we'd welcome further dialogue with you, and I think you've offered that in your closing remarks today as well. I do hope that our report will bring about changes that are so desperately needed to improve the experiences of women in the future. Diolch yn fawr iawn.

The proposal is to note the committee's report. Does any Member object? No. The motion is therefore agreed in accordance with Standing Order 12.36.

Item 7 today is the Welsh Conservatives debate on general practitioner practices and funding. I call on Sam Rowlands to move the motion.

Thank you, Deputy Presiding Officer, and I move the motion in front of us today in the name of my colleague Darren Millar. And, Members, the numbers are stark: there are 99 fewer GP practices in Wales today than there were in 2012, and it seems to me that the Welsh Government is doing precious little to stop that number moving to 100. And this is a downward trend that's followed declining levels of funding from the Labour Welsh Government. Currently, less than 8 per cent of NHS Wales funding goes towards general practice, which is below 2005 and 2006 levels. Of course, this is at a time when Welsh Government are refusing to spend the full amount of money from the UK Government on our NHS, and we really are seeing the ill effects of that.

That reduction of GP surgeries hits our communities hard. We've gone from a system of traditional family doctors who know people, who know their relatives and ailments, to a scenario where we have GP deserts, with poor provision putting even more strain on the GP surgeries that do remain. That reality contrasts sharply with the stated aims of Welsh Government.

We are very used to nice words emanating from Cardiff Bay, Minister, such as the 'A Healthier Wales' plan, which wants to ensure that people stay healthy and independent for as long as possible, and who can argue with that? But the huge waves of GP surgery closures stymie that aspiration. Wanting a move towards primary and preventative care that's closer to home simply doesn't square with the situation that we face now. Our communities are losing GP practices where they are needed most, and as a result, that type of care is further away, and as a result less impactful.

We know this has a particularly negative effect on some of our most vulnerable older people. Indeed, as our motion sets out, the 'Access to GP Practices in Wales' report, which was published by the Older People's Commissioner for Wales, highlighted the importance of GP practices in alleviating pressures on hospitals and supporting patients across Wales. Strong, well-funded GP practices reduce the strain on hospitals and allow older people in particular to live more independent lives. Older people are also the ones who are used to that traditional way of accessing GPs that I outlined a moment ago, and navigating new ways of doing things can be difficult at times for them, particularly when waiting lists are longer and there's a battle to be seen by a GP.

It's clear that many of our residents across Wales are deeply dissatisfied with the way the Welsh Government are running the NHS and our GP practices here in Wales. It's also general practitioners who are less than satisfied with their working conditions. Now, data from the Royal College of General Practitioners found that 67 per cent of GPs do not have the time to take a rest break, which they would need every day, and that 70 per cent of GPs work more than the contracted hours most days. It's no wonder we have a recruitment and retention crisis for our GPs here in Wales. Their data also shows that 25 per cent of GPs in Wales do not expect to be working in the profession in five years' time, and whilst some of that 25 per cent reduction is linked to retirements, the two main reasons given are finding general practice too stressful and having to work too many hours in general practice. So, it's clear that the current system is under severe strain and cannot continue in a way that provides both high-quality care for patients and an appropriate work-life balance for those GPs. It's clearly unsustainable.

But it's not just the GPs themselves that need that support. There are others, of course, who work in our general practitioners' surgeries. An example that comes to mind are our general practice nurses, our GPNs. They are there to provide direct patient care and help patients with longer term conditions, and the Royal College of Nursing has concerns about the workforce numbers there in particular, and wants Welsh Government to make sure that nursing in GP settings is seen as an attractive career option for newly qualified nurses. We on these benches would welcome a long-term strategy aimed at improving the physical, mental and emotional well-being of the workforce, whether they're GPs, GPNs, or anybody else working at the GP surgeries. That long-term planning would give people confidence that they can stay in general practice for years to come and not lose faith in the system. It also applies for a more general workforce strategy aimed at training, recruitment and retention, because those people are vital to a thriving health service, and the things that are pushing them away from general practice should be tackled head-on and fixed so our relatives know they can rely on the system for decades to come. 

With the current situation as it is, I'm seriously concerned that it won't be seen as an attractive career option at all. We are at risk of losing out on lots of talented people who do and can make a real difference in our communities. A significant part of fixing these solutions would be for the Welsh Government Ministers to make sure that the full Barnett consequential that comes from the UK Government is made available for health services here in Wales. But it does require a broader plan and strategy, of which funding is only one pillar, and I use the words of the BMA: 

'General practice is being forced to try and cope with inadequate resources, an unsustainable workload, and a workforce under pressure across the whole of Wales, with some areas in crisis. Burnout and attrition are impacting upon the profession and exacerbating these issues.'

The BMA's Save our Surgeries campaign aims to tackle these problems and make GP services sustainable well into the future. So, our motion today seeks to adopt these campaign calls, which include 11 per cent of NHS Wales's funding to be spent on general practice, and produce a workforce strategy to ensure that Wales trains, recruits and retains enough GPs to move towards the Organisation for Economic Co-operation and Development EU average number of GPs per 1,000 people.

And on that idea of GP services in future, I just want to address one of the Welsh Government's amendments that's in front of us here today, and that's amendment 3(b). This amendment calls the reduction in practice numbers part of a trend towards larger practices. I do think this is a little bit disingenuous from my Labour colleagues. In reality, what's happening is surgeries are being forced to shut because of funding and staffing problems, and not because of some kind of Welsh Government master plan for larger practices. So, I'd like to know, Cabinet Secretary, perhaps in your response later on, whether you think losing 99 GP surgeries has led to better provision and coverage for the people that we represent across Wales. Or, in actual fact, has losing 99 GP surgeries made things worse? In reality, those remaining practices are under even more strain now, because they're taking on patients from those practices that have had to shut down. That means longer waiting lists, more pressure on GPs and other staff who have a lot more to deal with, and we haven't seen any funding increase to match that extra responsibility. So, it's no wonder that those staff are often feeling overwhelmed. And it goes to another one of the BMA's key points, which is about capacity, which they describe as inadequate, because reducing the number of practices, of course, reduces capacity, and means that staff in those remaining practices are facing a job that they will be less likely to remain in on a long-term basis, contributing towards 25 per cent of GPs saying they'll no longer be in the job in five years' time.

To put it plainly, the number of patients is increasing while the number of GP surgeries and GPs is reducing. It's something that cannot carry on as it is, because we are really approaching a breaking point right now. So, I hope Senedd Members across the Chamber will support our Welsh Conservative motion, which is ambitious, but realistic for general practices here in Wales. Diolch yn fawr iawn.

I have selected the three amendments to the motion. If amendment 1 is agreed, amendments 2 and 3 will be deselected. I call on the Cabinet Secretary for Health and Social Care to move formally amendment 1 tabled in the name of Jane Hutt.

Formally.

And I call on Mabon ap Gwynfor to move amendments 2 and 3 tabled in the name of Heledd Fychan.

Diolch yn fawr iawn, Dirprwy Lywydd. As we on these benches have highlighted time and again in this Siambr, there is, let's be in no doubt, a crisis in primary care in Wales. At the end of 2023, there were only 374 GP practices left in Wales, a decrease of nine since December 2022. Over the same period, there's been a 0.3 per cent decrease in full-time-equivalent GPs, and an increasing trend in partners handing back NHS contracts due to mounting pressures. And this is a crisis that's been a long time in the making. The total number of GPs in Wales has decreased by more than 400 in 10 years. We are now on the verge of seeing the one-hundredth practice closure in Wales in just over a decade. The total number of practices has decreased by 18 per cent, with our rural communities suffering the brunt of the crisis.

The Government's proposed amendment to this motion suggests that a reduction in surgery numbers is a sort of efficiency measure, something to be welcomed. But I beg to differ, similar to what we were just told by Sam now, as does, indeed, the Royal College of General Practitioners, who've argued that we are not looking at a bigger-practice-by-design model, but a crisis in the sustainability of general practice. We're witnessing a vicious circle of GPs retiring earlier or leaving the profession due to increased workloads, leading to further strain on the remaining workforce.

The workload of GPs continues to increase, and individual GPs are responsible for more and more patients. In September 2022 the average full-time GP was responsible for 2,210 patients, compared to 1,676 in 2013. This represents an increase of 32 per cent in the number of patients per full-time GP, a significant workload increase for each individual practitioner. Meanwhile, a junior doctor enters the workforce earning, as it stands, around £13.65 an hour in Wales. This is all symptomatic of chronic under-resourcing by the Labour Welsh Government, who have failed to even acknowledge the true scale of the problem, and, as reflected in our amendment to the motion, of an unfair financial settlement for Wales from a UK Tory Government in Westminster, which fails to deliver a level of funding for our public services in Wales on the basis of need.

These are arguments that are by now well rehearsed—so, too, is the chuntering from the opposite benches. The responsibility for the multiple crises in our NHS lies both squarely in Westminster and Cathays Park. They are the product of 25 years of mismanagement, exacerbated by more than a decade of austerity. Bold action is needed now more than ever to save the NHS, and we in Plaid Cymru have been clear about what this would look like. We recognise that the problems in our health service run deep and would take immediate action to address the problems in primary care. Alongside reversing a decade of cuts and restoring the general practice budget to 8.7 per cent of the NHS spend, we would work with the profession to develop a retention and training programme, with a view to recruit 500 more GPs over a two-term period. Our ultimate aim, of course, is to reach the Organisation for Economic Co-operation and Development's average ratio of GPs per 1,000 people, but we're realistic—we know that fixing Labour's mess will take time. Janet.

Thank you, Mabon. If you are so concerned, as you profess here today, why didn't you stipulate this as one of your parts of your co-operation agreement?

Yes, I think it's pretty clear that we don't agree with the Government. I'm not sure if you understand co-operation, but you have to agree on things to put them in a document that you're going to work together on. We didn't agree on this. So, that's the simple reason why it's not there. And also, in addition to restoring the general practice budget, this means working with the sector to develop a training and well-being programme for GPs that would give them the time they need with each patient and to develop their skills. We'd work to ensure that GPs are retained and that working in Wales is an attractive offer for those that want to make a real difference. This would all necessarily be part of a wider package of reform that looks at the organisational culture of the NHS in Wales, being clear about where responsibility lies and ensuring that Ministers are not able to pass the buck for policy failures. It is long since time that the Welsh Government took the necessary measures to protect and reverse the decline in our primary care service. Even to acknowledge the true scale of the issue would be a start. As such, I welcome this debate this evening and look forward to the Cabinet Secretary's response.

I'm convinced about the importance of primary care in Wales. Firstly, I would like to thank those working in primary care for what they are doing for us as patients. When primary care is working well, then it reduces pressure on all the other parts of the health service. It needs to be readily accessible for patients and needs to work closely with social care providers to reduce the need for hospitalisation. When it fails to meet patient needs, then the default becomes visiting A&E and then waiting to see a doctor there, because you know you might have to wait 24 hours, you might have to wait 18 hours, but you'll definitely see a doctor, and, when you can't do that with a GP, then that's where the system breaks down.

Primary care has not recovered from the merger of primary care and secondary care, which has resulted in the proportion of the budget spent on primary care continually reducing. Primary care services play a vital role within the wider system of health and care in Wales. Services have come under increasing pressure from rising demand and constraints in capacity. Changes need to be made to ensure that primary care services are sustainable and can play the key role that is required of them within the NHS in Wales.

Primary care is about those services who provide the first point of care, day or night, for more than 90 per cent of contacts with the NHS in Wales. General practice is a core element of primary care. It is not the only element. Primary care encompasses many more health service areas, including pharmacy, dentistry and optometry. It is also, importantly, about co-ordinating access for people to the wide range of services in the local community to help meet their health and well-being needs. Vaughan Gething, when health Secretary, identified three major priorities for primary care in Wales: maintaining the sustainability of the sector, improving access to services, and delivering more care in a community centre. Central to delivering these objectives are the GP clusters or primary care networks. There are 64 networks or clusters in Wales, with a population of between 30,000 and 60,000 patients. It is based on promoting partnership and collaborative working. The networks allow general practice and a range of other primary and community care practitioners to get together with their local health board to share community-based services for their population. Where things are going well, a wide range of new services are provided, often using new models of care. Within a cluster will be GPs specialising in different parts of the body. And, going back to the previous debate, there will be GPs specialising in women's health. 

BMA survey evidence showed that 80 per cent of GP respondents had concerns about the sustainability of their practices. The efforts of the Welsh Government to promote recruitment to improve the state of general practice were widely supported, and I also support them. We need to improve the state of general practice. Far too often, we—and I don't exclude Members in here—seem to think that secondary care is, in some way, superior. It is not. General practice is the most important part of the health service, because that's the bit that you're most likely to meet. 

The need to return services to a community setting and improve access is widely acknowledged. Some services, such as the use of pharmacists, better use of home physiotherapists and occupational therapy services and community reablement for respiratory and cardiac conditions build on well-established practice. Social prescribing is also important as a means for primary care to reduce the chance of becoming ill through the better use of non-medical interventions and to influence social determinants. And if we could do one thing, we would deal with the obesity crisis, and that would cause an awful lot of a reduction in the number of people needing to visit GPs.

Within ABMU, they have a home first approach, which is an umbrella term for a range of services to patients, delivered on discharge from hospital, with access to ongoing care and assessment post discharge in a community setting. Home first services offer rehabilitation at home or in a bed at a reablement facility, therapy-only support, medication management, nursing and social worker support, well-being services via the third sector or a complex needs assessment, which includes ongoing assessment in a care home. Again, this is all about working together. The aim is always to deliver a home first ethos for patients and to advocate what matters to them with the teams working collaboratively with all partners, patients and their families.  

The percentage of the health budget spent on primary care has continually reduced, and the percentage spent on secondary care has continually increased. As a first action, can I urge the Welsh Government to give the protection that it gives to expenditure on mental health—i.e. that percentage is fixed—to primary care? That's not one of the headline makers, as this resolution is, but it's something that can be done, it can be done this year, and we can stop the continual reduction in expenditure on primary care. 

And finally, Plaid Cymru continually talk about that everything is wrong with Westminster: why don't they bring us a debate on independence?

I'm sure not many of us were surprised at the Older People's Commissioner for Wales's report that was released just last week, and I think it is also time to seriously rethink our primary care services from the bottom up. We should put on record that the detail you put into your speech there in opening this debate, Sam, was absolutely spot on. We can't afford to lose another single GP practice. 

In 2023, it was indicated that older people's experiences were of suffering immensely, with over 40 per cent of older people aged 60 saying that they were less likely to try and get a GP appointment, access an out-of-hours GP service or request a home visit due to reported NHS pressures. Eighty nine per cent of older people reported feeling anxious about the state of their GP services. The latest report tells us that a significant majority of older people are encountering challenges in scheduling suitable appointments, with approximately two thirds reporting difficulties in contacting or communicating with their GP practice, whether through telephone or even online channels. 

This latest report—sorry. It is not just access that is an issue. Indeed, nearly 60 per cent of older people think GPs have not been effectively communicating with allied services, such as district nurses, pharmacists and secondary care providers, in some instances resulting in missing or misfiled medical documentation. I don't blame the GPs. We've got the most amazing GP practices in Aberconwy, but whenever I speak to any of them, the GPs themselves, their staff, everybody is absolutely under severe pressure and exhausted. And they tell me that this Welsh Government needs to sit up and realise they’re not going to be there forever. Who is going to replace them? It is this disconnect that I want to highlight. These services are fundamentally not equipped for purpose and have not been able to adjust to the demands of our growing and ageing population. What I see at the heart of this is a primary care framework that is out of date, inefficient and unable to effectively build relationships of trust between patient and doctor. And I have to be honest, I’m not actually blaming the Minister to a large degree on some of this, simply because some of these GP practices do run themselves, if you like, rather like a business, and I know sometimes, if things go wrong within that practice, it can be very difficult for us to actually—. Because they’re self evaluating.

We must examine ways in which we can better identify those who may not require an urgent face-to-face appointment. Since COVID, my own practice, now, if you ring up to make an appointment that day, they will say, ‘We’ll get the GP to phone you’, the GP phones you, you explain what the issue is, and he will actually decide—or she—whether you need to come in and see them, or whether they can actually dispense something, dependent on the issue. So, I do think we need to look at modernising our—. We’re too indoctrinated, almost, to believe that you need to see a GP for every ailment.

To begin solving the issue of access, we could look at signposting of patients to online consultation tools that enable GPs and other primary healthcare providers to triage patients in a less time-constraining and resource-heavy manner. A Welsh NHS app would be key here, but bear in mind I think it’s 37 per cent of my residents in Aberconwy do not use the internet—either they have no broadband, or they haven’t got the skills to be able to use it. So, again, we have to be very careful we don’t marginalise our older people. One constituent wrote to me recently that their previous online system in England was excellent, with medical records easily accessible and prescriptions quickly requested. However, upon moving to Wales, they noticed that the lack of an NHS app means that GP practices rely on localised systems that are unable to communicate with other systems, such as health boards, meaning health records about life-threatening allergies, for example, were not properly transferred.

Being able to signpost and engage with patients online is essential to a modern Welsh NHS. However, as highlighted in the report, digital exclusion remains a significant barrier for many of our elderly. We must accept that some of us are just not tech savvy. I’d like to think I am, actually, but there are people that, fair do's, they can’t. So, it’s how the Welsh Government can educate and help, and, you know, systems where we can maybe put classes on again, or really help older people to engage. But there will always be a significant number of people who want to be able to use the traditional methods of contacting their GP. What we should be doing to enable this is increasing awareness of digitalised services.

Janet, you need to conclude now, please.

Yes, I know. I know. As funding is clearly the predominant problem for our health service, I think it is time that we shift our focus away from endless funding pledges and begin to take a more holistic, modern approach towards reducing the pressure on our GPs by reforming the system so it is adaptable, efficient and personal, and I believe, though, Minister, that this is where I do believe that you have a part that you could play, and it would be a really effective part for you to play. Thank you.

Perhaps I’ll start by responding to Mike Hedges. I can promise you, Mike, that we have had discussions about independence very often put forward by Plaid Cymru, but, if you’re eager for another one, we’ll discuss it in the group next week, and we’re very happy to have that conversation. [Interruption.] We look forward to that, because this is an issue that we are calling for in terms of fair funding for Wales, of course. But this is an issue that deserves our attention.

We would all, of course, know that this is a hot topic, wherever we represent. There have been references made to rural communities. I represent South Wales Central; you would think that access to GP surgeries would be easy for a number of our communities in those areas, but it’s not, and one of the things that we do have to bear in mind is how interlinked access to surgeries is with so many other policies. Particularly, in my region, buses are the major problem. If you don't have access to a car, then accessing a GP surgery can be very difficult, and I'm not talking now about the challenges of getting an appointment—we all know that appointments are very scarce.

But there are two surgeries at the moment in my region that are facing closure: the surgeries in Cilfynydd and Ynysybwl. Nobody else is interested in taking over these two surgeries. They've tried, but no-one is interested. The model has changed, there's a centralisation of services in larger sites, which do have some advantages in terms of providing greater expertise, but for those who are most vulnerable, it's very challenging.

In Ynysybwl, for example, to reach the surgery that people will have to go to, you have to take two buses. If you're in a wheelchair, only one wheelchair can travel on each bus, so they sometimes have to wait. If there's more than one person in a wheelchair, they check, 'What time is your appointment?' So, those things are very challenging. But also, what if the bus doesn't turn up and you reach your appointment late, which does happen very often? Some doctors are flexible and are willing to see that patient, but not all doctors. So, we have to look at the system holistically. I've been talking to the doctors who are facing the closure of Cilfynydd and Ynysybwl and the centralisation of services in Pontypridd, and they urge me, 'Can you improve the bus services?', because they understand these challenges. Taxis are extremely expensive.

But the main thing that we see is how difficult it is for GPs at the moment, the huge strain on them, and why, therefore, they are considering leaving, early retirement and so on, and why more people don't want to take over the surgeries when they become available. We heard from a number of GPs in the Senedd as part of the BMA's Save Our Surgeries campaign, and it was clear how much passion that these GPs had for what they do. They want to do a good job, but we've heard about the challenges already this afternoon when people aren't heard. 

But we must also ask why some GPs don't perhaps hear some of the things that they should hear, and don't act in the way they should. It can be because of the immense strain placed on them, and one thing that became clear to me in talking to those GPs was that they were very honest about how difficult a job it is at the moment, the impact on their mental health, the strain, the pressure as well. We've heard about absences because they see, because of the waiting lists that we have, people's condition deteriorating, people coming back to see them more often, and the pressure that that causes. So, one solution isn't enough here, we're talking about a number of different elements.

But the truth is that we have to see action now. We know what some of the challenges are. There are solutions in these proposals and what we have included in our amendments, and I think that we are all agreed that we want a system that works wherever you live in Wales, that the training is available, that the services are available. It's all interlinked, it isn't just about GPs, but all of the infrastructure that is needed. So, I'm pleased to support, and I hope that there will also be support for our amendments. We have to have fair funding in order to get the public services that our communities deserve.

For my contribution, I wish to focus upon a recent set of visits that I undertook around Mid and West Wales to gather the views of rural general practitioners about the most pressing issues that they face. Firstly, let's look at the blunt demographic realities of rural Wales. According to the Office for National Statistics, Wales has an older population than nearly every single region of England, with my home county of Powys having the highest at 27.8 per cent aged 65 and over.

Rural populations have unique characteristics and challenges. There are the mental health issues around living in isolated areas. There are the unique challenges in accessing timely medical care. In Powys, we have no general hospital, so everybody has to access a general hospital over the border in England. And there are travel challenges as well, which Heledd has just spoken about.

I just want to speak about our farming communities as well. There are particular barriers for them; when farmers fall ill, they often cannot seek prompt treatment from their local GPs because they can't leave the farm—literally. Instead, they must wait for overstretched GPs making lengthy home visits, allowing treatable conditions to deteriorate along the way. And in rural areas, we have a very poor housing stock. Many of those properties are owned by landlords who are very, very reluctant to treat conditions in those homes, which exacerbate those illnesses.

So, I have the following three asks, if I may. Transport has been touched on, but it's even worse in a rural area; there are literally no options. We've heard about the survey from the older people's commissioner: elderly respondents cited the lack of public transportation as a major barrier preventing them from seeking access to GP practices. I would therefore be interested to know from the Cabinet Secretary what conversations you've had with the transport Secretary to ensure that routes enabling access to healthcare are a real consideration in the forthcoming bus Bill.

Secondly, spending in rural GP settings is actually much higher, because of the unique operational challenges that they have with no general hospital being nearby. Local practices that I've visited have informed me that they must provide these enhanced services, such as phlebotomy, which would perhaps be more readily available in urban areas.

Thirdly, recruitment and retention. We've heard a lot about this today, but in rural areas, we had a scheme called the 'targeted enhanced recruitment scheme', which lapsed in February of this year. Rural areas did benefit from that particular scheme, and, in fact, in one GP practice that I visited, I met one of the GPs who'd come through that scheme and decided to stay in that rural surgery, so it was successful. So, I'd like to hear from the Cabinet Secretary what issues she can think of that present the challenges of moving that forward. I think—

Will the Member give way?

Yes, of course.

I thank the Member and I appreciate the comments that the Member has made today. I wonder if I could press for your support for a fourth call. The conversations I've had with local surgeries are around the deliberate profiteering from landlords of GP practices for no justified reason. Would you support calls for a national conversation, both here in Wales and the UK, to stop that practice, so that already pressured GPs can get on with focusing on their patients, rather than these hefty bills for no reason at all?

I'd like to thank the Member for that, and that was an issue that came up when I visited the GP practices, that, actually, their costs were higher and they had no control over those, particularly, as you say, when landlords would present them with a bill that they couldn't actually meet and that forced them into a particular area. So, thank you for that intervention.

I am going to finish, and I'd like to finish with a call for a rural GP premium. I'd like the Welsh Government to consider how you could enact this. This would actually help stabilise our rural practices; it would attract and retain talent and ensure that our local surgeries can continue providing those enhanced surgeries that our rural communities depend upon. We've heard, haven't we, the reality is that our GP practices, especially in rural areas, are collapsing under immense pressures. I look forward to further contributions, but also to hearing the Cabinet Secretary's view on a rural GP premium. Diolch yn fawr iawn.

GP practices are not only a local lifeline for patients, but they also alleviate pressures on Welsh hospitals, saving costs for health boards. It has therefore been the worst kind of dumb health economics to progressively cut their share of NHS Wales funding. Of course, this is not new, and  Labour Welsh Governments have form for this over many years.

It's now 12 years since both the British Medical Association Cymru and the Royal College of General Practitioners relaunched campaigns warning that Wales faced a GP crisis, that 90 per cent of patient contacts are with general practice, yet funding as a share of the NHS cake had fallen, and that they had relaunched their campaigns because the Welsh Government didn't listen. It is now decades since a BMA Cymru briefing in the Assembly, as was, at which the chair of the north Wales local medical committee said:

'General Practice in North Wales is in crisis, several practices have been unable to fill vacancies and many GPs are seriously considering retirement because of the currently expanding work load.'

It is now eight years since GPs in north Wales wrote to the then First Minister, accusing him of being out of touch with the reality of the challenges facing them. The Royal College of GPs stated then that general practice in Wales provided 90 per cent of NHS consultations for only 7.8 per cent of the budget—it's even lower now. Prolonged underinvestment, they said, means that funding for general practice has been decreasing compared to the overall Welsh NHS, yet we face the significant challenges of an ageing and growing population.

Consultations, they said, are becoming longer and more complicated, as they deal with an increasing number of patients with multiple chronic conditions. And they said that nearly four in 10 patients in Wales found it difficult to make a convenient GP appointment; 84 per cent of GPs in Wales were worried that they had missed something serious with a patient due to pressures; more than 52 per cent of GPs faced significant recruitment issues; and Wales needed to employ 400 more GPs.

It's now more than five years since a BMA Wales report showed that managed GP practices do not provide value for money. It’s now almost three years since BMA Cymru wrote to this health Minister, now the Cabinet Secretary for Health and Social Care, urging a radical shake-up of the health and care system in Wales, with the chair of the BMA’s Welsh consultant committee stating:

'After repeatedly raising concerns over the last few years that the situation was worsening, we are sadly seeing our fears borne out. If action is not taken immediately to resolve this situation then patients will die'.

Jumping forward, it is no wonder that BMA Cymru's Save Our Surgeries campaign is now calling on the Labour Welsh Government to ensure that 11 per cent of NHS Wales funding is spent on general practice, and that Wales trains, recruits and retains enough GPs to move towards the OECD average number of GPs per 1,000 people.

I was one of several cross-party MSs who attended a meeting on 8 March with north-east Wales GPs, at their request, to hear about the many challenges that they are facing in primary care. They told us that the health board’s managed practices are not providing the same level of continuity of care, patient satisfaction rates, out-of-hours attendance rates, preventative work, or accountability as GMS practices, and that it is in the health board’s interest to support the GMS practice model.

They told us that GPs would like to provide more services closer to patients' homes as part of 'A Healthier Wales'; that they have the expertise to do this, but need political support to shift the funding from secondary care and have appropriate facilities to do so; that they would like to be able to triage patients waiting in ambulances outside A&E departments, which would improve the patient experience while reducing both waiting times and hospital admissions; and that the future of primary care needs to be secured by placing appropriate resources in place now. That’s what the GPs told us.

Convenient access to healthcare from GPs in general practice is key to the future of the Welsh NHS. It is more cost-effective to care for patients in a primary care setting than elsewhere in the health service. By ensuring decent access to GP services, we can help to keep our population healthier for longer, enable more people to successfully manage their conditions in the community, and avoid unnecessary and expensive hospital admissions. But general practice cannot do this without adequate resources. A move from Labour denial to essential action is long overdue.

I rise to discuss today, in support of the amendment tabled by Jane Hutt. Earlier this year, I visited North Celynen general practice in Crumlin, within my constituency of Islwyn, and the staff who work there are actually on the front line of our beloved national health service. They tell me first-hand of the exponential and scalic increase in patient demand. They tell me of the complexity of co-morbid conditions post COVID, and the severity of those presentations. And all of this alongside the amazing advances in medicine and patient awareness. In short, we face the perfect storm of retiring GPs and practitioners, and subsequent workforce and capacity shift.

But it's true to say that the elephant in this room is the billions of pounds less that Wales does not receive as a direct result of decisions made by the Conservative Government in Westminster, and it is difficult and demanding for staff. But, ultimately, our practices know, and they tell me, that a great part of this for them is this endeavour that our healthcare is free at the point of care for all, irrespective of wealth. I was told by professionals that tensions still exist in ensuring appointments can be given to patients, and adequate time can be spent with patients due to that demand. 

In April 2022, the Welsh Government established the general medical service access commitment—a pledge that people would have their needs responded to the first time they contacted their practice, without being told to call back at another time. By 31 March 2023, though, 95 per cent of GP practices said that they had achieved this commitment, and so it's vital that that continues and is maintained. So, I welcome the Welsh Government investing £12 million over three years from April 2022 to help GP practices build their capacity through additional staff to support this important commitment, and those other improvements, to access equally. So, the access commitment requiring GP practices to adopt a blended model of access, offering a mix of remote, face-to-face, urgent, on-the-day and pre-bookable appointments is part of that.

Dirprwy Lywydd, you only have to pick up a copy of today's Western Mail and read the letters pages to know how beloved our NHS is and remains. Elaine Ryan wrote, 'Nye Bevan dreamed of a first-class healthcare system free at the point of delivery, so, today, I experienced that Nye's vision's superlative care.' So, let's all support and cherish what may continue for many years to come. But let us in the Senedd be under no allusion, though, that 14 long years of Tory UK Government rule at Westminster has seen all aspects of public life suffer because of the concocted Tory choice of cuts, or, if you prefer, austerity. Thank you, Dirprwy Lywydd.

I'm pleased to participate in today's debate, but, sadly, like all of us, far too many of my constituents are simply unable to receive the treatment and care they deserve. But, before I begin, may I take the opportunity to express my gratitude to all doctors, nurses and medical staff, as well as non-medical staff, who are delivering the best possible care for my constituents, despite the challenges posed by Welsh Government policy?

GP practices are indispensable for local communities and access to them when needed is essential. They quite literally provide a lifeline for people, particularly when travel to other areas of the county is restricted due to illness or disability. Access to GP surgeries also helps alleviate pressures on other aspects of the NHS, most notably A&E departments. In my constituency, we have the Argyle Medical Group surgery in Pembroke Dock, which I've previously raised in this Chamber. The surgery is one of Wales's largest, serving over 20,000 people. Unfortunately, the number of registered GPs has decreased from nine in 2021 to eight. Indeed, on their own website, it says,

'We have fewer doctors working for us than ever before',

before going on say that minor illnesses and injuries will be dealt with by other trained medical staff. This, coupled with other issues—the telephone booking system being overly busy at peak times, and access to same-day or future appointments being ad hoc—has resulted in significant difficulties in accessing the surgery. However, I want to put on record my thanks to the hard-working staff at Argyle Street for their dedication to delivering the best quality healthcare possible against a difficult backdrop, not helped again by Welsh Government policy.

This situation is a clear failure of long-term planning by the Welsh Government, as there are insufficient GPs being trained or incentivised, either through pay or conditions, to meet the necessary demand. It is unreasonable to expect same-day GP appointments when funding for practices is insufficient, and so is it right that less than 8 per cent of the Welsh NHS budget is allocated to them? We must heed the advice of the BMA and restore funding for GP practices to historic levels of 8.7 per cent of the health budget, with the aim of increasing this to 11 per cent in the next five years. This will help halt the decline in the number of practices and GPs, ensuring that surgeries like Argyle Street can see an improvement in their circumstances. None of us want to see surgeries to be overworked and understaffed, as it is detrimental to both them and the health and well-being of their patients.

Additionally, we must address the unique challenges faced by GP surgeries in rural areas, particularly in recruitment. Without steady recruitment, rural surgeries close, leaving communities without access to essential healthcare services. We must make roles outside of the major urban centres in Wales more attractive both professionally and socially. We saw this in my constituency at Laugharne surgery, a rural GP practice, highlighting the lack of staff, looking to close. The rural premium that we often talk about is very real when it comes to accessing healthcare. Uniformity and equality of service and provision across Wales is missing.

I'd like to conclude my contribution this afternoon by reiterating my thanks to all staff within GP surgeries for their hard work and dedication in caring for patients across Wales. To those watching or not watching, I want to tell you that you are not alone, and we on these benches recognise your needs. If others in this Chamber recognise their needs too, then I urge you to support the Welsh Conservative motion this evening. Diolch, Dirprwy Lywydd.

As the Cabinet Secretary knows full well, in Mid and West Wales the challenge of keeping rural GP surgeries open is intensifying, and it's the change in the social fabric of our rural communities that is one of the main factors responsible for the pressures on medical services. It will be no surprise to those of us who live in rural communities that the demographic changes over the past decades have contributed a great deal to these matters—our young people leaving, and older people moving into our rural areas in their stead.

This demographic shift means that, across the region, we have an ageing population, and this is reflected, and has been reflected, over the past decade. We've heard about this from Jane Dodds already. In counties such as Ceredigion and Powys, where we've seen an increase of 5 per cent in those over 65 years of age. What this demonstrates is that the Welsh Government needs to do a great deal more to try and keep our young people in rural Wales, and to attract those people who have already left back, if they so wish.

As a result of this ageing population, we're now facing a very real and rapidly increasing conundrum. On the one hand, our rural communities' healthcare needs have arguably never been greater. However, as we've already heard this afternoon, those front-line GP services are increasingly at risk of moving further and further away from the rural communities they serve. Added to this, an ageing population means the complexity of individual patients' needs are often at unprecedented levels, and the traditional 10-minute appointments are now far from being suitable to either the GP or the patient in delivering a holistic health package. Couple this added complexity with a 32 per cent surge in the average numbers of patients per full-time GP over the past decade, and the picture and strain on our surgeries becomes even clearer.

Of course, it isn't just our rural communities that are ageing. An increasing number of our GPs are also ageing and are retiring, and, as we have seen very recently in Laugharne and at present at St David's in Pembrokeshire, there is a real possibility that we could see a number of our communities being left without any GP provision at all at a time when our rural transport connections are shrinking very quickly, which makes it even more difficult for older people in particular to get to surgeries.

It's clear, Cabinet Secretary, that the current bonus system for junior doctors has failed to achieve its objective. So, I'd like to see the Government thinking more outside the box, and I'm happy to support the call by Jane Dodds for you to consider, perhaps, the issue of a rural bonus for GPs, and also think about how we can alleviate the pressures on our GPs. One way of doing exactly that would be more prescribing by local pharmacists. As it happens, I had an opportunity recently to visit a pharmacy in Llanidloes, Powys, that provided a prescription service, thereby taking a great deal of pressure off the local surgery, and it would be good to see such a model being rolled out as a matter of urgency across the whole of Wales. 

To conclude, therefore, as Mabon outlined earlier, we urgently need a system that ensures that working in Wales, and in rural Wales in particular, is attractive to those who are eager to serve our communities as GPs. 

I call on the Cabinet Secretary for Health and Social Care, Eluned Morgan. 

Diolch, Dirprwy Lywydd. I want to start by putting on record how much I value the work that GPs and their teams do every day to keep people in Wales safe and well. General practice is the cornerstone of the national health service, providing high-quality care close to our homes, often in the face of incredibly high demand. This is a vital and much-loved service. GPs and their teams of healthcare professionals are a trusted source of advice and care, and are the gateway to the rest of the healthcare service, rooted in all our local communities. The majority of healthcare is provided in primary care. The equivalent of almost half the population of Wales contacts their GP every single month, but we can all support general practice by looking after our own health by eating better, being physically active and maintaining social relationships and connections. We can also help support our local GPs by choosing the right service for our health needs, and that doesn't always mean calling the doctor for an appointment every time we feel unwell. Pharmacies now provide advice and free treatment for 27 common ailments, compared to seven that they can help with in England. This, as well as the introduction of the 111 service that deals with 70,000 calls a month, has helped to take pressure off GPs, because we want to make sure that GPs continue to be there for us when we need them, and we want them to do the work that they alone are trained for. But, just like the rest of the NHS, they and their services will continue to adapt to meet the changing needs of the profession of healthcare and the public.

Over recent years and in the face of record energy costs and persistently high inflation, the trend across the UK has been for GP partners to consolidate their services to reduce costs. GPs, of course, are independent providers—they're not employed directly by the NHS, although generally the NHS is their only contractor. Many are keen to build in additional resilience to their GP practices so they can employ pharmacists, allied health professionals, highly qualified nurse practitioners, who all help to take the pressure off them. And it's much easier to do this if you merge your practice with others, and this has led to a reduction in the overall practice numbers, but to more larger practices. My husband's own practice in Ely is an example of this. It merged with another practice, but it's providing exactly the same service from the same premises, but there's more resilience in the system. I hope the Chamber will—

Will you take an intervention on that, Minister? Thank you very much. Why is there the disparity, then, between the general medical services contract for GP surgeries and the ones directly run by health boards in that case, because I and Darren Millar visited Madryn House Surgery in Rhyl a few months ago, and that was the evidence we heard from a GMS contractor? I see casework in my constituency where there are grave complaints about health board-run GP services, where it's not necessarily the case with GMS-run contract services.  

Well, they're employed by different people, so their contracts are necessarily going to be different. But I hope the Senedd will allow me to indulge just for a couple of seconds, just to note that my husband will be retiring from GP practice in 12 working days' time after 30 years of service in the community of Ely. So, I want to thank Rhys for his service to that community. [Applause.] I want to thank also all GPs across Wales. I want to put on record how much I value the work GPs do in their teams every day to keep us well.

The fact is that the number of GPs in Wales remains steady. The number of staff apart from GPs themselves working in GP practices is increasing significantly, but even for GPs, the target of 160 new GP trainees each year is consistently being exceeded. I think it's probably worth noting that there are more GP partners per head in Wales than there are in England. We're also seeing an increase in the number of GPs taking up salaried positions, either within independent GP services or directly employed by health boards. It seems that many younger GPs don't want to be partners and to take on the responsibility of running what is, effectively, a small and complex business that is wrapped up in complex regulation, which is there to protect the public.

We've consistently supported GPs, we've consistently worked with GPC Wales, and have taken steps to sustain and to strengthen general practice. And that's true also in rural areas. The fact is we do have a rural incentive to train GPs in rural areas, and we've just increased the amount we give them from £5,000 to £7,000. And on top of that, when there is a need to try and attract people to certain areas, the health boards put the additional money on the table. I can give you an example. In the Goodwick practice, which was about to close, they offered £20,000 extra to try and attract people there, and they still didn't come, so it's not always about money; they now want to be in a more resilient service. People don't want to be working on their own. That seems to be the pattern that we're seeing.

Last October, we introduced the unified contract that simplifies what services all GP practices must provide and reduces unnecessary bureaucracy, so more GP time can be freed up to care for patients. Now, for the first time, through the unified contract, we've been able to make our expectations about access to services a contractual requirement. This ensures consistency of approach across Wales, and it's this consistency that has helped us address the 8 a.m. bottleneck in Wales, which remains a significant issue still in England. The new contract also provides a foundation for future digital improvements through electronic prescriptions and the use of the NHS app. These will benefit and convenience both practices and the public. The new contract was developed in recognition that GPs are a part of a wider system of care. Because at the heart of our primary care model for Wales is the principle that people should be able to access care that meets their needs at the right time closest to home as possible.

Thank you for taking an intervention. You're absolute right, people should be able to access the care that they need closest to home. But, clearly, with 99 surgeries having closed across Wales in the last 10 years, physically accessing those services has become more and more difficult for many people, especially in our rural communities. Would you acknowledge that?

What we've done is to put in place new urgent primary care centres, but I recognise, particularly in rural areas, that is a challenge for people who don't have access to vehicles. It's something I brought up recently with the new chair of Hywel Dda, just to try and recognise that, actually, people are challenged. Health boards have to make that a part of their consideration when they're planning for how services should be provided. The fact is there are lots of alternatives now in terms of where you can get support. You just think of pharmacies, where 600,000 consultations really took the pressure off GP services. Seventy thousand people take advantage every month of the 111 service.

We've invested £5 million in allied professional healthcare workers and more than £8 million to ensure that there are more community nurses available on weekends, and this will ensure more support for GPs, through community resource teams, and will help people living with illness. Investing in primary care services is very valuable, and that is where most healthcare happens; it is central to the preventative agenda. Could we provide more funding for primary care? Yes, we could. But the fact is that, since 2005, we have increased the amount provided by £250 million.

So, whilst you are right to say that the proportion that we spend on GP services has gone down, the amount has gone up significantly since 2005. And why is it that it's gone down? It's gone down because we've deliberately tried to respond to the pandemic and the long waiting lists. We said we're going to spend £1 billion on clearing the backlog. The backlog is in secondary care, not in primary care, and that's why that balance is not where we want to be. But we're clearing the backlog, and I hope you understand the reason, because in our strategy, 'A Healthier Wales', we're very clear that the direction we want to travel in is more support in our communities and in primary care.

Deputy Llywydd, in order achieve our—[Interruption.]

No, sorry, Russell. The Minister is already out of time, and I've given her some time for the interventions.

—'A Healthier Wales' ambitions, that's what we will do: rebalance. But we must bring waiting times down. To do this, we have to look at the whole system. But I would like to conclude just by thanking our doctors, particularly those working within our communities.

I call on Peter Fox to reply to the debate.

Diolch, Dirprwy Lywydd. Can I thank all Members for their contributions today? There is no doubt about it, from listening to you all, that there is clearly something very wrong with our Welsh health service as it relates to GP practices when we see such a significant reduction in the number of GPs across Wales.

Can I thank Sam Rowlands for opening our debate? His contribution set out the concerns around our GP practices. Sam shared that number of 99 fewer GP practices now—that is really significant—and pointed out the reduction in funding levels and how years of underfunding has led to the situation that we're in. It's hitting people hard and citizens hard. He pointed out that we need that workforce strategy. Recruitment and retention is so fundamental; there's a crisis here in Wales. 

Mabon highlighted, as others did, the crisis in primary care and certainly rural Wales. We heard about those reduced numbers of GPs and the contracts that are being handed back. I think we've all seen that in our communities, with over 18 per cent, Mabon said, of surgeries being reduced. There is a clear need for wider NHS reform. 

Mike Hedges thanked the primary care services across Wales, recognising the vital part they play, but recognised that when it goes wrong it causes problems. But he also pointed out and reminded us about the other facets of primary care, which are so important, and how important the sustainability of GP practices is. 

Janet pointed out and reflected on the older persons' commissioner's report and how we can't afford to lose even one more GP practice. It was really concerning that elderly people are struggling to engage with GPs as they need to.

Heledd said that it's the hot topic wherever we are across Wales, and asked how we look at things like public transport, because it's preventing people from accessing their GPs. It's difficult for GPs at the moment, we know that, and they're under severe strain. I thank Heledd and the Plaid group, because I understand you will be supporting our motion tonight.

Jane Dodds shared the views, as others did, about the rural practitioners and the problems they have with an older demographic across such a wide area, and that was echoed by Sam Kurtz later on. The rural challenges are significant, and they're different in many ways to many other areas, especially where you can't even access a general hospital and you have to cross the border to get the things you need. It also helped us understand the pressures on the farming community and how poor housing stock can also have an important influence.

Mark Isherwood pointed out that GPs are a lifeline. He pointed out the cuts to NHS funding here over the years and said that the Government were told by the BMA many times over the years about the threat to the sustainability of GP practices. It's clear those concerns were known.

Rhianon played the usual card where she blamed the UK Government—total denial. I would suggest she visits her local GP and asks them what they feel about the current practice and the contracts they might be under.

Sam Kurtz, as I said, again, talked about rural areas, but he also wanted to, as we all do, thank those people who work—all practitioners and their teams—day in, day out for us. He recognised it's not their fault. He shared the example of Argyle Street and how they've had a reduction. And this is what I'm finding in my own constituency: GPs are employing different types of practitioner, but they really want to employ another GP, but the contracts won't allow them to do it, and that is the real issue.

Cefin pointed out, again, those challenges around rural GP practices and how the need for healthcare has never been greater in those areas, and the complexity of ageing populations, and that 32 per cent increase in patients per GP—how much more pressure that is putting on.

The Cabinet Secretary went on the record about the value of GPs and their teams. I know you believe that and we all recognise that they are the cornerstone, they are vitally loved services. And there is a lot of call. You said that a number equivalent to half of the population contact their GP every month. And that is why it is so important, that's why we've got this debate here, because we're hearing from hundreds of people—all of you must do. Even if you're not saying it in this Chamber, you must be hearing from your practices, sharing those concerns, because why is it only us who are hearing them? You must be hearing them.

Will you take an intervention, Peter?

Yes, I certainly will.

One of the concerns that I continue to receive is that bottleneck at 8 a.m. in the morning. Colleagues are agreeing with that. 

Write to me about it.

I will. I'm intervening on this, because I think in the Minister’s response the Minister suggested that wasn't the case. The Minister is saying to me to write to her on that. I think we must all do that when we get that experience, because the Minister is obviously being told something different. So, I'm very keen that the Minister gets to know about these issues.

Thank you for that intervention. Absolutely, I think we all experience that 8 a.m. blockage, and if you can't get an appointment, you've got to start again the following day.

It's in their contract.

But they won't answer the phone. How do you complain? Or you're having to apply for an appointment over an app, which takes you over 10 minutes to fill out.

So, it's quite simple, Dirprwy Lywydd, we have to recognise the fundamental importance of a sustainable primary care service, and currently there is no way we could suggest our primary care, in its current form, is sustainable. In my own constituency, as I've pointed out, I've spoken to at least two practices recently. They're struggling to make ends meet. The contracts do not cover the valuable discretionary services GPs offer to our constituents, and I raised this recently in a short debate. That funding regime in our health service constantly favours secondary care. Indeed, less of our Welsh NHS funding, as we've heard, goes to general practice, and that is a backward step. This is leading them to cease providing these important services, moving forward.

This leads to huge pressures for the vulnerable people who then have to make huge trips or have huge waiting times to get the services they require. Clearly this short-sighted arrangement within the health system here is having a profoundly negative effect on many of the most vulnerable in society. It's really affecting their well-being and, ironically, putting additional pressure on hard-pressed secondary care. I urge Members to support our motion, as to not do so is turning your backs on the general practitioners and, through doing so, turning your backs on our citizens.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections. I will therefore defer voting under this item until voting time.

That brings us to voting time. Unless three Members wish for the bell to be rung, I will move immediately to voting time.

The first vote this afternoon is on item 5, Member debate under Standing Order 11.21. Open the vote. Close the vote. In favour 29, there were 20 abstentions, and four against. Therefore, the motion is agreed.

The next vote is on item 7, the Welsh Conservatives' debate. I call for a vote on the motion without amendment, tabled in the name of Darren Millar. If the proposal is not agreed, we will vote on the amendments tabled to the motion. Open the vote. Close the vote. In favour 16, no abstentions, 37 against. Therefore, the motion is not agreed.

I now call for a vote on amendment 1, tabled in the name of Jane Hutt. If amendment 1 is agreed, amendments 2 and 3 will be deselected. Open the vote. Close the vote. In favour 27, no abstentions, 26 against. Therefore, amendment 1 is agreed.

I now call for a vote on the motion as amended.

Open the vote. Close the vote. In favour 27, no abstentions, 26 against. Therefore, the motion as amended is agreed.

That concludes voting today, but please remember we have not concluded business. So, if you're leaving the room, please do so quietly.

Item 9 is the short debate, and I call on Cefin Campbell to speak to the topic he's chosen. Cefin.

Thank you very much, Dirprwy Lywydd. It's a great pleasure for me to put forward this debate on developing a rural poverty strategy for Wales, and I'm very pleased to give a minute each of my time to Siân Gwenllian, to Sam Kurtz and to Mabon ap Gwynfor.

I think the most obvious place to start is to ask the question, 'Why do we need a rural poverty strategy for Wales?' Well, for those of us who live in rural areas, what we see around us is a picture of decline—banks closing, schools, post officers, pubs, and so on, all closing; young people leaving rural Wales to seek work, to seek affordable housing, or a better life or better leisure facilities. In rural areas, in general terms, this is the picture that is familiar to everyone. Levels of income per head are lower than the average in Wales; the levels of gross value added and productivity are also lower. Taken together, the levels of deprivation in rural areas are lower than in urban areas. Who would think that Ceredigion, which has house prices that are amongst the highest in Wales, has 30 per cent of children living in poverty—the second highest rate in the whole of Wales. And what this shows is that the external view of relative wealth can hide poverty under the surface, and that, truth be told, is the situation in rural Wales as a whole: significant poverty hiding in the shadows, and invisible.

To add to this, the cost-of-living crisis has had a damaging impact on our rural communities. The Bevan Foundation has talked about the triple pressures on rural areas, namely high costs, low incomes and poor access to public services through a lack of support by Governments of different stripes. As Professor Calvin Jones from the economics department at Cardiff University has said:

'Rural Wales is in trouble. Probably more trouble than in living memory, and from forces and trends that are unlikely to disappear any time soon. Economic dysfunction is old hat here of course. The social problems consequent on poor wages, low value added, and a lack of economic opportunity and market income are many and longstanding. These include poverty, the hollowing out of towns, poor service provision for rural areas, and the out-migration of the young.'

That's the pattern that all of us who live in these areas are familiar with. And despite the seriousness of the situation, every time I've called on the Welsh Government in this Siambr to develop a strategy tailored specifically to dealing with rural poverty—and I have done that several times, as some of you will know—the Government has said 'no', stating that poverty is poverty, wherever one might live. Well, I disagree. Research shows that urban poverty and rural poverty are different, and they should be treated differently.

So, as a result of a lack of response from the Government, I decided to take the reins and commission research, and to develop a strategy myself, by taking advice from experts and drawing on the most recent research in relevant areas. So, on the basis of this, I've developed recommendations in a number of policy areas, from transport, childcare, housing, energy, digital services and the rural economy, and I've come to the conclusion that this Government, and policy makers more widely in all parts of Wales, should give more consideration to rural Wales in everything that they do—in all of the strategies, all of the policies and all of the work programmes they develop and implement.

Colleagues, one thing that has become abundantly clear in my research is the fact that current policy-making processes do not give appropriate recognition to the different and specific needs of our rural communities. Now, in Northern Ireland, for example, public bodies have a statutory duty to carry out a rural-proofing test on everything they do—every strategy, policy and work programme. This comes under the Rural Needs Act (Northern Ireland) 2016. The Welsh Government would argue that it has a rural-proofing tool that can be for integrated impact assessments. But Audit Wales found in 2018 that there are, and I quote,

'very few examples of public bodies using the Welsh Government's Rural Proofing Tool in revising or developing services. Too often, this results in a single broad-brush analysis that can overlook and ignore differences.'

So, the rural needs Act in Northern Ireland was developed precisely because a similar, non-statutory requirement likewise failed to meet the needs of rural communities there. So, if there's one thing—and only one thing—that I hope people will take away from the work I've done on rural poverty, then I hope it's the need for a similar law to the rural needs Act here in Wales. Also, we so desperately need appropriate targets for reducing poverty in rural Wales, something we know is not in the Welsh Government's current child poverty strategy, for example.

And finally, we know that people in rural areas do not claim all of the benefits that they are entitled to, and we should do more to ensure that they do so. There are examples of best practice here, including, for example, Hwb Bach y Wlad in Carmarthenshire. The scheme includes taking a mobile unit around rural communities to talk to people and to offer support and advice to them, to individuals and families alike. This is excellent. Over the past four months, Hwb Bach y Wlad in Carmarthenshire has provided successful support to over 4,800 people, which is incredible, and it goes without saying that this model needs to be emulated in terms of community engagement across all rural parts of Wales. 

I now want to turn to specific policy areas and outline some of the most important specific issues, and propose possible solutions to them. In general, we know that all of these factors are drivers of poverty in rural Wales. They include: poor transport links and digital connectivity; fuel poverty, particularly in off-grid homes; high housing costs and low availability of affordable local homes, and too many holiday homes, Airbnbs and so on; poor access to childcare services; a fragile rural economy—nine out of 10 microbusinesses in rural areas employ fewer than 10 people; a lack of support for rural businesses; and uncertainty facing the agricultural sector, as has become clear during this week.

So, a number of these issues overlap, of course, and they call for co-ordinated solutions. Now, we've suggested in the strategy that will be published very soon a number of measures from the short to the longer term that touch on every policy area, so I don't intend to go through every one of them. So, in coming to a conclusion, I just want to refer certain aspects. 

In terms of transport, we need to rebalance the funding allocated to buses as compared to the funding provided to trains, with a view particularly to delivering free bus transport for our young people. 

On housing, we need to build on what has been achieved via the co-operation agreement, and we must go further, including following the example set by Gwynedd Council of buying back properties on the open market and letting them to local families. On energy, we must ensure that the Warm Homes programme is fit for purpose when it comes to rural dwellings, which tend to be off-grid and less well-insulated because they are older properties. Seventy four per cent of homes in Ceredigion and 55 per cent in Powys are off-grid homes, which means that the cap on energy costs doesn't apply to those who depend on oil.

We must expand the free childcare offer as part of a wider package to tackle child poverty, and we must consider interim measures, such as payments to grandparents who care for their grandchildren. At the end of the day, they are carers and they should be recognised financially and acknowledged financially for the invaluable work that they do. 

With digital issues, there remain too many digital notspots in rural Wales. We must see a new programme to ensure that fibre broadband is rolled out to everyone through a national broadband company, and that should be established as a priority.

Finally, we must create a new deal for self-employed people, a disproportionate number of whom live in rural communities, as I said at the beginning.

Also, we've suggested creating a new model to boost the rural economy in Wales, including the expansion of Arfor and the possibility of developing a new rural development board for Wales. As Professor Calvin Jones said:

'Rural Wales is in trouble. Probably more trouble than in living memory'.

I urge the Government to take these challenges seriously and to work with us to develop a strategy that would tackle rural poverty and revive our rural areas socially, economically and culturally. Thank you.

I'd like to thank you, Cefin, for bringing this short debate before us this afternoon. Like you, Cefin, this has been a concern of mine, as I represent a rural area. Everyone is aware that we are facing outmigration. It's happening in Dwyfor Meirionnydd and in Gwynedd; we're seeing the population growing older, and we're seeing the numbers in schools declining and the number of babies born in Gwynedd and the Welsh-speaking heartlands is falling. And why? That's what I'm eager to see: that commitment from the Minister to do a piece of work to look at why this is happening and why we're experiencing these things. There's one thing that's certain, which is that there is less investment in our rural areas, in the infrastructure, and we need to see the Government committing to that. How do we do that? Well, I'd like to hear the Minister this evening committing to calling on the Westminster Government to provide fair funding for Wales. Imagine what we could do with Crown Estates money and HS2 money: that could transform our rural areas. Thank you.

Thank you for the opportunity to participate in this important debate. In a report commissioned by the Bevan Foundation on poverty in Arfon, the fact was underlined that there's a cost-of-living premium in rural parts of Arfon as a result of a lack of childcare, lack of public transport, high costs of public transport, high housing costs, high energy costs because of the low-quality housing stock, and a lack of access to supermarkets because of transport challenges, which leads to higher costs of living.

The report refers to food deserts, and these exist across the UK nations and they exist also in some of Arfon's communities, such as Dyffryn Nantlle and Deiniolen, where there isn't a supermarket, where public transport infrastructure is poor, and where people face having to pay more for food because of the cost of transport and travel and a lack of local choice. Dyffryn Nantlle is amongst the 10 per cent highest of food deserts across Wales and England. It is a difficult, vicious cycle, and part of the response is to improve public transport significantly. It's disappointing, therefore, that the possibility is that the Government is going to postpone the introduction of the bus Bill. Providing the ability to local authorities to commission bus services according to need is vitally important to solving and tackling rural poverty. It's disappointing to hear that that is no longer a priority, and I'd like to hear what the Cabinet Secretary's views on that are.

Thank you, Cefin, for the opportunity to contribute this afternoon.

Forgive me if I draw attention once more to the cross-party group on rural growth's inquiry into rural productivity, where I think there's an opportunity to tackle rural poverty by improving the prosperity of those who work and live in rural Wales. I wonder if the Cabinet Secretary in his new role has had an opportunity to look at the report. If not, I'd welcome the opportunity to sit with him and discuss some of this, knowing that a lot of the 19 recommendations here are cross-portfolio, but understanding his role as the lead Cabinet member for rural Wales. But there are genuine opportunities within this report that do not require big money bags being spent to improve productivity in rural Wales. These are some small changes that can be implemented that can deliver real change in rural Wales, that would benefit people that we represent across Wales. Knowing that 80 per cent of Wales is rural, agricultural land, it just goes to show the importance of ensuring that rural Wales does have its opportunity to be prosperous, just like other parts of Wales too. Diolch, Llywydd.

The Cabinet Secretary now to reply to the debate. Huw Irranca-Davies.

Diolch yn fawr iawn. Diolch, Cefin. Thank you, Cefin, for tabling this short debate on rural poverty, and also Mabon and Siân and Sam for their contributions as well. I think we can all agree that this a crucial issue, because we know that, across Wales, including in our rural communities, many people are struggling with the cost of living, so it's right that we look at how poverty is experienced in different communities, and also at what we as Welsh Government can help with, and where our additional asks should be as well, I have to say. To that end, I'd be very happy to receive your report and have a look at it, Cefin. And Sam, just to say, we are digesting your CPG's report as well on rural productivity, and I'd be happy to sit down with you and talk through it in due course. We've been a little busy of late, but we will, we will.

What we're talking about here is over 80 per cent of Wales that is classed as rural, with around a third of our population, one in three people, living in rural areas. And those rural areas are quite different as well. There is deep rurality and there's also rurality at the top of the Garw valley, which is quite interesting in terms of some of the support, when we talk about giving rural support. So, I really do welcome the chance to debate the approach we're taking to help people right across Wales, and to ensure that we have equal access to the support that is on offer, regardless, I have to say, of whether you reside in a deeply rural or an urban area or areas in between. And on that basis, we believe, fundamentally, that taking a strategic approach to Wales as a whole is the right way forward, whilst also recognising the different challenges in different communities, including in rural areas.

So, we're doing this, for example, through the child poverty strategy. We're clear that we need to work together over the long term to help improve the lives of children, of every child in every part of Wales, right across Wales. No child should grow up in poverty. Every child in every part of the country should be able to look forward to living happy and hopeful lives and fulfilled lives. So, in order to help achieve this, we're driving collaboration within Government and more widely across Wales to rebalance actions towards preventing poverty, whilst also mitigating its worst impacts.

The strategy also rightly acknowledges, by the way, Cefin, that rural communities can face particular challenges. So, this is why the Government's wider work as well to support rural communities is so crucial. And that's a wide range of policies. So, yesterday, for example, I set out my plans to take forward support for the farming sector over the next couple of years. We know, as you pointed out, that there's a higher proportion of self-employed people in rural areas, who are more likely to live on lower incomes. Many self-employed people work in the farming industry or the associated supply chains. So, we've tried to show here that we as a Welsh Government are indeed listening, will continue to listen to rural communities, and, hopefully, with some of the reforms being taken forward, rural communities will benefit significantly from ongoing support for the food and farming sector as well.

But let me turn to some other areas. You've rightly pointed out that certain aspects of poverty are more prevalent, more heightened, in rural areas. So, for example, the risk of fuel poverty is higher, with around 28 per cent of households using off-grid fuel. This is a real issue. Now, since June 2022, we've taken the decision to allocate nearly £4.5 million in funding to enable the Fuel Bank Foundation to introduce a national fuel voucher and a heat fund in Wales, and this is where the Garw becomes quite interesting, because the voucher scheme, which has provided more than 57,000 fuel vouchers to date, supports all eligible households that prepay for their fuel and are at risk of disconnection. The Garw is interesting, as well as deep rural mid Wales, because the heat fund in particular responds to the needs to rural communities by providing for deliveries of oil and gas to those not connected to the mains gas network, and I know there are people in deepest Ceredigion, as well as deepest Garw, who have received support from this. In fact, it's supported 311 households to purchase off-grid fuel, and, to date, these interventions have supported a total of over 143,000 people.

We're also taking action to improve access to services in rural areas, recognising the difference. Transport links, which you mentioned, Cefin, and others touched on, particularly in rural areas, are essential for connections between people and communities and services and for access to opportunities as well. So, that's why Fflecsi, even in challenging times, is offering access to public transport where, previously, there was none. We are now trialling Fflecsi in 11 rural areas, where we are seeing—it's good to see—significant passenger growth, with the trials having now been used for over 100,000 journeys. 

Now, in mid and west Wales, through the local transport funding 2023-24, we are funding just under £1 million for TrawsCymru bus infrastructure in Ceredigion, and over £3 million on the development of Haverfordwest bus station. I'm just giving instances here of how we direct investment towards our rural communities. 

You touched on digital connectivity in rural areas. It's not always as good as it is in urban areas, but I'm looking across at Luke here—it's not always good in some of our rural areas within what are regarded as semi-urban or peri-urban areas. We've got to work on this right across the piece. But we will, Cefin, continue to use the levers at our disposal to support businesses, homes and the public sector in Wales to get the connectivity they need.

So, the full fibre roll-out with Openreach has now delivered full fibre broadband to over 44,000 homes and businesses across Wales. It's backed by over £50 million of public funding. That's the difference that these devolved institutions can actually make. 

We'll continue to use these existing initiatives, including Access Broadband Cymru, as well as maintaining a close working relationship with the UK Government, to ensure that the needs of Wales are addressed through Project Gigabit. That has to reach every part of Wales. 

So, I hope this makes clear to the Senedd that, as part of Wales-wide strategies, whilst recognising the differences, there is support that particularly benefits those living in rural communities to help tackle rural poverty. And can I just say? We know that in rural areas and urban areas, and all places in between, the last 14 years have not been kind to them. We've got communities and families across Wales, including across the countryside, feeling the impacts of damage to the UK economy. We know that help is needed, so we have put in place the discretionary assistance fund and the single advice fund, providing support that is really crucial for those struggling with the cost of living. In February 2024 alone, over 2,200 awards were made from that discretionary assistance fund in mid and west Wales alone. They totalled more than £257,000 for those in most financial need. And between January to December 2023, in the mid and west Wales region alone, over 18,700 people have accessed the single advice fund services and were supported to claim over £10.4 million of extra welfare benefits. We are really trying to target and drive this home within rural areas, as well as wider Wales.

The council tax reduction scheme is helping people who are on a low income, or claiming certain benefits, to pay some or all of their council tax bill. In mid and west Wales alone, over 47,000 households are in receipt of funding through the scheme. Almost 37,500 households pay no council tax at all. And, of course, rurality and the impact of people living in rural communities should always be considered in the development of policies. I'm sure, as all of us across the Siambr will know, the well-being of rural Wales is inextricably linked to the performance of the Welsh economy. It's for these reasons that the Welsh Government is required to undertake an integrated impact assessment when developing any policy. The process brings together a range of impact assessments into a coherent framework, rather than bits and bobs of everything, but this includes equality, Welsh language, the socioeconomic duty, children's rights and rural-proofing. I wrote to you, last week—I hope you've had it—a letter setting out the approach we take and the questions officials need to consider in the context of rural-proofing when developing those policies, and it's quite extensive. Cefin. 

Will you take a quick intervention?

Yes, indeed. 

You used the word 'should' twice, maybe three times, in describing the rural proofing that should happen by Welsh Government. Now Audit Wales, as I mentioned earlier on, has clearly shown that this doesn't happen to the extent that it should. So, in order to avoid the arbitrary, ad hoc approach that, clearly, has happened in the past, would you be in favour of tightening that up by looking at Northern Ireland and emulating what they have, which is a rural needs Act, and rural-proofing becomes something that we have to do rather than should or maybe do?

Cefin, look, it's a fair point, but can I suggest—? There is a requirement on officials, cross-Government, to undertake an integrated impact assessment, including rural-proofing. Officials have to consider every policy in the context of rural-proofing. If it helps, I'm more than happy to speak to other Cabinet colleagues, as this is in my brief, and re-emphasise the need to actually do this, but it has to be done. It's there within the way that we do this within Government. And if there's work to do on that, rather than put it on a statutory footing, I'm more than happy to drive this home right across all portfolios when developing policies.

I do understand the importance of doing all we can to tackle poverty in our rural areas. I'm not convinced that a rural poverty strategy on its own is the right approach. I'd rather that we focus on the actions, some of which I've laid out already—there may be more that we can consider, and that's why I'd be interested in receiving what you have come up with, Cefin—focus on the actions that we are currently taking, and actions that we can take going forward, through the plans, the actions and the strategies that we've already got in place, to make tangible improvements in the day-to-day lives of people living in rural communities right across Wales.

But I thank you genuinely for bringing the debate and the contributions from other Members. It's right that we discuss this, and it's right that we discuss the way that we can lift the lives of everybody in Wales, not just out of poverty, but to develop lives that are full of richness and opportunity as well. Lifting people out of poverty is one thing. Lifting them to even higher ground than that is something we should all be looking for. Diolch yn fawr iawn.

I thank the Cabinet Secretary and everyone who contributed to that debate. That concludes our business for today.