Y Cyfarfod Llawn

Plenary

10/01/2023

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

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

1. Questions to the First Minister

Good afternoon to you all and a very happy new year.

A happy new year to you all.

The first item on our agenda this afternoon, in 2023, and in the first meeting, is questions to the First Minister, and the first question in 2023 is from Peter Fox. 

The Cost-of-living Crisis

1. What support is the Welsh Government providing to third sector organisations to help them through the cost-of-living crisis? OQ58917

Well, Llywydd, happy new year to you and to everyone else too. 

I thank the Member for that question. Third sector organisations in Wales both provide vital help to others in the cost-of-living crisis and are directly affected by it themselves. We have increased funding to the sector on both counts, most often alongside our local authority partners.

Diolch, Llywydd. And can I wish you, First Minister, and other Members here, a happy new year as well? Recently, a charity contacted me with their concerns about the impact that the cost-of-living crisis is having on their staff. They highlighted that their staff are of course highly skilled and provide a valuable service to people from across Wales. Many of these organisations also provide employment to people who were vulnerable, giving them an opportunity to become fully involved within their community. However, the charity noted that they are simply unable to provide additional financial support to their employees to help them through this difficult period. Despite increased Welsh Government funding, as you just referenced, First Minister, they've used the money to expand services rather than to help improve staff pay and conditions. There are, then, worries about the well-being of staff and their families, as well as staff retention rates, at a time when demand for third sector services are ever increasing. First Minister, I realise that there are numerous demands on Welsh Government resources at this time, but I wondered what discussions you have had with your colleagues and others about ensuring that planning boards fully consider their role in improving conditions for third sector staff when commissioning services. Thank you.

Llywydd, I recognise the dilemma that Peter Fox points to. I want to, as he did, pay tribute to the fantastic work that voluntary organisations and the third sector carry out here in Wales. And it's not a surprise to hear that many of those organisations, where there has been some extra funding available, want to put that into expanding the services that they provide, given the significance of those actions in local communities.

And working in the third sector should be properly rewarded; it shouldn't be that people feel because they're working in that sector that they themselves should not receive adequate remuneration. I'll make sure that we raise the point that the Member has made in the different forums that we have. I'm pleased to say, Llywydd, that the Cabinet committee on the cost of living that met every week in the autumn term had representation from the third sector on that committee—the Wales Council for Voluntary Action, the Child Poverty Action Group, Citizens Advice. We heard from them all over that period. So, the third sector has a voice right in the heart of the Welsh Government. But the pressures on the sector are absolutely real. Yesterday's announcement by the UK Government of the reduction in support for the third sector in energy costs will mean that there will be even further dilemmas for the sector to bear, and the Welsh Government cannot be the answer to every dilemma that every part of Welsh society faces. 

First Minister, credit unions have a vital role to play in supporting people in our communities, a role that is of course all the more critical during the cost-of-living crisis. At the last meeting of the cross-party group on co-operatives and mutuals, we had a presentation on how credit unions have come together to develop their Moneyworks Wales scheme, aimed at helping employers to help their staff. I know Welsh Government is doing lots to support credit unions, as highlighted just last week, but how can it make sure that employers are aware of this initiative and encourage them to participate? 

I thank Vikki Howells for that, Llywydd. It was very good last week to have an opportunity there, with three other ministerial colleagues, to highlight the work of the Cardiff and Vale credit union. There were other colleagues, I know, out on the same day drawing attention to the services that credit unions are now able to provide, and we know that, whenever credit unions find themselves in the news, or with additional publicity, then more members come forward to join. The Welsh Government provided support to the sector in the run-up to Christmas to make sure that its services were as well advertised as possible. And early results from that campaign suggest that 7,000 additional members were made for the credit union movement in the run-up to Christmas. So, looking around, Llywydd, I see three other Members who were members of the first-ever employer credit union in Wales, when South Glamorgan County Council established a credit union that worked through payroll deduction. And that's exactly the system that Vikki Howells is pointing to—the Moneyworks Wales campaign is a campaign to encourage employers across Wales to offer payroll deduction facilities to their employees, so that they can join credit unions in that way. I'm pleased to say that, as one of 13 different credit union projects, the Welsh Government will fund Moneyworks from April of this year so that they can go on encouraging as many employers as possible, in as many communities as possible, to make that way of becoming a member of a credit union available to people who work for them.

13:35
Waits for NHS Treatment

2. What action is the Welsh Government taking to eliminate multi-year waits for NHS treatment? OQ58907

Good afternoon to Dr Hussain. Llywydd, in the six months following publication of the planned care recovery programme, long waits in the Welsh NHS have fallen by 23 per cent. That is the result of significant additional investment, expanded facilities, service reform and, most of all, the enormous effort of NHS staff themselves.

Thank you very much, First Minister. Of course, we all acknowledge the tremendous stress our NHS is currently under, but multi-year waits have been around since well before the pandemic, especially in orthopaedics. One of my constituents has been waiting for a total knee replacement since 2019. He has been waiting in agony for three and a half years, and all the local health board can tell me is that the waiting list is over four years long and that the patient should see his GP to manage the pain. First Minister, do you agree with me that it is totally unacceptable that patients should wait that long, or that secondary care should be placing these additional burdens on an already over-stretched primary care sector? I remember raising similar questions during my first term in the Senedd, and yet, here we are nearly a decade later having the same old discussion about orthopaedics. First Minister, when will Welsh patients finally get the service they deserve?

Llywydd, I don't accept the general picture that the Member paints, of this being a condition that has always been a problem in the Welsh NHS. Waiting times in the Welsh NHS had been falling for four and five years in a row up until March of 2019 and beyond. It is the impact of the pandemic that has built up those lengthy waiting lists, in every part of the United Kingdom. As I said in my original answer, long waits, the longest waits in the Welsh NHS, fell by 23 per cent between the end of March and the end of October of last year, and that includes gains in orthopaedics, which is one of the most difficult specialities to see a way of resolving the backlog and increasing activity, because of the impact that COVID continues to have, in the way that operating theatres and other procedures are carried out in the Welsh NHS. Of course we want to see those waits brought down further, and, while people are waiting, I think there is a role for primary care clinicians in helping people to manage their conditions in the best way possible.

In Swansea Bay particularly, the Member will be aware that the health board is intending to concentrate planned orthopaedic care in the Neath Port Talbot Hospital, freeing up capacity at Morriston, retaining 10 beds in Morriston for the most complex cases, and, in doing so, to have dedicated beds that will allow even more procedures to be resumed as fast as possible.

13:40

First Minister, do you agree with me that it takes some front for a Conservative to criticise the national health service? One of the issues we've seen over the last decade has been how austerity has ripped the heart out of our public services. Brexit ripped the heart out of our economy. What we need to do to celebrate the seventy-fifth anniversary of Aneurin Bevan establishing the national health service is to provide it with the sort of funds it requires in order to deliver for people today and in the future. That means that you need to be absolutely crystal clear in your next meeting with the Prime Minister: austerity has failed for a decade, it's not going to succeed in the next decade, and if we want to see the national health service succeeding as it has, and as Aneurin Bevan wanted it to do, then we need to invest in it for now and the future.

I thank Alun Davies for that question, Llywydd. He reminds us of how fiercely Aneurin Bevan was opposed by the Conservative Party at the time. There never would have been a national health service had that party had its way. Where he is certainly true is this: Llywydd, if you look at satisfaction levels with the national health service, they were at their height in the year 2010, and they've been at their lowest in recent months. Why is that? It's because, in 2010, there had been a decade of investment in our public services. The level of investment in our NHS had reached the level that was available in our European neighbours. A decade of austerity has eroded all of those gains. It lies at the root of the difficulties that we currently face—the difficulties we face with people feeling obliged to go on strike to express their dissatisfaction at the impact that pay held back over a decade has had on their lives, and we see it in the investment that has been available across the United Kingdom to keep that service in good order. I'll certainly make that point when I next see the Prime Minister, but it's a point we make more generally to people across the United Kingdom: this country needs a Government prepared to invest in the NHS and to repair the damage done by the last 12 years.

Questions Without Notice from the Party Leaders

Questions now from party leaders. The leader of the Welsh Conservatives, Andrew R.T. Davies.

Thank you, Presiding Officer. It is remarkable that the First Minister says that this country needs a Government to invest in the NHS when he and his colleagues voted to cut the NHS budget in 2011 and 2012. The record shows that you're the only politicians in this Chamber who have ever voted to cut the NHS budget, First Minister. 

The other point of difference to other parts of the United Kingdom that has happened over the last week is you've brought forward a proposal and instructed the NHS to discharge patients without care plans and suitable provision within the community when they're discharged. Doctors and health professionals have said that patients could potentially die or come to serious harm. Do you agree with the doctors and health professionals on their assessment of your plans?

Llywydd, I completely reject the characterisation that the leader of the opposition has made, and he should know better. It is utterly irresponsible of him to misrepresent the advice not of the Welsh Government, but of the Deputy Chief Medical Officer for Wales and the Chief Nursing Officer for Wales. I have their letter in front of me and it does not in any way bear out the accusations that the leader of the opposition has just made. It refers throughout to safe discharge. But, what it does is to say to the system that the system has to attend to the balance of risk across all of those people for whom it seeks to provide care. We have people, as he well knows and often puts to me on the floor of the Senedd, who are struggling to get access to the front door of this system, often people with very significant needs. At the other end of the system, prior to Christmas, we had 1,200 patients in a health service bed in Wales who were medically fit to be discharged. Now, what the letter from the deputy chief medical officer and the Chief Nursing Officer for Wales does is to say to health boards that they have to balance those risks. If there are patients in a hospital bed waiting for tests to be done, they could be safely discharged and called back in when those tests are available. It may be that not every element of a care package is in place, but the care package that is there is safe enough to allow discharge to take place. Instead of a culture of perfection around discharge, and the culture of crisis at the front door of a hospital, the letter seeks to rebalance that and to do it in a clinically responsible way.

That was good advice to the health service in Wales; you will find parallel advice being prepared in other parts of the United Kingdom. I support what the chief nursing officer and the deputy chief medical officer have said to the service, and I think it will result in better care for many patients, who otherwise—with very critical needs—find themselves waiting too long to get access to the front door of a hospital.

13:45

First Minister, I'm not misrepresenting anyone's advice. The British Medical Association, the Royal College of General Practitioners, the Royal College of Emergency Medicine, practitioners on the front line, week after week, day after day, last week, were coming out saying that this advice is bad advice, and ultimately it puts patients at harm. That's not me saying it. A quick Google on any of the computers that everyone's on in here today will find that on the news stories that accompanied this particular announcement. If you say it's misrepresenting, why didn't you have the health professionals in before this announcement was made, to give the security and assurance that they would require to back up the advice that your deputy chief medical officer and chief nursing officer put out there last week, rather than rushing out the advice and causing concern, causing worry, and causing distress?

Llywydd, the advice was not rushed out in any way; it was given out on 30 December. The 27 December was the single busiest day in the 75-year history of the Welsh NHS. On that single day, 550 patients were admitted to a bed in the Welsh NHS. Five per cent of the whole of the bed capacity of the NHS used in a single day, and still with ambulances having to wait to discharge patients into A&E departments and people having to wait for treatment when they arrived. The letter responded in a sober and responsible way to that set of circumstances, advising clinicians of how they could safely make arrangements for people who are medically fit to be discharged—1,200 people in a hospital bed for whom the health service had already completed everything that the health service was intending to provide to those patients. I simply do not think it can be responsible to characterise that advice in the way that the leader of the opposition has sought to do this afternoon.

I have merely taken the comments and quotes and observations of health professionals, First Minister. I haven't added any of my own words. As I said, the evidence is there for people to see. You say this evidence wasn't rushed out. Twenty-seventh of December to 30 December, that's 72 hours. A fundamental principle was changed in the discharge process, which was having care plans in place for people who were discharged. What people want to know is, can you give an assurance that when people are discharged there will be that help, that support, and that guidance, so that people don't end up being readmitted because the circumstances that they have been discharged into are not good enough for them to be looked after for the condition they went into hospital originally for? Because otherwise, you will be betraying their confidence in the ability of the health and social care system here in Wales to put them back on the road to recovery and ultimately security in life.

Llywydd, the advice deals directly with ensuring that people are not discharged in circumstances that would lead to their rapid readmission. It talks about people who are, for example, waiting for an assessment, and suggests that it is better that someone might wait for an assessment at home, rather than waiting in a hospital bed—a hospital bed that is then not available for someone who is not in a medically stable condition waiting for assessment, but is waiting to get in through the hospital door to receive the treatment that they need. The balance of risk is something that the health service deals with day in and day out, and always has.

What the letter did was to make sure that the clinicians knew that, in making those decisions, they had the support of their most senior colleagues in the service in Wales behind them in making those difficult decisions. There is nothing in the letter at all that suggests that anybody should be unsafely discharged, that anybody should be discharged in circumstances where it would be known that that person would need to seek readmission. It simply sought, in a responsible way, to respond to the circumstances of the health service by saying that people who could be safely looked after at home could be accelerated in that journey in order to make sure, in one of the most basic principles of the whole of the NHS, that those with the greatest need were able to get to the front of the queue. 

13:50

Diolch, Llywydd. On NHS pay, First Minister, we've estimated, based on figures that you've shared with us, that you could afford at least an additional 3 per cent extra pay award in this financial year. Now, I understand the health Minister has said that she does not recognise those figures, so can we assume that the pay award that you are intending to offer will be less than that figure? You said a month ago that there was no additional money available in this financial year, and now you've found it. You're now saying that there will be no additional money next year, so it can only be a one-off payment. But why can't you apply the same process that you have done to this year's budget to next year's budget? And even if that is not sufficient, do you accept that you do have tax-raising powers that could generate additional revenue? So, it's not right to say that your ability to turn a one-off payment into a recurrent pay rise is entirely determined by Westminster; it's a political choice.

Well, there are political choices here, Llywydd, and there are also hard facts, and it is simply a hard fact that you cannot spend one-off money to pay for recurrent bills. Now, the Welsh Government has written to our trade union colleagues making sure that we are able to go on talking to them. We've put a package of measures together. I'm glad that we will have a meeting with our trade unions on Thursday of this week.

One element of that package involves the offer of a one-off non-consolidated payment in this financial year. The amount of money that has been brought together for that has been hard-won over the Christmas period, in which Cabinet colleagues have all had to look at plans for spending in the final quarter of this year and agree to ways in which that could be reordered to release money to support that offer. But that is money available only in this financial year.

We will discuss with our trade union colleagues; that is the right place for us to discuss the quantum of money that is able to be found, and then we will discuss with them the best way in which that money could be dispersed amongst our public sector workers.

So, it is interesting that Plaid Cymru has joined the Welsh Conservatives in suggesting that the way to finance public sector pay in Wales is to raise taxes even further than they are already on the Welsh population. The leader of Plaid Cymru is right that that is a political choice, and that is a political choice that this Cabinet rehearsed in detail in the lead-up to the draft budget. There was a moment—a brief moment, as you know, when Liz Truss was Prime Minister—in which there were plans to reduce the level of income tax across the United Kingdom, and that did, I believe, open up a realistic possibility that we might have been able to raise income tax rates in Wales without disadvantaging Welsh citizens next year beyond the position they are this year.

Welsh citizens will pay higher taxes next year, Llywydd, than they have for the last 70 years. They're being asked to do that in the teeth of a cost-of-living crisis where they are already struggling to pay fuel bills, energy bills, food bills and other bills too. This Cabinet looked to see whether we should take more money out of their pockets by raising taxes, and decided that that was not a sensible course of action. That remains our view and, therefore, it's not a course of action we will follow, to find one-off money this year and to find recurrent money next year by raising tax levels even higher in Wales.

13:55

But the progressive use of income tax in order to defend public services from Tory austerity is a long-standing socialist position that we espouse in this party, and it's something you used to believe in as well.

You did recognise, in your comments yesterday, the collapse in trust in the pay review body process. How do you intend to rebuild this trust? Do you intend to change the nature of the remit by focusing squarely on what pay levels are necessary to recruit, retain and motivate staff, and leave the question of affordability for politicians to decide? And can you also say whether you're open to the union suggestion that any rise agreed for next year is backdated to January this year? That's a principle that you have accepted in your pay negotiations in Transport for Wales. And are you open to asking the pay review body to revisit its recommendations for this year, made before the huge hike in living costs, and reflect any higher award in a permanent pay rise?

Well, Llywydd, the Government will carry out our negotiations with trade unions with the trade unions. That is the right way for these matters to be resolved, and that, actually, is the way that I think is respectful to our trade union colleagues, that we discuss these matters directly with them, rather than by proxy on the floor of the Senedd. And that's what we will do.

We will, in doing so, talk to them, as I say, about how any sum of money we may be able to establish in this financial year can be dispersed amongst trade union members. We will certainly want to talk to them about ways in which trust could be re-established in the pay review process. There will be ideas that we will want to put on the table as to how that could be done, and I'm very keen indeed to hear from our trade union colleagues as to how they think that confidence in that process can be restored.

I think it is very important, from a Welsh worker's point of view, that we are able to do that, Llywydd. Over 20 years, and particularly in the last 12 years, we have been involved in seeing off a series of attempts by Conservative Chancellors to move to regional pay in public services. There is nothing they would like more than to see Welsh workers paid less than workers elsewhere. The pay review process protects Welsh workers from pay regionalisation, and that's why I believe that a real effort to re-establish trust in that process is worth making.

But the pay review process has led to a decade-long, real-terms cut in the wages of our NHS staff. So, the system is broken, and I make no apology for holding the Government to account and asking them to state what are your broad democratic principles. And we are here being the voice of NHS staff. We've been on the picket lines talking to them. We're making the points that they've asked us to share with you.

It's good to see that you are prepared to address, at long last, the massive increase in the use of private sector agency staff in delivering NHS services. Does this mean that you distance yourself from the position of the Labour Party in England, which is calling for the greater use of the private sector in the NHS—privatisation by proxy, essentially? Are you, as a Government, prepared to recommit to the principle you espoused 16 years ago, which was to completely phase out the use of the private sector in the NHS? Or is that promise to go the same way as Keir Starmer's 2020 leadership pledge, which was to end outsourcing in the NHS?

Well, Llywydd, I think it was the BMA that described the Welsh NHS as the NHS closest to the founding Bevanite principles of the health service of any of the four UK nations, and that is a position that I would wish to see us maintain. The impact of the pandemic meant that we have made greater use of private sector facilities than we would have prior to that, and there was no criticism of that, as I remember, during the pandemic period, because we needed to use all the facilities that we could put our hands on to make sure that people suffering from coronavirus had the treatment that they needed. In the aftermath of COVID, we will be making use of some private sector facilities to erode the backlog of people waiting for care that we talked about earlier this afternoon. Actually, I make no apologies for doing that. I regard it as a short-term measure to deal with a backlog. But when we have a backlog of the sort that we have seen—and we've heard this afternoon about people waiting in pain to get the treatment that they need—I make no apology for the fact that we will use facilities in the private sector here in Wales in that short-term way to erode those backlogs. At the same time, we want to build up the capacity of the health service itself, so that in the long run it is able to provide for all the needs that are there in Wales within the public service.

14:00
Flooding of Land in Mid Wales

3. What support is the Welsh Government providing to Natural Resources Wales to alleviate the flooding of land in mid Wales? OQ58916

I thank Russell George for the question, Llywydd. We have provided over £71 million to flood risk management activities across Wales for this financial year. This represents our biggest budget ever. The £39.5 million provided to NRW for flood risk management works includes specific provision for schemes in mid Wales. 

Thank you, First Minister, for your answer. You will know that I've regularly raised issues with you and other Ministers in regard to the flooding of land across mid Wales. You may recall the issue of flooding of homes in Llandinam I raised with you last February, and indeed other areas. Of course, there is great anxiety and worry, as you will know, for people whose homes have been flooded, but they worry that their homes may be flooded as well. We're currently in a position in mid Wales where rivers are overflowing. Further flooding of low-lying land is expected today as a result of levels in the River Vyrnwy and the River Severn. Currently, there are a number of Met Office warnings in place.

A key lever in terms of preventing and reducing flooding risk is the better management of the Clywedog and Vyrnwy reservoirs. I wonder if you can provide an update, First Minister, in regard to the works that I know you and NRW are involved with, especially in regard to the possibility of enhancing the Clywedog dam to provide greater resilience. It's also been my view, for many years, that the operating rules of both dams need to be explored and looked at to allow for greater capacity of storage in the winter months. I know the counterbalance to that is that those dams need to be kept high in times of drought, but I'm absolutely of the view that those rules are out of date and need to be examined and explored. I wonder if you could update me, First Minister, on the Welsh Government's involvement and discussions in regard to the operating rules of both dams.

And finally, compensation for landowners when landowners' land is flooded, sometimes in a planned way, in order to allow for flooding of homes upstream not to occur. Those particular landowners will be considerably disadvantaged. I wonder what considerations the Welsh Government has given in terms of supporting those particular landowners.

Llywydd, I thank Russell George for the number of important questions that he has raised. He is right to draw attention to the fact that, across Wales today, with the amount of rain that we've had in recent weeks and with the volume of rain that is forecast for today and for Thursday and into the weekend as well, there will be communities anxious about what this will mean for them. There is good advice for individuals available through NRW—its own website and other sources of information. Russell George has, as he said, Llywydd, regularly raised issues of concern in communities in his own constituency. He will know that there was a recent public meeting in Llandinam, and I know that he himself has been involved in further discussions with NRW on measures that could be put in place in that village. Purely by chance, Llywydd, I was travelling from south to north Wales at the start of last week and stopped off in Llandinam, partly to have a look at some of the things we had talked about here. It's very easy to see for yourself, if you're there, how close the River Severn comes to the village and the flat nature of the agricultural land that separates the river from people's homes.

The point the Member makes about the Vyrnwy and the Clywedog reservoirs is a really important one, because some people's concern, further downstream, is that water released from the reservoirs adds to the risk of flooding, particularly at points of high rainfall. The Environment Agency is responsible for managing the releases and the water levels in those reservoirs, and it has been releasing water out of both reservoirs at the start of this year. We have an assurance that they will be stepping back from that in the light of the weather forecast this week. But officials of the Welsh Government do remain in regular discussions with the Environment Agency about the operating arrangements it has for both reservoirs, and I'm very happy to make sure that the points made by the Member this afternoon are taken up further in those discussions. 

14:05

I think it might be worth, First Minister, encouraging people to look at the map of flood and coastal capital investment that is available online. You have already mentioned that there has been Welsh Government investment of £71 million for this financial year. I understand that an interactive map providing more detail on these schemes will soon be published. I'd welcome, if you're able to provide it, any update on that, because it would be very useful, particularly for owners and residents of the additional 45,000 properties that the Welsh Government has committed to protecting over this coming term. 

I thank Joyce Watson for that important point, Llywydd. We are committed, alongside our partners, to making more information available to residents in Wales so that, if people are anxious about the state of the rivers or the risk of flooding, they know where to go to get that information. Lots of it, inevitably, these days, Llywydd, is online information and we know that that is not equally available to everybody. It's why the consultation that we're involved in currently is important, to make sure that information is available in a way that is accessible to all. The eight properties that were flooded in Llandinam, in Russell George's constituency, all turned out to be occupied by people who were quite late on in life and where access to online forms of warning and information probably weren't the best way of reaching them. So, the consultation, which will be live on 23 January, is a way in which we will be able to make sure not simply that the new forms of information to which Joyce Watson has drawn attention can be put in place but that we make sure that there are ways of reaching others for whom more conventional ways of receiving information might be necessary.

Gender Recognition Reform Bill

4. Does the Welsh Government intend to follow in the footsteps of the Scottish Government with a gender recognition reform Bill? OQ58937

The powers available in Scotland are not currently devolved to Wales. We will seek those powers, as set out in the programme for government. Legislative use of any new competence will, of course, be for the Senedd itself to determine.

Thank you, First Minister. There are obvious, justified concerns following the Scottish legislation being rushed through and, due to the nature of the United Kingdom, how it will impact women here in Wales, particularly with regard to 16 and 17-year-olds and sex offenders now being allowed to self-ID without medical diagnosis, and the clear and obvious risks that come with that. What conversations have you had with the Scottish and UK Governments on how this legislation will affect us, and will you therefore rule out such legislation in Wales?

Well, I'll certainly not rule out any such legislation, Llywydd, nor do I accept that the Scottish Bill was rushed through the Scottish Parliament. I have indeed had an opportunity to hear directly from the Scottish First Minister about the passage of that Bill, and it was very thoroughly and very carefully debated through the Scottish Parliament's own procedures. It was supported, in the end, by Members from all political parties in the Scottish Parliament, including Members of the Conservative Party, and I just don't accept the characterisation that the Member has made. We will do as I've said, Llywydd: we will seek the powers. If we obtain those powers, we will put them to work here in Wales, and we will put proposals in front of this Welsh Parliament, so that those people seeking gender recognition are able to do so in a way that is not stigmatised and does not involve them having to go through a lengthy medicalised route in order to establish themselves in the way they themselves would wish to see established.

14:10

First Minister, would you agree that discourse on sensitive matters such as gender recognition should be conducted with respect and compassion? It really doesn't help when anonymous groups and intolerant keyboard warriors inflame discussion with untruths and intolerant language. First Minister, I'd be really interested in your view on the UK Government's immediate response of threatening to block the law from gaining Royal Assent.

I entirely agree with what Ken Skates has said. This has been a deeply polarising debate. The proper role for elected politicians, I believe, is to promote dialogue, rather than to seek to deepen conflict. I was surprised by the UK Government's reaction. They are threatening to use a power that has never been used in the whole history of devolution. They appear to say that they will not accept a gender recognition certificate obtained in Scotland, when they already recognise such certificates that are obtained in Belgium, Denmark, Iceland, Luxembourg, Malta, Norway, New Zealand and Switzerland. A number of those countries use the same self-declaration process to be used in Scotland. When we have a system that recognises certificates from other parts of the world, it seems very odd indeed that the UK Government is not prepared to recognise a certificate that is created in another part of the United Kingdom. I will say this to be absolutely clear, Llywydd: if anybody obtains a gender recognition certificate in Scotland and then comes to Wales, that certificate will be recognised here for all the purposes that you would expect it to be recognised for.

Waiting Times

5. What is the Welsh Government doing to shorten waiting times in the health service in South Wales West? OQ58932

We are committed to reducing waiting times across the whole of Wales, investing £170 million recurrently to support improvement, and £15 million to support transformation of services. October data demonstrates that waits over two years have reduced by 26 per cent since March 2022 at the Swansea Bay health board. 

Diolch, Brif Weinidog. A constituent of mine from Morriston has been suffering with knee problems for 15 years, and has been waiting for five years, almost to the day, for two partial knee replacements, being in constant pain the whole time, and having had to give up her pub as a result. When I highlighted my constituent's case in a letter to Swansea Bay University Health Board, they said that waiting times for orthopaedic surgery in Swansea are now in excess of four years. I'm sorry it doesn't fit in with your understanding of the situation, but they also pointed to historic under-resourcing of orthopaedic surgery. The fact that there have been two questions this afternoon on the same issue from Members in South Wales West shows how full our inboxes are of these cases.

Yes, Westminster's underfunding of Wales and Tory cuts to public services are obviously a massive part of the problem here, but health is a Welsh Government responsibility. So, will the First Minister pledge in 2023 to acknowledge his own Government's agency and responsibility, and tell us what he's going to do to ensure the people of Wales, including my constituent, are properly looked after from cradle to grave and not left in pain and despair for years?

I've already set out this afternoon a series of things that the Welsh Government is doing to make sure that the health service is in a position to treat people in a timely way. That is our ambition, and I'm sure it's the ambition of Members across the Chamber. As I've said, two-year waits in the Swansea Bay health board were 26 per cent lower at the end of October than they were at the end of March last year. That does demonstrate that progress is being made, albeit that there are people waiting longer than we would wish. I pointed out in my answer to Altaf Hussain that the board itself has a plan to concentrate planned orthopaedic surgery in Port Talbot hospital, being able to protect that capacity for that purpose, while retaining 10 beds at Morriston for those more complex cases. That separation of planned and emergency care is something that we've talked about regularly on the floor of the Senedd, and this is an example, and there are other examples in other parts of Wales, of the effort that the health service is making to separate those two streams in its work to be able to protect elective capacity and therefore to be able to make progress on those long waits in a way that will, I hope, bring relief to Sioned Williams's constituent.     

14:15
Support for Exporters

6. What support will the Government offer the exporters of Welsh goods in 2023? OQ58935

I thank Joyce Watson, Llywydd. Global trading conditions remain unpredictable as we enter 2023. In addition to the turbulence created by Russia's invasion of Ukraine, Welsh exporters face new barriers to trade with our nearest and most important market. We offer practical assistance to partners to adapt to new trading environments and find new opportunities for the future.

Thank you for that answer, First Minister. This time last year, the Counsel General told this Senedd that the Welsh Government would maintain or improve EU standards. That commitment is imperative if we are going to erase the continued Brexit burden facing Welsh exporters. At the UK level, we must make Brexit work, and some sort of regulatory alignment for food products and sorting out the Northern Ireland protocol is urgently necessary. The Labour Party has set out how it would do that. But, today, could you comment on the positive news that export values by Welsh businesses have recovered beyond pre-pandemic levels, and indicate how the Welsh Government will help exporters to continue in that vein this year?

Llywydd, can I begin by welcoming the reports that have been seen today of progress in discussions between the UK Government and the European Commission on the Northern Ireland protocol matter? At the heart of that will be the issue of regulatory alignment, to which Joyce Watson has referred. In order to be able to make sure that Welsh exports get unfettered access to the European Union market, our European Union neighbours will need to know that the standards of those goods do not undermine the rest of the single market. So, if progress has been made in the way that's been reported, I certainly welcome that, and it would, I hope, prefigure a different approach to the whole relationship that the United Kingdom needs to have with our nearest and most important market.

As far as Welsh exports are concerned, I thank Joyce Watson for drawing attention to the fact that the value of Welsh exports has recovered beyond pandemic levels. It's a real tribute to the activity of those who work in this field, because the barriers have been real and the barriers continue to exist. Just one word of caution on the figures themselves, Llywydd, which, of course, is that the cash value of exports has been driven up by inflation as well as by the volume of exports. So, there may be a small amount of gloss on those figures that we will need to take into account.

The Welsh Government will go on supporting our exporters in the first half of this year; there are 15 different trade missions planned between now and the end of June. Some of those will be sector specific; there are food trade missions, there are trade missions in the field of games development, which has become such an important part of the UK economy, there are trade missions in the field of aerospace as well as multisector missions. They will go to Dubai, to the United States, to South America, to Japan, to South Korea and to a series of destinations in Europe. And the Welsh Government's support to our exporters will be there to make sure that the success to which Joyce Watson has drawn our attention can be continued from last year into the first half of this.

14:20
Public Transport Connectivity

7. Will the First Minister provide an update on Welsh Government action to improve public transport connectivity from Swansea? OQ58897

I thank Mike Hedges, Llywydd. The creation of the South West Wales Corporate Joint Committee is key to improving public transport connectivity between Swansea and its partner authorities. That committee has met regularly in 2022, and Welsh Government officials will meet leaders of the CJC next week to take forward development of a regional transport plan.

I thank the First Minister for that response. The published rail timetable for December 2022 didn't have the 15:12 service from Llansamlet— this was added after I raised concerns under business questions. An issue I've raised previously is that First Cymru terminated the 33 bus in Frederick Place, which is 300 yd from Llansamlet station, which, in Swansea, can be a long way in the rain. What discussion has the Welsh Government had on the reintroduction of the X10 Swansea to Cardiff bus service and on an integrated train and bus service with one ticket for bus and train transport?

Well, Llywydd, first of all, I congratulate Mike Hedges on the success of his lobbying efforts on behalf of his constituents in Llansamlet. I know that Transport for Wales, who are responsible for the rail service, of course, that he mentioned, are working hard to try to make sure that there is an increased range and availability of integrated tickets to make it easier for people to make journeys by public transport. In the end, individual bus services under the current system remain the responsibility of individual operators. We know that the system, over many years, has put profitability before passenger need, and that is why this Government will bring forward a bus Bill in front of the Senedd to make sure that we have a different approach to the organisation of bus services in Wales, one that allows us to put people before profit and make sure that the extensive sums of money that the public invest in bus services in Wales reflect the public interest. Then we may see fewer of the sorts of difficulties that Mike Hedges has drawn our attention to this afternoon. 

Betsi Cadwaladr University Health Board

8. Will the First Minister make a statement on the critical internal incident within Betsi Cadwaladr University Health Board? OQ58933

On 19 December, an internal critical incident was declared at the board in the face of rising COVID pressures, rising flu numbers, public concern about strep A, a nurses strike on 20 December and an ambulance strike on 21 December. Declaring an incident of this kind triggers actions designed to reduce the pressures on the system, as seen elsewhere in Wales and across the United Kingdom.

We've had two incidents of this kind in the space of a fortnight in north Wales—two internal critical incidents. And I can give the First Minister an assurance that it does feel to be critical within Betsi Cadwaladr University Health Board day upon day, for patients waiting a long time for treatment, for staff who are working under huge pressures and for ambulance workers who've had enough of queuing outside of hospitals. And if the First Minister's defence is that these are problems that exist in all parts of Wales, then let us remind the Senedd that this particular health board has been in some level of raised intervention for almost eight years. Now, yes, we need to tackle NHS problems across Wales, but I again ask the First Minister, whilst he's trying to do that with his health Minister, will he look at a new pattern of delivering healthcare in north Wales? The board is too large, it is too unwieldy, people have lost faith in the board, and we need to press the reset button in order to provide healthcare in a way that I'm afraid Betsi Cadwaladr University Health Board cannot currently do.

Well, I hear what the Member says, of course. The only point that I have to make is the point that I have made when I have responded to the suggestion last year. To reconsider everything in north Wales, to put north Wales into a situation where there is uncertainty in everything that lies behind the health service—I don't think that that is going to help anyone who drives an ambulance or anyone who is waiting for treatment in north Wales. 

There are important things that need to be done in the north of Wales. I don’t disagree with that. I don’t disagree that that might involve greater responsibilities being discharged at the different locality levels within the north. But the idea that a wholesale reorganisation is what health services in the north of Wales require, and that that would lead to a solution to the problems that the Member outlined in his supplementary question—. I think that that is guaranteed to make things more difficult, rather than to solve those problems, and it’s not a course of action on which we will embark.  

14:25
2. Business Statement and Announcement

The next item is the business statement and announcement. I call on the Trefnydd to make the statement, Lesley Griffiths. 

Member
Lesley Griffiths 14:26:23
Minister for Rural Affairs and North Wales, and Trefnydd

Diolch, Llywydd. There is one change to this week's business. I have extended the time allocated to the statement on NHS winter pressures to 45 minutes. Draft business for the next three weeks is set out on the business statement and announcement, which can be found among the meeting papers available to Members electronically. 

Trefnydd, can I call for a statement from your colleague, the Minister for Health and Social Services, in relation to the situation at the Betsi Cadwaladr University Health Board? Members will be aware that there was some discussion in the media about a £122 million fraud investigation that is being undertaken by NHS counter-fraud at the moment, alongside a review by Audit Wales—a high-level review—of board effectiveness. Now, clearly, these are matters of concern for a health board that we know was already struggling to perform and deliver its services at a standard that the people of north Wales deserve, and I do think that we need an opportunity to question in this Chamber the Minister on the action that is being taken, in order that we can be confident that it is appropriate.

Can I also call for a statement from an appropriate Minister in relation to the Welsh space industry? I was very pleased yesterday to see Wales’s first satellite launched into the air, at least. It didn’t quite get into space. [Laughter.] It didn’t quite get into space, but there was a successful launch from Cornwall of a rocket from the bottom of an aircraft, which got into the outer atmosphere. As I say, it wasn’t quite met with the success that we had all hoped for, in terms of ForgeStar-0 actually being released, but I do think that there is a growing interest in space as an opportunity for our economy here in Wales. We know that there are plans in Llanbedr in north Wales with Spaceport Snowdonia as well, and I think that this growing interest is something that Wales should capitalise on as soon as possible in order to make sure that our economy benefits from it. I do think that it’s time that we had, given the events of last night, an opportunity to consider it further in the Chamber. 

I should note that I saw a meteor in the sky last night as well, over Cardiff, which was quite exciting. I don’t know if anybody else noticed it, but if you get on to Twitter and put 'meteor Cardiff', you will see, on people’s ring doorbells and the like, that many people had been able to witness this ball of fire in the sky, which was quite exciting to witness on my way to Wetherspoon’s last night, at about 8 p.m. [Laughter.]  

Thank you, Darren Millar. In relation to the first issue that you referred to, with Betsi Cadwaladr University Health Board, you will be aware that there is a process to go through, and I'm sure that the Minister for Health and Social Services will update us at the most appropriate time, but I do not think that that will be before next month.

In relation to your second request, it would be from the Minister for Economy. I will certainly ask him if there is anything that he thinks is worthy of an oral statement to update us on the Welsh space issue. You are quite right—I didn't see the meteor because I was actually watching the news, where a lot of people in Cornwall were getting incredibly excited about this rocket going up. As you say, it didn't end in the way that we would have wished. 

I was just thinking, what did you see on your way back from Wetherspoon's if you managed to see a meteor on your way to Wetherspoon's? [Laughter.] Anyway, I'll leave that to the imagination. Delyth Jewell. 

14:30

Diolch, Llywydd. I'd like to request a statement, please, outlining whether legislation in Wales covering homelessness is sufficiently compassionate. Just after Christmas, I was made aware of a homeless man who'd sought help from a Catholic church in my region. The man had been released from prison and he'd lost his flat. He'd approached social services and Cornerstone, and he was given a tent and a sleeping bag and told that they would see him after the Christmas break. The parish priest housed him over Christmas in a hotel at his own expense before the man came back to stay in the church shed. Now, the priest, I know, asked the authorities whether a tent over Christmas really fulfils society's duty of care for the vulnerable, and I have to say I share his alarm. Is that really the society that we are? Can a statement please outline what support is expected to be given to everyone presenting as homeless and set out what would need to be done to raise awareness and to remind local authorities and support services across Wales of those responsibilities please, and to ensure that more desperate people, in the depths of winter, aren't left to just make do with a tent?

Thank you. I think you raise a very important point about compassion. And I too attended, in my own constituency, a group of homeless people who were very worried that they would be given a tent. And I was very pleased to be assured that would not happen, but, clearly, you give an example of when that has happened. Obviously, the legislation around homelessness, particularly in relation to people coming out of prison, has been updated over the years. I don't think there is anything new for the Minister to give us an update on, but I will certainly ask if that is the current position. 

Trefnydd, I'd like to hear from the education Minister about what is being done to address misogynistic ideology in the classroom. The case of Andrew Tate has lifted the lid on a pervasive, toxic and dangerous culture that is targeting vulnerable boys in particular. And it's endemic. I must confess I'd not heard of him until the current legal case, because I'm not on the platforms or algorithms that promote his hate speech. But his influence among younger men and boys is astonishing. He was the third most searched person online last year, after the late Queen and Donald Trump. His videos have gained more than 12 billion views on TikTok. I'm extremely anxious to know what is being done in our schools to safeguard girls and to encourage all students to question and challenge the misogynistic content that they're being exposed to. Because if society doesn't address the problems facing boys and young men today and help them answer the questions of what it means to be a good man, then predatory people like Andrew Tate will. 

Thank you. I think you raise a very important point, and, like you, I had not heard of this man. It was absolutely horrific what was coming out in the news at the time this story did hit the media. I think we need to be very, very clear that we need to ensure that we protect all children and young people, and, in particular, boys, from harm and influence from individuals on abusive and unhealthy relationships. All education settings in Wales have a legal duty to ensure that children have access to a safe learning environment, and I know the Minister for education expects those safeguarding responsibilities to be taken very seriously. You'll be aware of Hwb's dedicated 'Keeping safe online' area, and the guidance and the tools and the training on a range of online safety issues are available for schools to access. 

Thank you, Llywydd. Happy new year, everyone. 

Two statements, if I may, Llywydd. Further to written correspondence from yourself, Minister, I request a statement on Natural Resources Wales's astonishing increases in regulatory fees and charges. As you will know, the proposed charge for the disposal of sheep dip is set to rise tenfold, with NRW providing no evidence to underpin this increase. Also, the charge for standard rules permits for on-farm anaerobic digestion is set to double, and water resources fees are set to increase from £135 to over £6,000—a percentage increase of over 4,500 per cent.

What is missing from these price increases is transparency as to how these figures were calculated. Is NRW looking to make a profit from fees and charges, or are they cost-neutral? The unintended consequences of these charges will curb the advancement of new tech, hinder the industry's delivery of net zero and significantly impact animal health. Given these concerns and those of the agricultural sector, an oral or written statement on this matter would be much appreciated.

Secondly, noting Welsh Government business tabled up until February 7, the annual bovine TB eradication statement still has yet to be tabled. Therefore, I would like to reiterate my call from November for an updated statement on the Welsh Government's bovine TB eradication programme. Diolch.

14:35

Thank you. I haven't seen your correspondence, but that could be because NRW falls within the portfolio of my colleague the Minister for Climate Change, Julie James, so it may have been transferred over to her. But obviously I'm very aware of the ongoing Natural Resources Wales consultation regarding their regulatory fees and charges for 2023-24. I think the whole aim of that review is to ensure that NRW achieves full cost recovery, with some of the current charges having not been reviewed for many years. But obviously I fully appreciate this is a very challenging time for all our farmers and I'm aware of the concerns within the agricultural sector. So, what will happen after the consultation is that those proposals will go in front of the Minister for Climate Change prior to implementation. But it is the responsibility of NRW to recommend the appropriate fee structure to Welsh Ministers.

In relation to the TB eradication programme, I actually have a meeting tomorrow, and I will be tabling a statement as soon as possible.

Trefnydd, as you will be aware, next month will mark three years since the devastating flooding as a result of storm Dennis, which particularly affected South Wales Central. The subsequent report by Natural Resources Wales outlined that one of the biggest challenges they were facing in responding to flooding was capacity, due to being under-resourced in terms of staff. A report published by Audit Wales just before Christmas outlined that this was a continued problem, and stated that greater urgency is needed to deal with the challenges facing flood risk management. I'd therefore like to request a statement from the Minister for Climate Change, responding to Audit Wales's report, outlining how the Welsh Government will be taking forward the recommendations made.

Thank you. I'm assuming that the Minister will be currently considering the report that you refer to. You will have heard the First Minister say in his question and answer session that we've put significant funding once again into our flood risk management programmes, and it is really important that our local authorities and NRW have the staff to be able to implement all schemes.

Good afternoon, Minister. And also

happy birthday to you too.

Just to embarrass you. [Laughter.]

Could I please ask for a statement from the Minister for Climate Change regarding the measures being taken to reduce pollution in the River Wye, and what the Welsh Government's position is on calling in decisions on intensive poultry units? As a resident of Hay-on-Wye, as you will know, I'm very passionate about the river, as I know many other people are as well. We know that there are three reasons for the pollution in the Wye. They are farming and agriculture, industrial pollution and the issues around storm overflows. Whilst I support farms and farmers to diversify, in Powys, there is certainly a growing concern around the intensive poultry units and those growing in terms of numbers. And there is one that is being proposed, as I understand, now in Builth Wells, for 100,000 chickens. So, therefore, I would be very interested in what the processes are around planning and also around the calling in of decisions by the Welsh Government. Thank you. Diolch yn fawr iawn.

Diolch. As you're aware, Welsh Ministers did issue a direction on 5 January in relation to a specific planning application on a poultry farm, and that direction does prevent the granting of planning permission until Welsh Ministers have been able to assess whether or not the planning application should be called in or not, and such directions, as you know, are issued routinely where a Welsh Minister does consider a call-in. At the moment, obviously, nothing further can be said about that specific one, but I know this is an issue that the Minister is looking at very closely, in particular to Powys.

Trefnydd, I'd like to ask for two statements—one from yourself, on the defective regulations that we put through here on 13 December, the Trade in Animals and Related Products (Amendment and Legislative Functions) and Animal Health (Miscellaneous Amendments) (Wales) (EU Exit) Regulations 2022. You stated on 13 December that you'd come forward as soon as possible to amend those to make sure we get good legislation on the statute book. Could you please update us as to when you intend to do that?

My second Welsh Government statement that I'd like to ask for is from the Deputy Minister for Climate Change on the shambolic home to school transport changes in the south of my constituency by Powys County Council. Children have been left in the rain, left on the side of the road, told to catch service buses that arrive late or arrive too early. We've had young children told to hang around outside the school for an hour and just to get on with it, and in some cases they've been put on service buses that are going completely the wrong way to where they're supposed to go home because of poor timetabling. Trefnydd, the Liberal Democrats in Powys County Council have lost control, so I would like to ask for a Welsh Government statement on what Welsh Government can do to get control of Powys County Council to make sure that no more young children are left on the side of the road in my constituency.

14:40

In relation to your first point, I will be amending the legislation as soon as possible. You'll appreciate this is the first week we are back after the Christmas break, but I do intend to continue to bring forward that amended legislation as soon as possible. 

I certainly don't think that is the case with Powys County Council, but I do suggest you write to them around your specific point.

This morning, the weather was atrocious. In the downpour, I walked to the train station. Luckily, it's only five minutes away from my house. But, in other parts of Bridgend county, too many kids had to walk over an hour to get to school, no doubt arriving soaking wet. I first raised this in September 2021. Nothing has changed. This barrier to education in still in place. So, I would like to ask for an urgent statement from the Government outlining their plans to tackle this. The Government has discretionary powers it can use. Parents are simply fed up.

Thank you. As I say, this is a matter for local authorities. I don't see that this is an issue for Welsh Government. I would give you the same advice as I've just given to James Evans; I think it's really important you raise it with your local authority.

May I ask the Minister for Education and Welsh Language to make a statement on how the Government intends to ensure timely Welsh-medium assessments for children who require an autism assessment? I have a few cases in my constituency of children who require Welsh-medium autism assessments but who are having to wait years. For example, Rhodri—not his real name—who is eight years old was referred in February for an autism assessment. The option of an online assessment with the Healios company was offered, and the first assessment was held yesterday. Welsh is his mother tongue, and the assessor decided that the next assessment should be undertaken in Welsh to ensure the fairness of the result and that such an assessment could be swiftly arranged. Today, however, I understand that the only assessor available to do this work is away on maternity leave, and the case was referred to the local neurodevelopmental service. The result of all this is a wait of two or even three years for a face-to-face assessment in Welsh. The difference in the service offered to those who wish to access a service in Welsh is wholly unacceptable. So, I'd be grateful for a statement on how the Minister intends to remedy the situation as soon as possible, please.

Thank you. I think the situation you set out is indeed wholly unacceptable. If there's only one member of staff who's then on maternity leave, then obviously I appreciate they can't just get somebody in at very short notice. However, a wait of two to three years for such an important assessment is clearly too long. I will certainly ask the Minister if he's aware of the issue that you raise—I'm assuming it's up in Betsi Cadwaladr University Health Board—and have a discussion with the Minister for health to see if there's anything further we can do.FootnoteLink

Can we please have a statement from the Minister for Climate Change to update us on the proposed and long-awaited bypass for Llandeilo? The page summarising the status of the project on the Welsh Government website did pledge that the Government would recommend a favoured option from the four options remaining as part of the WelTAG stage 2 consultation by the winter of last year. But, on Friday, this was changed to the spring of this year. This further delay of some months comes after delay upon delay. The WelTAG stage 2 process looking into just four options has taken four years. The original pledge to build the bypass goes back seven years, and the people of Llandeilo have lost all faith and trust in that pledge. So, can we have a statement as a matter of urgency from the Minister to inform us of the reasons for these further delays?

14:45

Thank you. Well, that would be for the Deputy Minister for Climate Change, and, as you know, the whole road review and road building programmes have been looked at very closely, but I will ask the Minister—Deputy Minister, sorry—to issue a written statement. 

3. Statement by the Minister for Health and Social Services: NHS Winter Pressures

The next item, therefore, is item 3. That's a statement by the Minister for Health and Social Services on winter pressures on the NHS, and I call on the Minister to make her statement—Eluned Morgan. 

Diolch yn fawr, Llywydd. Thank you for the opportunity to update Members on NHS winter pressures. Members will appreciate this winter is proving to be particularly challenging for health and care services across the United Kingdom. This is our third winter of living with COVID. While we knew respiratory viruses would become more prevalent this year, the disruption of seasonal patterns has made the likely impact of these viruses much more difficult to predict. Despite this, we are still delivering around 376,000 consultations and procedures a month in secondary care, in hospitals. In December, we reached about 400,000 contacts in GP and primary care services. So, every single day, every week, there are thousands of people receiving excellent care in the NHS in Wales, but what we do accept is that there are many others who are not receiving the care that they deserve.    

We have asked a lot of our staff over the last two and a half years, and we know pressures have meant staff have often not been able to consistently provide the level of care that they want. We also recognise the strength of feeling amongst our workforce, as reflected in the announcement of further planned strike action amongst ambulance unions, as well as the continuing action by the Royal College of Nursing. It's important to note the impact on capacity as a result of recent industrial action, and that has placed additional pressures on our systems due to reduced staffing and, in some cases, limited or no availability of certain services during these periods.

We are dealing with an increasingly complex case mix of patients. We have more than 500 confirmed patients with COVID in our hospitals and we're seeing rapid increases in other respiratory viruses. In addition, other groups of patients are presenting with increased levels of serious illness, and, while the position has improved since Christmas, there are still over 900 people in hospital beds who are ready to leave but have had their discharge delayed for various reasons. Sickness absence rates among staff have also increased to 6.9 per cent. The result is greater prevalence of long delays for people trying to access care, and the risks of harm we know are associated with such delays. As a consequence, the experiences of people seeking urgent and emergency care across Wales have not always been to the standard that they deserve, and for that I am truly sorry.

We went into the winter having seen record levels of demand on the 111 and ambulance services in October and November, with every expectation that these pressures would increase further throughout the winter. But let me give you an example of the extreme pressure that we saw on our services on 27 December: the 111 telephone service received the highest number of calls ever reported for a single day; the ambulance service received 210 immediately life-threatening calls, amongst the highest daily figures on record. We think 100 is high, and we had 210 on that particular day. As the First Minister said earlier, over 550 people were admitted to hospital in one day. That's the equivalent of around 5 per cent of the available bed capacity in Wales. There were 551 COVID patients in acute hospital beds, which is over 5 per cent of total bed capacity, and around a further 3 per cent of beds were occupied by patients in hospital with influenza. There was also the equivalent of 12 per cent of the total bed capacity in Wales taken up due to delayed discharges.

Now, this level of pressure, at a time when staff illness and absence have had a significant impact, has created massive challenges for the system. Planning for winter started as early as April. We’ve worked hard, every fortnight meeting with local authorities to secure over 500 extra community beds for step-down care, and we’re working towards more over the coming months, which will help improve flow throughout the health system.

We must learn from the recent weeks and months, and we are committed to working with clinical leaders and professional bodies to support meaningful service redesign. We know one of the biggest challenges the health system faces is helping people to leave hospital as soon as it's safe for them to do so. Last month, I launched a new discharge planning guidance report, which sets clear expectations for health boards and regional partnership boards, and that is supported by a national flow programme. In April, we made a five-year commitment of £145 million through the regional integration fund to enable regional partnership boards to build on models of care developed to support rapid discharge and admission avoidance.

We’ve also made significant investments in urgent and emergency care this year, and if we hadn’t, the situation would be a great deal worse. Thanks to early investment made available in June, the Welsh ambulance service has been able to deliver a range of actions to increase capacity ahead of the winter. This includes recruitment of 100 additional front-line staff, who will be responding to calls within the next two weeks; new rota arrangements, which will equate to 72 whole-time equivalent staff; and new investment in triage and video consultation technology to support more confident decision making about whether a patient needs to be taken to hospital.

We have also invested in increasing capacity in urgent primary care centres and in expanding same-day emergency care services to provide people with alternatives to attending busy emergency departments, or admission to hospital. These interventions have supported around 7,000 people a month to access urgent care services away from the emergency department, and have helped to reduce and stabilise emergency admissions.

We know there is a lot more to do and there are no quick fixes. We share the public’s concern that our services remain under extreme and persistent strain. This is why we have established a five-year programme to transform urgent and emergency care services, which is supported by £25 million per annum, of which health boards received £3 million each in April. In addition to these interventions, and as the winter has progressed, we’ve issued further guidance to health boards through a revised local options framework similar to the approach we took at the peak of the COVID outbreak. We’ve also written to health board clinical leaders urging them to make every effort to keep people at home, and not to admit people to hospital unless absolutely necessary. Last week, we held a national discharge summit, and we have also asked clinical teams to return those in hospital to their homes or to an alternative place of safety as quickly as possible to help preserve our hospital capacity for those at greatest risk, and with the greatest chance of benefit.

We can expect the next few months to be really tough, but I really want to express my thanks and gratitude to staff for their continued efforts during what continues to be a really difficult time. Thanks also to families who have supported the discharge of their loved ones; this is going to really help us free up hospital beds for people who need the specialist care that only our hospitals can provide.

We’ve made extensive preparations for the winter, and whilst we have seen tremendous pressure over recent weeks, at levels we've never seen before, the actions that have been put in place have enabled us to broadly stabilise the position since the festive period. We’re now preparing for the next phase of pressure as children return to school and as life begins to go back to normal after the Christmas break, as well as changes in the weather, which we know often bring a new surge in the demand during this time of year. Thank you very much.

14:55

Happy new year, Minister, to you and thank you for your statement today, and I'd like to start by adding my own thanks and appreciation to our incredibly dedicated and hard-working Welsh NHS staff and professionals. Minister, over the last decade, your Government has failed to invest more than £400 million in the Welsh NHS compared to other Governments across the UK. Whilst COVID has caused significant harm to our NHS, your Government, of course, has been responsible for the Welsh NHS for nearly 25 years. So, do you accept that if you had used the funding correctly, we'd be in a better position than we are in now? And, to use a cliché that I don't like using, but I shall say it in this regard, why didn't you fix the roof whilst the sun was shining? 

Minister, you claim that planning for winter pressures started in—[Interruption.] I can hear the First Minister talking away. It was the First Minister in his statement yesterday to the press who told us that the first 10 years of devolution were wonderful under a Labour UK Government. So, if that's the case, why didn't you fix the roof then? Why have we got these problems that exist now?

Minister, you claim that planning for winter pressures started in April, but I'm concerned, as I relayed at the time, that the publication of the plan to tackle these pressures was late in coming forward. And it is clear that the process, I would suggest, isn't working. So, can I ask you what is it going to take for health boards and your Government to review the impact of winter pressures, and what immediate action can you take to fully utilise the summer months to prepare for another winter? 

Minister, I do welcome your points on the ambulance service—that's very welcome—but I do feel that they don't go far enough. In your last update, you told me that you will be making sure ambulance handover delays are reduced, but the chief executive of the Wales ambulance service, Jason Killens, said it is now not uncommon for in excess of 30 per cent of our available crews to be tied up outside hospital waiting to hand over patients to care, which means that they're unable, of course, to go back to support patients in the community, resulting in longer waiting times for them to arrive. So, what progress have you made in this area, Minister, because Wales continues to have, as we know, the slowest ambulance response times on record and the worst A&E waits, and the longest NHS treatment lists in Britain? 

I have given you a number of suggestions, Minister, for developing different areas. One is winter war rooms, and I would suggest we need winter war rooms that have 24/7 data-driven control centres to provide accurate information on bed capacity in hospitals and care homes, run by clinicians and experts who can identify pressure points and act to reduce deadly ambulance delays and lengthy waits in A&E. I wonder what consideration you've given to this policy, Minister. 

You talk about a five-year transformation plan. I kind of sigh when I hear about transformation plans. It's not that I disagree with transformation plans, but, since I've been here, I've heard about transformation plans over the past 10 years, but then we don't see the outcomes that are delivered from those transformation plans. I do wonder whether there's a lack of cultural change within the Welsh Government and a lack of trust in innovation that will only further add to the issues that we face within the Welsh NHS. 

Minister, you know I've constantly called for surgical hubs. We've got more than 50 further hubs in England coming, in addition to the 91 that are already in place. We're falling further behind in this regard. I welcome the addition in your statement, that you apologise to patients for the quality of service that they are receiving, however, I can't help thinking that we should have just been preparing—you should have been preparing—during the course of the pandemic for post-pandemic progress, and I wonder if you could update us, Minister, on your plans in terms of starting to build the hubs that I and my colleagues have been calling for. It's not just me saying that; the Royal College of Surgeons welcome the announcement of those surgical hubs to end the limbo that patients face. Minister, I'll end my questions there. 

15:00

Well, thanks very much, Russell, and a happy new year to you as well. Just in terms of how we compare to England, and I think it's really important, let's look at the figures here, because the Nuffield Trust—this is not us as a Welsh Government—the Nuffield Trust tells us that we spend more on health and care than they do in England, okay? So, if you look at the figures in Wales, we are spending 5 per cent more than England—that was pre COVID—and 30 per cent more than England if you include social care. So, don't talk to us about spending more compared to England. We are doing that; we do need to do that because we've got an older and sicker population. But the fact is it's really important that we talk, not just in general terms, but let's look at the facts, not produced by us but by an independent, acknowledged expert group. Part of the reason we're in this situation—and if you want to start playing politics, I'll play politics as well—is that we have had 10 years of austerity and that has starved us, compared to what was going on previous to that under Labour. It was a policy. It was a deliberate policy. Austerity was a policy. And do you know what, the real frustration of those people who are on the front line today—[Interruption.] The real frustration is that they were promised, they were told, 'Take a dose of austerity, but it'll be okay at the end of that', and the problem is that that bargain has just been broken, and that is part of the reason we're in the situation we're in today. And if you look at the number of GPs we have in Wales, we have more. According to the Nuffield Trust, we have 63 per 100,000 compared to 57 per 100,000 in England.

And you talk about preparing. My God did we prepare for this winter. We spent months and months and months preparing for this. And you talk about planning: we have planned. We had a transformation plan, we had the six goals for urgent and emergency care, and as a result of that, we now have the 111 service that has been rolled out across the whole of Wales, diverting only 20 per cent of the people who call to emergency services. Just imagine how many of them would have gone directly to A&E before. We have urgent primary care centres across the whole of Wales, we have same-day emergency care centres, we have pharmacies and we have—. And we've done this week after week. Every fortnight, Julie Morgan and I have been meeting with the leaders of local authorities to prepare for these 500 additional beds that are in the community. This is not something we've thought up now. They made an announcement yesterday in England on this. Yesterday. That's not going to be ready for months, because I can tell you that we have worked really, really hard to make this happen. They are in place in Wales. Proportionately, they're not nearly as ambitious as we have been in Wales. Not just ambition, but we've already delivered them and we are going to be delivering more. And do you know what's more? Do you know what's more is that, actually, we've now got health trusts in England asking to come and see and to learn from our six goals for urgent and emergency care? That is the reality in terms of us being prepared, and we have got a transformation plan. It's not going to be switched overnight, but it is already making a difference.

And you ask about waiting lists: well, just before Christmas, I'm sure you were as pleased as I was that, at last, the waiting lists are going down in Wales. They had gone down for the first time since the pandemic, and they're going up in England. Let's just be absolutely clear—[Interruption.] Let's just look at the facts—and I'd suggest that you go and do that.

You talk about winter war rooms, well, I can tell you, I feel like I'm in a constant winter war room when it comes to the NHS. Every fortnight we've been meeting to identify where exactly in the system the blockages are, what are we going to do about it, what do we put in place. I spent the day in the Heath hospital last Friday. It was fascinating to watch them identify exactly, 'Right, where is the problem, how do we get these people out, what is the blockage?' So, there's a lot of that that's already going on, and I can tell you that there is very sophisticated data that is being used to make sure that we improve the situation.

You keep on banging on about surgical hubs. I've been to the surgical hub that already exists in Abergele; I've been to the surgical hub that already exists in Llanelli; and I've been to the surgical hub that already exists in Cardiff, in the Vanguard hub where they're doing ophthalmology. They're happening, they exist, and they're seeing patients already. So, we are on it; it is happening. There's a long way to go, but it's really important, I think, for people to understand that we are getting through these waiting lists, and ours are going down while they're going up in England.

15:05

A very happy new year to you all. Clearly, it hasn't been a good start to the year for the NHS. I can only thank the staff for their work in circumstances that are becoming more and more impossible. 

This is not the statement that I had expected today; it's not the statement that I think the people of Wales needed to hear. This isn't a plan; this is a status report. It's a report on what Government has been doing to try to get the NHS ready for winter, to try to deal with current pressures, but frankly we know that what this Labour Government has done hasn't worked. What we want to know is what they're going to do differently. The results of the crisis are plain to see for patients; they're plain to see for staff. But where's the change of direction? In fact, where's the kind of action that shows that the Government is in genuine crisis mode here? Because this was only going to be a half-hour discussion—a half hour on what's clear from my postbag, and, I'm sure, everybody else's here, is no doubt the biggest health crisis, other than COVID itself, of course, that we have witnessed.

What I'm seeing is a Labour Minister finding blame for the crisis rather than suggesting new solutions to it. She has the audacity, frankly, to appear to blame the nurses, saying that their industrial action has placed additional pressure on systems, when it's pressure on them, on the nurses and others, together with a decade-long pay squeeze, that led them to vote to strike. And whilst I absolutely agree with the Minister on the injustice of the Conservative years of austerity, she has to recognise that this is Welsh Government's fault. Does the Minister recognise that the failure to support staff in particular is Welsh Labour Government's fault?

She points to the delayed transfer of care figures as a cause of lost capacity in the system, but it's her job to create that capacity. What we need is a more ambitious plan, frankly, to speed up patient flow through the health and care system. She mentioned today the creation of 500 extra community beds. That's positive, but we've lost thousands of beds. I wrote to her some weeks ago, asking for work to be done on the possibility of setting up COVID-style temporary community step-down facilities. The First Minister—rather patronisingly, I thought—said yesterday that those suggesting that are well-meaning, but that the problem is a lack of staff, not beds. Well, (a), it's both, and, (b), Welsh Government is responsible for both: both bed numbers and staffing capacity. And, frankly, woeful workforce planning, plus of course the current lack of meaningful engagement on resolving industrial disputes, is making staff shortages worse. Does the Minister recognise that the failure to resolve delayed transfers of care is the Labour Government's fault?

I have a few other points that I want to question you on briefly. It's clear that the combination of COVID and flu is causing problems. There's a target of vaccinating 75 per cent of everyone offered a vaccination. Only some 41 per cent, as I understand it, of healthcare staff have been vaccinated—41 per cent of those who are most vulnerable. Does the Minister accept that the Government is failing by a distance in reaching its targets in terms of the numbers that need to be vaccinated for COVID and flu?

I have to turn to preventative measures again. The Minister again refers to work that is being done in this area: £145 million, a five-year programme in order to actually avoid people having to go to hospital. But, the way of doing that in the long term is to make us a healthier nation. Where is the investment? And whilst I, of course, appreciate that funding is tight today, where are the plans to make that major investment in order to transform our attitude towards preventative and to take pressure off our health service in that way?

And finally, Llywydd, although winter pressures is the subject of this statement today, we now know, don't we, that there are pressures throughout the year; that's the case now. We must ensure that there is scope within the health service to flex, if you like. The health service should be running at something around 85 per cent of capacity. It seems to be running at 100 per cent, 110 per cent and 120 per cent of its capacity all the time. Can the Minister tell us when the NHS in Wales was running at around 85 per cent of its capacity last? And does she accept that it's the fault of the Welsh Labour Government in terms of failing to generate that capacity within the system?

15:10

Thank you very much. First of all, I think it is important to recognise not just what we've done, but what we intend to do. And you're quite right, just to give you some ideas of where we're going to be going next, we're going to be making sure that we try and expand the number of hours that those urgent primary care centres are open, so that will divert more people out of those normal hours. Certainly, what I was hearing from people in A&E last week is that, actually, the difficult time is when everything else is shut. So, opening those primary care centres for longer hours would be important. The same thing in relation to same-day emergency care centres. So, that's something else that we're working on.

We have those 100 new ambulance workers that are coming on stream this week and next week. So, that will make a big difference. And, of course, we will be pushing ahead to try and create more of those community beds on top of the 500 that we've already delivered. This is not easy stuff, because you still have to find people. Staffing is the big challenge, particularly when it comes to care, and that's why we have committed to making sure that we keep up with the real living wage as the No. 1 priority in our budget when it comes to health and social care.

Industrial action. Let's be clear: industrial action is going to lead to pressure on the NHS. That's the purpose of a strike, to make sure that people feel a bit of tension and to make their voices heard. So, I don't think I should apologise for that—I think they'd be a bit worried if they didn't think it was having an impact. I think it's really important that one of the issues that we will be discussing, I hope, with the unions later this week is a discussion around the pay review body, the independence of the pay review body, and what we can do to build more confidence into that. We've got to be very careful with this, because if we go away from that, then you're going to get into regional pay and that may not work out the way that some people would like to see in Wales. But I do recognise, I think, there are some issues that we need to look at in relation to the pay review body: when you take the temperature of inflation, for example. So, we saw inflation shoot up after the Ukraine war, and that didn't happen until about February. The temperature was taken of the NHS in terms of pay, inflation, in March/April, and that was at about 6 per cent. Well, now, of course, we know it's well over 10 per cent, so I think there are issues there where we need to see what more can be done in relation to the pay review body.

When it comes to beds, step-down facilities, I'm afraid I'm in the same place as the First Minister: there's no point in creating beds if you can't create the staffing that goes alongside them. One of the real challenges we've had in delivering these 500 extra beds is that, as soon as we're appointing people, some of them are leaving. So, we're losing people before they actually get to the job. This is the challenge. So, this is why I find it fascinating that, only today or yesterday, the UK Government think they're going to fix this for winter. That's not going to happen, because we have found this incredibly challenging, even to deliver on those 500 additional beds.

But there are other things that we can do, and one of the things, I think, we can learn from is the models that are happening in terms of hospital at home. So, it's great to see that's already happening in Cardiff: monitoring 60 people at home who would otherwise be in hospital, making sure that everything is available to them and, if there is an issue, that you can send somebody out to them. We're going to have to embrace new technology. We're going to have to do things differently as we become an ageing population with more complex needs.

We are employing more staff than we've ever employed in the NHS before. We employ now 105,000 people in the NHS in Wales. We are employing more nurses than ever before, so we are recruiting more than we're losing. I think it's really important for people to recognise that: that actually we are recruiting more than we're losing, which is not enough. We know it's not enough, and we know we need to do more, which is why we've seen a huge, huge increase in the number of people we are training with Health Education and Improvement Wales and others. And that's why we've given an additional sum to HEIW in the budget: £265 million to train the next generation of health workers.

When it comes to the targets in relation to vaccination, I'm very pleased. We had a target to reach 75 per cent when it came to COVID and the over-65s. We've reached 80 per cent. On flu, we're at 74.6 per cent, so we're nearly there, and we're very confident that we'll get to 75 per cent in the next few days. It is disappointing to see how few NHS and care workers have taken up the opportunity, and in particular for the flu vaccine. This is something that I have asked over and over again of the health boards to really promote with their members. It's very, very disappointing that that is the case, and again we would keep on asking them to take up that opportunity.

You talked about prevention. I think it's really important that we all understand that we have a role to play when it comes to prevention. We can all do what we can to keep ourselves fit, to eat healthily, to take exercise, to not smoke. All of those things are things that actually will make a big difference to our ability to provide what we can in the NHS in the future. We all know there's an obesity crisis, and it's something that we really need to address, because actually it will translate into complex care necessary in things like type 2 diabetes.

The other thing, I think, just to be clear, is that I have set out some very clear guidelines in terms of what I'm expecting from the NHS next year, and priorities. They are going to be far more targeted priorities to make sure that we focus our attention on the things that I think matter most to the people of Wales. One of those things that we've made very clear in our report and in our strategy, 'A Healthier Wales', is that actually we need to see more care in the community. We need to get more support out from our hospitals into our communities. When we're talking about discharge from hospitals, for example, a lot of those assessments at the moment are being done in hospitals. The clinical evidence suggests that you should be doing it in people's homes. So, that shift is something that again we'll be pushing the NHS hard on when it comes to them developing their strategies for the future.

15:15

I'm grateful to the Minister for her full statement this afternoon. I think all of us, on all sides of the Chamber and whatever our political differences may be, have a great well of gratitude to everybody who's working in the current circumstances across the national health service and in local government providing social care as well. I think we all recognise the enormous pressures that are on the national health service. We debated earlier, during First Minister's questions, the impact of austerity on the national health service and the ability of the service to respond, given successive issues around funding in the last decade or so. But you also said, in answer to, I think, Rhun ap Iorwerth, that the service itself has got to change to reflect changes in society and changes in need. I'd be interested, at the height of this winter crisis, if you could identify the issues that you're dealing with today that are long-term issues and aren't the short-term issues that we see creating the headlines, and how you believe we should be addressing those fundamental structural issues in the national health service as it approaches its seventy-fifth birthday.

Thanks very much, Alun. Certainly, I think there are major, major challenges for the NHS. It's important that we recognise and talk about them and that that's a conversation we need with the public. This is not something that should remain in this Chamber, because these are going to be really tough decisions that everyone's going to have to live with. So, if you think about the opportunities that are available to us today that weren't available in the past, which are incredible, I saw a baby in the Heath last Friday who was born at 21 weeks—an absolute miracle. And there's no question that that baby would have died in the past. We've got to understand that that's a miracle, it's wonderful, it's because the NHS works that that baby is alive today, but that comes with some choices that we have to make. And so I think we have to have a conversation about where our priorities are within the NHS.

There are also, of course, new developments all of the time. Some of that will be really helpful to us. Digital remote consultations I think are really positive things that have already happened and have transformed the way we deliver care already. But I think the key thing in terms of where the challenges are in future—. I think there are some issues around capital that we're going to have to deal with, how are we going to deliver with the facilities that we've got, but also I think we do have to have that conversation about changes in society. When Aneurin Bevan set up the NHS in 1948, people worked until they were about 65 and they died when they were about 68. And that's the reality. It's great that people live for much, much longer than that, but our structure has not fundamentally changed to reflect that difference.

The missing gap is what do we do within that care space. Obviously, local authorities are doing their very best in that space, but obviously they have limitations also on their economic abilities. So, that is the space, I think, that we need a very challenging conversation with the Welsh public around: what we're going to do to support people in an ageing population with more complex care needs. Because along with an ageing population comes a more challenging situation in relation to what kind of complex cases you're having to deal with. So, we're not just dealing with someone going into hospital, say, with cancer; they might have cancer and diabetes and a bad ear, or lots of things at the same time. And we just have to understand that those are the kind of challenges that we're facing in future. 

15:20

I have a number of Members who wish to question the Minister on this statement. If you keep your questions succinct and effective, then that will enable me to call other Members in your groups later on as well. So, I'll start with you, Gareth Davies, and see if you can do succinct and effective for me. 

As ever. Diolch yn fawr iawn, Llywydd, and thank you for your statement this afternoon, Minister. I wish you a happy new year, and to all Members of the Senedd. Yet again, we're—

Just one thing: thank you for wishing us all a happy new year; that's the last time we need to be wished it. Thank you very much for doing that, but we'll save on time if we all wish each other now a happy new year, smile at each other, be kind to each other, as Jack Sargeant always reminds us in this place, and carry on with our questions. Don't worry, I won't include that 30 seconds in your time allocation. Carry on, Gareth.

Yet again, we're in a situation of talking about winter pressures when we're in the full throes of wintertime, which is a reactive measure rather than a proactive measure, Minister. Any prudent Government would be making this type of statement when the sun shines, when we're wearing shorts and sandals. But I want to focus my question on how winter pressures reflect on care homes. I visited Sandford Care Home in Prestatyn last Friday, where Sean, Nicky and the team do a fantastic job of caring for our most vulnerable and elderly people. But many of the problems they face are as a result of NHS pressures—long ambulance waiting times, delays in discharge—and not being able to fill their maximum capacity of 40 beds because of staff shortages, with the recruitment and retention issues that we're all too familiar with. So, will the Minister outline this afternoon what steps the Welsh Government is taking to address the knock-on effects of NHS pressures on the social care system and ensure that our most vulnerable people in society aren't left behind? Thank you.  

Thank you very much. That was excellent; well done. I think it is important. I hope you have listened to the speech, which demonstrates that we have indeed been very proactive during the summer months in preparing. Obviously, we've never seen anything like the demand that we've encountered over this winter.

When it comes to care homes, I think it is important that we pay tribute to the incredible work that they do in looking after our elderly. Obviously, they're also in a situation where they're encountering long ambulance waiting times. I think it's important for us to recognise that there are times actually where we will need to try and support people in the homes. I've seen some fascinating statistics about, once you go into hospital for a period of more than a certain number of days, how likely you are to die if you're over a certain age. I think it's really, really important that people understand that, actually—. And most people don't want to die in hospital; it's not because they're going into hospital they're dying, it's because they were going to die anyway. So, I think it's really important that we try and understand what is it that matters to the patient, where is it that they'd like to have that compassionate care. Very often, that is in their homes.

I understand, and I know my colleague Julie Morgan understands very clearly, the difficulties in recruiting people in care homes, which is why we have once again acknowledged that we will be honouring the real living wage in the budget in April. That's really important, I think, for us to understand that there is an issue there that needs to be addressed. It's not going to be easy, because there's a lot of competition out there when it comes to jobs, but I think that is an area where we need to work very, very closely with our local government partners to make sure that we are making the very best possible offer, and that we look not just at pay, but also look at conditions around pay as well.

15:25

You say in your statement, Minister, that 12 per cent of bed capacity in the NHS is now full as a result of delayed discharges, and in response to that, of course, you say that you've secured an additional 500 community beds for step-down care. Clearly, that is to be welcomed. It would be good to hear where they are. As a Member in north Wales, I would be interested in hearing how many of those are in north Wales. But of course, we had a network of community hospitals that used to provide exactly this step-down service across Wales. That capacity was lost—the capacity that you are now trying to recreate and rebuild—when community hospitals were closed in Flint, Blaenau Ffestiniog, Prestatyn, Llangollen, and so on.

A number of us warned you at the time that you would regret doing that, because there's always a need for that step-down provision within the system, or—as we're currently seeing—the system is going to have blockages and we're going to end up with a situation where 12 per cent of the bed capacity has suffered as a result of delayed discharges. So, do you accept that it was a mistake to close those community hospitals, particularly those across north Wales? Do you regret that that happened? Because there's no doubt that that's contributing at least a little to the crisis that general hospitals are now facing.

Thank you very much. I'm happy to give you a list of where we found that capacity. The capacity of course is reliant on our ability to collaborate with local authorities in the area, and that's where we've been working with them closely, as well as with the NHS in those areas, too. When it comes to step-down facilities, I do think that generally speaking, people prefer to get the care that they need in their homes, and that's the direction of travel. We must also bear in mind that when it comes to community hospitals, they are very expensive to run. That's something that I've learnt. And if you look at how many hospitals we have in Wales in relation to our population, then I think it's important that we understand that we are in a situation where it is very expensive for us to run hospitals, and that is why stepping into our communities is something that we're trying to get the NHS to do, to provide far more within communities and in people's homes, where most people want to access that care.

Diolch, Minister, for your statement. And as you've already alluded to, there is a role for all citizens to play a part in alleviating the pressure on the NHS, whether it's in terms of our own health management or accessing appropriate services. But what is the Welsh Government doing to support citizens in doing this, and what more could we do as Members of the Senedd in our own constituencies to encourage people to take more responsibility for their own health outcomes?

15:30

Thanks very much. Well, this is an area where my colleague, Lynne Neagle, takes a leading role in terms of public health. We have, of course, got a very clear programme of activity—'Healthy Weight: Healthy Wales'—where we try and encourage people to make sure that they participate, and they understand what healthy food is and how they use it and how they cook it. We've put a lot of support, of course, into our schools. So free school meals have now gone into primary schools; making sure that that is the right kind of food is really important.

So, there's a huge amount that people can do, and, of course, we also give a significant amount of money to Sport Wales to make sure that they are helping in our communities, especially with young people, to get that idea of exercise in as early as possible. And it's great now that we have a relationship with the Football Association of Wales to make sure that we can roll that out across the whole of Wales, making sure that people understand their responsibilities when it comes to health as well. 

Thank you for your statement, Minister. I appreciate that these are challenging times, and, of course, we all thank the wonderful NHS staff who are working so tirelessly. However, Minister, seven health boards in Wales have nearly 1,800 patients medically well enough to be discharged from hospital. The Aneurin Bevan health board in my constituency have said that they have around 400 patients who could be discharged, but they are unable to. This is the second highest amount of the seven health boards. It's becoming clear that the only way that we're going to stop this crisis upon crisis is to reform and drastically improve social care in Wales. 

Minister, the UK Government health secretary has announced a winter package that will allow thousands of NHS patients to be moved into care homes, to enable the release of hospital beds for emergency patients. I understand that £250 million has been allocated to upgrade these hospitals and buy beds in care homes for patients medically sound enough to be discharged. Is this something that you'll look to do in Wales? And, at the end of your statement, you were talking about prevention and you recognised that there might be increased pressures now that schools have returned. From what I understand today, from what I've heard, there are already high levels of staff and pupil absences in Bridgend schools because of contagious illnesses. How are you working with the education Minister and local authorities to perhaps adopt local authority advice for schools to ensure that pupils stay at home when they have contagious illnesses? Thank you. 

Thanks very much. Well, I'm glad that you recognise that there are lots of people who are ready for discharge. It's very interesting that your leader earlier was saying, 'Actually, just be very careful about when you do ask people to leave who are medically fit for discharge.' So, it's about risk, isn't it? It's about where the risk is, and what's important for us is that we do get people out who are ready for discharge and who do have that support at home, so that we can get people who are in urgent need of support in through the front door. And, of, course, I think we all recognise that there is a need for fundamental reform when it comes to social care.

When it comes to winter packages, well, welcome to the party, UK Government. We've been doing this for months—we've been doing this for months. We put £25 million on the table last April to prepare for this, because what we were told time and again was: 'Don't give us that money—' . What usually happens is that it's given in September, which is too late—September is too late. They put that money on the table yesterday. There is no way that they're going to get people—. And you try and find those beds, because, I tell you what, we've been doing it week after week after week. We have been buying up that capacity in care already, in care homes. That's what we've been doing—these 500 beds in the community. That is precisely what we've been doing. So, it's a lovely idea; it's a shame that they didn't think about it earlier, because we are on it, we're delivering it, and I think it's going to take a lot longer—. In fact, they made an announcement in September that they were going to produce 7,000 of these. They've hardly scratched the surface of that, so this is really a rehash of a UK Government announcement that they made in September. 

A constituent of mine fell and broke her ankle recently, and she lives near a large A&E unit in Morriston Hospital and a minor injuries unit in Neath Port Talbot hospital. She went to MIU, thinking that the waiting times would be less. That's something that is guidance on many websites, but it was appointment only. She was told she'd have to go to Morriston and the wait for an x-ray, she was told, would be 48 to 72 hours. She's immunosuppressed, so she knew that waiting in a crowded A&E department in flu season wouldn't be a very good idea and would actually be dangerous for her health. She is now going to have her ankle re-broken and operated on—a problem that could probably have been fixed with a cast. So it's plain to see that the plan hasn't worked. You mentioned in your statement that you will learn the lessons of the past weeks and months. So, what are the lessons for Welsh Government?

15:35

Thanks very much. Well, I'm very sorry, of course, to hear about that individual case. There are examples where people are getting the support in some of our same-day emergency care centres, where they go in, they get an appointment, they know when they're going in, they get the cast done on the same day. I'm sorry that that hasn't happened in this case, but I can assure you that it is happening all over different parts of Wales.

Certainly, I think it is important that we learn lessons. Starting early was a good idea. I think we have to understand that our profiling of our expectations in relation to demand, after the pandemic, we probably didn't organise for quite as many people as we thought may become sick as a result of the flu. It came earlier than we expected, so we probably have to be ready a little bit earlier. And we got our 100 ambulance workers out, and they're ready, but they're ready this week—it would have been great if we had them ready just before Christmas. So all of those things would have been good to have had, to have been brought forward a little bit, but that modelling, it will be interesting, when we have time, to look back on where our modelling went wrong and what is it that's happening. Again, though, we've just come out of a pandemic, we've never been here before, so obviously people's immunity systems are down after a couple of years of not being exposed. And I guess none of us really knew quite how many people would get sick over this particular period. I don't know about you, but almost everybody I know has had some form of flu over Christmas—it's really affected huge, huge numbers of people. And obviously, whilst people like me have managed to get through it, just about, there are people who are much older who have really suffered and have finished up in our hospitals.

Thank you, Minister, for your statement. Every year, we have winter, every year, we have winter pressures, and we've not learned any lessons. The announcement made last week, which stated that patients could be discharged without the need for a care package, raises serious ethical, equalities and human rights concerns. Doctors have rightly condemned this policy as dangerous. What rights impact assessments were made prior to this new policy change? Minister, the Equality and Human Rights Commission made a string of recommendations in its 'Equality and human rights in residential care in Wales during coronavirus' report. Why have you ignored those recommendations and put the lives of older people and disabled people at risk?

Finally, Minister, what steps will you take to ensure that this and any future policy decisions regarding social care are fully assessed in terms of their impact upon the human rights of Welsh patients, and measures put in place to prevent any breaches? Thank you.

Thanks very much. Well, as I say, I think we've learned lots of lessons in the past, which is why we did all that preparation work much, much earlier. And I think the situation would have been a lot worse had we not had those urgent primary care centres, had we not had the 111 service, had we not had SDEC, had we not had pharmacies helping people out, had we not had those 500 extra beds in the community. So, we did do a huge amount of preparation; the demand was much greater than we expected.

When it comes to care packages, I think it's really important, if you look at the academic and the clinical evidence, it suggests that those assessments, in terms of care packages, should be made in people's homes, not in hospitals. It's not me saying this—this is clinical evidence. And so, what's important is that people understand that this is not trying to get a problem off our system into somewhere else, it's actually better for the patient. And on top of that, let's not forget that there's a lot of flu in our hospitals at the moment. People who are old and vulnerable are in hospital, and some of them are catching flu in hospital. We need to get them out so that they don't catch flu. So, all of these things are really important.

When you talk about human rights, I think we've got to talk about the human rights of those people who are having difficulty in getting an ambulance to them. A lot of those people are old, let's not forget. The people who are calling ambulances and who are not getting the service that they should be getting within a required time are old people as well. So, there's no discrimination here. The people who are suffering mostly are older people. So, I think it's really important that people understand that this is about the risk across the whole system. And getting that balance of risk a bit more shared out across the whole system, I think, makes sense.

15:40

I want to make two points and ask two questions, if possible. The Minister said earlier that Wales has more GPs than England. But, I'm concerned that this shows a lack of understanding of the situation that we're facing. The population density of England is far greater than Wales's is. It's far easier to access a doctor when you have 1,000 people per square mile than in south Meirionnydd, for example, when you only have 20 people per square mile and it's harder to access those services. So, that's the first point that I want to raise, and I want to ask whether you accept that there is a need for more investment in health services in our rural areas so that people can access those services they need.

I also note that you've said several times so far that flu and COVID are present in our hospitals. But, as Rhun said earlier, if the hospital bed occupancy rate goes above 82 per cent then these hospital-acquired infections, such as flu, such as COVID, are going to spread. But, occupancy in our hospitals is now over 100 per cent; of course those infections are going to be spread. Of course people are going to suffer, and that's because you haven't invested in the nurses and you've cut the number of beds. It appears that lessons aren't being learnt. One clear way of learning these lessons is by holding an official inquiry into COVID in Wales so that we can know the way forward and how not to make those mistakes in future. Will you now accept that there is an undeniable need for an inquiry of this kind in Wales?

Thank you very much. Just to make it clear, what we're trying to do when it comes to GPs is to ensure that we understand that there are many people who can help, not only GPs. So, increasing the numbers of physiotherapists, of pharmacists in our communities, more advanced nurse practitioners—. I know that there are some excellent examples on the Llŷn Peninsula, for example, of advanced ambulance practitioners helping in our communities there. So, there's no need to always—. Although we are doing better in terms of the number of GPs than England, I think it's important that we understand that we are trying to create a system where we use the skills of the whole team. I think it's very important that I make clear that we haven't cut the number of nurses; we have more nurses than ever before, and we are still recruiting more than we are losing. So, that simply isn't the case. In terms of an inquiry, well, you know our response to that.

I feel compelled to tell you a story that's positive. I live in a very rural area. On 17 December, I had to attend to a lady who'd fallen and had a serious head injury. We called the ambulance service. We were told it would be a two-hour wait. So, imagine our surprise when one turned up within 15 minutes. We must talk about those positive stories as well, and there are many. I do want to thank everybody who works in the health service.

I also just want to talk about a high-risk issue as well, that our UK Conservative Government are about to impose on our health workers: the shameful anti-strike legislation, which portrays our health workers as uncaring. That will do nothing to help them feel valued. Potentially, if I was them, I would leave. I would think, 'I am not being valued in my role'. 

The one issue I would like to raise with you, if I may, Minister, is about the pooling of budgets within health services and social care. We've heard a lot about the social care issues that are facing our health services, and I'd just like to say to you that, in Powys, we have a coterminous local authority with the health authority. I'm just wondering if you're able to think further and give us some information around how we could be looking at those, possibly piloting some really good initiatives in Powys, for example. Thank you. Diolch yn fawr iawn. 

15:45

Diolch yn fawr. Thanks for that, because I think it's really important that people understand that, although there are some examples of not great things happening in the NHS at the moment, there are also hundreds of thousands of great things happening in our NHS, and 376,000 consultations a month is a pretty good figure; 400,000 contacts in general medical services in a week. These are incredible figures, and certainly when I go around, very often what I get is people saying, 'Well, personally, I've had a great service', and I think it's really important that we do talk up that great service, because, frankly, it must be very demoralising, obviously not just for me, but for people working in the NHS, if all you hear is negativity.

In terms of the unions, I couldn't agree with you more. I think the anti-strike legislation that is being introduced is wholly unnecessary, and I think it was very provocative, the discussion yesterday, when they talked about productivity. You just think, 'My God, what world are these people living in?' Have they no idea how exhausted these people are? It was, I think, a huge insult, in particular, to start off negotiations with that. But, when you're talking about pooling budgets, well, you'll be aware, we've already pooled £144 million a year through the regional integration fund, which people can't access unless health and social care are working together, also with the voluntary sector. So, already we have that ring-fenced. I think we can and I think we should go further, and certainly my No. 1 priority, in terms of my guidance to the NHS for what they should be doing next year, is that they should be looking at what we can do in the space of working together in relation to care, with local authorities, and making sure we put more support from the NHS back into our communities. 

Minister, thank you so much for your statement this afternoon. Now, technology, without a doubt, is advancing at a rapid speed, with companies coming out with major developments to improve health outcomes. So, I'd be interested to know, Minister, what, if any, tech devices the Welsh Government is looking into to alleviate pressure on our health service this winter and going forward. The reason why I'm specifically asking this question is because I attended CES, the world's biggest tech conference, and managed to see some of these huge developments taking place in medical technology. Now, without sounding like a medical rep who's come back from the States, one company that really stood out was one called MedWand Solutions, which actually has recently launched its MedWand device, no bigger than a mouse, linked to your computer. But this handy device actually provides a ready-to-use system, which includes a tool that allows you to link a laptop to, in fact, a small device, which has sensors that can listen to your heart, measure heart rate, perform an electrocardiogram, listen to your lungs, measure blood pressure, oxygen levels, check temperature, and even listen to your abdomen. It can even look into your nose, throat, mouth and ears, as well as inspect your skin. Now, just this one device alone, Minister, has the potential to seriously change the landscape when it comes to providing healthcare from up close and afar, as well as alleviating pressure on our hardworking staff across the sector, including within hospitals, doctors' surgeries, and even make life easier for paramedics as well.

Now, patients with multiple health issues, the elderly, those with disabilities, alongside those who struggle to get out and about, would really benefit from this. I'm sure it's obviously a lot more intricate than what I've described here in front of you all today, but the main point I'm trying to make, Minister—. And I may be sounding, like I said, like a medical rep now, but similar devices to this would not only improve outcomes for patients across Wales, but would also alleviate pressure on our NHS, which is something you want to do and we want to see as well, not just for winter, but all year round as well.

As you've said, Minister, our health staff are under immense pressure, and it's going to keep on getting more challenging for us all. So, it might be a long and complicated process to get something like this rolled out here in Wales, but, Minister, will you commit to looking into this product and similar? And as I asked earlier, please can you kindly outline what other devices or tech solutions the Welsh Government is looking into to alleviate pressure on the NHS? And I'd really welcome the opportunity to talk with you further about this in more detail and provide you with contact details, if you so wish. Thank you. 

Thanks very much, Natasha, because I am absolutely wedded to the idea that, if we are going to transform the way we do, in particular, care, then we're going to have to rely more on technology, and I'm very much looking forward to going to see how the Delta system works in Hywel Dda next week. So, already some of this technology is being used in our communities, and certainly, when it comes to care in future and doing care in the community, I think we've got to start by saying it's digital by default, and if you can't do it with digital then you move into other areas. So, I think it's really important. None of this stuff is cheap, none of it is easy, but I'm absolutely committed to this.

If you look at digital, then we are investing more per head compared to England. We're investing £18 per head compared to £11.50 per head in England. So, we've got the digital priorities investment fund, which is £60 million. We have a digital medicines transformation portfolio as well, and that's going to make sure that we have roll-out of transformation in relation to prescription of medicine in primary care by the summer of 2023. We've got secondary care—amazing work being done already, but that needs to be rolled out, and then we'll have a central repository for all prescriptions, so that everybody can know what's happening across the service. We have the Wales community care information system. That has been rolled out in most health boards now, and that was one of the objectives that I set for the chairs of the health boards. We have the national data resource, we have the digital maternity record, we have the Welsh nursing care record. Technology Enabled Care, TEC, Cymru give us advice on all of this. We've got the national video consultation service that we've given money to. We've got the Welsh emergency department system, we have the cancer informatics programme—the list goes on and on and on. So, we are absolutely all over this space. One of the restrictions is that everybody wants these technicians, so we are competing in a very difficult market when it comes to this, because everybody wants these digital experts, and the NHS is having to compete in that space.

15:50

Thank you, Minister, for today's statement. Of course, there is excellent work happening every day in our NHS, but it's important that we all recognise today the huge pressures facing staff. I've received so much correspondence that has been heartbreaking over Christmas—and I'm sure everyone else has—from constituents who are patients, members of patients' families, but also from workers who say, 'We simply can't cope. Yes, we're doing our best, but we can't continue to work at this level', and they are talking about leaving the NHS, and we can't afford to lose these people. Also, there are heartbreaking stories about people who are dying whilst waiting for ambulances, or those who are taking your advice, as you mentioned on Radio Cymru, and taking responsibility for their own health, but who then ignore symptoms that are very serious indeed and reach that point of dying at home or dying when they're at crisis point. So, can we have an assurance too that we send a message to people that they should continue to contact the NHS when they need to?

Another point I'd like to make—you also referred on Radio Cymru this morning to diabetes. Now, we must also recognise that there is that strong link between poverty and diabetes. If you're poor, then you're twice as likely to have diabetes, so what Rhun mentioned in terms of prevention is so very important. But how will we support people who now are facing the cost-of-living crisis and can't afford to eat healthily, can't afford to exercise? So, how will we ensure—? This is a problem for the whole of Government, and there is a responsibility on the Labour Government. You are in charge of health and you have that responsibility. We have to see some action.

If the responsibility is entirely on our shoulders, and we are expected to care for everything without people taking responsibility for their own actions, then we're not going to cope. If you look at the situation—[Interruption.] If you look at the situation in terms of an ageing population, it won't be possible in future for us to provide the services that are required. So, we need to ask the Welsh people to help us in this.

We have put things in place, such as the help that we are offering in terms of Help us Help you, the help that we have provided through 'Healthy Weight: Healthy Wales'. A great deal of funding has gone into these schemes, and also the pre-diabetes funding that we've put into the system, which is making a difference. So, we are trying to ensure that we are providing the help where we can. We understand that the cost-of-living problems are going to have an impact on people, and we are aware that the people who are going to pay the greatest price are the poorest people in our society. That's why we've been targeting our funding towards those people. We have allocated a great deal of funding to help people through this crisis and, truth be told, it's the responsibility of Westminster to give us that funding, and to provide that funding, but we have stepped into the breach because the Westminster Government hasn't done its work.

15:55

Diolch, Llywydd. Minister, you've told us that we have a problem with not being able to attract sufficient staff—I accept that—but you don't seem to acknowledge that we do have a problem with having insufficient numbers of beds. Now, I've raised this issue a few times in the Senedd before, but I'm going to do so again. When will north Denbighshire get its promised community hospital? We saw beds axed in Rhyl, in Prestatyn, in St Asaph and in nearby Denbigh—scores of beds. And as a result of a loss of those beds, there is now extra pressure on Ysbyty Glan Clwyd. There's no denying that. That is a fact. Now, you tell us that we've got more staff working in the NHS than ever before. So, if we've got more staff and fewer beds, why can't we have some extra beds put in? 

Now, I heard the First Minister's response to me, and I've heard your responses to me on this issue before. You say that you don't have the capital to be able to invest and that there have been rising costs on that particular project. Now, I've checked the figures, okay. I've checked the figures. Within the period that you announced that you would deliver that hospital, which was back in 2013, nearly a decade ago, you did build a hospital, but you built one in south Wales, the Grange hospital, okay. The cost of that hospital was £360 million. It's original budget was £172 million, okay. So, a massive additional cost, in the order of £188 million. Now, I do not begrudge the delivery of that hospital for the people that it serves in Gwent; it's an important investment. But where is the investment in north Wales? You've closed hospital after hospital after hospital, and we still haven't seen our hospital. Its current estimated cost is £64 million—that's a fraction of the investment that you've spent in the south. When will we see our hospital in order that we can deliver the sorts of improvements in access to care that people in north Denbighshire require?

Can we finish the question now, and can we ask the Minister to respond?

Diolch yn fawr. I think it's really important that we recognise that the staffing challenge when it comes to healthcare is a global challenge, so people all over the world are looking for the same people, especially people like anaesthetists. So, we are in a very difficult and competitive environment.

When it comes to investment in north Wales, I think it's really important that you understand that, actually, we have made investments in north Wales. Ysbyty Gwynedd has had that accident and emergency department. I've recently signed off £70 million for a new mental health unit in north Wales. That's despite the fact that the capital challenges, in particular for us in health, are extremely difficult at the moment. But, obviously, if we see some proposals where we will see transformation—. Because that's what we need to look for now, transformation. More of the same is just not going to cut it any longer. What is important is that we look for transformation when it comes to capital investment in the NHS in future. 

4. Statement by the Minister for Economy: Developing Technological Clusters in Wales—Medical radioisotope production and nuclear medicine expertise

The next item, therefore, is a statement by the Minister for Economy on developing technological clusters in Wales. I call on the Minister to make his statement—Vaughan Gething.

Diolch yn fawr, Llywydd. The Welsh Government has consistently highlighted the importance of harnessing science, research and innovation to address societal challenges. To meet these and capitalise on opportunities, we need a coherent, co-ordinated and collaborative approach. 

A new innovation strategy for Wales is being developed in line with our commitments in the co-operation agreement and programme for government. We plan to publish in early 2023. It will provide a vision for innovation that can help to draw together our areas of strength and opportunity. We know that there are clear, transferable benefits for the economy from developing clusters of research expertise and capitalising on commercialisation and skills that arise from research.

Since 2012, the Sêr Cymru programme has helped to develop and sustain Wales's research capacity and capability. We've recently finished a consultation on the next phase. Previously, we used EU structural funds to significantly help to support research and innovation. Sadly, the UK Government has broken its promise that Wales would not receive a penny less in replacement funds. The undeniable reality is that we do not have the funds to support the next stage with the same level of public funding as before. We need to focus and theme future research calls. I expect to make a further announcement on the future of Sêr Cymru shortly.

16:00

The Deputy Presiding Officer (David Rees) took the Chair.

Critically, a small nation cannot have strength in depth right across the board. We can, however, point to clusters of technology in Wales that lead their field. The south Wales compound semi-conductor cluster is one. Combining industrial excellence and world-leading research, this cluster delivers the components that make our modern world work.

Today, I confirm our clear ambition for Wales to grow another technology cluster, while also tackling a fast-approaching challenge for medical treatment around the world. This concerns the continued production of medical radioisotopes, critical to cancer diagnosis and treatment. The equipment in facilities making these lifesaving radioactive substances is coming to the end of its useful life and being closed down. Without action, we face a real prospect in the medium-term future of not having medical radioisotopes, or the ethical nightmare of having to ration them.

The vision that we have is the creation of a critical mass of nuclear science—research, development, and innovation. Not only can Wales become the leading place in the UK for medical radioisotope production, but, with this, we can attract higher skilled jobs; create a surrounding infrastructure; support local communities; and build localised supply chains. Employment from delivering this project would cover a variety of skills and occupations: drivers, operations, production, technical staff, office staff, research scientists and engineers. It could provide well-paid, sustainable and attractive employment during both construction and operation.

As with our compound semi-conductor cluster, Sêr Cymru has already pump-primed the process, through funding a nuclear technology research chair at Bangor University’s Nuclear Futures Institute. This, and a past legacy of working with nuclear energy technologies, show north Wales as the most suitable place to develop such a cluster. Complementary research, industry expertise and activity in Wales and the wider UK will contribute and play their part in creating this new cluster.

Our initial aim is to secure the supply of medical radioisotopes for Wales and the UK through an advanced radioisotopes technology for health utility reactor, which I will now refer to as ARTHUR. The pilot project ARTHUR contributes to several aspects of the current programme for government. It reflects our commitment to build our research, development and innovation capacity in health and life sciences, while ensuring that Wales is a full partner in delivering the UK's 'Life Sciences Vision'.

This will be a major Wales and UK-wide strategic initiative. It will develop a sustainable supply of medical radioisotopes for diagnostics and treatments. Together with the north Wales medical school development, it will help to stimulate the wider north Wales economy. This represents a major collaborative development between the department for health and social sciences and the economy department within the Welsh Government. The potential from a new medical school, aligned with project ARTHUR and other health technologies, represents the best regional solution to a sustainable and secure radio-diagnostic and radio-medicines capability in north Wales.

More than that, NHS Wales and partner NHS services in England, Scotland and Northern Ireland will be key customers and stakeholders. To succeed, we must secure funding from different sources to create a public sector national laboratory for the supply and use of medical radioisotopes. We have all seen the consequences of supply interruptions through recent experiences, such as the temporary loss of isotopes from Cardiff University's PET imaging centre. This impacted diagnostic scans for several diseases, especially cancers. This demonstrates just how significant an impact a more general loss of supply would have on patient outcomes.

Project ARTHUR would be a multidecade endeavour, a commitment of some 60 to 70 years. Jobs created, both direct and in the associated supply chain, would be long-term and sustainable. Our facility, up and running, would then be one of only half a dozen across the world. And looking locally, successfully delivering project ARTHUR would help to sustain and improve the economy, especially in north-west Wales, an area, of course, with a long history of employment in the nuclear industry.

The ARTHUR vision includes creating a technology campus in north Wales to parallel other UK campuses with a nuclear element. These include Harwell, which is the Rutherford Appleton laboratory, and Culham, the UK Atomic Energy Authority in Oxfordshire, and at Daresbury in Cheshire.

The research component of ARTHUR would not confine itself to health research alone, but could also inquire into materials research for application in both fusion—that's fusing hydrogen isotopes—and fission energy, which is the conventional nuclear energy. This research could help to deliver reliable, sustainable and affordable low-carbon energy, and improved nuclear technologies with less waste and environmental impact and with greater efficiency.

The scale of achievement needed to deliver this is considerable. I will continue to make the case with the UK Government to co-operate in supporting our efforts. This development benefits and supports future cancer diagnostics and treatments right across the UK. I have raised the issue with a number of UK Government science Ministers, and my officials maintain a constructive dialogue with UK Government counterparts. The challenge of medical radioisotope supply and the opportunity of a research reactor is well recognised. Now is the time for some decisive action and commitment. The implications of not acting will be counted in poorer patient outcomes that could have been avoided, and a lost economic opportunity.

As everyone knows, we are now experiencing significant economic pressures, but that is not a reason or an excuse for failing to plan for this clear future need. We must prevent a future health and economic crisis. I have therefore approved expenditure for a technical feasibility study and the development of an outline business plan. This plan will build on the technical work already undertaken in the earlier strategic outline business plan.

Our ambition is to provide a paramount technology cluster in north Wales. It would offer significant opportunity in a vital technology and substantial collaborative opportunities with like-minded countries, including Australia and Canada. This could clearly become a global centre of excellence and a source of pride for Wales and the wider UK for decades to come. I hope that we can generate cross-party and cross-Government support to do just that.

16:05

I thank the Minister and I very much welcome his statement today. The use of medical radioisotopes is an important part of modern medical practice. Their use in non-invasive diagnostic imaging techniques at an early stage helps to identify and stratify commonly occurring critical conditions such as heart disease and ultimately cancer. Disruptions in the radioisotope supply chain, which have happened regularly, do in fact disturb the availability of medical testing for people everywhere, so I do genuinely welcome this statement, which will make Wales a leader in the production of these life-saving cancer treatment substances. This plan, however, will require considerable financial investment, including from the UK Government, as the Minister stated. So, I'd like to ask the Minister what discussions have been held with the UK Ministers in this regard, and with which departments specifically has the Minister had conversations to seek support for developing the site and getting the appropriate funding that's required. 

With regard to Cwmni Egino—I apologise for my pronunciation—it was reported towards the end of last year that they were developing a business plan for the site with the aim of construction starting in 2027. So, can you confirm, Minister, that the business plan is now complete and that the project is in fact on schedule? May I also ask the Minister for more details regarding the economic benefits of this investment at Trawsfynydd? It is reported that this plan will create around 200 jobs, which is always welcome, but can you advise how many of these jobs will be high-skill jobs? And do you envisage this site being expanded to include other sectors to support advances in physical sciences, making Ynys Môn a hub for the nuclear industry, not only in Wales, but for the United Kingdom as well?

Finally, Minister, you will be aware of the problems that people living on or in fact commuting to Ynys Môn are currently facing due to the repair work being undertaken on the Menai bridge. So, what considerations have you given, and what discussions have you had, with the Deputy Minister for Climate Change regarding the adequacy of the current transport infrastructure links to the island, and whether they could potentially hinder any further developments at the Trawsfynydd site? Thank you so much.

16:10

I'll just deal with what I was modestly confused by, almost as if Wylfa and Trawsfynydd were on the same site in some of the points. The Traws site is an obvious candidate for the proposal we're talking about today, but in moving forward with the business plan, it will be site agnostic. Trawsfynydd has a nuclear licence for development, the other site being Wylfa, but we'll need to look at what is the best fit in terms of developing the site. The Cwmni Egino development is focusing on the potential for small modular rector production, as I've made clear in previous statements. Now, the size and the scale of the reactor we're talking about for ARTHUR is sufficiently small that you could do both on either site, because what we're talking about is a reactor that would be essentially 1 per cent of the size of the previous Horizon proposal on Wylfa.

I think that shows you can do something small with entirely different safety questions around it in terms of the scale, but it is essential for the way that a modern health service works and functions. If you look at the development in Australia, they have not just done something that deals with their own healthcare needs for that part of the world, not just in Australia but for partner countries as well, but also the significant additional economic and research activity around the site. And that's where I think there is potential, not just for the direct provision of the radioisotopes that we need—we know that supply in western Europe is coming to an end—but there is a wider technology cluster opportunity that is available. That's where I'm interested in seeing what we can do.

I've had direct conversations with the Department for Business, Energy and Industrial Strategy in the UK Government. As I say, I've had this conversation with a number of science Ministers. I've spoken to George Freeman about this in one of his previous iterations as science Minister. And as I said in my statement, there have been constructive and regular conversations between my own officials and those across the UK Government. 

We're in the fortunate position of having myself and the health department being in the same place and wanting to see the opportunity taken up. We need to have a similar conversation that would be ideal with both the health department and, indeed, BEIS in the UK Government, and there are then questions about the future funding. We would like the UK Government to be a partner in doing this. It is also possible that you could deliver some of this with private sector investment. My preference would be that we'd see this as part of a sovereign capability for the UK, with the ideal site, I believe, being here in Wales. However, there are a range of options and opportunities, because as we have seen in other parts of the world, there is a return on capital investment and a potential return on the operating cost of such a site, if successfully delivered.

Once we've gone through what I've outlined today, we'll have a much better idea of the technical facilities and capabilities we'd be looking to build, and a much better investment projector to be able to take this forward. And I would hope that a UK Government of any particular political shade would recognise the significant opportunity this represents and what that would mean in terms of genuine economic development in long-term jobs here in Wales. 

I thank the Minister for his statement. 

We agree that harnessing science research and innovation to address societal challenges is important, as is improving investment in science, technology, engineering and mathematics and research and development, which will have huge benefits for the Welsh economy, and we must continue developing our manufacturing and exporting in these areas. Of course, we support the ambition of establishing new technological clusters across Wales. However, if we really wish to boost Wales's technology research and design, manufacturing and exporting sectors, we have to have a strong research, development and innovation base, but Wales has had historically low levels of R&D for decades.

The British Heart Foundation found that, in 2019, total expenditure on R&D in Wales was £794 million, or 1.2 per cent of gross value added. Out of the three devolved nations of the UK and each of the nine regions of England, Wales has the lowest R&D expenditure as a proportion of GVA. They also found that 82 per cent of people believe it's important for Wales to be undertaking medical research, and 34 per cent of people think not enough research is currently happening in Wales.

Neither the UK Government's continued stalemate on Horizon association and the cut that is coming via the UK shared prosperity fund will help this funding situation in Wales, of course. However, the UK Government added funding to research in England to help with the Horizon stalemate and this meant a Barnett consequential. I asked you, Minister, in December to confirm the Barnett amount and asked whether it would be added to university research, but you declined to commit to the consequential being passed on. It is fair for the Welsh Government to criticise the Horizon stalemate, the shared prosperity fund and the damage caused, but it is questionable to then not allocate the Barnett consequential from the interim funding.

To see the full effect of programmes like the tech clusters and the Welsh Government's export plan, we must do everything we can to support our research base here in Wales. Scotland confirmed its amount and passed it on shortly after I asked this question to you in December, which meant an extra £24.6 million for Scottish research. Will you follow suit? If you were to make that call, that would go some way in making our universities more competitive. Quality-related research funding in Wales should be at £100 million; there's a shortfall of £18 million. At the very least, will you commit to uplifting QR funding by £18 million by the end of this Senedd term?

16:15

There are a couple of specific questions. On the £18 million by the end of this Senedd term, we've yet to pass the budget we've just laid in draft form, and of course that's got to go through scrutiny and a final vote. We then have other budgets, and of course we'll look to the future of research funding in those future budgets. It all depends on not just the overall settlement the Welsh Government gets but the priorities we set within it. In our draft budget, we've set out health and local government, including education within that, as our big priorities, and that has consequences for the way we allocate the budget not just to those departments, but to all others as well.

I recognise the point you're making about Horizon. I will be able to announce shortly what is happening, so there'll be clarity on that. I've just been checking with my colleague the finance Minister, but we do expect to be able to make an announcement on that in the very near future, so there won't be much longer to wait. There'll be clarity on the money that is happening, what we've got, and how it's going to be used post Horizon. I hope that the broadly positive conversations that appear to have taken place on data sharing between the EU and the UK will be helpful for unlocking more for the future. Horizon is but one aspect of that, tied up with the Northern Ireland protocol and broader relations between the UK and the European Union. We continue to want to be constructive in that and making clear Wales has a very direct interest in the outcome of those discussions.

As I said in the statement, there's the undeniable reality that the replacement for structural funds is not going to reach the quantum that we previously had, and we've previously used a significant amount of that in research, development and innovation funding. The way that the shared prosperity fund in particular has been set up has essentially excluded higher and further education research. That's a significant problem. You and other Members will no doubt have heard directly from Universities Wales about the very direct problems that is going to cause, and the fact that when those funding streams come to an end, I'm afraid that we expect some people will find their employment and the research projects will come to an end. That's not an outcome that I think anyone in this Chamber campaigned for, but it's the direct reality of choices that are being made. It's within that backdrop that we're looking to develop not just this project, as the proposal I think does have significant economic potential in a discrete area that I hope will maximise support around it, but the broader points around the innovation strategy that we are developing.

Part of that is—and it's one of the challenges we need to set ourselves for the future landscape—we get just over 3 per cent of competitive UK funding calls coming to Wales, so we're underachieving in actually acquiring from those UK-wide funding pots. That's a big challenge for us to address. At the same time, one of the positive things the UK Government has been doing is saying it's going to put more money into the future of research, development and innovation spend. We need to make sure that Wales gets its share of that. I think that's a separate question compared to whether we can find the capital funding to see this project through with what I think that will then do in attracting a particular level and a particular type of research funding and economic activity to Wales. I think ARTHUR is slightly different, but there is a much broader point that I recognise on what we're going to be able to do with the future of innovation funding as well as the strategy that I look forward to being able to launch in the not-too-distant future, following what I hope will be constructive conversations with our co-operation agreement partners.

I very warmly welcome the statement. This is what levelling up looks like. This is what technological clusters and what successful economies have. It will also help stimulate the economy by attracting highly skilled jobs and create a surrounding infrastructure. The UK has no domestic supply of many radioisotopes, relying on imports from European facilities. This is an opportunity to have such a facility. Medical radioisotopes are critical to the diagnosis and treatment of diseases such as cancer, and they can also be used to sterilise medical equipment. I have two questions. The Minister mentioned Bangor; which other universities is the Welsh Government working with on this project? Is this the start of developing a non-hospital medical physics industry in Wales, and how will it work with the National Physical Laboratory in Teddington?

16:20

I think the two detailed questions are actually around some of the points that we're looking to address in both the technical specifications around what we'd want to do on the site, but then the broader call for people to be involved not just in the creation of a radioisotope production facility, likely to be in north-west Wales because of the likely candidate sites, but what that then means in terms of research and collaboration with both other Welsh universities and other institutions around the UK. There is no facility like this within the UK, and if we're successful in creating it, I fully anticipate that there will be significant UK-wide interest in the potential for a technology cluster and high-level UK research and funding to go alongside it.

I think you make an important point about our current supplies of radioisotopes. We don't produce any within the UK in any material way. What we do is we rely on production from European Union countries, essentially. There's all the transport of those in. I remember from the difficulties of considering what a 'no deal' Brexit might look like on more than one occasion that the ability to successfully import radioisotopes was a significant factor within that. We know, and we knew at the time, that that production would come to an end at some point in Western Europe, who we currently rely upon. So, it highlights the fact that we've known that this is a challenge, we're planning for it, and we do have a plan in Wales about how to address it, not just for us, but for the wider UK, and, indeed, countries nearby where there's a potential for export, because, at the moment, there aren't other proposals to try to fill this gap in other comparable healthcare systems. As we get through this stage of it, I'll be more than happy to come back on the detail and the potential.

The Minister mentioned the open-pool Australian lightwater reactor project. I've actually spoken to some of the experts in Australia in medicinal nuclear; I've spoken to experts in Canada as well, and I'm due to have a meeting with the Jules Horowitz research reactor in France and the München research reactor before long. The Minister mentioned there that there's no comparable development. Well, the Jules Horowitz is a comparable development, and the UK is a key partner in the Jules Horowitz development, which would ensure radioisotopes for the UK post Brexit.

But nevertheless, in January 2015, Dr François Bénard and his colleagues at the University of British Columbia had shown that cyclotrons could replace large nuclear reactors as the main source of radioisotopes. Dr Bénard, the pre-eminent expert in this field, said:

'With this solution, we’ll be able to make completely locally-grown isotopes, without any long-term radioactive waste'.

By December 2020, Canada's health regulating body had given their approval for cyclotron production of technetium-99m to be used in their health procedures. It's been lauded as a greener, more reliable way to make technetium-99m, and it opens the door to huge possibilities, not least because many of the world's most common cyclotrons will now be able to produce technetium-99m.

So, does the Minister accept that it is therefore not necessary to develop a nuclear reactor and all of the dangerous radioactive waste and damaging environmental impact that comes with this, and that we should reach out and work with TRIUMF and British Columbia university so that we can develop these cyclotrons at Trawsfynydd in order to roll them out across the UK?

Actually, the cyclotron at Cardiff University that provides the PET scanners in Cardiff was one with which we had a particular problem. So, our challenge is, right across the UK, we don't produce enough. We significantly import those as it stands. And for all the potential of cyclotrons, we don't think—. The advice that I'm being given, the basis on which we're planning, is that that isn't going in itself to deal with all of our needs. And that's the point: how do we deal with all of our needs for a modern healthcare system? We're talking about a very significantly different scale of proposal compared to the former Horizon proposal on Wylfa. So, it's nothing like the same scale.

When it comes to the characterisation of the Jules Horowitz reactor in France, our understanding is it's not going to be ready in the time frame that we want it to be, and indeed that it's not primarily being built for medical radioisotope production. There are different conversations that appear to have been had, but I've had direct conversations with officials in the Welsh Government office for science, within the NHS and economic development, and we do think that there is a need and a gap to be filled. We believe that north-west Wales is the most likely area of the UK for that to happen, and where we would like it happen, because of the potential to secure both the supply for health service use, but also for the economic development potential that would come alongside it as well.

I recognise the Member has an entirely upfront, broadly sceptical view to a range of these issues, and concerns around safety and what would happen. I think it's entirely legitimate to keep on asking those questions. We'll keep on developing the proposal and we'll need to make choices around securing future funding. I look forward to engaging with him and partners constructively about that, even if we don't always agree on every single aspect of it.

16:25

I'd like to start by thanking the Welsh Government for their continued recognition of the highly skilled workforce that we have in north Wales and for the investments being made in the health sector, including the medical school in Bangor. Medical radioisotopes can now be created by particle reactors, as was mentioned earlier, rather than nuclear reactors, and have been for some time in other countries. The latest and next-generation accelerators are much smaller and have a lower cost than previous generations. I'm told that the best locations for these, that may have a shorter shelf life, could possibly be by medical facilities and in areas with good transport infrastructure. So, I was wondering what has the Welsh Government done already and what research has been made into the latest technology alternative to nuclear, which has obvious drawbacks, as was mentioned earlier by Mabon? And what consideration has the Welsh Government given to investing in these, and also the assessment regarding transport from the rural area? The transport around there is quite difficult as well if there's a shorter shelf life of this product.

One of the challenges is the fact that there is a short shelf life for these products. It was one of the concerns about a 'no deal' Brexit. I had to go through, I think, three different iterations of 'no deal' Brexit planning, and as well as challenges for pharmaceutical suppliers and a whole load of other things, radioisotope supplies were always near the top of the list as to what would happen. In fact, in the previous Senedd, Mike Hedges was regularly asking questions about whether we'd be able, on a licence basis, outside the European Union, to be able to have isotope supply. Some of that was resolved, but the challenge was really about if there would be delays because of the point about the shelf life. When it comes to our current import journey for the bulk of the isotopes that we use, we manage that successfully. However, having a production facility in Wales, including in north-west Wales, would be adequate in terms of shelf life and our ability to get it from where it's being produced to where it's needed. But in terms of going through the greater detail that this work would now undertake, it should deal with both those transport issues and indeed the point that yourself and Mabon ap Gwynfor have made about are there alternative technologies available, how far can they fill the gap, and then the need that is still there for, as I say, something that will be 1 per cent of the previous Horizon proposal and a very, very different scale of operation being proposed with all the attendant issues around that. I recognise the concerns people will have about the safe operation of facilities like this, as well as seeing the potential for investment. I'm very proud that we're continuing to make progress on the north Wales medical school. I see the former Minister for north Wales on the screen in front of me—it was part of the conversation we had in the last Government, and we're looking to carry on and deliver within this term as well.  

Diolch, Dirprwy Lywydd. Minister, thanks very much for your exciting statement. I think the ARTHUR programme has all of the potential to become an incredibly important, strategic part of the economy of north Wales and, indeed, the wider nuclear arc across north Wales and the north-west of England. Of course, as you said, north Wales is in a unique position of being the only part of the UK that is really getting ready to embrace this opportunity and the supply chain opportunities that it could open up.

I was just wondering, in terms of other projects that you're leading on, how does this fit with your work in prioritising magnet projects that crowd in investment, based on comparative advantages that we have in Wales, for example the advanced manufacturing research centre and advanced technology research centre? And also, as you've outlined, this programme has come as a result of Ministers and officials across Welsh Government departments working very closely over quite a significant period of time. Indeed, when you were in your previous role and when I was in the role that you now have, we worked very closely in developing the outline ideas for what you've proposed today. How far do you think we would have come by now had Ministers and departments at a UK Government level been working as closely as Welsh Government, particularly BEIS and the Department of Health and Social Care?

16:30

Thank you for the points and questions. On your point about magnet developments, this is a good example of what you could do, because if you had the operation of a facility that would probably have likely north of 200 people employed directly in the ARTHUR facility, it would be extraordinary not to have other activity around it. And the OPAL facility in Australia is a good example of that. You've seen something where there is a significant capital outlay but the opportunity to see the capital outlay returned in 15 to 20 years, to have an operating profit, and to see more jobs created around that, and they'd have to be crowded in around the facility itself. So, you really would be drawing in good-quality jobs, not just for people to come in and to live in the area, but the opportunity for people in the local area to be part of the direct engagement in that activity and the supply chains that we would want to see as localised as possible. And I do know that the leaders of the two local authorities, Ynys Môn and Gwynedd, are broadly positive about the opportunities to do this, and I'm looking forward to talking with north Wales leaders about it in the future to go through more of the detail on this.

And exactly the same for the AMRC and the ATRC that you talk about as well, because there are real opportunities to gain a much greater whole from the project rather than simply the individual parts of it at the centre. And I do think that—and it is some time ago now—in pre-COVID times, we started discussing this in our previous ministerial roles, and to see the time it's taken to get here, we could definitely have got here sooner rather than later if there had been more focus on this and less focus on other issues that have caused the instability within the UK Government that we've seen over the more recent past. I am, though, looking for a constructive conversation with Ministers in the current and any future UK Government, because I genuinely believe that this should be an opportunity for a no-regrets investment to deliver significant economic benefit and to deal with a real and pressing healthcare need, and I look forward to what I hope will be a constructive and positive response from the current or a future iteration of the UK Government.

5. Statement by the Minister for Social Justice: Cost of Living

Item 5 this afternoon is a statement by the Minister for Social Justice on the cost of living. I call on the Minister to make the statement, Jane Hutt.

Dirprwy Lywydd, as we enter the new year, we recognise that the cost-of-living pressures continue to be relentless. Too many people are desperately worried about staying warm and having enough food to eat, and for many people, the challenges are more stark.

The cost-of-living crisis has shone a harsh light on different groups' ability to deal with fast-rising prices. The Resolution Foundation recently reported that the underlying disposable income gap between the disabled and non-disabled population in the UK is 44 per cent. They also report that rates of food insecurity are much higher among families with three or more children, single-parent families, and among certain non-white ethnic groups. I want to provide reassurance to people across Wales that the cost of living remains our priority. We offer support through our fuel support scheme, through our Warm Homes programme and Nest scheme, through the Fuel Bank Foundation fuel vouchers and the heat fund, and, of course, through the network of more than 300 warm hubs, which have been established in communities across Wales with support from the Welsh Government.

Warm hubs offer a range of support depending on their location and their facilities. This includes a simple warm space with refreshments, to more substantive food, activities, free access to computers and Wi-Fi and charging points for phones and tablets. A number also offer the opportunity to meet with financial and welfare advisers. Before Christmas, I visited a number of warm hubs to see first-hand the valuable work that these hubs are doing in our communities and to support people through this cost-of-living crisis.

Our fuel support scheme has already ensured that nearly 290,000 households have received the £200 payment this year, and I would urge those eligible households to ensure that they do apply for this vital support this winter. We continue to provide the support needed to help people maximise their income and access the benefits that they are entitled to through our single advice fund and our 'Here to help' and 'Claim what's yours' campaigns. We are working with local government to streamline and simplify access to our Welsh benefits.

I'm pleased that the Welsh Government's draft budget contains an additional £18.8 million to continue the support for the discretionary assistance fund into 2023-24, as well as additional funding to pay the real living wage to social care workers and additional support for our care leavers' basic income pilot. This is despite our budget being worth up to £1 billion less next year. 

We will continue to provide support for households through our support for a more generous social wage. This includes initiatives such as our childcare offer, our council tax reduction scheme, free school meals and PDG access, the school essentials grant and help with health costs. All of these programmes leave money in people’s pockets. This financial year, we will be spending £1.6 billion on schemes that directly support people with the cost of living and put money back in people’s pockets.

Last week, Welsh Government Ministers visited credit unions across Wales to promote the vital support that they offer to those struggling with their finances. And we're continuing to invest in credit unions to ensure that they are able to provide access to fair and affordable credit. The Cabinet cost-of-living sub-committee is providing strategic direction to our response, ensuring a joined-up approach across portfolios and bringing together people with lived experiences, experts, service providers and organisations supporting people struggling with rising costs.

We will continue to do all that we can to support households affected by this relentless crisis, but the key levers for tackling poverty, powers over the tax and welfare systems, sit with the UK Government. We've called on the UK Government to put in place a number of practical actions that will have an immediate and positive impact for those most affected by the crisis. In April, the UK Government will reduce the level of support available via its domestic energy price guarantee. Meanwhile, businesses, charities and public sector organisations learned yesterday that the support available to them will be significantly reduced, further squeezing their budgets and impacting on services on which we all rely. We have called on UK Ministers to uplift the discretionary housing payment and local housing allowances. And their arbitrary five-week wait for universal credit payments is the root cause of severe financial hardship and distress for many people. People waiting are forced to turn to support from the discretionary assistance fund to see them through this hardship. We call on the UK Government to look again at this, particularly at this time of the cost-of-living crisis.

On 21 and 29 November and 7 December, I met with representatives from a number of energy suppliers to discuss the issues surrounding pre-payment meters and the cost-of-living crisis. I'm deeply concerned that, as more households fall behind with the payment of their electricity and gas bills, they may be unfairly driven onto pre-payment meters. Moving householders onto pre-payments meters should be seen as a last resort. Energy companies should absorb the cost of standing charges for pre-payment customers who are particularly at risk of disconnection as a result of the rising cost of fuel. This should not be a cost for the Government to take on; Welsh Government has consistently called on the UK Government and Ofgem to introduce a social tariff to protect the most vulnerable households and to remove standing charges for customers on pre-payment meters. I remain concerned that a worryingly large number of householders on a traditional pre-payment meter have not used their vouchers as these have a 90-day expiry date. It is important that these households access and use their UK Government vouchers.

Deputy Llywydd, we have been clear that we will do everything that we can to support people through this cost-of-living crisis. The Welsh Government alone can't solve this problem, it is only through co-ordinated effort and ambition that we can address this cost-of-living crisis and the wider determinants of poverty. But, I want to thank our partners and stakeholders across Wales for their continued support in addressing this cost-of-living crisis. And finally, as we start this new year, I urge people to make sure that they access the help and support that is available to them and that they are entitled to.

16:35