Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd

Health, Social Care and Sport Committee - Fifth Senedd

25/11/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Andrew R.T. Davies
Dai Lloyd Cadeirydd y Pwyllgor
Committee Chair
David Rees
Jayne Bryant
Lynne Neagle
Rhun ap Iorwerth

Y rhai eraill a oedd yn bresennol

Others in Attendance

Dr Andrew Goodall Llywodraeth Cymru
Welsh Government
Vaughan Gething Y Gweinidog Iechyd a Gwasanaethau Cymdeithasol
Minister for Health and Social Services

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Amy Clifton Ymchwilydd
Researcher
Claire Morris Ail Glerc
Second Clerk
Dr Paul Worthington Ymchwilydd
Researcher
Lowri Jones Dirprwy Glerc
Deputy Clerk
Sarah Beasley Clerc
Clerk

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

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

Cyfarfu'r pwyllgor drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:31.

The committee met by video-conference.

The meeting began at 09:31. 

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Croeso i bawb, felly, i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd trwy gyfrwng rhithiol. O dan eitem 1, allaf i groesawu fy nghyd-Aelodau i'r cyfarfod, gan ddatgan hefyd fod Lynne Neagle wedi ymddiheuro eisoes y bydd hi ychydig bach yn hwyr? Gallaf i bellach nodi taw cyfarfod rhithiol ydy hwn gydag Aelodau a thystion yn cymryd rhan trwy fideo-gynhadledd. Yn naturiol, fe fydd pawb yn ymwybodol bod y cyfarfod yn ddwyieithog a bod gwasanaeth cyfieithu ar y pryd ar gael o'r Gymraeg i'r Saesneg. Mae'r meicroffonau yn cael eu rheoli y tu ôl i'r llenni, a bydd pobl yn ymwybodol o hynny. Ar gyfer y cofnod, os bydd fy rhyngrwyd i yn ffaelu yma yn Abertawe, yna rydyn ni wedi nodi cyn hyn y bydd Rhun ap Iorwerth yn camu mewn i'r bwlch fel Cadeirydd dros dro nes y byddaf i'n gallu dod yn ôl. Oes unrhyw fuddiannau i'w datgan gan unrhyw Aelod y bore yma? Dwi'n gweld nad oes.

Welcome, everyone, to this latest meeting of the Health, Social Care and Sport Committee here at the Senedd via video-conference. Under item 1, may I welcome my fellow Members to the committee meeting? I note that Lynne Neagle has apologised in advance that she will be a little bit late this morning. I also note that this will be a virtual meeting, with Members and witnesses participating via video-conference. Everyone will be aware that this meeting is bilingual and that interpretation is available from Welsh to English. The microphones are being controlled behind the scenes, as it were, and you will all be aware of that. For the record, if my connection were to fail here in Swansea, then we have already decided in advance that Rhun ap Iorwerth will step into the breach as interim Chair whilst I try to reconnect. Are there any declarations of interest to make from any Members this morning? I see that there are none.

2. COVID-19: Sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol a Chyfarwyddwr Cyffredinol Iechyd a Gwasanaethau Cymdeithasol a Phrif Weithredwr GIG Cymru.
2. COVID-19: Evidence session with the Minister for Health and Social Services and the Director General for Health and Social Services and the NHS Wales Chief Executive

Symudwn ni'n syth, felly, i eitem 2, parhad efo'n sesiynau tystiolaeth—rydyn ni wedi cynnal mwy na 17 ohonyn nhw nawr, dwi'n credu—ar COVID-19. Mae'r sesiwn dystiolaeth yma eto gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol, a chyfarwyddwr cyffredinol iechyd a gwasanaethau cymdeithasol a phrif weithredwr y gwasanaeth iechyd yma yng Nghymru. Felly, dwi'n falch iawn i groesawu i'n sgrin ni Vaughan Gething, y Gweinidog Iechyd a Gwasanaethau Cymdeithasol, a hefyd Dr Andrew Goodall, cyfarwyddwr cyffredinol iechyd a gwasanaethau cymdeithasol a phrif weithredwr y gwasanaeth iechyd yma yng Nghymru. Mae gyda ni ddwy awr o dystiolaeth o'n blaenau ni. Mi fyddwn ni'n cael egwyl tua 10:45, mewn rhyw awr a chwarter. Dwi'n gobeithio y bydd yna doriad naturiol yn y llif o gwestiynau, ac i ddechrau ar y llif o gwestiynau yna, Rhun ap Iorwerth.

That takes us on to item 2 on the agenda this morning and the continuation of our evidence sessions, of which we've had more than 17 now, on COVID-19. This evidence session, again, is with the Minister for Health and Social Services, and the director general for health and social services and chief executive of NHS Wales. So, I'm very pleased to welcome to our screens Vaughan Gething, Minister for Health and Social Services, and also Dr Andrew Goodall, director general for health and social services and chief executive of NHS Wales. We have a two-hour evidence session ahead of us. We will have a short break around 10:45, so in about an hour and a quarter's time. I hope that will be a natural break in the flow of questions, and to begin that flow of questions, Rhun ap Iorwerth.

Bore da iawn i chi'ch dau. Dim ond er mwyn trio gosod rhyw fath o gefndir i'n trafodaethau ni yn gyntaf, allwch chi ddweud wrthym ni ar y pwynt yma mewn amser beth fu impact y toriad byr o 17 diwrnod, y firebreak a welsom ni yn ddiweddar o ran niferoedd achosion, sut mae'r feirws yn cael ei drosglwyddo, a'r rhif R allweddol hefyd?

Good morning to you both. Just to try to set out a little bit of the background to our discussions this morning, first of all, can you tell us at this point in time what the impact of the recent 17-day firebreak has been in terms of the numbers of cases, how the virus is being transmitted and the all-important R number?

Well, in terms of the number of cases, we should have a range of indicators showing a significant fall from where we were and where we were headed. If you recall, going back to when we introduced the firebreak, we'd indicated that there were challenges about the transmission rate and in particular we were seeing that in terms of NHS pressure and the harm that was likely to cause. I remember saying that there was an element of harm that was baked in, as it were, for at least another few weeks ahead, and so, with the firebreak, you'd need to see that flow through and then to see the impact of the firebreak another two to three weeks afterwards. We saw, as expected, a rise in the first phase of the firebreak in cases, and we've then seen a very sharp fall. So, it's taken us back to where we were a week or two before the firebreak was introduced. So, we have had an impact on significantly reducing cases, and if you look at the charts that we've been providing, you'll see that, without that firebreak, we would have seen that curve continue upwards and upwards. And that would have resulted in more people coming into our hospitals and more people losing their lives.

The other positive that we can now see from the firebreak is that we have seen sustained pressure in our national health service on hospital bed numbers—and Dr Goodall may be able to provide more detail on this—but it's meant that we still today have more people in our critical care beds than our normal capacity, which is 152 beds. We have surge capacity to give about 100 more than that. We've actually got, I think, about 30 more beds than our normal baseline. The last time I saw the figures, I think, was yesterday, and there were 180 people in critical care beds, and I think over 60 of those were COVID treated. So, over a third of the beds were COVID patients. That also means, though, we have well over 100 people in critical care who are not being treated for COVID, and that's a big point of difference to the spring, where of course we cleared capacity and we had very few people. What we are seeing, though, is a positive, in that we're seeing a levelling off and a slight fall in hospital admission numbers, and that's really important because that's going to give our health service an opportunity to regather ahead of Christmas. And we know that we're going to see more mixing over Christmas. We know that's inevitable, and that will provide more pressure on our service as we go forward.

So, we've seen an impact. What we haven't seen, though, and this is the difficult part, is the response in terms of a new form of public behaviour, where we're taking fewer risks and having less contact. And the problem is, and we said this at the outset, if we go back to pre-firebreak rules and patterns of behaviour, and it's the patterns of behaviour more than the rules that matter so much, then actually we'll see a return to a growth rate that could see us actually, again, in significant difficulty as we're getting towards the end of this calendar year. So, there's a good impact, but still real challenges.

09:35

Thank you for that. We'll come back, if we can, to impact on hospitals and what things are looking like in the hospitals, but just to stick on that general picture, you did make it clear that the trajectory would be a fall and then the curve going back up. The shape of those curves is important. We've looked at graphs like we've never done before over the past few months. Can you comment on whether that trajectory now, the increase that we're seeing again in parts of Wales, is worse than or better than you had foreseen prior to the firebreak? Again, so that we get an assessment of whether we believe the firebreak delivered what it was meant to deliver.

Well, the firebreak delivered what it was meant to deliver, and there's a choice for all of us about our choices that really drive new infection rates. We're seeing a rise, and it's a relatively modest rise across the whole country, if you look at the overall figures. And we did say that, if we could then have a more suppressed growth in the virus, then we could keep ourselves in a position where we'd be able to cope to the end of the year and then regather and reassess. The challenge is that, in some parts of Wales, we're seeing more significant growth.

So, for example, in the Gwent area, we're seeing, frankly, coronavirus burning much brighter in Gwent than it is in other parts of the country, and that gives us real cause for concern. It's not just Blaenau Gwent, which is often talked about; all the Gwent authorities are seeing a rise, and that's driven largely by younger adults. And we know that we can't segment our population and keep young people away from older people, because frankly they live together, often. It's not just ethnic minority households where you have people of different age ranges living together. And we know that people are interacting together, which means we can't segment the population. So, we will see that, I'm afraid, coming through over the next few weeks at higher rates and with higher admissions from people likely to have harm. And that's the challenge we have.

So, at this point, I couldn't tell you that I'm 100 per cent confident that we won't need to do things before Christmas. In fact, if we don't see a significant levelling off and levelling down, then we may have to do something different before Christmas. That's why we've spoken about the potential to have a common approach to some of the tiers in England or Scotland, to understand whether that's the right thing to do. Again, it would make it a more simple message for the public and aid public understanding and behaviour choices, and then make sure that we've got the headroom for Christmas, and we then need to make choices post Christmas too. 

One step that you gave an indication that you were going to be taking in order to try to understand what's better happening, probably in those areas of the south Wales Valleys more than anywhere else, was the introduction of mass testing. Now, the mass testing that happened in Merthyr Tydfil on that first day didn't strike me as being the kind of mass that I expected, where you look at whole countries being done. You know, Slovakia: 3 million people being done at the same time. Give us an idea, if you can, of how you intend to actually roll out mass—and by that, I mean the bulk of the population—testing in parts of the south Wales Valleys, areas of high incidence, and what impact do you think that could have in terms of just giving us a handle on things?

09:40

Well, the mass testing programme is voluntary. So, we're not forcing people. We can't force people. We'd have to change the law to require people to have a test.

But it's a really significant step to change primary legislation to require people in a given area to have a test, and that isn't something that we're contemplating doing. 

The first few days, we had about 1,000 people tested each day, so we did see a number of people responding. And, again, in Liverpool, if we think back to there, they had a very high response initially and they tested about a third of the city, and they've uncovered, I think the last figure was 700 to 800 asymptomatic cases; I haven't seen the check-in for the last few days. The challenge is: are we getting to all parts of the community and getting a significant understanding?

In Merthyr, what we're doing is, we started off with the one centre. We're expecting to have more than a dozen extra ones. We're also doing proactive testing around schools. So, the three high schools, and the further education college, will have a testing programme where they will provide testing around that site. And, to be fair, I spoke with the local government Minister and the education Minister, and the heads of those three institutions, the college and the council at the end of last week, and they were both really positive and 'can do' about how they could help in promoting testing around their site, because they understand that it would actually be good for them, because they could understand where in their school or the college people have got coronavirus at present, how they can then better protect people, and if there are people who are isolating, the test may allow them to come back.

So, we've got some challenges, and, actually, that will give us, if you like, a more representative segment of the population, because if we can get significant testing done around those secondary schools, we'll have people from all parts of Merthyr coming in there, and it won't be quite so self-selecting. And it's also then an opportunity to reinforce the messages around why this is being done, why there are risks, and to engage with the parent community about why we want to have those tests done, and why it's important for them, as well as the wider community, for that testing to happen. 

So, I actually think—. That's something slightly different to what Liverpool have done, and I think we'll learn lots from that. So, over the next week, we'll learn more, and we then need to make choices about what else we might want to do. And that again is against the backdrop of challenges in the rest of the country, and, as ever, none of this is straightforward. 

There are two things that worry me there. More than two things, but let's look at two things. One: why are people choosing not to go for tests? Are people choosing not to go for tests because they know that will heap a lot of hassle on them? What if they test positive? Then they'll have to self-isolate. It could just be we want them to test positive. And, secondly, what do you do to those people who say, 'Well, you know what, I know I'm supposed to self-isolate, and I'll do what I can, but I can't do what I have to do; I can't do what I deep down know I have to do because I have a life to live and a family to feed, and so on'? How do you make sure that we change people's behaviour? You say you're not going to change the law, which is disappointing. But, how are you going to get people to go for those tests, and how are you going to make sure that more than, say a third of people, which is the current figure, as we understand, actually do self-isolate effectively?

Well, we're not clear about the figures in Wales. The studies that have been done have focused on England at present, and, actually, part of—and you've talked about support—the support that people have is not just the financial support that's there, but it is about the fact that there are regular calls from the test, trace and protect service to people that are isolating. We've been able to achieve that and able to reach a higher number of people. So, we don't know the differences between Wales and England. We haven't had a proper study done on the levels of self-isolation success, but we can be confident that there are a number of people who aren't isolating for the full period. There's anecdotal feedback, again, about people not really understanding the message.

That's part of the reason why it's really important to have consistency, because this isn't an area where there should be any difference between parties, regardless of our perspective on a range of other things. When people test positive, we want them to isolate, there's a support payment that's available, and we want them to understand the impact of not isolating. So, it's important not to say 'I've tested positive, so as I'm going to need to isolate, I need to go to the shop and do a big shop to make sure I've got enough food.' That's entirely the wrong thing to do, because immediately before you have symptoms, and for the first few days afterwards, is when you are at your most infectious, when you're most likely to pass it on to someone else. So, going to the shops is entirely the wrong thing to do, and yet there are people—. You can understand some of the logic of it, about, 'I'm going to be indoors, I can't get out to the shop for a while, let's do this now, then I'll go home and I'll begin.' That's difficult, so that's also why the broader support, whether that's community, family, or if people haven't got local contacts they know to help them with things like shopping and provision, that's also where they can still contact either the third sector or their council, and they can help to direct people to have that support provided to them. So, there's a wide range of messages.

And part of the challenge about why people don't isolate is, it's a mix of things. There are more conspiracy theories floating around now; that's an analogue for some people—do they really need to do it? Or that stuff about, 'It's not really that serious', when of course it is—that's why we have people in our hospitals, that's why people are dying each week here in Wales and across the UK and the wider world. There are also then challenges about the practical concern over, 'Well, can I survive if I don't go to work?' And, actually, the support payment should help with that, and in particular, in our care sector, where we've also got the additional support of a statutory sick pay top-up.

So, we're looking to try to help support people, we're looking to try to win the argument and persuade people that it's the right thing to do for them, and, importantly, the right thing to do for all of the people around them that matter to them as well. But if they go out whilst they're infectious, then harm will be caused somewhere along the line. And it doesn't matter if you're 21 and feel fit and healthy, because a small number of people in that group will still become unwell and, actually, you're more likely to see other people in different generations—your parents, your grandparents, or your friends' parents, grandparents, other loved ones, contacts and people you may know in the workplace—and they may have a different risk profile. And that is how we see a high rate that had driven some of the infection in under-25s eventually translating into over-60s rates, and those, I'm afraid, translate into hospitals and, ultimately, some of them end up being in our death figures.

09:45

Symud ymlaen rŵan i gwestiynau gan David Rees. David.

Moving on now to questions from David Rees. David.

Diolch, Gadeirydd. Morning, Minister. Morning, Dr Goodall. I suppose I want to go—. I will come back later on some of the points you've raised, but I'll just look at the issues regarding services in hospitals at this point in time, and particularly waiting times. We've obviously recognised the challenges that hospitals faced. In March, it was decided to stop all other services so you could prepare the hospitals and prepare staff for the different—. I understand that. But the consequences have been that there have been delays, therefore, in treatment for other people who may not be seen as having life-threatening conditions but could have life-changing conditions. You did indicate at one point, Minister, that you think it will take a whole Assembly term, perhaps, to get back to where we were. Is that still your thinking, and if it is still your thinking, what's the strategy for getting back as soon as possible to where we were?

Yes, I do still think it will take pretty much a full Senedd term; there's no point understating the scale of the challenge we face. It will be the same in Scotland, England and Northern Ireland too. There'll be a huge effort needed to get back over the backlog created and the harm caused, and that is both the direct harm from COVID and the long tail that will have, so not just long COVID, but people have been significantly unwell and needed hospital treatment, and we don't understand all of the impacts of that yet. So, that's part of our challenge, in getting that element of treatment right that we haven't had to deal with before, and the significant numbers of people who have had COVID and will have recovered to some degree, there's then also the harm caused by putting off other treatments. And, again, we know that, in terms of the choices we made to put off other treatments, the public also make choices. Because they were concerned, lots of people didn't attend appointments that were available to them.

So we will need—and you're right—more radical interventions for a number of people than otherwise would have been the case. There is a significant backlog already. And I know Dr Goodall can tell you some more about not just the quarter 3, quarter 4 plans, but about the outline planning that is already taking place with staff for the future. And we ultimately need to get to a point where we have a more detailed plan. Now, that is a little bit further ahead, but there are already conversations taking place now about how we would look to address the backlog. And you have to remember that, when we get through in our population a coverage in a vaccine, we're still going to be operating at a different pace and a different level of throughput compared to previously. Because if you compared, say, the start of February this year to February next year, well, we hope we're still going to be vaccinating people in February next year. Even after we complete the vaccine, there'll still be some community prevalence and transmission, and it will still affect the way our service operates. And now I think—and Dr Goodall will confirm this to say if I'm wrong—we're only able to undertake about half of the throughput we would otherwise undertake in terms of elective activity, because of the additional infection prevention control measures, because of personal-protective-equipment wearing, and that isn't going to suddenly disappear overnight at some point in the future. So, actually, we have a much bigger challenge, a really big backlog as well as normal demand coming through, we have exacerbated conditions across a range of areas, and then we still won't be able to operate at our maximum efficiency level.

And we also need to think about our staff, because when people talk about the NHS currently, actually, that's loads of pressure for our staff, and that has an impact in the here and now, but importantly, also, in the future too. In the future, some of our staff will need a break, they'll need support, and that again will mean we’ll have fewer staff in the workplace to be able to undertake the work that is required. And that's hugely important, that we're able to factor that in and plan that, because, otherwise, we'll end up breaking our staff, and that will be a poor reward for the work they have done to keep all of us safe. So, it's multifactorial; there isn't a simple answer. But I can tell you what is the wrong answer, and that is just to say, 'Our staff just need to work harder and get on with it.' That is absolutely not the approach we can take, because that will poorly serve our staff and it will poorly serve the public.

09:50

I don't think anyone has said that, or I haven't said that, so—. But on the issue, Minister—

I'm not suggesting you have, David. I'm saying that's part of the commentary that I know is somehow out there, and you just need to know about it. 

But on that staffing issue, can I ask a question, therefore? Is part of your strategy to actually look at your workforce plan and make amendments to that workforce plan to include more training, more development, more staff and more resources? I know it's a cost, but, as you pointed out, staff are going to be needing breaks, they will need support and they will need replacement. Therefore, we need to look at—. And if you're talking about a throughput being reduced, let's say, from eight operations a day to five operations a day, are you looking at, perhaps, more capacity in your hospitals to do more surgery by having more theatres, more staff and more resources? Are you looking at that aspect as well?

Yes, we're looking at everything. The problem is, the way we would traditionally have looked to recover—. Thinking about the four years of progress we've made, with year-on-year progress on reducing waiting times, we then had a challenge in the time before the pandemic with the tax and pensions issues. That, again, was a UK-wide issue, where, because of tax and pension changes, there were a number of NHS staff who were not prepared to undertake waiting list initiative work. Now, that meant that our progress stalled a bit. But we're asking, broadly, NHS staff to undertake NHS waiting list initiatives as extra work, or we're using the independent sector, or we're using capacity in England. Now, the challenge is that our independent sector isn't particularly big, and it's a short-term measure as opposed to a sustainable answer for the way we want to treat people. The English capacity isn't going to be there in the future, because they have a huge backlog to address, so we should not expect there will suddenly be lots of extra capacity in England for us to use here. And then, of course, as I said, our staff are tired already and they'll be really tired in the future. So, asking them to work harder and just saying, 'Put on more waiting list initiatives' isn't the answer in itself as well. So, we actually have a real challenge.

And then it isn't just about more theatres, because you need staff to run the theatres, and that is one of my concerns. We have, actually, invested in our staff successively at an increased level. Even through the period of austerity, we've made choices to increase staff training across a range of disciplines. That means that, in some areas, we're in a slightly better position than England. So, we have deliberately trained more nurses, we've done really well on GP recruitment. There's a range of areas where you can say that's positive. The trouble is that we're dealing with such a big challenge, that even with the extra training choices we've made over previous years, that still means we're going to be fighting an uphill challenge in how we actually deliver that extra activity, how we eat into the backlog. So, the money is always going to helpful, and I know there's going to be some more detail today, but that in itself—the initial announcement—isn't going to be able to deliver all of the activity we're going to need.

I'm just trying to be honest about how difficult this is going to be, and it will still mean we're going to need to recruit people from other parts of the world, when, of course, other parts of the developed world will have exactly the same challenge we have in addressing their own significant backlogs too. So, that's why I think there's the honesty required about the length of time it will take rather than simply saying, 'Train more staff.' It will give us more staff in the future, but that is in the future, and I'm shortly about to announce decisions that I'm making on future training amongst our NHS workforce as well. I'm hoping to have that announcement out either today or tomorrow, but that will be out soon, and that will again show what we've done in the past and what we're looking to do to invest in the future.

Okay. I've got Andrew who wants to come in at this point with a short supplementary. Andrew. Then we'll come back to you, David.

Thank you, Chair, thank you, Minister. You were talking heavily about the staff then; quite rightly so, because without the staff, none of this could be delivered. In a recent RCN staff survey, they indicated that 34 or 35 per cent of nurses felt less valued by the Welsh Government than they do across the UK. Basically, it was the highest level of dissatisfaction with a Government in the UK. So, do you recognise that level of dissatisfaction amongst the workforce, and what are you doing to address it, given the stress levels in that same survey indicated 75 per cent of nurses have indicated greater levels of stress in the workplace today than what they would usually experience?

09:55

Well, I don't know the numbers of people who addressed that survey. What I can say is that we've always had not just good a relationship with the RCN, but with other trade unions representing the nursing workforce. We've made choices over a sustained period of time to increase training for nurses. We've maintained things like the bursary to help new nurses come into the workplace, and I actually think, when you look at what we're doing, we have a materially different position on our nursing workforce compared to colleagues over the border in England.

But the challenge with that is that just saying that now doesn't mean that there isn't a real period of difficulty for our staff in the here and now and in the future too, and it isn't really enough to say, 'We're in a better position than England'; we still have a big challenge to address here. And I have regular conversations with leaders of nursing trade unions, including the RCN, and I'm, of course, concerned if there is an impression that somehow nurses are not valued, because nothing could be further from the truth. And I've invested lots of time, energy and effort in conversations with nurses, nurse leaders and indeed the 'Train. Work. Live' recruitment programme. We have had a significant focus on nurse recruitment and retention, because the future of our NHS workforce is already here: the overwhelming majority of people who will be working for our NHS in five and 10 years' time are already in the NHS. So, it isn't just about the importance of getting new staff into our service, it's also about looking after the staff we have.

Just to pick up some areas to complement the Minister's comments. First of all, just in terms of our context in Wales, we were able, through the Minister, to launch the workforce strategy, which ties into 'A Healthier Wales'. And I do think that our commitment to compassionate leadership principles and also to well-being—which was a very significant emphasis within 'A Healthier Wales'—is helping us in our ongoing discussions with staff representatives, which happen on a very regular basis. I was chairing our latest meeting of the partnership forum just two weeks or so ago, and able to talk through some of the current concerns and pressures within the system, and myself and the Minister are very accessible for any of those discussions.

On workforce more generally, the Minister is right. On the one hand, we have taken some longer term decisions that mean that our future pipeline will be issuing the numbers of health professionals in a number of settings, right through from GPs to community nurses to the more specialist end, who will be able to support our system in broad terms, and that is a positive investment and active choice that's been made on behalf of the system.

Having said that, we have to deal with the pressures and the problems that we have now, which were around before COVID-19, but actually are now exacerbated as well. We have actually seen a more significant increase in our workforce staff across Wales over the last 12 months on the latest figures, so when you compare June last year with June this year, there's been actually a 7 per cent growth in our numbers, which is probably around three or four times the normal level of annual growth, so that's at least securing some more substantive staff within our system.

But I am concerned that, ultimately, whatever choices we're looking to make in our system, in overall terms, it remains the same workforce that we're asking to do different things, and there is a real danger of diluting some of those choices, some of which are recurring at the moment. We have to prioritise a vaccination programme, for example, because there is a window with the significant positive announcements about the ability to now move ahead with vaccines over these next few months or so, but at the same time, we need to deal with current pressures, we need to be able to accommodate the restoration of activities and, of course, we need to be able to continue to expand our capacity. So, I am mindful that sometimes we are juggling some of the workforce priorities.

From a planning perspective, we have wanted to ensure that over these recent months, from the initial decisions taken in March, that we've been able to increase a level of restoring activity not just in our hospital system, but actually across different settings as well, and I think that the NHS's focus remains on wanting to continue that for as long as possible in as many settings as possible, and to maintain that commitment to deliver services for Wales. But whilst we have seen increases in our elective activity, we've seen a doubling, even a tripling, of elective activity taking place in some of our individual health boards in Wales. The Minister is correct that we remain suppressed in terms of the ability to get back to normal levels, and that will continue, unfortunately, while we still have COVID-19 with all of the practicalities of that, from PPE to the safe hospital environments that we need to create.

So, the quarter 3, quarter 4 plans were initially focused on moving beyond essential services and allowing a restoration of activity to take place, not because we felt we were going to recover the waiting lists over the winter period, but that we would be maintaining that. So, our existing planning is making sure that we can demonstrate the increases that are necessary, but it's important that we know how we would continue to build up other choices of activity through the winter into 2021-22. Our annual planning cycle will pick that up as well.

But there will also be some areas where we will need to ask for some investment to go in to deal with the immediate pressures. So, the Minister is aware that we're doing some proposals and plans at the moment, working with the NHS, around diagnostic services, including endoscopy care, for example, which has been quite significantly affected by just the environment in which we're having to provide care at the moment. And that will need us to think differently in terms of the ability to expand and develop staff to make sure that we can bring specialisms into our areas, but also may require choices that are both developing local capacity, but probably also the development of regional centres in Wales, which, I think, is going to also be different—working above the health board boundaries. So, whilst we are working our way through the winter, our intention is to provide the Minister with some formal advice—probably during January, I'd hope, Minister—that will at least give us scope for the things that we need to do next. But, obviously, we'll have to deal with that as part of the budgetary process and choices that Government is going to need to take, not least for the budget for 2021-22, of course. 

10:00

Great. Back to David Rees. Some of the issues, I think, you were asking, have already been tackled with that very comprehensive answer there from Dr Goodall, but David.

Yes, thank you, Dr Goodall. Thank you for that. It's very important to highlight the fact that the electives are not just the issue—there are diagnostics, there are therapies, there are other services as well as the elective surgery and other practices. It's very good to hear that. 

Perhaps one final point from me. I've got a couple of points on targets, but one point on waiting lists. We've seen a rise. I know there's a 13 per cent rise in the overall figure, but we've seen a dramatic rise in the over-26 and over-36-week waits. Has that—? We've got to address those issues, but also we know that there have been people who have not come in, as you've described and as you've pointed out—people have not come in to services, have not come into hospitals. Particularly in the initial period, they didn't come for urgent referrals, go to the GPs—cancer referrals were down by up to 75 per cent in some cases. Has that factor been taken into account when you look at what your waiting lists are likely to be in years ahead? Because, at some point, these people will come into the system, and will be added to the lists. So, have the lack of referrals and the percentage of referrals that haven't come in as you would have expected them to been factored into your calculations as to what your demands will be in the years ahead?

'Yes' is the straight answer. We know that there is a suppression of real demand and need coming through into the system; we know that will reappear. That's likely to reappear at a later stage where there's more significant intervention likely. And that's difficult because you understand that people are worried, and they're balancing a range of different worries. Often, we say that it's a cost to the NHS when people miss their appointments: 'Please turn up. Please don't make the NHS waste money by not coming to your appointment.' Actually, at this period of time, there's got to be some understanding for people who are worried and are either not attending for a range of appointments because they're worried. We still want them to contact the NHS if they have got an appointment to tell us that they're not coming, but the more significant issue is people who aren't coming in the first place.

But, on cancer, you know, we've been clear: we're going to have a single cancer pathway, which will be a much more accurate indication of how successful we are at getting people through our system, with all of the suspension delays that that includes as well. So, this is definitely part of what we're factoring in. It's part of the conversation that is already taking place with our cancer clinicians; not just in cancer, of course, but in a range of other areas where we know that there are people who have not come in. I regularly talk about stroke because we saw the emergency stroke admissions fall significantly in the spring, and that is not because the population suddenly got healthier; it's because people were too afraid to come into a hospital environment because of the significance of the pandemic at that time. So, really difficult challenges, and we'd ask people to come forward. We'd much rather have people coming into our systems, so we know about them, we can balance and then prioritise the risk, rather than having that risk being unaddressed and unmanaged at all. But, I recognise this is really difficult.

We had seen cancer referrals drop off very materially—over 70 per cent reduction—certainly as we were going through March, April and into May. I was able to report at the last committee that I attended that we had seen recovery in that, and that has maintained around cancer referrals. As you would expect within the system, with a particular focus on essential services, this is one of the areas that we wanted to ensure was able to be discharged through the pandemic response and then to continue to focus on it. So, our referrals are back to normal levels, if not a little higher for cancer at this stage, and our activity has returned almost to normal levels on cancer treatment, but I'm still keeping an eye on that, because, in any individual week or month, we can see sometimes that does drop by about 10 per cent or so. So, I would say not fully back to normal levels, but certainly to a very significant level.

The Minister was announcing last week that we're looking to have a shift around the recording and reporting of the single cancer pathway to be the way in which we are looking to lead and deliver our cancer services in Wales, and actually that is also a deliberate choice at this stage, that, whilst of course you will have seen the figures tracking the old measures, the reason for going for the single cancer pathway, having worked on that with clinicians and stakeholders, is that that is a better representation of the delays and cancer experience of patients who are moving through our system. So, that is the reason that we have wanted also to maintain that as part of our restoring and resetting of activity at this stage.

But it's going to be more difficult for us to work out some of the ongoing harms. We are doing some work on just understanding some of the issues around health access, on some of these essential services as well as others, but, of course, with the cancer referrals that have come into our system, there is always a very high proportion of those cancer referrals that never turn into cancer diagnoses, and sometimes what's difficult to understand at the moment is the difference between perhaps people who stayed away from our system: were they likely to end up on a cancer pathway or would they have just been given news that they were able to just get on with normal lives in the normal way? So, we're just doing some work to understand what some of the data is telling us on that.

10:05

Yes, thank you for that. I understand the points you have raised and perhaps I'll have the opportunity to discuss the cancer cross-party group's report this afternoon in the short debate with the Minister. But can I go on, now, to targets? Minister, you changed or introduced new targets for A&E, for example. Can you explain—? The four hours was easy to understand, straightforward, everyone knew exactly what it was. Are the new targets going to be as straightforward for people to understand, and have they been introduced because of COVID or have they been introduced because of other practices?

These were not introduced because of COVID. These were introduced because we've had an ongoing conversation with our clinicians about having measures that are helpful and honest in terms of reflecting how successful we are at appropriately treating people. So, this actually comes from clinical leadership. So, Jo Mower, who is the vice president of the Royal College of Emergency Medicine, as well as our clinical lead on emergency care, she actually undertook a period of engagement with her peers across Wales, and they have come up with this group of measures. The pandemic actually delayed the introduction of these measures, and we're piloting them, and actually they're deliberately made simple to try to understand. So, how long does it typically take for a patient to be triaged from the point that they arrive in the department? So, that's the first sort of contact. How long does it take from their arrival to when they're assessed by a clinician? And then where do patients go after they leave? So, that helps to tell us both how successful they are at resolving the problem within the department and how significant the need is coming into it, and it also helps to tell us something about whether we could and should be able to successfully support and care for people outside of the emergency department as well, and there's something there about again suppressing unnecessary demand, because it's really important for patients and the people working in those departments that they see the people they really need to see, and there's a challenge there about making sure the rest of our system is able to see those people in alternative ways.

So, I think those are simple measures to understand, and we're still reporting against four and 12 hours as well. And again, the important part about this is, this is designed and delivered with clinicians. It's their view on what are useful measures and how they can tell you something about quality. We also then have, within each of the departments—. I don't know when you were last in an emergency department, but you've got the opportunity with the different smiley faces, which you're used to seeing in airports, perhaps, as well, to tell about your experience. And that in itself is an easy and a simple way to understand how people feel about the service as well. So, the four and 12 hours are a simple measure, but they're a bit of a blunt instrument, and this should tell us more in a useful way about the performance of our system. And, as I say, it's been designed by clinicians not politicians, and I think that's really important.

Thank you, Chair. Just to comment further on this, I see this as applying our prudent healthcare principles in Wales to one of our big pathways and allowing us to ensure that, by tracking and monitoring performance in different ways, we can actually focus on the impact on patient care and actually on individual outcomes for patients. That is a prudent healthcare set of principles that we have committed to and signed off within 'A Healthier Wales'. 

I do think that there is a need also to recognise that we are also transforming a range of our services in Wales that perhaps also raise some questions about how we are going to monitor the patient experience, including some of the timings around that. So, we are currently rolling out the phone first, contact first, initiative in all of our A&E departments across Wales to support the unscheduled care pathway. That had started in Cardiff in terms of the opportunity for people to be either diverted to alternative settings or to be booked in for a later attendance to avoid congestion in departments. And obviously, that raises questions in itself from that initial contact about how one would be monitoring the timing around those areas where they are agreed outcomes with patients at this stage.

The third thing I was just going to add is that, consistently, with discussions happening elsewhere, you'll be aware of the work that the Royal College of Emergency Medicine, beyond Wales, has been doing also in England, which, again, is looking to shift the focus away from some of the process timings, and the four-hour target in particular, and similarly looking at what this means in terms of the patient outcomes and experience as well. So, there is learning across our borders in terms of what that means. Even though we have developed this in Wales, it's also consistent with the principles of developments across the border in England as well.

10:10

The last question from me—and I apologise if I missed it in your statement regarding changing targets in A&E, but, clearly, ambulance handover times have been an issue. They've been very quiet, because, obviously, COVID has been dominant in the discussions, but there are still challenges. I know of ambulance crews that are still sitting, sometimes, in an ambulance outside A&E for long periods of time—sometimes, their whole shifts. So, does this introduction of a new system in A&E benefit, and are you going to link it into, ambulance handover times, and therefore how are you going to ensure that the ambulance service meets its red to amber targets? 

Okay. So, we have already reformed the way that we measure and assess performance around the ambulance service. And it isn't just the performance of the ambulance service itself, because they're not really in control of handover times. So, that is a measure where we've, again, looked at having a system to incentivise performance and improve handover. But, of course, we were starting that and then the pandemic hit, and then, actually, everything has gone up in the air. 

So, just as, within a hospital, there are different requirements and different challenges in providing care because of the additional measures that are now necessarily in place—our capacity is reduced because we've got more distancing between people than we would otherwise have had in our departments, as well as PPE. So, that's a real challenge for the receiving emergency department. And equally, there's an additional challenge for the paramedic crews themselves, because they've got to put on and take off PPE as appropriate with the people they're caring for, and that takes—the figure I've got is that it can take up to six minutes to put on PPE. Now, that may not sound a lot, but, when you're responding to calls, or when you're arriving on a scene, actually, that can make a real difference. So, actually, there's delay that's built in in all parts of what we're doing.

And I understand the real pressure that that places upon paramedics and the real frustration that they have about not being able to provide patients with the care they want to and not being able to see them put into an emergency department when that's the right place for them to be. So, we continue to look at all of the wide suite of measures that we've got to look at the ambulance performance, and we'll continue to do those. As I said when I introduced those measures, far from lessening scrutiny, it's actually provided more scrutiny, because there's more information. In the same way, I think the emergency department measures are going to do the same, but this is a continued focus and there is more work that carries on between the ambulance service and the health boards to understand what more we can do, because we recognise that it's a real pressure. 

Amser i symud ymlaen. Mae'r cwestiynau nesaf o dan ofal Andrew R.T. Davies. Andrew.

Time to move on. The next questions come from Andrew R.T. Davies. Andrew.

Thank you, Chair. I'd like to cover a couple of areas—recovery and delivery of services and also patient access and safety of services, if I may. 

Dr Goodall, you did touch on the quarter 3, quarter 4 plans that the LHBs had submitted in earlier questions. I was wondering whether you could share with the committee more information on those plans and how they will enhance the delivery of service and make some small progress into the massive waiting times that we've seen.

Yes. First of all, the quarter 3 quarter plans have been building on our approach through the pandemic response. We, back in March, April, were needing to look days and weeks ahead and were unable to look further in terms of the end of the financial year, certainly. And it was a deliberate choice to continue to build on our experiences in the first two quarters. Inevitably, at that point, because it was more driven by the emergency response to the pandemic, we were driving a focus, really, around essential services there, in line with the World Health Organization, and we have continued to use that as a backdrop to our services.

But the quarter 3 and quarter 4 plans have been important to try to move on the focus about the ability of the NHS and its resilience to recover and reset activities. As I was saying earlier, inevitably, there'll be a focus around what goes on within the hospital environment, but, actually, a lot of the restoration has been also around other services that wrap around the hospital and, ultimately, protect it. GPs and pharmacies have obviously stayed open throughout the area, but they've been able to introduce, themselves, some further enhanced services and the opportunity to see patients differently but back to more normal numbers, if I could put it in that way. But we've seen also a restoration of other services, like the national screening services, like the ability of dental services to see patients in a more normal setting, and also optometry services across Wales as well.

But it's the hospital environment that we will need to focus on in terms of where we will see the greatest impact of the COVID-19 pandemic on the backdrop. And, therefore, we have, in quarter 3, quarter 4, wanted to ensure that, as far as possible, we can maintain a level of routine activities in hospital settings, even through the winter period time. So, the quarter 3, quarter 4 plans were a response to the winter protection plans that were set out by Welsh Government, and the Minister obviously issued a statement about what his own expectations are. And we have wanted people to take account of the normal winter pressures, of course, that we experience, particularly in the turn of the calendar year—areas like flu that we would expect, normally, to work their way through—and recognising it is the highest point of pressure, but to make sure that, despite that, and even if this involves local judgments by health organisations and not just the health boards, they are able to maintain a level of activity.

So, in the responses, we've needed people to have some flexibility about responding to emerging trends. Clearly, one of the original assumptions, unfortunately, was that we were going to see an impact of an increase in COVID admissions from community prevalence, and where we are at the moment, of course, with our numbers being at the highest levels that we've seen, has some implications for some of the choices that are needing to be made on a local basis. So, the three health boards that feel as though they are more feeling that pressure at the moment in the all-Wales context will be Aneurin Bevan University Health Board, Swansea Bay University Health Board and Cwm Taf Morgannwg University Health Board. But, of course, we are seeing the community prevalence turn into hospital admissions across Wales at this phase.

Perhaps just to show, however, that there are some factors within the quarter 3, quarter 4 plans that may be more helpful to us on assumptions, it does look at the moment that the flu season is very negligible, learning from the southern hemisphere experience, but also recognising that we've got the highest vaccination levels on record for our flu programme, which is a good sign of the public stepping forward to protect itself. We at least do think that there is going to be some mitigation of some of the pressures, at least not having a flu season on top of COVID-19 and, obviously, our wish to restore activities. But we will continue to carry on with a level of urgent and elective work. I think, inevitably, the turn of the year will still be our greatest pressure point, unfortunately, because that has always happened, in my experience in the NHS in Wales over the last 30 years or so. But we will hope to have other plans that mean that we can start building up a level of elective activity, particularly as we go into 2021-22. And, as I was saying earlier, that does mean offering up some plans that, whilst we need to do them over the next 12 months, I think we're going to have to have a three- or four-year outlook on this as well.

10:15

Just on those plans—to the Minister, if I may—if you look back on what the other nations of the United Kingdom have done, in particular Scotland and England, they seem to have had more activity and more energy into the resumption of services as the summer progressed, in particular around July and August. Is it a fair observation that the Welsh Government took more time to build up its plans and therefore was later introducing the resumption of services and the health boards submitting their plans for quarter 3, quarter 4?

No. The permissions were there to recommence, and they didn't need permissions from the Government to recommence a range of those services. And it's about working with the NHS rather than the Government determining, 'You may now move on this.' There's a relationship between, obviously, the Government and the role of Dr Goodall as the director general, as well as chief executive of NHS Wales, but I wouldn't say there's been any intervention from the Government that has prevented activity taking place. The limiting factors have been the ability of our staff to come through the end of the first wave of the pandemic and then how much pressure we will have wanted to put on them to resume activity. And, as I say, we're balancing a range of really difficult factors here about what our staff have been through, what they can then do in terms of returning and needing to reorder the hospital environment. Because, as you know, we've needed to create COVID-lite or green zones so that more planned activity can take place. Given the estate that we have, actually, perhaps the more significant limiting factor was actually getting our estate to a position where we understand how we can use it in a way where more planned activity can take place.

So, there are a range of different factors, but I wouldn't say that the Welsh Government has prevented our system from undertaking activity, and I think it's important to have a properly balanced outlook on where we are and what we're able to achieve, and as you can see, there's more activity taking place now, but that has to be balanced against the other harms that we're managing.

10:20

In those plans for quarter 3 and quarter 4, I'm sure there have been requests for additional support and help from Welsh Government. Are you in a position, Minister, to identify what specific levels of support have been requested from the health boards to maintain that throughput in the hospitals through their plans?

I think Dr Goodall may want to comment on the quarter 3 and quarter 4 plan, but I'll make a general point here, and that is that this isn't really about additional support in the sense of there needs to be more money to do things. Our ability to have different testing facilities, to give people assurance, is an important part of what's been done already since the resumption of more planned activity, but we're not really talking—. We did actually provide capital to help with the zoning of green and red zones within our hospital estate, and that was really important. Since then, it's not really been about capital expenditure to enable more activity to take place; it's actually the balancing of the different people that are coming in to our system and the reality of managing the COVID pressures that we have. Actually, the squeezing on non-COVID activity is going to come from whether we can successfully suppress COVID rates and community transmission, and that is the biggest factor in how much we're going to be able to do through this winter.

We received, from an NHS perspective, stabilisation funding that was to cover through the winter period to the end of March, and whilst that included a level of restoring activities, that is not about looking to address all of the backlog of our waiting lists at this point, because it would not be possible to discharge that through the winter, particularly with our expectations around, at that time, from a planning perspective, a second wave. We'll need to see what happens in terms of the sustained pressure for that, because that does have a knock-on effect in terms of some of the choices. So, that funding gave a stability and confidence to the NHS, at least, about what it could plan for to maintain a level of restoration beyond the essential services, as I was just outlining earlier.

So, from a funding perspective, we'll need to continue to see where we need to develop that further in the future. I think one of the approaches that we're going to need to take is that whilst there will always be things that we can do to target a backlog, some of this will need to reflect a more sustainable level of funding, so that there are strategic choices that are going to need to be made about what we need to do. And that's why, I think, some of these areas will be driven by what local organisations can do, but, inevitably, we're going to need to oversee choices on behalf of Wales in overall terms, and possibly beyond just the boundaries of health boards, for example an opportunity to develop services on a regional or even on a national basis as well, just to make sure we maintain some momentum around the choices that we make through this winter and beyond.

Before the Chair cut me off there, I was just going to press the point about additional resources, if I may, to the Minister. I appreciate that mental health isn't part of your brief anymore, but on Monday, I had a meeting with the Royal College of Psychiatrists, and they were making the point that there is capacity there if it's commissioned for additional clinics, additional support outside of what would be classed as normal working times. So, that was the type of resource I was trying to get from you, Minister. Have you contemplated the ability of the NHS to work outside the normal working routines? Obviously, that does need resource from the centre to support the health boards in commissioning that call for additional clinics and additional capacity. So, have you had that request come in to help you increase the capacity?

If we have requests to increase capacity, then yes, we'll of course look at them. Our challenge, though, is that we've provided stabilisation funding as a first port of call, for health board to look at the resources they have, because we've prioritised mental health funding over a successive number of budgets. If there is additional capacity that could be used, then we'd expect health boards to be able to access that and use that in accordance with their own understanding and responsibilities for the populations that they serve. They wouldn't necessarily need to come to the Government for every single choice, and it's important that we do reflect and understand that, because otherwise, if I'm making every choice in a ministerial office, that will slow down decision making and will take away responsibility not just that front-line clinicians have, but that their own service managers and leaders have. So, if there is extra capacity, I would expect health boards to be able to use it. It's only if they get to a point where they do need additional resource from the centre, rather than making use of their own, that we'd expect anything to come in to us. And of course, we're going through another budget round. We'll see more from today. I hope we'll get clarity today about what we've seen in brief in the headlines, about what that will mean for the near future as well. But we'll look to make use of all the resources we have across the system. We're not sitting on a big pot of money here in the centre. We have allocated into different areas to allow activity to restart. We're expecting the budgets we've already provided to actually help people to restart that activity.

10:25

The key here is obviously patient confidence, and there is evidence that as the COVID crisis has unfolded, patients have been reticent about engaging with services despite their reintroduction. What work has the Government undertaken to reassure the population at large that the NHS is open, it is safe, and above all, if you have an issue that you want addressed, you should engage with the NHS here in Wales?

This is a regular feature in questions that I get in press conferences, but it's also a regular feature of things that I say proactively in press conferences. Particularly over the summer, we've regularly said the NHS is open, it is here for you, it is available for you if you have a healthcare need, please come to the NHS as you would normally expect to. There are different ways of accessing the NHS now, and actually from a patient point of view, many of those access routes are simpler. And they're different for different people, of course, because whilst many people will welcome the ability to remotely access services, there are a number of others who want to go and physically see a clinician. But the NHS has never been closed for business. We have said successively and repeatedly that we want people to come in, and that's not just the message from the Government, it is the message that all of our local services are providing in their local populations.

Again, with all of the challenges and messaging that exists, part of the difficultly is that we're telling people about the big and significant threat from COVID that will increase over the winter, but at the same time, if someone has a healthcare need, they could and should access the service. Because as we discussed earlier with David Rees, putting off some of those appointments, putting off some of that interaction with the healthcare system—actually that's a bigger challenge for the country, and certainly a bigger challenge for those individuals, if they then wait a longer period of time before they access the service and there is a real issue that needs to be addressed. So, I think we've been pretty consistent and very clear in our messaging, but I can't always dictate how other people choose to take on board that message in what's reported. So, we're not entirely in control of how the public receive their information.

It is a fair observation, Minister—? Macmillan, for example, have highlighted the campaign around re-engaging with cancer services, and other than a short campaign in June, they cite that's the only engagement Welsh Government have had to promote cancer services on a public level, whereas in other parts of the United Kingdom there have been comprehensive public information campaigns about the level of engagement and reintroduction of services.

We've regularly talked about the fact that referrals into cancer services have fallen, we've regularly talked about wanting those people to come in to our service, we've regularly talked about the fact that we're seeing a recovery in people actually coming in. So I don't think it's fair to say there's been no attempt by the Government to try and persuade people who do have healthcare needs that they should come to the national health service. I think we have had a consistent message across all service areas that we want people who have healthcare needs to come to the NHS, because we are open for business.

I've wanted to make sure on behalf of the NHS that that was understood. I shared myself, openly and publicly, my concerns in the earlier part of the pandemic response, seeing just some of the numbers drop off for both emergency care and also for our essential and other elective services as well. I wanted to ensure that people do understand that the NHS is very focused on providing the access where it can within the system.

I think in terms of answering your points about how we reassure the public more broadly, there's something about the attendance at our respective sites, whether they are hospitals or other healthcare settings, and demonstrating the segregation that's happening, the streaming that's happening, and that there is a physical aspect to that that people see, about the approach and the practices that are occurring. There is something that we need to do and maintain, and we have been doing this within our health board areas, about tracking the outcomes for patients. So, for example, health boards are tracking the outcomes for patients who are going in for operations to be able to positively report—. I don't know whether you will have seen some of the outcomes from Cardiff, for example, but the operations there have been successful, patients have been able to be safely accommodated within those streams, and I think we need to describe that. 

I think, thirdly, we need to be confident about some of the alternative settings that we are devising for patients, because it's not all about accessing hospitals as the particular focus, because of the likelihood of a higher risk around COVID in those types of environments. We need to use the alternative environments. 

And the final thing is to reassure them around some of the transformations of services that are taking place across Wales, because we need to maintain the shift, to not just present the traditional services that we've had. And if you look at examples like the virtual access and the remote consultations, as part of the roll-out of that really significant change of technology, we've actually had very high satisfaction ratings—I think, actually, between 90 and 95 per cent from patients, saying that they really liked that way of engaging and the manner in which it was discharged, and actually welcomed that as a change of service as well. So, there are lots of examples where we are trying to make sure that we continue to retain the patient experience as we make these changes on an ongoing basis. 

10:30

Dr Goodall, you did reply in earlier questioning to the point I made—and the Minister did as well, in fairness—about the stress levels and, in particular, staff satisfaction. So, I won't rehash that question. But I just seek a point of clarification before I conclude my questions. You said there had been a 7 per cent increase in staffing numbers in the NHS between June 2019 and June 2020. Is that a real-terms increase, or does that relate to—? Because there was this campaign to bring former staff back in on a temporary basis to help with the COVID crisis. So, have we seen a genuine whole-time equivalent—I think that's what they tend to use as the words to describe the appointments—and that is a lasting increase we've seen of 7 per cent, or does it take account of those people who were encouraged to come back in on a temporary basis and they'll be lost from the head count over time?

Inevitably, it's an active reporting of the head count and those individuals that we're using in there, but you're absolutely right to say that, of course, there will be some factor—that the June figure for this year, of course, will need to account for the fact that we have tried to develop our staffing arrangements in response to the pandemic itself. Having said that, some of the increase that we are seeing is more on a substantive basis about services and changes that we were broadly putting in place. And inevitably, as we track through perhaps where we'll be on the June 2021 figures, we'll just need to see whether that is a recurrent growth that has stabilised. But certainly for a large part of it, they were probably reflecting substantive posts. I accept your point that we have expanded out our workforce, clearly, because we've been responding to this as well. 

What I would hope that we can do, however, in the interim, is—. It will be necessary for us to continue to develop other choices for staff within our system. And whilst that is a higher than normal growth, I do think that to respond to the impact of the pandemic, we are going to have to maintain some of these higher levels of workforce into the future. And that's why we're running workforce planning through quarter 3 and quarter 4, but also we have our annual workforce planning process in place as well to see whether we can secure that. I'm more confident that some of those changes may well stick for the future if we see the pipeline being addressed. So, at some point, we will have the benefit of 200 GPs who have come into our system through this year. And some of the increases over the last two or three years will bite, but probably not for the next 18 months or so, certainly. 

Diolch, Andrew. Dwi'n mynd i gymryd toriad mewn rhyw 10 munud, ond yn y cyfamser, cawn ni gwestiynau gan Lynne Neagle. Lynne. 

Thank you, Andrew. I'm going to take a short break in 10 minutes' time, but in the meantime, we'll have questions from Lynne Neagle. Lynne. 

Thanks, Chair. I think some of my questions have been answered, but can I ask about capacity for staffing specifically in critical care, please? There have been a number of media stories on this recently, so I'd like to have some assurances really that we have got sufficient staff capacity to manage, particularly if cases continue to rise again. 

I think this is an important question, because we often talk about bed numbers, but actually the beds need to have staff around them, and if we're going to maintain appropriate ratios, we need look back to what we did in March. We had to pause other activity to allow not just the physical reorganisation and the provision of physical ventilators, but actually it was about the opportunity to retrain our staff so they could actually provide a level of critical care. And you can't just flick a switch and do that—you can't tell someone, 'Actually, your shift has changed, you're now going to be a critical care nurse.' It doesn't work like that. So, actually, it's part of our challenge in having had some of those people who had been trained previously. If we're going to open more beds—and, as I say, we're about 180 critical care beds now, so that's nearly 30 above our normal capacity—if we're going to keep on going up, and, say, we do end up having another 100 beds, that will mean there will need to be some refresher training for staff to get those beds open and running, otherwise we'll be saying we're providing critical care when we're not, and we're not providing the appropriate ratios with staff who are trained to do that. And that then has a real impact on non-COVID services, because if we take those people out, they can't undertake the other activity they were doing. And that's why it's so important that we don't get to that point.

Every now and again, when I see people talking about statistics, they say, 'Actually, Wales has got 40 per cent or 60 per cent of its critical care beds available and free.' Well, that isn't true. That isn't a fair reflection of what's happening, and equally, I think, that encourages the idea that, somehow, there is loads of room and capacity to cope. Well, coping, in terms of critical care beds, you could do that, but it has a real consequence, and it goes back to the point that David Rees was discussing about the alternative harm that is created, and that is significant. 

10:35

Okay, thank you. Can I ask about people who have had COVID, and who are living with long COVID? We know that there are an increasing number of people experiencing really debilitating health issues as a result of having had COVID previously. In England, they've got specialist clinics for people with long COVID, but there hasn't been a similar announcement in Wales. What assurances can you offer that people who are living with long COVID are going to have the support that they need in a timely way?

Well, this is something that we have regularly discussed within the Government, not just with Dr Goodall, but in particular, with our chief therapies adviser, because we are looking at—. And it's called different things by different people—'long COVID' is the most common name. I think, within the health service, they're calling it 'post-COVID syndrome.' We're talking about the same thing—the longer-term impact of having COVID, and either recovering from it and how long that recovery is, or, as with some other conditions, where they don't appear to recover in the sense that it's a recurrent thing that can come back with the same symptoms. So, part of our challenge is we don't understand it fully. So, that's why the research activity is so important. It's also why, I think, the national pathway that's being developed is important too. 

Now, again, there's some trialling of different activity in different health boards. Cardiff and Vale are talking about what they're calling a 'clinic'. And, yet, actually, we also want to make sure that, wherever you are, you're able to access support and advice, so primary care is hugely important in this. And this is certainly going to be standard business for general practice, and colleagues in primary care, because we're not going to be able to corral everyone who is recovering from COVID into a range of a handful of specialist clinics. I don't think that's a fair fight, actually. That won't provide the access we know we're going to need to give people, and that's why there is such a focus on the therapy side of it, in terms of supporting people, and the national pathway. But we'll learn from what we are doing, and we'll learn from what other countries are doing as well. 

I understand why people like the idea of a set of national clinics being set up, and that sort of highlighting of the issue at a particular point, but that isn't, at present, the professional advice that I'm getting about how best to support to people. And, ultimately, we need to help people to improve their recovery and to improve their prospects of recovery and getting back to some form of normal. And this will be one of those tails, and, as I say, the long tail we'll have, of dealing with a condition we don't properly understand, and the impact that will have in terms of resource for the future. Dr Goodall wants to come back in. 

Yes, just to speak in terms of our overall numbers. We estimate now that, since March, over 1,600 patients have been discharged from our hospitals, and, obviously, some of those will have been very seriously ill within the hospital environment, and actually stayed there for a very extended time before they came home. But I think we also need to recognise that some of the long COVID experiences are not only being described by those that have been within our health system. There are individuals who have been able to care for themselves when they had COVID in their home environment, didn't require admission, but are also having some knock-on effects as well. So, I think those figures potentially screen the level of support that's going to be necessary.

And whilst I accept that it's perhaps not an issue necessarily directly for the Minister today, from a ministerial perspective, but, obviously, we also need to keep an eye beyond long COVID on mental health impact more broadly. And a number of studies recently, even over the last three weeks or so, were describing the mental health impact on individuals who have had COVID themselves, and the ratio may be as high as one in five describing themselves as really struggling with emotional and mental health issues. And I think we are going to have to try and describe that in the right manner. 

I do think, however, it was a good active intervention early on in this, when, in May, we were able to introduce the rehabilitation framework for Wales. And whilst we have to look at the specifics around the COVID experience, I think, actually, that does give us a really good opportunity to drive it, as the Minister was saying, more in terms of our day-to-day services rather than treating it only as a specialist issue.

10:40

Thank you. And then, Minister, you mentioned GPs, and a constituent spoke to me this week who had been to a GP and who felt the GP was very dismissive of her long COVID. So, how are we going to ensure that all GPs have got an understanding that, actually, this is something very significant that can really be very debilitating for people?

Well, all of us are learning, including general practitioners—because general practitioners weren't aware of COVID any more than I was or Dr Goodall was at the start of this year, and so we're all still learning, and that's part of the challenge that we all face. I know Dr Lloyd will tell you that once you're qualified, you're not then imbued will all the medical knowledge you will ever need in your lifetime. There's change, there's change in practice for common conditions, and here we have a condition that is going to be relatively common. You wouldn't put this on the 'rare disease' list, because the numbers of people that have recovered, the numbers of people that have—. Some of the stories about people who have never particularly recovered, in essence, but it's a recurring condition that doesn't need hospital treatment. But as Dr Goodall said, it's had a real impact on people.

So, I have real sympathy for a range of our healthcare practitioners who, again, won't have all the knowledge about what they're going to need to do, but it is about us deliberately wanting to make sure that knowledge is shared. And actually, I think, within general practice, our therapists and all of our staff in the health service, they will want to learn, because this, as I say, is going to be standard business for our health service for some time to come. Every practice and every cluster, I think, is going to have a group of people they're going to need to treat, to care for and understand, and that is about learning. I would not want anyone to think that they would be dismissed by a healthcare practitioner, and that is the response they should expect. It's actually about how we understand the very real impact, in physical and mental terms, that this is going to have for some time to come.

So, are we likely to get to a stage where we've got a clear pathway, then, for people with long COVID, even if it means different things in terms of delivery in different health board areas? Is there going to be some sort of clarity on that?

Yes, that's exactly what we're trying to achieve. That's why we're looking to develop a national pathway. So, the rehabilitation framework is helpful. We know there's more we need to do, but we're deliberately trying to develop that national pathway so that people can have some consistency and equity across the country as well. What I wouldn't want is that people think, 'If only I lived in Aneurin Bevan, I would get the right treatment, but because I live in Powys, that won't happen.' And that's why I think a national pathway will be helpful for the public, but also for our clinicians as well, because there is learning here that is not just national within Wales, it's international. And having a more common, national approach, I think, will help people to understand what we understand about the condition, and then, as that develops, how we share that understanding and learning as well.

Okay, thank you. Can I just move on, then, to talk about hospital transmission and ask for an update, in particular on any strategies? We've seen some significant outbreaks in hospitals. Are there any strategies that are currently in place to try and manage hospital transmission of COVID?

Yes, there's some direct advice that Public Health Wales have given that's been endorsed by medical directors and nurse directors and also public health directors that are leading on much of the work that is taking place now. That is then about reinforcing the need to get it right when it comes to infection prevention and control, and it's more important than ever. In a normal flu season, we talk about infection prevention and control measures and having to have areas sealed off because that's an infectious disease that causes real harm for certain sections of the population. This, of course, is worse. And it's also because we've got community transmission. So, there are people who don't know that they have COVID who are coming into our environment—that's both staff and the public too—and it's part of the challenge and why we have COVID-lite and COVID green zones rather than to be able to operate, say, a 'COVID-free environment', because you can't give that guarantee. It's a great headline, saying, 'We want a COVID-free environment', but actually, with community transmission where it is, that's not a practical or honest way to address the issue.

We are, though, looking at what we need to do, both with the message for our staff and the message for our public, what happens with testing on coming into a hospital environment before admission, whether planned or emergency. So, there's a range of different things that we're doing as well as looking at what happens when you do then get an outbreak.

Unfortunately, the professional advice that I've received is that, given the current state and prevalence of COVID, we're likely to see further outbreaks in closed settings, so prisons, care homes and hospitals being areas where there's a real risk. Because the prisoner population health is not great; they've got a range of issues they deal with, and it's a closed environment—risk for staff in prisons as well. In our care homes, we've seen the harm that's already been caused. And we've also seen the harm that's caused if you do get an outbreak in a hospital setting, so it's right near the top of my worry list. But also, there is an understanding of a need to share and to continue to re-examine practice within the service as well. So, it isn't just a national perspective. Within local health boards, I think there's a clear understanding at health board leadership level of what they're going to need to do to continually reinforce what we all need to see happen in our hospital environments.

10:45

We absolutely need to continue to ensure that core infection-control policies and procedures are in place, but there has to be an enhancement around those based on the learning about this virus. I've described it in other arenas, but you have to be 100 per cent compliant, 100 per cent of the time, in respect of being able to contain this, and as the Minister said, the most significant area—and we know more about this now than in the first wave—is simply the impact of asymptomatic staff and patients in terms of their arrival into any healthcare setting, and needing to therefore plan and mitigate that as much as possible.

Now, I do think that some of the changes of testing technology and some of the rapid tests that are now coming our way, that we're going to be able to apply to have those cycles in place with very quick turn around should be able to help in those environments as well about what we're supporting. And just to make the general point, Chair, that, of course, it's one reason why we wanted to give confidence and reassurance about our PPE supply chain, and at the moment, we continue to be on course for the end of this month to have about 24 weeks' worth of PPE, so that if there is any concern about how we would access that within any of our healthcare setting environments, from care homes to hospitals, that people should be secure, that we do have the relevant levels of supply available, even with an increasing level of community prevalence of COVID-19.

Well, I just had one other question, but I can leave it if we're short of time.

Well, what I was going to suggest was that we could go into our pre-planned break now, and then you can kick off then after the break, Lynne, okay? So, we'll break now until 11.00 a.m.

Gohiriwyd y cyfarfod rhwng 10:47 ac 11:00.

The meeting adjourned between 10:47 and 11:00

11:00
3. COVID-19: Sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol a Chyfarwyddwr Cyffredinol Iechyd a Gwasanaethau Cymdeithasol a Phrif Weithredwr GIG Cymru (parhad)
3. COVID-19: Evidence session with the Minister for Health and Social Services and the Director General for Health and Social Services and the NHS Wales Chief Executive (continued)

Croeso'n ôl i bawb i ail ran y cyfarfod yma o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon. Rydym ni'n parhau efo'n sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol, a hefyd gyda chyfarwyddwr cyffredinol iechyd a gwasanaethau cymdeithasol, a phrif weithredwr y gwasanaeth iechyd yma yng Nghymru, sef Dr Andrew Goodall. A hefyd croeso'n ôl i Vaughan Gething, y Gweinidog. Parhau efo'r cwestiynau, fel y dywedais i, a Lynne Neagle sy'n gofyn y cwestiwn nesaf. Lynne.

Welcome back, everyone, to the second part of this meeting of the Health, Social Care and Sport Committee. We are continuing with our evidence session with the Minister for Health and Social Services, and with the director general for health and social services, and the NHS Wales chief executive, namely Dr Andrew Goodall. And also welcome back to Vaughan Gething, the Minister. We'll continue with the questions, as I said, and Lynne Neagle will be asking the next question. Lynne.

Thank you, yes. Just a final question on hospital transmission is to ask you about the Healthcare Safety Investigation Branch report on this, and what you're doing to respond to those recommendations.

I think, in terms of the direct response, as well as Dr Goodall coming in, I'm expecting to have something come back to me, because the chief medical officer has asked for some learning to take place between public health directors to share what's happening, and I'm also expecting something to come from Public Health Wales.

Just to comment on the report, we had received a copy at the end of October. We've had our nosocomial group reviewing that, which is chaired jointly by the chief nursing officer and the deputy chief medical officer for Wales. Of course, we're actively considering those findings and other learning in respect of hospital transmission. First reading of it—I think a lot of the areas are consistent with what we're learnt and tried to issue into the system, but actually some of our recent actions do seem to be in line with the recommendations there as well. So, I think there'll be, probably, some benefit from us just trying to include those at this stage.

I think, probably, one of the areas that we need to think more about—and, again, this is more the learning from the virus and what it means—ultimately, we are stuck by the fabric of our hospital buildings and healthcare settings across Wales. We can't transform those over night, and I think probably the underlying issue of ventilation and how that is a factor that just helps us is probably an area that we still need to continue to explore with our specialist estates staff. So, as I said, unfortunately, we'll be limited by where we are, but I hope that perhaps we can do a bit more in that arena as well, because that will help us, I think, with future transmission too.

There is a—[Interruption.] So, I think there is an interesting point about ventilation in that report, and that is something that's going to come back, again, through the nosocomial transmission group about how that's progressed to, again, make sure there is appropriate ventilation. We've seen studies from other parts of the world—in particular Spain—as well about the importance of ventilation as a protective measure to help reduce the risk as well. So, I think it's worth highlighting that as a factor that I'm particularly interested in and, in fact, the transmission group are particularly interested in as well. 

Andrew, who knows a lot about of ventilation, as he spends most of his life outdoors—you've got a supplementary here.

As my great complexion shows. Just maybe on the point that Dr Goodall highlighted about hospital configuration, I know recently, in the Cwm Taf outbreak, some of the briefings referred to the large wards—the open wards—at the Royal Glamorgan Hospital and the lack of single-bed rooms to, obviously, use to try and isolate the outbreaks. Has any progress been made—and I appreciate we're talking relatively recently, all this happening, but it is the case that unless you get more of those single-bed rooms available then there's going to be continuing problem, isn't it? So, I appreciate ventilation's an issue, and that is wider, but has progress been made to create greater capacity in hospitals to create more single rooms so that people can be moved into them?

The hospitals, obviously, have to work with the fabric that they have. It may affect some of the shared areas that we have, where people have had to reduce the number of patients being held in areas that could have up to six patients, and then reduce some of those numbers. Physical alternations were made across Cwm Taf Morgannwg just to try to create, effectively, as close to possible, those cubicle environments, but that would have still been limited. And you're right to make the point on how infection control can be better managed in that environment. Of course, one of the reasons for pulling forward the Grange University Hospital opening was actually what that offered in terms of capacity, with a real focus around single-room environments more generally, and that will help some of the infection prevention and control mechanisms. But, yes, some operational progress on that, but it doesn't remove actually the physical alterations on the site, which still have been very difficult on a substantive basis.

Diolch yn fawr, Lynne. Symud ymlaen i fater arall nawr—David Rees.

Thanks very much, Lynne. Moving on to another issue—David Rees.

Thank you again, Chair. Minister, I want to talk a little bit about test, trace, protect. Clearly, the issue of testing is going to be critical. I very much welcome the extra funding you've put into supporting resources and increasing the number of staff for test, trace and protect, but I suppose—. I just had an e-mail from an individual who's in test, trace and protect, and there are concerns over the ability to actually get people to respond very carefully. Are you sufficiently confident that the funding and the resources you've identified now will deliver on all the needs of test, trace and protect? Because, if we can test them, trace them, and basically get them to protect others, we can put the greatest suppression on this, but there are large numbers who have still not given their full details, and there are large numbers that are still not necessarily listening to the requirement to self-isolate or whatever once they've been told. And there's also the situation where I know people are not going to protect themselves until they are told by TTP to protect themselves. So, are you sufficient that the resources are there to do all that work?

11:05

I don't think it's just a question of resources, and I think it's important to think about all the different things that we're doing. So, we know that, through the whole service, we've got a very high success rate in terms of 98 per cent of positive cases and 93 per cent of close contacts being contacted through the whole period of time, and then fast forward that to the most recent week we reported, where 92 per cent of positive cases—so, still over 90 per cent—and 81 per cent of their close contacts were successfully contacted. That shows the impact of the significant pressure, from the overall whole achievement since we started in the third week of June to where we are now. So, we are still getting to high numbers of people, and there is a question of resources in that.

So, in the firebreak, we took the opportunity to look again at what we were seeing coming through the doors and the phones, as it were, and we were seeing the very high pressure that our service was under, and that reinforced the previous choice that I'd already made to have 600 extra staff, taking the whole team up to 1,800 in our contact tracing service. I then made the choice to invest nearly £16 million to get another 1,300 staff in. So, in terms of providing resources to do what the contact tracing part of it can do, then yes. And that also goes into the protect part of it: the regular provision of calls to support people whilst they're isolating and to provide reassurance and to direct them to services if they need to. Because not everyone, at the start of their isolation period, will understand or have thought of everything that they would want to know or have questions about. So, in that sense, we're deliberately investing to give ourselves the capacity to maintain high levels of contact tracing performance.

The reason why I say it isn't just a question of resources, though, is that it still relies on the public response. We've changed the law around duties, so there's a duty to isolate, there's a duty not to provide false information, there's a duty for employers not to try to encourage or attempt to require people to break their self-isolation, but there's still a real behavioural challenge here. Even having a law in place, it's about how we persuade people to do the right thing for them, their family, their community, their friends. And that's the thing that—. It isn't just a matter of the resources we invest in test, trace and protect. That's our broader conversation with the wider public about the importance of doing the right thing for all of us, and that is more difficult. And we shouldn't pretend that a communications campaign, which we will be increasing, successfully—I hope you'll notice it, and I hope that Members across all political parties will be prepared to share some of those messages, because they're about the position for the whole country. But it isn't just a comms campaign and posters and things to share on social media; it's actually about the conversations that people have within their friendship and family groups about what they're doing and why, and the understanding of the information that's being provided. It's why having trust in the information we provide is so important. So, that isn't just a resource question. That's our whole national conversation on whether we can persuade all of us to do things differently to keep all of us as safe as possible.

I accept it's not just a resource issue—there is a behavioural issue, and I'm sure Jayne will come on to some of the behavioural issues in a short while—but it is a component. I have cases where I know that contact tracing didn't contact individuals for over 10 days, which means that if the person hadn't been self-isolating over that time themselves, because they took the decision themselves to do so, not because of the help desk, but because they knew where they were, then that person would have been out in the community for 10 days before they were even contacted. So, there is an issue also on resources. I accept it's not just, but there is an issue and we need to get it done.

Coming on to testing—

Sorry, just to be fair, on that, in having high percentages of people who are successfully contacted, they're not 100 per cent—so, 92 per cent of positive cases, 81 per cent of their close contacts. So, that's a high percentage, but it's a recognition that there are people who aren't successfully contacted for a number of reasons. Sometimes, that's about the information being provided, and sometimes that is just about the ability to get people when they're in, and that, in itself, shows part of the challenge.

So, I've never set out that there's 100 per cent achievement—it wouldn't be realistic. But we will have real challenges and real examples that I'm sure that Members of all parties will get from their constituents where they won't have been contacted, because we've got very high numbers of people who are getting COVID and their contacts. But it's how successful we are overall in reaching that wider group that will help us to provide a real defence, and, actually, the technical advisory cell group, our scientific advisory group, have indicated that a successful contact tracing service does make a real difference in suppressing the R rate, and that's what we're currently managing to do. So, it's a proper and positive achievement, but we could be more successful with even greater buy-in from the public.

11:10

Okay, and I understand that. Testing—I understand that, on 15 November, the Welsh Government's own update indicated that there was approximately 15,000 Welsh lab capacity for antigen testing, and that's without the UK lab capacity that is being used. I suppose one of the things that I wanted to find out is: are we fully utilising all the testing capacity? Because I understand that there actually weren't that number of tests undertaken. For example, on 19 November, only 13,000 tests were undertaken, so that's less than the Welsh lab capacity, and, if you add in the English lab capacity as well, that's definitely less. So, what percentage are we currently operating at, as utilisation of the lab capacity? And if that's of a reasonable gap, are we doing enough to get more tests done?

I'll give an example before you answer me. As I say, I've been contacted by someone who's in the TTP side, talking about care home testing. They currently use, obviously, the English lighthouse lab systems and it takes up to six days to get answers back, and they're not being sent for people who may have—. If someone has mild symptoms—[Inaudible.]—they think they've got a mild cold, or they're feeling a bit sniffily, they haven't got the traditional three symptoms that have been assessed and required for a test under the current testing scheme, but they're coming back positive six days later. So, are we looking at or should we be looking at using our Welsh lab capacity more effectively for care homes in particular so that we're avoiding going off to England and waiting six days for our results to come back?

Well, as I say, when we've looked at overall performance—I think we've run through this before, but I want to be clear about where we are—we reviewed again where we were with testing in care homes in particular. We've worked with the sector and we've tried to understand where we are with lighthouse lab testing and the UK Government-led programme. And we had seen an improvement. We've then seen a stalling in improvement, and it's a matter that I've raised not just with Matt Hancock, but officials have discussed it as well. But we actually think that we should see a more sustained improvement in turnaround, and, in particular, turnaround within a couple of days from the asymptomatic programme. So, this isn't about whether people have symptoms; we were testing staff on a regular basis in the sector.

We do know, though, that, again, even with a high level of performance in a two-day turnaround, there will still be people who wait too long for those test results, and that's really frustrating. It's frustrating for me and more so for the staff, their colleagues and families around that care home in wanting to have answers and to provide the reassurance that the testing should provide on the levels of transmission and keeping people out of the workplace who shouldn't be there. So, isn't something where I say, 'There isn't a problem, don't worry about it'; there is a problem and there is a need to see further improvement.

When it comes, though, to which testing routes we use, there was agreement across the sector in general that the asymptomatic testing should be lighthouse labs. When you then get a positive, it'll be Public Health Wales labs that go in and do the testing for staff and for residents. And that's part of the reason why we're not maxing out our Public Health Wales lab capacity, because we want to be able to have the ability to deal with those outbreaks when and where they arise. 

Our bigger challenge in terms of the use of all of the capacity is actually that we've got more tests available than the public are taking up. So, it isn't actually a supply issue. In the last couple of days—. We're still regularly testing around about 10,000 people a day—sometimes a bit higher, sometimes a bit less—but it's been relatively consistent in that arena for a number of weeks. I'm just getting rid of a message that's come up on my screen. And, actually, we've had surplus tests available each day for a number of weeks now, so it's still about persuading people, if you're symptomatic, then get a test, there are tests available. And you'll recall, maybe about six weeks ago, there was more concern that there weren't enough tests available, and, actually, we've been in a position for some time where there are plenty of tests available for the public demand that's coming in, and, actually, I'd rather be able to take up the capacity that's there. So, it isn't about seeking to max out all of the capacity.

And it's also, then, about our ability to turn around. You'll know that we've invested more money in turnaround times in Public Health Wales labs; that's now in place to help to deliver a faster turnaround. And if we are in a position, as we regularly review the position, where we need to consider switching tests back, away from lighthouse labs, then that is something that we can consider. But we've just undertaken a review and we're looking to see the lighthouse lab system improve. And also, with the new series of lateral flow devices that give us a test result within about 30 minutes, we're thinking about how we use those as well. So, there's a range of different things in the mix for us about how we test front-line staff in health and social care.

And, again, to be fair, Dai, you've raised this point as well, it's not just about residential care, it's also about domiciliary care and it's about front-line staff in the health service. Many of them are mobile, so the district nurses, GPs who undertake home visits, and others as well, and so we're thinking about what that means. And, again, I've got choices that I'm going to need to make imminently about how we use not just the mass testing programme and lateral flow devices for that, but also about choices for that much broader group of people. And that, I think, should help us to give the certainty and the assurance that people need. And I think that will move, materially, the conversation on, but my bigger concern is that symptomatic people get a test and isolate at the point they're symptomatic, because we have plenty of testing capacity available.

11:15

I understand that. I understand also your argument to keep a percentage for covering some of those circumstances you need to cover. And I also appreciate your view that not everybody is taking up the tests as possible. But on that particular point, something for you to think about, not to answer today but to think about, is that I know I'm being told that there are cases of individuals in care home staff who have, basically, as I said, a feeling of cold, a feeling of mild cold, mild symptoms, not necessarily the three symptoms that have been prioritised clearly. But they then come back a week later and, actually, their system has tested positive, but they didn't go when they had the symptoms because they felt it was a cold and that's all they wanted to do. And I think this is a subject, when we look at prioritisation, you might want to expand your symptoms for those categories of people in those care homes, in settings in which vulnerable people are living, who might need a test then rather than simply waiting until the traditional symptoms of coronavirus come in. That's something for you to think about.

Okay, the lateral flows you've talked about, I don't want to go into the mass testing, but student testing has been mentioned. I think it's got to be done by two weeks today, 9 December. Are you in a position, basically, to be confident that everything is in place for that testing to be completed by the end of the term for students to be able to go home? Or will the test give an indication as to whether they are positive or they are not positive? Are you comfortable that everything's been done and is ready for all that?

Everything possible is being done, and, again, this isn't a compulsory testing programme. So, it's still about people wanting to do the right thing and recognising that, again, if you're a typical undergraduate—not every undergraduate is the sort of traditional 18, 19 and early 20s; I remember, even in the past, over half my lifetime ago when I went to university, there were plenty of mature students at university too—but the typical undergraduate profile, you're at less risk of harm but you could easily go back and return to someone who is my age or older in your family home and they're in a different risk profile. Every decade increases the risk profile materially, and so, it's about encouraging them to do the right thing. And, again, it's a behavioural point rather than a hard rules point, because it's about how you can understand the risk you present to other people, how you can protect your loved ones, who, we understand, most students will want to go home and see.

I'm not going to try and encourage one of the Members, who has a university-age student who's just gone to university, to talk about her own experience, but it's a difficult choice, isn't it? Because we're already saying to students who have gone to university, 'Your experience will be different, and you can't have the sort of freshers experience and the sort of social experience that I enjoyed when I went to university. It's going to be different for you, and it has to be different because of the risk you present to your friends at university, but also your families and friends when you get home as well.' So, it's a hard message, but the overwhelming majority of our students have been responsible, and the education Minister and I, I think, are assured that everything that could be done is being done, and it's about all of us taking our own share of responsibility for our choices as well, and clearly those young adults who are studying in university.

11:20

Yes. Just a final point on testing, I think you nearly mentioned it, but I also wanted to probe a little bit more on the Welsh lab capacity and English lighthouse capacity. We have seen challenges, there's no question of that, and we have seen turnaround times being longer than they need to be and should be to enable us to be effective in delivering our protective approach. Are you looking at seeking greater lab capacity within Wales, so that we continue to use our own capacity and not rely upon a system that has been shown to be lax in being able to deliver on time?

Until the end of the summer, lighthouse labs did deliver fast turnaround in high numbers—

Can I highlight that the end of the summer was when there were lower numbers of infections? We are at a higher rate now.

Well, as I said, since then, we've seen a fall-off in performance, even before we got to having the higher numbers coming through. So, actually, for a period of time, lighthouse labs did deliver a fast and effective service, and our challenge is to get back to that point where they're delivering greater volume. There have been some challenges in the increase in the lighthouse lab programme, so this is both about the processes within lighthouse labs, as opposed to getting the tests to people and getting them from wherever they get tested back into a lighthouse lab.

So, Imperial Park 5, the development in, I think, Jayne Bryant's constituency in Newport West, we're seeing more cases go through there, but in the initial phase, that was slower to increase the volume and the turnaround and the quality checks that were needed. As that comes more on board, it should provide us with greater certainty to have larger numbers of tests, and for the great bulk of the population in Wales to go through that lighthouse lab to give us greater certainty of the timeliness of the results turnaround.

You'll recall that, actually, in north Wales, when most of the lighthouse lab results go to Manchester, that, again, has been relatively high performing. If you look at the test results for north Wales, actually, lighthouse labs test results are materially quicker in north Wales than in south Wales. We also saw a period of time when, actually, there was a problem in the Manchester lab, and north Wales had a much bigger problem than the rest of Wales at that point in time, as well. So, we are reliant on the turnaround improvement within the individual labs, and that is about lab processes more than anything else, and it is a regular feature of not just concern, but it's something that I discuss with officials each and every week, and it's something that I have raised successively, as I've said, about where we get to.

So, there are always choices about how we use the different capacity that we have, and there are always choices about how far we rely upon the programme that exists, but we're not in a position where I can simply take over that lighthouse lab. If we were looking at the start of this again, and we had the resources to do that, I would much rather NHS Wales was operating the lab with the same capacity and resource available to us that is there in Newport. That would be my clear preference, but that isn't where we are, and so I'm trying to do the right thing to get an improvement in the system we have, because there isn't much prospect of being able to blow up the current lighthouse labs system we've got and to invent an entirely new one. So, improvement and a continued focus on what we need to see happen to keep people in Wales safe, because the sooner people get a test, the sooner they get the result, the faster we can protect them and people around them.

Mae'n amser i symud ymlaen, ac mae Jayne Bryant wedi bod yn hynod amyneddgar, felly mae'r sgrin ichi, Jayne Bryant.

It's time to move on, and Jayne Bryant has been extremely patient, so over to you, Jayne Bryant.

Diolch, Chair, and good morning, Minister. Despite the evidence that most people want to do the right thing, you've highlighted this morning that we haven't seen the change in patterns of behaviour following the firebreak that we would have liked. Now, we're in this very precarious position as we enter the Christmas period. What's your assessment of why some people haven't changed their behaviour, and is there any learning from this firebreak period to take into the next few weeks?

11:25

Definitely. So, we continue to have opinion surveys that are run; Public Health Wales run opinion surveys, there's Ipsos MORI that do work for every one of the four Governments, understanding where people are so we understand the messages that may or may not work. And there's specific work that we've done ahead of the broader campaign that's going to start to be run from next week. And so that is about understanding how and why the public have responded to the firebreak, and there's been pretty overwhelming support for that—there's a real broad appetite in the public for measures to protect the wider public. But we're seeing against that a rising number of people who are more sceptical still, and the challenge is that a relatively small number of people not taking the same precautions as the great majority of people in Wales are can still present a significant risk to us in population terms.

So, that is about the understanding that many people in Wales still get their information from UK media, so there are still challenges and risks of confusion in the message. And we actually found that many people in Wales thought that the rule of six applied in Wales, when it didn't. And so there's a challenge there about where people get their sources of information. That's also why it would be more helpful if we could have more common messaging across the UK. But that does rely on us, as I say, agreeing with what that message is, and that's part of the difficulty that we have. Because at various points in time, we haven't agreed with the message in England, so we've made different choices, as we have a responsibility to. But if we can have a more common approach, then we're more likely to have common information for the public, and that should help and aid some of the points around behaviour change.

We're also looking at what we can do with our messaging online. So on the NHS app, messaging that we are able to get through that. And it's also part of our challenge then about the different sources and different voices. Because myself and the First Minister—and Dr Goodall when he does his regular turn at press conferences—when we give messages, there is a range of people who will listen to that, trust it and understand it, and there are still high levels of engagement with those press conferences. But, actually, there are lots of people who don't watch traditional news media and don't get their information there. So, whilst there are high numbers of people getting that information there, there are lots of people who don't. But it's also the case there are lots of people who will start by mistrusting or not believing what a politician says. So, as much as I smile at people, not everyone will accept everything that I say.

So, we recognise there needs to be a multiplicity of voices. That's partly our front-line health and social care staff, but there's a risk, as I think we discussed in a former committee, about needing to protect our staff too, because that rising tide of denial and conspiracy theories has been seen in very unpleasant and wholly unacceptable abuse directed at our staff. But it's also about broader information. I saw something—and I can mention his name, because—. Will Carling tweeted something that I thought was rubbish, and there are a range of other healthcare professionals saying, 'This is not true.' Now, Will Carling may not be a voice that people in Wales will necessarily listen to and seek public health advice from, but he's someone who's got a significant social media following and there are people who buy in and have a level of trust in messages that he, and other people, to be fair, put out. I've also seen stuff from Denise Welch, and others.

So there's actually a challenge about having a range of people who aren't healthcare professionals, who aren't politicians, and the messages they give really matter. And so endorsement of positive, accurate public health messaging and advice, and asking people to think about what they do, from a range of different voices, is really important. Because we shouldn't pretend that that isn't how some people get their information, and what are the things that they rely on and matter to them. And so we've got to work with how people use information and get information now, rather than trying to pretend that a broadcast on BBC and ITV will get to the whole population and that there'll be buy-in from that. That might have been the world that I grew up in—of course, you're too young to remember that—but the world is very, very different now.

I think that that's a key point, and one of the witnesses that we had last week, Professor Heymann, was talking about the importance of role models, particularly—well, for all sections of society, really. But I think we've seen some of the really important work that, as you've said, health professionals have been doing. But just how are you looking to expand the role or the use of role models within different sections of society, such as perhaps younger people, perhaps looking at some BAME groups within Wales, and access information as well? Are you making progress on that?

11:30

Yes, and when the campaign launches, you will see a multiplicity of voices and there will be targeting of messages, and I guess the success would be if you didn’t know it was happening but people in different sectors of the population knew it was happening. Because I'm relatively young for a politician—not as young as you, of course, Jayne—but I'm a middle-aged man in real life and so, actually, my experience is very, very different to someone in their 20s who's grown up with a different set of views and norms. So, that's why we've got to have a range of campaign information that's aimed at different people. We've got good partners who are working with us. I'm really pleased that the FAW and the WRU are going to be working with us. They have a reach in different areas, and in particular given that it's in women's football and women's rugby, that's a very different profile, too, so it won't just be male voices in the campaign we're going to have, although actually, and unfortunately, in terms of our understanding of the riskier behaviour, it is typically men who undertake riskier behaviour when it comes to challenges around COVID. But there'll be a range of voices and there'll be a range of languages. We've already got work that every health board has done in terms of outreach for black and Asian-origin communities as well. There'll also be an all-Wales door drop as well to look to try to reinforce the message ahead of whatever may happen at Christmas, not just the rules, but how people choose to behave. I think that's really important—to think about a wide range of different ways to speak with the public, because it's partly about giving information, but it's also partly about the two-way process, so, engaging as well.

Thank you, Minister. Again, Professor Heymann mentioned last week that,

'People have to be trusted to do their own risk assessment, but they have to, at the same time, have the right messages so that they understand how to do their own risk assessment.'

How do you feel that communicating those sorts of messages of why you need to do something, what you need to do, and what the outcomes of not doing those things are, how can you get that across, not just with those role models, but perhaps how Government communicates to people as well?

Well, we're making much greater use of digital resources, so, all those different social media platforms. It's important to remember that Twitter is not real life, and there are lots of people who never use it, either, and it's a bit of an echo chamber in some ways. There are other platforms where there's more engagement. It's also about our ability to target some of that geographically and to have an understanding of the different range of influencers, which is a phrase that I didn't really understand until a few years ago. I didn't know it was a thing, but actually it is for a range of different age groups, and it's important, as I say, to reflect and recognise that that's how different people live their lives and get their information, and to work with that rather than try to say people should avoid doing that.

So, we are working in a very different way. Even if we think about the start of this term compared to where we are now, the Government is making much greater use of its digital resources, and different platforms, which is an essential part of our public health response to the pandemic. It's difficult because the advice we get from our behavioural scientists and advisers is about an understanding of the benefit of what's being done, and that isn't always a benefit for the individual. There's something that is altruistic about this, doing this for other people. If you're 21 years old, fit and healthy, you're more likely to be protecting other people than yourself in your choices, but that should matter because you have connections to those other people, and most people in the country aren't selfish and only interested in themselves. So, there is that broader community feeling for us to work with as well, and that's where it's so important to think of this as a real national mission. We really are all in this together, and, as I keep on saying, it's about taking care of ourselves and each other, and we've got to have that theme running through all the choices and how we help people to understand their own risk. So, you can expect to see and hear more about considering how and why you do things, and understanding the risk that means and how you try to manage some of that. And that won't be radically different and new, because lots of that information's already been provided, and it's often about making it as easy to understand, but then as easy to apply, because we live our lives differently.

So, what involvement in the public health agenda are behavioural psychologists and the international evidence playing?

11:35

We do work with international evidence, and it's a really important factor for us. So, even in the first wave, when you think about the challenges that we saw—not so much in China, but the more directly applicable challenge when we saw COVID in Europe—there were very important messages, not just about the threat of the health service being overwhelmed, but about understanding the population response to some of the measures that were taken. I don't know if you recall seeing queues of people socially distanced queuing up to buy bread in Spain and Italy, but you saw a population response there that accepted they were at a point of real crisis. So, there's something there about understanding that behavioural response, the likely response of the public and what that's meant internationally in countries that are more comparable to where we are, as well. That's why we take so much interest in Ireland, because it's more culturally similar to the rest of the UK than, say, other European countries. It's also why we do talk with behavioural scientists, and we've worked with them ahead of our communications campaign to understand the insight about how we make it as effective as possible. The difficulty then is, for all of that insight and understanding, there's still the understanding of the real response of the population in real time as we're going about with the different pressures on people's lives.  

Thank you. And finally from me, what strategies are you proposing to help support those people required to socially isolate and those vulnerable groups who were previously shielding? We did hear last week again some international evidence, like from New York, of some small gestures of people knocking on the doors of those who were being asked to isolate to check that people had everything that they needed in terms of food, but also checking they were okay for their emotional well-being as well. So, what are you proposing to happen here in Wales, and is that something you've looked at as well in that international evidence?

Again, we've looked internationally at what other countries are doing. So, in terms of some of the practical support, people on the former shielded list should still be having priority slots for online shopping. That matters. Between myself and my sister, we get our mum's shopping and we deliver it. My mum isn't going to do an online shop. That isn't the way things work for her. So, it's different for different people as well, which is why some of that point about the direct contact people have—. So, even though I can't go to my mum's house, the fact that I go there most weekends and have a conversation with her through the door, as it were, through an open door or through an open window, that's still contact, that still matters—and the call I have with her, and the same for my sister. So, that will be something that many people will understand in their own family groups. And we're encouraging people to keep on doing that because it really does matter, as well as the broader, if you like, altruistic response to supporting the wider community as well, and there's still lots of community activity that is still continuing. One of the really positive features of the response to coronavirus has been the fact that there's been an upsurge in community activity and volunteering, and that has meant that there is more of that practical support that has been self-organised within communities without the Government asking people to do it. And it's why we continue to work with both the third sector and local authorities to help them to try to direct and support people who may not have that advice.  

In terms of not just our ability to maintain essentials, but the advice that's being given, this is difficult, and I know it's a contested area because there is different advice that exists. But the choice the Government has made is based on the advice of our chief medical officer, which is consistent with the advice that other chief medical officers across the UK give, and that's about not reintroducing shielding, because the advice is there, and we update on our own site the frequently answered questions for people who were formerly shielding, but we recognise there was real harm caused in the previous shielding period. And, again, we talked about mental health earlier, and there was a real impact on mental health and well-being. Many people are choosing to stay in their own homes as far as possible, but that sort of precautionary approach about, again, avoiding contact, as we're asking the whole public to do, is more important for those people on the former shielding list again, but there can still be some contact, albeit different—video calls, in the way we're dealing with today—and also rather older methods of talking, whether through a window or on the phone. It may be old tech in today's world, but it still matters to people to have that connection, and I think that is going to be hugely important as we carry on for the months ahead. And as the days are shorter and the nights are longer, I think that human contact is even more important. But, as I said, I'm really grateful to people across the country, in different communities, for the fact that there are many people who are going out of their way to do this, with friends and families, yes, but also volunteering for people they may not have known beforehand. 

11:40

Symudwn ymlaen nawr at Rhun ap Iorwerth. Rhun.

We'll move on now to Rhun ap Iorwerth. Rhun.

Diolch yn fawr iawn. Eisiau trafod brechlynnau ydw i. A fyddech chi'n gallu jest rhoi'r diweddara i ni o ran trafodaethau y Deyrnas Unedig gyfan ar hyn o bryd, yn enwedig o ran amserlen ar gyfer cymeradwyo brechlynnau, materion yn ymwneud â'r gadwyn gyflenwi a storio, ac yn y blaen? Hynny ydy, lle ydyn ni arni ar y pwynt yma mewn amser?

Thank you very much. I want to talk about vaccines. Could you give the latest information to us in terms of discussions at a UK level, particularly with regard to a timetable for approval of vaccines and matters related to the supply chain, storage and so on? Where are we at this point in time?

Okay. So, in the regular four-nations conversations that we have as health Ministers, we regularly discuss testing, and we discuss vaccination now. And, so, we've all made choices to follow the Joint Committee on Vaccination and Immunisation advice on prioritisation, and we've all agreed on the population shares for vaccines to come in. We understand that there is a UK Government responsibility in terms of the regulatory side of stuff, and their relationship with the Medicines and Healthcare products Regulatory Agency. So, the vaccine safety side is there for all nations in the UK and the duty for the United Kingdom to make sure that vaccines are delivered into the UK. I know there have been some understandable concerns about ports and the end of the transition period with the European Union, but the UK Government have been clear that, even if there is an additional cost, they will fly in vaccines to make sure that they are safely delivered, and then the onward transit and transmission of the vaccine to go to different countries is something that is done on a proper population share. So, we'll get our share at the same time as other nations. 

The challenge about what then happens is that we have arrangements in place, for example, for the Pfizer candidate, if that meets all of its safety criteria and is available, and for the ultra cold storage, so under -70 degrees centigrade. That's why we're looking to have that delivered to the Welsh blood service, where they have those facilities for the storage, because there's only a limited number of times you can move that vaccine for it still to be effective. So, we're having to think about how that's then deployed, because storing it in the facilities we have at different points in the country is one thing, but then to get into different parts of the country after that, that means it's unlikely that we can take the Pfizer vaccine out to community settings to deliver it, and that may mean that the Pfizer vaccine may not be the first candidate to be provided in care homes. We need to understand more about its stability and the safety information of it. So, I've made a decision that we will not deliver the Pfizer vaccine in care homes for a period of weeks at the outset, and that will instead be delivered directly to front-line staff if it becomes available, because we can't be assured that it would be effective at this point in time. We may be able to switch that because we'll learn more from the first few weeks of delivery to our health and social care front-line staff, as I say, if the Pfizer vaccine is the one that we're able to deliver first. 

And, so, there'll still be some learning while we're doing all of this, and, again, we'll be learning, while we're doing, from what other UK nations are doing. But hat's a relatively consistent approach. I think the Scottish Government have already announced that the Pfizer vaccine isn't something they're going to expect to deliver in care homes, because you can't get care home residents to a vaccination centre; you have to take the vaccine to them. And it's one of the reasons why there's so much positivity around the Oxford candidate, because you can store that in a much more traditional way, in a fridge. So, that means its mobility is a real advantage compared to both the Moderna and the Pfizer ones that require significant freezer storage.

So, there's work being done all the time. I'm aiming to issue a further written statement next week because there's more work being done internally on planning and I'd want to give an update. I know Members and the public are interested, and so I'd do that in written statement form so that people can see that and understand the continuing progress of our plans in Wales and how we relate to other parts of the UK.  

What's the latest thinking on the timeline for approval? All of this has been remarkably fast-tracked. What's the current thinking?

Well, it's still possible we'll get a vaccine next month, but the caveat is, and you'll have heard the public comments that Matt Hancock's made, about, 'It may be possible for this to happen within early December as opposed to mid December.' All these things are possible, but they still have to clear their safety hurdle first, and that's a challenge, so we can't give people the certainty that I understand that people would want. But it is about the ability to get through all of those processes to make sure that we have a vaccine that is safe and has been delivered and we'll then be able to deliver that in accordance with our plan to deliver vaccines across the country. I don't know if Dr Goodall wants to come in, maybe, to help with this specific point.

11:45

Just to help on the planning and preparation side. Obviously, we've been using these recent weeks for how we would deliver this, having to look at it through the perspectives of different vaccination approaches, but it does mean that we're basically ready to press buttons. So, should the regulatory approval be provided, we can deploy within a matter of days, consistent with what would happen over the UK. So, there are daily reviews happening. Obviously, there are things that are outside of our hands at this stage, but the system is ready to be able to implement its preparations early. We will also not receive, of course, all of the vaccine overnight. So, there will be a staggered process for that, but we'll really take the bulk of this, probably, through January and February—again, subject to the regulatory approval. But we are ready, within a matter of days, to actually start the implementation process.

Okay. What about the interaction, potentially, between the COVID vaccine and the flu vaccine, and the impact that trying to roll one out could have on the other?

Actually, I think that the flu vaccine campaign has been a really positive thing for us in the context of the need to then look at a roll-out for COVID vaccines. So, there's the practical experience, and, actually, we've had a much greater willingness from the public to get themselves a flu jab this year. That's a real positive. So, we have a real prospect of getting to the target of 75 per cent of at-risk groups receiving the vaccine, which we've not managed before. So, that's a really positive thing. So, in practical terms, that's helped us in understanding how we could deliver a vaccination programme, albeit, as we've just discussed, the challenges that some the vaccine candidates are different in the way that they're stored and how they can be delivered.

Part of what we'll be looking into, in terms of safety information, is the potential interaction of any vaccine with other treatments. It's part of the safety information we'll want to see. I'm not yet aware that there is any real concern that the flu vaccine might interact in a way that will be problematic in terms of any of the new candidate vaccines for COVID, but I think there's lots of learning that's really positive for us about the flu campaign this year, and I actually think that there's a real public willingness to take up the vaccine, particularly as the prioritisation process will start to see people being protected earlier in the highest risk category. And the positive thing about that is it that it should help to reduce death rates, because the first phase of vaccination will be about keeping people alive, before we then go into the potential for population coverage and the broader immunity.

And I think this is one of the difficult things about just immunity as it were, and that is, the phrase 'herd immunity' was really described in a way that—. Not just Dr Lloyd, but other people say, 'Actually, you want herd immunity from a vaccine', but you get that by having enough coverage in the population that means that it's unlikely to reproduce and cause harm. The reason why the UK lost the measles-free designation from the World Health Organization is because of a fall-off in England in the measles, mumps, and rubella vaccination programme. That's the risk about not having consistent public health messages and conspiracy theorists—that it has a real impact. In Wales, we've maintained very high rates of MMR uptake, but it's about everybody having enough population coverage.

But the way that herd immunity was described in the early phase of the COVID pandemic, it was as if that was a deliberate strategy to allow coronavirus to roam unimpeded through the population, with all the harm that would cause. That sort of Darwinian approach was never something that this Government contemplated, and the danger is that the phrase, 'herd immunity' is now understood as something entirely different to the way that we would understand it in normal vaccinations programmes. That population coverage may give us herd immunity, and that's actually going to be a good thing for the public. But we need to understand the further iterations, the length of time that that coverage might take place, and whether, as with flu, this will be something that we need to have an annual programme for, or will it be slightly longer. Will it be a longer period of time before people need to have a booster? Or will it be something we'll need to change, the vaccine, as with the flu jab each year, to reformulate it each year to give that greater population coverage and protection?

So, even with the first phase of these vaccines, it's really positive in the future to be able to do this, but there are still things to learn, and there's still a need not to lose sight of the need to protect ourselves and each other by still not rushing ahead as if we're in that future phase, where the pandemic has ended, because as you and I and everyone watching knows, it's still very much with us.

11:50

Reit. Dŷn ni allan o amser, ond un cwestiwn byr. Dŷn ni wedi cyffwrdd efo PPE yn gynharach. Lynne, wyt ti eisiau gofyn y cwestiwn olaf ynglŷn â PPE, jest er mwyn i ni gael y diweddaraf? Lynne Neagle.

We have run out of time, but one quick question. We have touched on PPE already. Lynne, do you want to ask the final question with regard to PPE, just so that we can have an update on that?

Thank you, yes. As the Chair said, you did say earlier, Dr Goodall, that we've got 24 months' worth of supply of PPE. Is there anything you'd like to add to that, but also, what assurances can you offer that PPE will be available for third-sector organisations and others who might need to access it in addition to those entitled to the NHS supplies?

Yes. My reference earlier was to 24 weeks, which is—

—not quite to the level that you said. But, yes, we wanted to give broader reassurances about the supply line, because we've continued to build on that and work our way through, and I was able in the partnership forum that I was chairing two weeks ago with staff representatives to allow them to understand how we had built that up. And of course, that's not just about the NHS setting; it does include other contractors outside of NHS employees, so we do make sure it goes out to pharmacists, to primary care settings, to GPs et cetera, and of course, around half of the items that we've distributed to date now, over 450 million, have actually been in the social care setting as well.

We are listening and working through problems around PPE in other settings, so we'll continue to keep that under review. Early on in the pandemic, we had to revisit areas like funeral directors, for example, to make sure that supplies were available. So, without committing to every part of sectors, we are really mindful that certainly where people are providing services for vulnerable individuals and to communities, that we do need to continue to review that. So, we've got a very regular process checking on those things, and if we need to deploy more, then we will do so. But I hope, at least, the committee will be reassured about just that level of provision. Even face masks, recently, which were under pressure, we've had some orders that mean that that now will be, again, in a much better place as well.

Ocê. Diolch yn fawr i bawb. Dŷn ni allan o amser. Dyna ddiwedd y sesiwn. Diolch yn fawr iawn i Vaughan Gething ac hefyd i Dr Andrew Goodall am eu presenoldeb, ac yn ôl ein harfer, wrth gwrs, mi fyddwch chi'n derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio eu bod nhw'n ffeithiol gywir. Ond dyna ddiwedd y sesiwn, felly diolch yn fawr iawn i chi'ch dau.

Thank you very much, everyone. We've run out of time. That brings us to the end of the session. Thank you very much to Vaughan Gething and to Dr Andrew Goodall for your attendance, and as is customary, you will be in receipt of a transcript of the discussions to check for factual accuracy. But that brings us to the end of the session, so thank you very much to you both.

4. Papurau i'w nodi
4. Paper(s) to note

I'm cyd-Aelodau, dŷn ni'n symud ymlaen i eitem 4, papurau i'w nodi. Mi fydd Aelodau wedi darllen y llythyr gennyf i at Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru, ac hefyd yr ymateb oddi wrth gwasanaeth ambiwlans Cymru ynghylch data am achosion o hunanladdiad, neu achosion o geisio cyflawni hunanladdiad; mater a godwyd mewn pwyllgor yn ddiweddar. Pawb yn hapus i nodi rheini? Dwi'n gweld bod pawb yn.

To my fellow Members, we move on to item 4, papers to note. Members will have read the letter from myself as Chair to the Welsh Ambulance Services NHS Trust, and also the response from the Welsh ambulance service with regard to data on incidents of suicide or attempted suicide; an issue that was raised in a committee meeting recently. Is everyone content to note those? I see that everyone is indeed content.

5. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
5. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

Felly, dŷn ni'n symud ymlaen i eitem 5, cynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod yma. Ydy pawb yn gytûn? Dwi'n gweld bod pawb yn gytûn, felly dyna ddiwedd y cyfarfod cyhoeddus, ac awn ni i mewn i sesiwn breifat yn awr i drafod y manylion. Diolch yn fawr.

So, we'll move on to item 5, a motion under Standing Order 17.42(ix) to resolve to exclude the public from the remainder of this meeting. Is everyone content? I see that everyone is indeed content, so that brings us to the end of the public meeting, and we'll go into private session to discuss the details. Thank you.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 11:53.

Motion agreed.

The public part of the meeting ended at 11:53.