Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd
Health, Social Care and Sport Committee - Fifth Senedd18/03/2020
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Angela Burns AM|
|Carwyn Jones AM||Yn dirprwyo ar ran Jayne Bryant|
|Substitute for Jayne Bryant|
|Dai Lloyd AM||Cadeirydd y Pwyllgor|
|David Rees AM|
|Lynne Neagle AM|
|Rhun ap Iorwerth AM|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Dr Frank Atherton||Prif Swyddog Meddygol Cymru, Llywodraeth Cymru|
|Chief Medical Officer, Welsh Government|
|Dr Rob Orford||Prif Gynghorydd Gwyddonol dros Iechyd, Llywodraeth Cymru|
|Chief Scientific Adviser for Health, Welsh Government|
|Grace Martins||Uwch Gyfreithiwr, Llywodraeth Cymru|
|Senior Solicitor, Welsh Government|
|Neil Surman||Dirprwy Gyfarwyddwr, Iechyd y Cyhoedd, Llywodraeth Cymru|
|Deputy Director, Public Health, Welsh Government|
|Sapna Lewis||Uwch Gyfreithiwr, Llywodraeth Cymru|
|Senior Solicitor, Welsh Government|
|Vaughan Gething AM||Y Gweinidog Iechyd a Gwasanaethau Cymdeithasol|
|The Minister for Health and Social Services|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Claire Morris||Ail Glerc|
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.
Dechreuodd y cyfarfod am 10:03.
The meeting began at 10:03.
Bore da a chroeso, bawb, i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. O dan eitem 1, cyflwyniadau, ymddiheuriadau, dirprwyon a datgan buddiannau, dwi’n falch iawn o groesawu fy nghyd-Aelodau i’r cyfarfod. Mae pawb yn gwybod bod y cyfarfod yma’n ddwyieithog. Gellir defnyddio clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar sianel 1, neu glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. Dŷn ni ddim yn disgwyl larwm tân y bore yma. Os bydd yna un yn canu yn rhywle, dylid dilyn cyfarwyddiadau’r tywyswyr. Dŷn ni wedi derbyn ymddiheuriadau gan Jayne Bryant, ac mae Carwyn Jones yma yn dirprwyo ar ei rhan. Felly, croeso arbennig i Carwyn Jones.
Welcome, everyone, to this meeting of the Health, Social Care and Sport Committee here at the Senedd. Under item 1, introductions, apologies, substitutions and declarations of interest, I'm very pleased to welcome my fellow Members to the committee meeting. Everyone knows that this meeting is bilingual and headphones can be used for simultaneous translation from Welsh to English on channel 1, or hear the original language in amplified form on channel 2. We don't expect a fire alarm to sound this morning. If one should sound, then do please follow the instructions of the ushers. We have received apologies from Jayne Bryant, and Carwyn Jones is here as a substitute on her behalf. So, a particular welcome to Carwyn Jones.
Eitem 2, ac, yn sylfaenol, dŷn ni wedi cyrraedd y mater pwysig: cyfarfod briffio technegol ar COVID-19. Dwi’n falch o groesawu o’n blaenau y prif swyddog meddygol a’r prif gynghorydd gwyddonol dros iechyd. Byddan nhw’n rhoi gwybodaeth i’r pwyllgor yma am y diweddaraf am COVID-19. Felly, i’r perwyl yna, dwi’n falch iawn o groesawu Frank Atherton, Prif Swyddog Meddygol Cymru—bore da. A hefyd Rob Orford, y Prif Gynghorydd Gwyddonol dros Iechyd—bore da i chithau hefyd. Mi fyddwch chi’n ymwybodol bod y meicroffonau’n gweithio’n awtomatig.
Mae yna lu o gwestiynau, yn naturiol, fel y byddwch chi'n ymwybodol, ac wrth gwrs, mae sesiwn nes ymlaen efo'r Gweinidog ynglŷn â'r Bil mewn argyfwng. Ond, yn benodol, dŷn ni ar COVID-19 rŵan. Allaf i wahodd Dr Frank Atherton i wneud cyflwyniad byr ac wedyn awn ni i mewn i gwestiynau? Frank.
Item 2, and we have arrived at a very important issue here. This is a technical briefing on COVID-19. I'm very pleased to welcome today the chief medical officer and chief scientific adviser for health, who will be providing information to this committee with an update on COVID-19. So, to that end, I'm very pleased to welcome Dr Frank Atherton, the Chief Medical Officer for Wales—good morning to you. And also, Dr Rob Orford, Chief Scientific Adviser for Health—good morning to you too. You'll be aware that the microphones operate automatically.
We have a whole host of questions, naturally, as you will be aware, and we have a session later on with the Minister regarding the emergency Bill. But, specifically, we are discussing COVID-19 now. May I invite Dr Frank Atherton to make a brief introduction and then we will go into questions? Frank.
Thank you, Chair, and thank you, colleagues. So, I just wanted to give a quick update on where I think we are with the coronavirus epidemic in the UK and, indeed, here in Wales, and just to summarise some of the issues that we're really dealing with at the moment. I think everybody knows that the virus is now spreading quite widely outside of China, and what began as an event in China only three months ago is now a global pandemic. That was declared by the World Health Organization about a week ago. We've seen across Europe a number of countries run into very significant difficulties, not least with the provision of healthcare.
In the UK, we've seen the gradual increase in the number of cases. Here in Wales, we've had 136 cases identified as positive with coronavirus, and, very sadly, we've had two patients who've died with coronavirus in the last week.
So, we have moved now from a process of trying to contain the epidemic here in the UK to one of delaying its impact, and the reason for that I'll come on to in a moment, really. Essentially, we're trying to buy time so that the national health service and our public sector have time to prepare for a significant increase in the number of cases coming forward.
Colleagues, you'll remember that—you will all know that COBRA met under the chairmanship of the Prime Minister on Monday this week, and a number of additional interventions were announced to try to slow the spread of the disease and to try to reduce the number of potential deaths that we may be facing in the UK. Those measures are summarised in the paper that we've done. But, in brief, we're moving beyond asking people to self-isolated if they have symptoms that suggest coronavirus infection—those symptoms being, of course, a new, persistent cough and fever. So, for some time now, a week or so, we've been advising people with those symptoms to self-isolate for seven days.
On Monday, we made the change to advise all household contacts of cases to isolate for 14 days to try to slow the spread of the virus. The second intervention that was announced on Monday affects everybody in Wales, and it's around social distancing. It's about reducing the amount of social contact that we have as individuals and within our communities. This is a difficult ask of people, because it involves people perhaps not going to work, working from home; it involves not gathering in large or small groups in pubs, in clubs, in bars, in restaurants; it involves not going to the theatre, not going to the cinema. So it is not a minor measure; it's a significant step, and it's something that we're asking the public here in Wales to abide by.
Within the population, there are some individuals, we know from the way the virus is unfolding in China and in the rest of the world, particularly in Europe, there are some groups who are more vulnerable than others to severe infection, particularly the elderly over-70s and people with chronic diseases. We're often talking about adults who might be eligible for flu vaccine. People in those groups—it's really important that they particularly take the advice not to gather and congregate and to reduce their social contacts as much as possible.
There's a more at-risk group, a more particularly vulnerable group of people in Wales and in the UK who have particular conditions that make them exceptionally vulnerable to this disease and, in fact, to any respiratory disease. That group, people, for example, who have organ transplants or who are immunosuppressed for any reason, are really being given much more rigorous advice to isolate, to state at home, to really have as little social contact as they can. We're calling this the shielding process around the most vulnerable in society. We believe that there are about 70,000 people in that category in Wales.
So, why are we suggesting these measures? Why have they been introduced this week? Well, for two reasons. One is— everybody, I'm sure, has seen the epidemic curve—we are trying to reduce the peak of the epidemic so that we don't have such a burden on our NHS in particular, and so flattening that curve of the epidemic is very important to us. But some of the measures, particularly the one that will be coming on stream, we believe, in a week or so, around shielding the more vulnerable in society, are aimed at reducing the number who get severely ill, and who potentially might die. So, that's where we are with the epidemic. Obviously, things are unfolding very rapidly, Chair, as you will doubtless appreciate, and I have to try to answer what questions you have.
Thank you. First of all, I'd like to say that we appreciate so much the effort that you and your teams, and indeed the whole of the scientific and NHS communities are putting in to make us all as safe as we possibly can be. However, that doesn't mean to say that we don't have lots of questions, and some of our questions will be marginally repetitive, because we keep asking them, because we're not sure or really understand the answers.
I've got two areas I'd like to ask you on. The first is in connection with testing, and I know that it's something that a number of members of the committee have questions on. The World Health Organization was very clear that we should test everybody as much as we possibly can. I understand that we have a different set of rules that all the UK Governments have decided to stick to, and to be frank, if Boris Johnson and his team of officers were sitting there, I'd be asking him exactly the same question: why aren't we testing more people? Is it because we do not have the capacity? Is it because we do not have the kits? Why is the British medical evidence or science that you're basing this decision on so different to what the World Health Organization have said?
The reason why I'm quite troubled by this is that, when I look at the countries that have been marginally more successful in bringing this down—so, if I look at South Korea, a country that has 50 million-odd population, they do have a different social structure, a different culture. However, they have tested absolutely everybody, and they've gone from 900 cases a day down to below 100. And they have really contained it. So I'm looking at best practice and saying, 'Well, they've done it, and this is how they did it. Why would we not follow that kind of protocol?' The World Health Organization is very clear that you've got to test everybody, because if we don't test people, how do we know who out there is safe to go and help those who would need the help, the people who are in the vulnerable situation?
Thank you, Angela. So, I'll make a start and Rob may want to add to this. It is a question both of strategy and of capacity. So, on the strategic question first of all, at the start of the epidemic in the UK, when we were in the contain phase, it was really important that every case was identified and tested and that the contacts were identified, and those contacts were given clear advice as to what they should do if they became ill. That, we believe, has worked well, and has bought us some time in the UK. It was based on science, and we followed the science.
As we moved into the delay phase, there were two problems, really. One is that there is a capacity issue, and I'll come back to that in a moment, but the most important thing in the contain phase is to make sure that people who are symptomatic are isolated. And the advice to everybody if you are symptomatic to isolate yourself I think is the right advice, because it takes people out of circulation.
Now, there is a strong argument for testing more widely. I do need to stress that we have increased our testing very significantly here in the UK, and here in Wales. Wales was the first nation—we got testing into the lab at University Hospital of Wales very quickly, and they have significantly increased their capacity over recent weeks. We've tested about 1,900 people as of yesterday so far here in Wales, and that's a great credit to our staff. To go back to the capacity issue, the capacity's not unlimited, and so we have to think how best we use it at the moment, at the same time as ramping up our testing ability, our capacity.
Can I just ask, could you just tell us how long does it take for a test to be tested?
Processed. Thank you.
Well, it varies, but the turnaround time in Wales, when we introduced it, was really quite rapid compared with the UK average. It was taking 24 hours initially. We developed a test and our scientists in UHW brought the test in with about a six-hour turnaround. Now, that varies from day to day, but at the moment we're doing two runs a day and we can turn it around in that kind of ballpark area.
Can I ask a question? Is that true for wherever in Wales that test is taken, because I've heard reports that it's taking longer in, for example, the north to get results of tests back?
Certainly there are transfer issues, of course, which will affect that timing. At the moment, there's only the University Hospital of Wales that is able to do the testing. There are plans to increase testing and to have testing in north Wales and in Swansea. So, our expansion of testing does extend into those areas and should address some of those issues.
I've heard reports that it takes four days for tests to come back in the north. Would that be true?
That may relate to the timing of samples being collected and moved around. I can't comment on that. Just to say that the actual test, once it reaches the laboratory, is fairly quick.
Okay. Carwyn. I'll come back to you, Angela.
Just to explore the testing system, are we talking about a blood test?
No, unfortunately we don't have a blood test at the moment.
So, when you say 'samples', samples of what?
It's a swab.
It's a swab. It's a nasopharyngeal swab. So, it's based on that. We are looking to a blood test, because that would be a game changer, in many ways. It would help us in terms of our surveillance and in terms of our management of cases.
Can I just finish the point I was trying to make? Testing has a really important role to play and we do have limited capacity in testing. We are looking to ramp that up very significantly. While we have limited testing, it's important that we use it wisely and that we use it in the right way. We do need to use testing both to monitor how the disease is unfolding and we also need to use it to manage the cases. In terms of monitoring how the disease is unfolding, our surveillance, if you like, we are using our testing to look at people coming through intensive therapy units, people who are coming into hospital with pneumonias and people in sentinel surveillance sites in general practice. So, we do have the use of testing to monitor how the disease is unfolding.
We also need to use the testing, I believe, that we have to support people in getting back into work quickly. So, in particular, our health staff—health workers. Critical health workers are coming under pressure and so, as of yesterday, I issued some guidance to the NHS as to who should have priority testing for health workers so that we can get them back into work quickly and they're not unnecessarily self-isolating at home.
My next priority, I think, for testing, as we ramp up our capacity, which we are doing, would be for other essential workers, particularly in social care; teachers at the moment, while schools remain open, of course; and other public sector workers. And then we do need to go back to the question of significant testing in the community, and that is currently being kept under consideration at a UK level. So, I'm not ruling that out, I think we need to come back to it. I think we have a certain amount of testing capacity now. We are increasing it. We need to use that wisely and we need to think on a step-wise basis which groups we will get the best benefit from.
Lynne on this point and then—
I just wanted to clarify something, really, because I think the public thinks that a decision has been taken not to test. So, if we had the capacity, we would be doing the most testing possible. Is that the case?
To some degree, but I would put a caveat around that, and my caveat would be that there is an opportunity cost in testing. To test somebody requires a health worker or somebody who can take that swab to go out to administer the swab, to carry it back, and we have to think about what is the best use for our healthcare staff. Are they best deployed doing that or are they better deployed actually providing front-line services? I recognise this is an issue for the moment. This will become less of an issue when two things happen: one is when, as Carwyn Jones says, we get a blood test, which would make life somewhat easier; but also as the number of cases increases it will be perhaps less of an issue. But we are ramping up testing and we are keeping the idea of widespread community testing under review, and developing plans to roll those out if we get to the capacity that we believe we need.
Carwyn, on the back of that.
Yes, just to ask a question, really, about the purpose of testing. Now, the obvious purpose is to discover if someone's got the virus, but there's also a secondary purpose, possibly just as important, of ensuring that somebody is clear of the virus once they've had the virus. If we had a testing regime—let's assume we're in an ideal world where resources are limitless, and we know they're not but I accept the point you've just made. Presumably, if you were testing people beyond those who are seen as a priority, not only would you have to test them once but on a regular basis, just to make sure they hadn't picked up the virus in the meantime since the last test. So, it would actually be a system of constant testing and not just one test. Would that be right?
In theory, that could well happen. I just need to stress that there's very little point in testing anybody who is not symptomatic; the test will only be positive if somebody actually has symptoms. So, it wouldn't necessarily help with all those household contacts because they potentially could be incubating the disease.
I think that's an important point for the public to understand—that the test is effective when the symptoms show, and testing somebody with no symptoms is pointless. Would that be fair?
And then, in terms of the effectiveness and accuracy of the test, I know these are early days but is there any idea of how many test results come back as true results, and how many come back as false positives, false negatives? That's common in any medical test, we know that, but do we have any idea what the percentage might be at this stage?
It's a good test. It's both sensitive and specific, and so the number of false negatives is quite low. I was told when it was introduced that it was well over 90 per cent, probably 98 per cent, but Rob may have a more accurate figure.
I think it's fair to say that the infection comes and goes, that at some point you would likely be able to detect the virus and at some point you wouldn't. So, as you progress through the disease, there'll be a period where you may not be able to detect it. Once there's a blood test, it'll be much more sensitive and we'll know if your body's developed an immune response to the virus. That will be driven by market forces, and very soon I'm sure we'll see a much more sensitive and more appropriate test.
I think it's fair to say that science is a global community and we're learning from others, so as evidence emerges on the benefits of testing and different strategies, it will inform our thinking. We know there are studies coming from Italy. We will, of course, look at those and we'll ask others to comment. So, this is a continual process of iteration of looking at what we're doing, making sure it's appropriate, making sure we can scale it such that the first principle is reduce harm and protect the NHS, and then it's spread out from there. So, there is a clear and determined way of doing that, but resources and capacity are not infinite at the moment.
Angela, back to you.
I hear what you say and you talk about resources and capacity, but I do wonder, given that so much has now been cancelled—. There are a lot of healthcare workers—you know, you talk about healthcare and you immediately think of front-line staff in A&E having to go out and do a test, but actually there are an awful lot of people who are not anything like that, who work in the community, who could, I wonder, be trained just to take a swab and to make sure it's processed.
And then, picking up on Rhun's point about the effectiveness of getting something from north Wales down to Cardiff, there are lots of organisations throughout Wales with their own private laboratories because they make and do other things. Can any of those be adapted to ramp up capacity and we use all sorts of trained people?
But my other real issue about testing is that no-one's been able to say with real clarity—and maybe today you will be able to tell us—whether or not you can be reinfected. Because with testing, you will know if somebody's had it and then if they've had it again, because we don't know if this is a one-off or if it's something you can recatch, recatch and recatch like a cold because, again, that helps people to understand what this is all about.
On that question, we are learning about the virus; there's still an awful lot we don't know, and you're right to raise that question. We believe that in this epidemic, this wave of the epidemic that we're in, by and large if people have the disease, we can assume that they're not going to get it a second time in this wave. It is possible beyond this wave and into next year—. We have to remember that the common cold is a coronavirus, and it changes every year, and people get different varieties of it. So, that could happen in the future, but, really, our challenge at the moment is to understand the science, to learn about the virus, but really to focus on the epidemic at the moment. And it is reasonable and safe, I think, to assume at the moment that if somebody's been infected once, that's it for this wave.
So, my last question, then, is: will you consider issuing a protocol, because, actually, nobody knows what to do? If they've had it and they've recovered, what do they do? Can they go back to work, can they go see their mates? Can they—?
Well, we are saying that. That is the advice at the moment. If somebody has experienced symptoms of coronavirus and they've successfully isolated themselves for seven days, they are safe to go back to work, to re-engage with society, yes.
Two questions: (1) can you give us a timescale for the rolling out of testing for symptomatic key workers and family members of key workers in order for them to avoid unnecessary loss of working capacity, because that's one that we hear often—people who want to work and are frustrated at not being able to at the moment?
I can't give you a time frame but I can give you a sequencing. So, as of yesterday, we issued guidance to the NHS around testing for healthcare staff. That lists the priorities of staff who should be considered initially. The next steps will be to think about social care staff, about school staff and about other public sector workers. But I cannot give you a time frame because we need to both ramp up our capacity and match our capacity to the priorities that we're making.
Indeed, and maybe that's something that we could ask Government on—how many key workers there are, because that will have been identified so far and it will be able to—. There'll be models that identify how many are likely to be affected.
You answered earlier on that people who do not show symptoms—there's no point testing them. So, if a key worker is being requested to stay at home because a family member has symptoms, who actually is going to be tested?
That would be the person who is experiencing the symptoms—
The family member.
So, there would be a logic in testing the person who is symptomatic, because if they test negative, then there is no reason for the people in the household to be isolated.
And in the process, the procedures that you're putting in place, the family member will be of the same status as the key worker—him or herself? Because in terms of getting them back to work they're equally important.
It's a good point and one that we need to build into the protocol, yes.
Okay, thank you. And, secondly, surveillance testing—we hear a lot about it. What is it? How does it work? How accurate a picture does it give us of the story of the pandemic?
There are a number of figures that we can follow. You know the number of deaths from coronavirus that have been confirmed through testing. You know the number of people that are in ICU that have been confirmed through testing, and you know the people that have been hospitalised through testing. And they're all valuable figures to align with our models—to know where we are in terms of the curve. We don't know exactly how many people at any one moment in time, but we can infer things from the data of what that might look like. And that's all to do with how we think the virus behaves and its transmission—so if I was symptomatic now, how many people might I infect in this room, and how many people you might infect, and the period of time that might take. So, this is all wrapped up in the modelling, but there are some things that we can track daily, hourly. Daily is very useful to know how many ICU beds that we have available to us. So, surveillance is a constant theme and the best surveillance system is one that has the best data going into it, and the best actions coming out the other end. And that's obviously what we're trying to pursue.
So, no physical testing, swab taking happens under this umbrella of surveillance testing? That's just data—a theory?
Capturing data and using data to inform your decision making. So, surveillance is monitoring a thing and doing that day in, day out the same way. So, there are different types of surveillance. There may be non-health surveillance that we can do, looking at people's behaviours—how many people went to Wetherspoon yesterday versus last week. So, there are lots of surveillance and data streams that will come online and all of that will help us to inform decision making.
Okay, thank you.
Other retail outlets are available. [Laughter.] Lynne.
I've got a couple of questions, and some of them relate to what I asked the First Minister yesterday, but if I could just start with front-line staff. Clearly, it's absolutely imperative that we protect their health and safety. What assurances can you give that we have got the necessary equipment in place to protect our front-line staff?
Well, you always need more, and we will be stretched in terms of supplies, but the provision of personal protective equipment and the appropriate use of personal protective equipment is really important to us. There is a process of procuring more stocks of those; health boards are working on that and central procurement is working on that. And as you will know, I'm sure—the First Minister may have reported—we do hold some pandemic stocks in case of pandemic flu; they've been in place since about 2009. We have released some of those stocks now to health boards, and indeed to primary care, to help support staff there. But it is important that staff are protected, and there's a whole stream of work going on around procuring and distributing personal protective equipment.
Okay. And one of the issues I picked up with the First Minister yesterday was about the critical care capacity in Wales, which we know is considerably lower per head than, say, for example, Italy. The First Minister said in response that we were looking to double the critical care capacity in Wales. I just wanted to get your views, really, on whether you think a doubling is going to do it, given that we're starting from a lower base than somewhere like Italy, or whether we're going to be looking to go further than that.
So, on critical care, you're right to raise it, because it is expected to be one of the pinch points in the NHS. It's one of the most difficult areas that we need to address. At any given time, we have about 150 critical care beds, give or take, in Wales; it varies, sometimes it's 156. We do have existing plans, which we bring into place often in the winter months, to double that capacity if we need it. So, we can fairly rapidly double that. By repurposing some of the NHS estate, particularly theatres, recovery rooms, et cetera, and by working with the private sector, we believe we can go further with that; there's more we can do there. We are part of a UK-wide system to procure more ventilatory capacity. And we currently have a significant number of ventilators on order—about 700 or so. So, we are looking at every way we—
Sorry, is that 700 for the UK or 700 for Wales?
We are currently doing everything we can to look at where we can boost our critical care capacity. The question was, will it meet the likely demand? Well, the aim here, as I've said, of all the measures that I've mentioned before, is to draw down the curve, to reduce the peak impact on the NHS, at the same time as we are ramping up our critical care capacity, and our capacity generally in the NHS. We are looking to get to a point where those two curves—the expected demand and the supply of critical care, in this case—meet. We're not at that point yet.
A very fundamental issue will be the extent to which the flattening of the curve is successful. And that really depends on everybody in Wales taking on board those messages about social distancing. If that doesn't happen, my worry and my prediction is that we would exceed the capacity. So, it is really important that that public health messages that we're instituting on Monday are instituted to their full effect.
Now, if they are successful, and if the Scientific Advisory Group for Emergencies modelling—SAGE is the specialist scientific committee on emergency—if the calculations and the predictions in SAGE are correct, the measures that we're introducing on Monday should reduce the peak demand by over 60 per cent—60 per cent to 66 per cent. And if that happens, then we have a good chance of being able to ramp up the NHS capacity to meet that. If those social measures do not succeed, then my worry is that we will not be able to meet the predicted demand.
So, the two things have to go hand in hand. Society has to take a role in this; Governments can't do everything. People have to start to take those messages extremely seriously now; and at the same time we absolutely have to ramp up, as much as we possibly can, our ICU capacity and our capacity in the NHS.
That's why, just last Friday, the Minister announced—I think Wales went ahead of the other UK nations in announcing that we were transforming our NHS. We're moving our NHS to a new footing. We're reducing elective care rapidly; we're reducing out-patients; we're trying to use that time that we've bought through our public health interventions to repurpose our NHS, to retrain our staff, to move people into a very different place. And that's not an easy thing. It's a huge challenge for our NHS. But it's what all of our NHS is now focused on.
In terms of the modelling—we talk about the modelling a lot—can you confirm whether there is modelling of a Wales-specific context? Because COVID-19 doesn't respect borders, but demographics do mean differences in the way COVID-19 will have an impact on the ground, within our elderly population and so on.
Rob may want to come in.
Yes, absolutely. SAGE have a model. They have a number of modelling groups. Some of the best in the world are feeding into that group. There's an NHS model that we're using and applying that to our population. So, we can use that to project where we might be and—
And are we there in that context? The Welsh NHS, the Welsh population, the Welsh demographics.
Yes. In Wales, we have a technical advisory cell with scientists from Public Health Wales—epidemiologists. They are trained experts—they do this day in, day out for other communicable disease outbreaks. They use the same methodology; they use the same types of models. We're applying what we know about this virus and how it behaves to those models. The order of magnitude is bigger, but the methodology is still the same.
We're very fortunate in Wales—we have access to some really capable, bright professionals from a number of different spheres who can bring these skills together. So, we are in train with SAGE. We meet regularly. We're working seven days a week flat out to try and understand the behaviour of what we've projected and what we're observing.
And then what these interventions—and these are really important, as Frank stressed. If we're not doing those simple things of washing our hands, avoiding putting our hands in our mouth and near our face, creating more distance between us, we will give the virus safe passage, we will give it quarter, and we don't want to do that. So, there is a war effort going on here against this virus.
I have other questions, but I'll wait my turn if you want to go elsewhere.
I just wanted to ask about mental health, because in order for people to get through this period and comply with the measures, we do also at the same time need to support their mental health. I recognise that's going to be a challenge when all the efforts are focused on controlling the disease. I wondered what specific plans were in place. Because the other danger is that people are getting their information from a lot of worrying sources. What plans are in place to actually reinforce those public mental health messages, maybe using social media responsibly and harnessing the brilliant organisations we've got in the third sector so that we can maybe make that virtual support more available to people?
It's a really fundamental point. I'm sure we all know, from our discussions with our families and our own communities, that everybody is very stressed by this. Vulnerable people in society are more stressed than ever. There are a few aspects to this.
First of all, the mental health of the people for who we are recommending the most restrictive measures of self-isolation is really important, because this is not going to be a quick thing. We're talking about 14 or 16 weeks for the most vulnerable people to be isolated. That has a direct impact, and we all need to be thinking about how we can support people who are in that kind of a circumstance.
More generally, I can't point you to a plan, but there is planning in place through local resilience fora, through local authorities and working very much with voluntary groups. That absolutely has to happen, because I don't think Government can do all of this. We have to mobilise society now. We have to mobilise our communities. And it's really important that everybody plays a part in that. So, it's a really important dimension. I can't, as I say, point you to a plan, but it's so important that, as we go through this very difficult national process, the national effort that we're now going through, that we look after ourselves, and after our neighbours, and after our communities.
Ocê. Rhun nesaf, wedyn Carwyn.
Okay. Rhun next, then Carwyn.
Back to the question of personal protection equipment, I'm hearing stories from within the NHS of fears over a lack of provision of protective equipment. I'm hearing stories of even nurses on wards not having been given the most basic of training in what to do if somebody turns up with a cough. I'm hearing stories of a child being treated in an emergency department for—sorry, I don't know the name of the condition—a severe tightness of breath, and being treated surrounded by NHS staff wearing no protective equipment at all. And this is happening now. I'm concerned about this. How concerned are you? What is being done on those kinds of fronts within the NHS to make sure that it's operating as safely as possible? Because we need our staff to stay safe, because we're going to need them working.
So, let me just say at the outset that I hear those concerns, and I don't just hear them here, I hear them wherever I go. Staff are rightly very anxious about this, and we need to do everything we can to support that. I've talked about the national procurement. We're looking to get as much PPE as we possible can so it's available.
We have issued advice to staff, of course, and that needs to be constantly refined and reiterated. There is a huge amount of training for staff going on. This does not happen overnight. The pace of this has taken everybody by surprise, hasn't it? That's not an excuse; that's just the reality that we're facing. And so, getting everybody up to speed with their PPE requirements and how those special masks that healthcare workers in the most critical areas use—those FFP3 masks—are fitting, that is happening across Wales now.
Should a trauma surgeon, for example, working in the Welsh NHS now, have been fitted for a mask by this point?
I would expect that there will be a process in all of our hospitals to do that. That is happening now. Can I say to you that there isn't a specific surgeon somewhere who hasn't yet, because he's been busy operating, had that training? No, I can't say that. But there is a process for every health board, and I would expect every health board—I know every health board is rolling this out.
I can assure you that there are surgeons who haven't been fitted, and it's not because they've been too busy to be fitted, it's because the process isn't in place. It would be good if that could be fed back to the Welsh NHS leadership.
I have two questions, Chair. I suppose they're unrelated in a way, but they're certainly questions that people have asked me.
Schools: when we look at children and young people, they are in a very low-risk category. The assumption is that they will have mild symptoms and possibly they won't share much of the virus. Now, within schools, of course, there will be vulnerable individuals within schools who would need to be looked after and, of course, steps taken to make sure that they don't come into contact with the virus.
If those steps are taken with regard to vulnerable individuals, and if the steps are in place to stop teachers and pupils coming into contact with vulnerable people, is there any reason for schools not to stay open?
Is there any reason for schools not to stay open?
Perhaps I turned into a lawyer there, forgive me. But as long as those can be managed for vulnerable people, do schools need to close at all?
So, the question of school closures is a really difficult one and a contentious one. When SAGE originally looked at the various interventions that might support the reduction of the epidemic curve, the reduction of peak demand, school closures obviously were looked at. I know a number of countries, of course, have moved to school closures. The arguments for school closures would be that it does have some impact, but probably less impact than you might expect, in terms of the transmission of the disease. It wouldn't have no impact, it would have some impact, but the impact would be quite limited.
Against that, of course, you have to provide the counter-balance of the negative sides of closing schools, which would be, as you rightly say, children themselves aren't particularly badly affected. It isn't that they're not completely spared, but they're not the worst affected by this virus. There would be questions of the parents and how they would be withdrawn from the workforce, and we're starting to see that, to some degree, because the parents are often working in the health sector or in social care. And then there's a question about the children if they're being looked after by their grandparents, potentially passing the virus.
So, there are good reasons not to close schools. There have been good reasons. That is constantly kept under review. SAGE is continuing to look at that. I'm expecting that to be the discussion of further COBRA discussions in the very near future. So, there may be different decisions taken on that. At the moment, the advice is for schools to stay open. I'm very aware that schools are really struggling, as staff members themselves are identified or are part of a household and members are withdrawn from the workforce, and so some schools are really struggling. But that whole question of whether schools stay open or close is under very hot discussion at the moment, and I think we can expect to hear more advice from Government in the near future on that.
Okay, thank you for that. The second question from me is this: I'm not claiming to be an expert, but we know that the normal passage of any virus is for people to acquire it, and then enough people to acquire an immunity to it, so that it either disappears or mutates—it comes back as something else. As we know, the cold mutates every year—it's not one ailment, is it?
So, normally, the way that a virus would be dealt with by a human population is that immunity would be acquired by enough people for the virus no longer to have any purchase, if I can put it that way. Would that be fair?
Now, clearly, with COVID-19, that's not the approach, for obvious and understandable reasons. But that then raises the question, doesn't it? If we go into—I use the term 'lockdown' because that's what the public describe it as—. If we go into a further lockdown—the same as Spain or Italy—that would mean, possibly, as we've seen in China, that the number of new cases starts to drop, but could we ever be sure that there would come a point when it would be safe for people to go back to normal if that immunity isn’t there?
And secondly, leading on from that, does that mean then—. I'm not looking for you to tell me a date by which time everything comes back to normal. Does that mean then, that, in the absence of that immunity that normally builds up to a virus amongst the general population, the only time that we can say with any sense of being sure—when we can say to people they can return to normal—is when a vaccine is available? That's the worry, isn't it—the immunity that would normally be acquired for any virus isn't being acquired, and so, what happens then if people emerge back into society and back to normal, and the virus reappears, because it's been there, and people's immune systems aren’t used to dealing with it? Ultimately, of course, a vaccine is the way to deal with that, but we're some way away from it being (a) developed, and (b) available, aren't we?
It's a very good point, and it's back to the earlier point about some of the more draconian measures that have been taken in China, in Korea and in Singapore et cetera—it did involve more significant restrictions on people's activity. You called it 'a lockdown'. That can control it. If you put everybody in the country into solitary confinement, the virus would stop spreading for a while, but it wouldn't go away—it would still be there. And as you rightly say, when people come out of solitary confinement, then they would risk—. So, it can delay, but it can't stop an epidemic. So, the question of when you lift restrictions is a really difficult one. It's easier to impose them than it is to lift them. And again, that's an issue that SAGE is looking at. But Rob will have more views on this, because this is constantly looked at by the SAGE committee.
I think they're really fair comments, that once you lockdown, if you recede that naïve population, then you'll see an outbreak again. It's how we are able to manage that with testing and isolation. But it's not going to be turning things off for two weeks—it's going to be turning off things for a period of time.
However, necessity is the mother of invention, and the whole world are trying to throw everything at this to create vaccines, and the first trials have already started in humans. If this had happened a few years ago, that would have taken years. So, we'll see a huge elevation in terms of our ability to diagnose more accurately with blood samples, and we'll see a huge amount of information coming out about how to effectively treat people with the condition, and then how to bring a vaccine in.
There are other very infectious diseases—like measles—that we effectively manage through judicious use of effective vaccines. So, I think there is light at the end of the tunnel, but it's not going to be switched on tomorrow, unfortunately.
No, I well understand that, and there's nothing to suggest, is there, at the moment, that COVID-19 is any more resistant than other virus to the development of a vaccine? We just don't know. But there's no indication that it's somehow more resistant than a virus would normally be. Would that be fair?
We'll know very soon. As soon as the evidence is made available, I'm sure it'll be in the media.
I think I need to tie this point up, really. We're not able, nobody is able to say that by 10 July, everything will be fine. No-one's able to say that; no-one can give a date, and a lot of this is down to scientific prediction—we all understand that. But, are we saying that, where we stand at the moment, the only time that we will be able to say that things can return to normal is when a vaccine is available and when the population has been given that vaccine? In terms of being sure that the virus isn't going to return, would that be right, or is there another way of doing this that doesn't involve waiting for a vaccine?
I just don't think we have a crystal ball that can answer those questions at the moment, if I'm very honest. We know that if we do nothing, the most likely outcome is that we will have a significant epidemic with an epidemic curve, which will last about 12 weeks, and 95 per cent of the cases will happen in that window. Is it 12 weeks?
It's 95 per cent in nine weeks.
Nine weeks—I beg your pardon. So, we know that that's what will happen without anything, and what we're trying to do is to widen the curve to make it a slightly longer epidemic but a lower peak. But, really, we will only know what happens to that as we get further into the epidemic curve.
The other thing to say is that we don't know whether this will be just a single epidemic or whether there may be tails with smaller outbreaks beyond the initial epidemic curve. So, we don't have a crystal ball.
Right, we're coming towards the end now, so Angela and then Rhun to polish things off.
I just wanted to talk about two specific groups of healthcare professionals. First, social care: what plans are in place to, first, protect those who provide social care and, secondly, to mitigate the issues as and when social care workers, whether they're domiciliary or residential, in the public sector or the private sector, start going sick or self-isolating themselves? How are we going to look after our older and infirm people? That's a big, big area of concern, especially if we're telling over-70s to stay at home. They can't go out; they've got a carer who comes in twice a day; the families aren't supposed to go anywhere near them, because the families can carry the virus; the carer goes sick; the small business that runs this has only got seven or eight carers on the books, and half of them have gone sick or are self-isolating—what do we do? What plans are in place? Has anybody discussed it? Who is discussing it, so that we can go to interrogate them?
It is a really important thing, because we've got to empty our hospitals, and that requires us to get people back into the community—it requires those people to be supported in the community. That's an additional burden that is coming onto society and onto social care as well.
So, there is a huge amount of work going on in this space. It's happening mainly through the local authorities and social care colleagues. They're all looking at their plans for supporting staff. I've already mentioned that, in terms of the testing, we need to extend that as soon as capacity allows into the social care space as well.
So, there's a lot of work going on in this area—it absolutely is critical. I can't give any guarantees that that sector will not come under stress—I think it will come under significant stress. But, really, it's in the local authority planning—I think that's probably where your questioning is best directed at the moment.
Okay. My second area is the whole area of access to medicines and drugs, and the protection of pharmacists, who do feel that they've been left off the food chain. Are they on the food chain? Are they part of your emergency testing to get this part of the health workforce raised? I've been approached by many pharmacists who feel that the health boards have given them very little contact, very little guidance and a very little set of protocols.
There are concerns, also, over access to medicines, where people, perhaps, are on a medicine that has to be dispensed every couple of weeks, but, of course, if they're self-isolating and they don't have very many friends, or their friends don't want to come anywhere near them, how do they go out to get their medication? Is anybody looking at this? Is anybody looking at how we can extend, in a reasonable fashion, the amount of drugs that people can have?
What are we doing to protect out pharmacists? Many of them are saying that they don't have the protective equipment yet, but, more importantly, as more and more doctors' surgeries close and say, 'Do not come, we're going to telephone-triage you', the worried well and the worried unwell are going to go down the high street to the pharmacist and ask the questions. I've already got pharmacists in my constituency who have had to close because they're self-isolating and they're doing deep cleans.
Thank you. Pharmacists are a vital part of our system, and increasingly, as we reconfigure the NHS, they're going to continue and probably have an extended role in terms of minor ailment support, et cetera. The public has been advised not to go to any health facility, a GP or a pharmacy, if they have symptoms of coronavirus, but the best thing is to stay at home, isolate, and only contact 111 if you start to deteriorate. So, that's another message that needs to get to the public so that pharmacists and others don't become infected. There are questions around the supply of medicines. Many pharmaceuticals are based on substances produced in China and subsequently in India, which has now reduced external supply. So, there will be questions of supply, but those are being addressed at a UK level.
And the other part of your question, we need to think about, as part of our social care—and we talked about the vulnerable groups isolating at home and so, deliveries. Pharmacies in the UK and here in Wales are very good with their delivery systems, but we need to make sure that they're robust and can support people who are isolated at home. So, there is more to do, as pharmacists, and I'm not surprised that you're getting those kinds of comments from pharmacists; I will raise them again with our chief pharmaceutical officer, Andrew Evans and the team who are working on that. We're looking at policy to support them. We need to support all parts of our NHS. This, again, as I say, is moving extremely quickly, but we need to really look to our staff and support our staff in the jobs that they're going to have to do in the weeks and months ahead.
Okay. Rhun, and then Carwyn to finish off.
Can I thank you for answering our questions so openly today and thank you for the session a couple of weeks ago? It was a shame that that was in private because I found it particularly useful in terms of being able to dig out some answers to questions that are being asked of us by our constituents.
One of the unanswered questions, if I could return to that, is on schools. People are self-isolating; people are being sensible; people are respecting the advice that they're being given and they're looking out of the window and seeing a school bus passing on the way to school and they're aware that there are 800 or 1,000 or 1,500 pupils in a building down the road, which doesn't sit comfortably with them when we're in a context of self-isolating.
In an ideal world—. Carwyn Jones asked you to imagine a perfect world scenario earlier, but in a world where you could answer the negative points of keeping children from school—and I think there is a community model of being able to look after children so that key workers can continue to work, and I'd like Government to look at that—in an ideal world, would it be better, in terms of flattening the curve, if we were able to keep children apart from each other, not having them congregate in schools at this time, as the rest of the population is being asked to do?
It would have some impact, but Rob was going to talk to that.
So, we're using the models. We're using the models to predict. If you stop those interactions in school and if we infer that children have got a role in transmission, and if we ask how many children would have elderly parents or grandparents looking after more vulnerable groups, and if we ask how many in that population are front-line workers—nurses, social care workers and so on—that is quite a big ask for those models. That would require quite sophisticated analysis. That is under constant review. It was under review yesterday; it is under review today. I think that we'll hear more about what we can say with those models and be confident about, 'Will this have a positive impact on the NHS or will it have a negative impact on the NHS?' So, some of the questions we really want to have and we really want to ask of the models, they simply don't stand up to be able to answer that type of question, and so, there'll be a degree of uncertainty.
And, again, I don't think I'm being hypothetical. I think I'm painting what I believe could be realistic. If you were, for example, able to model a system whereby people not in vulnerable groups, people under 50, 60, no underlying health conditions, were able, in a community setting, to look after children, so that is fed into the model in terms of taking the risk away from key workers, does the congregation of the children have an impact?
I'm not saying it can't be answered and it is a question that we're asking. We're working with colleagues to ask those kinds of linkage-type questions of how many people you contact and where you go. So, we will answer that. We may not be able to answer it tomorrow, we may not be able to answer it before we have to close things down, but we know we have to reduce the number of infections: if I'm infected, how many people will I infect? We need to bring that down really low, such that the NHS can cope. Now, the measures that have been put in place at the moment are the ones that have the maximum impact and so the message is: those simple ones—the hand-washing, the keeping your distance, the not going to the pub—they are the ones that will have the maximum impact at the moment, and, if we don't follow those judiciously, then it's not a good outlook. So, we have to take that advice and everybody has a role to play in that. You can't say, 'Well, I'm okay'; everybody has a role, and, in particular, that community role of looking after each other and talking to each other and assuring each other that you're going to be okay, but we need to look after Mrs Jones up the road.
And I think that's very important, but, again, in terms of contact, if I became symptomatic, my son would have to self-isolate for 14 days. Frankly, he spends more time with his schoolmates than he does with his dad. So, in terms of contact with others and infecting others—. It makes sense to my constituents that there is an anomaly here and they're looking for those answers as to why that anomaly is there, in that schools are able to stay open.
So, it's just, to go back, that the first set of measures were the ones that were most impactful and the easiest to do.
Okay. So, it's a matter of timing, more than—?
It's a matter of timing.
The final question—Carwyn.
It's on travel, thank you, Chair. It makes absolutely perfect sense for the four Governments in the UK and, of course, the four chief medical officers to be working together. A common approach, obviously, is the most sensible way of doing things. But the reality is that we have a large land border with the Republic of Ireland, as the UK. Given the fact that it's far easier to seal Northern Ireland off from GB than it is to seal Northern Ireland off from the Republic of Ireland—which is impossible—what work's being done with the authorities in the Republic of Ireland to have a common approach across both GB and Ireland?
Well, obviously, there is a variation in some of the policy, and so we know that Ireland did take some decisions—for example, around school closures—early on. So, there are a number of points of interaction. On a fairly regular basis, my colleague Michael McBride in Northern Ireland—I'm sure he wouldn't mind me sharing this—does liaise with his counterpart in the Republic of Ireland. So, on a technical basis, there is a lot of sharing of information, and that helps to both share the science and the way in which decisions are being made.
Ultimately, different jurisdictions are making different decisions about the timing of the interventions that they're bringing in. One thing I would say is that closing borders doesn't help. It doesn't stop—we've seen that clearly—it doesn't stop transmission; viruses don't respect those kinds of boundaries.
So, it is difficult, I realise, for the public to understand when we have variation in what we're doing in the UK compared with what we're doing in some other countries, including the Republic of Ireland. The best advice that I get, that we get, as chief medical officers, is from SAGE. We're trying to really balance the science and draw on the science, and make the best decisions at a very difficult time. We're not just looking at the epidemiology, the pure science, if you like; there's a lot of behavioural science in all of this, and there are many scientific disciplines. I think we have a strength in the UK that we have a strong scientific background from all of those disciplines, and that is helping to inform our debate. It will be for the future to look back and say whether the decisions that we made were made at the right time, but we're doing the best we can with the best evidence that we have at the moment.
The reason why I ask—and this is my final question, Chair—is that there is a suggestion that the UK Government might look to close ports and airports if there was a shortage of border force staff. Now, of course, that's one thing, but, actually, it's impossible to monitor people coming into the UK because of the border with the Republic of Ireland. You just cannot do it from any perspective, whether it's political or medical, unless the UK and Irish authorities work together.
Okay, thank you.
Right, I think we're out of time, basically. Can I thank you both very much indeed? Can I also thank you for the paper that we had beforehand? Thank you for your detailed answers, and you'll receive a transcript of the discussions, just so that you can check that you've said what you meant to say, but you can't, obviously, turn the science on its head just because it might have been inconvenient. But the transcript will be on its way anyway, so thank you both very much indeed.
To my fellow Assembly Members: we will break now for 10 minutes, and we're next door with the session with the Minister from his front room, or wherever he is. Diolch yn fawr.
Gohiriwyd y cyfarfod rhwng 11:05 ac 11:16.
The meeting adjourned between 11:05 and 11:16.
Croeso nôl i bawb i adran ddiweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. Dŷn ni wedi cyrraedd eitem 3 rŵan, a thrafodaeth ar y Bil brys ar COVID-19. Dŷn ni wedi cael gafael ar wybodaeth gefndirol, a bydd Aelodau wedi darllen y papurau cefndirol ar y Bil brys arfaethedig ar COVID-19. Felly, i drafod hyn mewn manylder, dwi'n falch iawn o groesawu Vaughan Gething, y Gweinidog Iechyd a Gwasanaethau Cymdeithasol, yn fyw o'i gartref.
Welcome back, everyone, to the latest part of the Health, Social Care and Sport Committee meeting here in the Senedd. We've reached item 3 on the agenda, and a discussion on the emergency Bill on COVID-19. We've had some information, some background information, and Members will have read those background papers on the proposed emergency Bill on COVID-19. So, to discuss this in detail, I'm pleased to welcome Vaughan Gething, the Minister for Health and Social Services, live from his home.
Bore da, Vaughan, a hefyd yma yn y Senedd efo ni, dwi'n falch iawn o groesawu Neil Surman, dirprwy gyfarwyddwr, iechyd y cyhoedd; Grace Martins, uwch gyfreithiwr, Llywodraeth Cymru, a hefyd Sapna Lewis, uwch gyfreithiwr, Llywodraeth Cymru. Croeso i bob un ohonoch chi mewn gwahanol safleoedd. Croeso i'r cyfarfod a thrafodaeth ar y Bil brys. Dwi ddim yn gwybod, Weinidog—ydych chi eisiau gwneud ychydig o sylwadau agoriadol ar y Bil brys yma, a wedyn awn ni'n syth i gwestiynau?
Good morning, Vaughan, and also, here in the Senedd, I'm pleased to welcome Neil Surman, deputy director, public health; Grace Martins, senior lawyer, Welsh Government, and also Sapna Lewis, senior lawyer, Welsh Government. Welcome to all of you in different locations. Welcome to the meeting and a discussion now on the emergency Bill. Minister, do you want to make some opening comments on this emergency Bill, and then we'll go straight into questions?
Yes. I think the Bill will set out the true extent of the extraordinary times that we are living through, but it also is a deliberate choice by all four Governments across the UK to have a single piece of legislation to bring powers into being and to be available to all four Governments at the same time. I want to say at the outset that I'm tremendously grateful to civil servants in all four Governments, including our own team here in the Welsh Government—some of whom are before you—because this has required a tremendous amount of work in a very short timescale. So, the people in front of you have worked incredibly long hours and it's been difficult in terms of not just getting policy instructions, but trying to get to the point where we are today.
Now, the Bill should be published in full tomorrow—that's our expectation—but what we have got is a publication last night of a wider narrative of the range of powers, both devolved and non-devolved, that are in the Bill that is going to be presented to Parliament. So, we're happy to answer questions on what is now fully in the public domain, and it's a matter that we've pushed for and asked for in the Welsh Government as well, to allow you as Members to do your job on behalf of the public as well.
Diolch yn fawr am hynny, Weinidog, ac, wrth gwrs, dŷn ni'n gweld bod yna bum ardal—prif ardal—yn y Bil yma o'n blaenau ni. Awn ni'n syth i mewn i gwestiynau yn y ffordd—. Pwy sydd eisiau dechrau? Rhun.
Thank you, Minister, and, of course, we see that there are five sections or main areas in this Bill in front of us. We'll go straight into questions in the usual way. Who wants to start? Rhun.
Ie, hapus iawn i wneud. Bore da. Beth am inni fynd drwy bum ran y Bil yn eu trefn? Dechreuwn ni felly o ran cynyddu nifer y gweithwyr iechyd a gofal, er enghraifft, drwy dynnu rhwystrau i ganiatáu staff sydd wedi ymddeol i ddod yn ôl i'r system. Allwch chi siarad efo ni ynglŷn â'r bwriad yn y fan honno ac, o bosib, cyfeirio at ambell gonsérn sydd wedi cael ei godi efo fi mai dyma'r union beth anghywir i'w wneud, i ddod, er enghraifft, â meddygon a gweithwyr clinigol hŷn yn ôl i mewn i'r system?
Yes, I'm very happy to do so. Good morning, Minister. Let us go through those five parts of the Bill in order. We'll start, therefore, with regard to increasing the number of health and care workers by removing barriers to allow retired staff to return back into the system. Can you talk to us about the intention there, and perhaps refer to some concerns that have been raised with me that this is exactly the wrong thing to do, to bring doctors and clinical workers who are older back into the system?
Well, I understand why that concern is there but I think it's important to separate the ability to bring people back into the system and the normal regulatory requirements people have to go to to return to practice. I wanted to make that easier for those people who want to. There is not a compulsion here—that's important as well. Some people are saying lots of people won't want to, and we know that we're not looking to compel people to return, but those who have already said that they want to return to help. And that's the process, and needing to get that unblocked—and this is an emergency, so, normally, we wouldn't be looking to do this as quickly—and to take that away from how those people would then be deployed. Because a range of those people may be in higher risk categories, we're even thinking about non-contact work that they may still be able to do to help bolster front-line services. So, for example, the steps that I've already taken to allow IT and video calling—as we're doing today but couldn't quite manage yesterday in the Senedd—to allow more consultation to take place in this way, more by way of phone as well—well, actually, retired staff don't need to come into contact with potentially symptomatic members of the public to do that, and it may mean that we're able to free up other staff who would otherwise be doing that to deal with front-line roles as well. So, it's the two different parts—how do we get people back into the workforce who are prepared to come back, and then how do we use them?
So, the legislation is a sort of regulatory element, is it? Could you just describe to us, briefly, how it works?
Well, regulators have to—. For all of our healthcare professionals who are on a register, they have to meet a series of requirements, and you'd normally have to undertake a series of measures to return to practice. We're looking to condense the time frame for that to happen. Now, that doesn't mean that they simply pitch up and on day one they're able to act, necessarily. There's still something about appropriate induction for people to return, and it's one of the points that membership bodies—BMA, RCN and others—have raised, rather than saying, 'We'll change the power so people come back on day one, and that's it, people are thrown back in. Because, if we're going to ask people to redeploy into different roles, it may well be that they can work in a different way.
So, there's a regulatory part of it about the way that—. Whether it's the Nursing and Midwifery Council, the General Medical Council, the Health and Care Professions Council, and there's a wider group of regulators too—it's about how their regulatory requirements can be changed, and that's a reserved matter. So, that's a UK Government function on behalf of the four nations. And then there's then how we make use of them. Well, actually, that will be for health services across the four nations to make choices about how best to make use of the additional workforce that I think we'll be able to have come in. And that's a different question to people at the start of their career, where we're looking to change the way that people may be able to come into the workforce towards the end of their practice and change the way that, for example, junior doctors—who are already doctors, but—the range of practice they may be able to undertake.
Yes. I was going to ask, on that question: for people who might be brought into action earlier than they had thought, are there regulatory changes that are brought in through this legislation, in order to ease that kind of proposal?
Well, the Nursing and Midwifery Council, for example, have agreed, in the outline, a range of measures to allow people to complete placements in terms of the end-of-year training so people can undertake front-line work in a way they might not do to the same extent. So, third-year nursing students towards the end of their time may be able to undertake a clinical placement, and for that to count as them being qualified as well. So, that will require some changes that the NMC are going to take through. But this gives a clear signal about where we want people to go. But this does allow, from a UK point of view, if we need to make those regulatory changes at the front end, to allow that to happen as well.
But, again, that's got to be optional, because I don't think we could really compel people to complete their training in the way that is possible, and that also is for people to be paid to do that, as opposed to—. So, we're talking about what bands people would be on to undertake that front-line work rather than to say, 'Everyone must do this'. Because, obviously, some people may not want to, for understandable reasons—some who may be in categories where we're asking them to reconsider their contact in any event. There could be people with chronic conditions who are nevertheless undertaking training to be nurses in a variety of fora, for example.
Is this still on this point?
On this, yes.
Thank you, Minister. Now, I'll take an example: my wife has obviously recently retired from radiography, and her HCPC has recently just expired, as it happens. So, are you saying that the reserved matter situation is that the Government is talking to organisations such as HCPC to ensure that, if they decided to go back into the profession to help out, the re-registration process is smoothened, but it's still a requirement of the individual to start that process before they go back in?
Yes, in essence, and they'll see that there's a link here to the indemnity process as well, to make sure that the staff don't just have the ability to stay in the regulated health professions, they can practise and to smoothen and quicken that, but also to make sure that indemnity provision is available, so they don't have to take on personal risk. I think there's then a link also to pension matters as well, because some of the NHS pension rules might otherwise prevent people from returning. So, you'll see a range of those things. So, it's not just the one aspect about the regulations, it's all of those things that we need to take account of to allow people who want to return to work and are able to.
We have to think about how they're deployed as well, because they have a significant altruistic motive for—the overwhelming majority of NHS staff do in any event. That doesn't change when people retire as well. So, it's about how we make use of that ability and goodwill, and about how we do so. We're not asking people to take unnecessary risk, and we're removing the barriers from them being able to do so.
Still on the first area, Rhun?
Yes, just in general, to gather your thoughts on how we've arrived at the proposals that we have now. Are there elements of what is in this Bill that are there because you asked for them as Welsh Government, that they are there because of a response to concerns that were raised during the process of forming the Bill?
Well, it's been a process of all the Governments talking to each other, and I don't know if Neil wants to run through some of the areas where we've not raised—. There is both the point about where proposals are made and we say, 'You need to think about the context in Wales, and that's different.' That's both about the issue about how powers are exercised and who exercises them, as well as thinking through what is the right policy response, because, actually, the starting point was a pandemic flu Bill that was in preparation, and officials from all four Governments were already engaged in that. So, the starting point is something where we had pretty much agreement, and it's then been sorting through a range of possible proposals, thinking about whether they are useful or not.
So, I don't think it's easy to say, 'Here are six things we asked for, and we got four of them.' It's much more an iterative process, a conversation between all of the Governments to arrive at a point where we think we agree on what we need to do and on the utility of it as well. So, this isn't about taking powers for the sake of them, but, actually, we think that these powers are things we may need to be able to do to have the most effective response to the crisis that we face.
Neil, do you want to add to that?
Yes, just very briefly. The Minister's correct, this has been an absolutely unique process. I've been in and around legislative work for quite a number of years, and, in fact, my legal services colleagues have been telling me on the way over to this committee meeting that the First Parliamentary Counsel has commented that in her 30 years of experience, she's never known anything quite like this either.
So, the speed at which we have had to work to try and craft that four-nation solution that the Minister described has been truly unique. I think we have—and I say this slightly hesitantly, only because we haven't yet seen the final print of the Bill, and that is coming out sometime today, we will see that later. So, to make a final check on what provision it makes for Wales, we will need to see that, and we need to seek assurance that it does what we have asked for to do.
However, I would say, despite the difficulties in trying to craft that four-nation solution, we've largely succeeded. It's been torturous at times. It has not always been comfortable in terms of the negotiations with UK Government and with others. We have, at various times, all wanted slightly different things, and, in particular, for Scotland and Northern Ireland, there's been a need to seek very specific provision, because they did not have the founding legislation that we have in the form of the Public Health (Control of Disease) Act 1984, especially Northern Ireland. So, they have started, in many cases, from a very different legal base, and for Northern Ireland, I think—perhaps I shouldn't put these words in their mouths, but they have been seeking through these provisions to try and catch up with other parts of the UK in terms of broad public health legislation.
So, we started at different points. I think we have crafted what we hope is a sensible and proportionate solution to the threat posed by this pandemic. I was whispering in my lawyer colleague's ear just to say that there are relatively few Welsh-specific provisions that we have asked for that are not part of that wider UK provision. There is one relating to the Disclosure and Barring Service checks, but I have to ask Sapna to explain.
Sapna's the one, then. You're in the frame.
We've asked for specific DBS checks to be relaxed in order to facilitate these new workforce people coming into the system. The reason we've asked for that is we're in a slightly different position to England. They already had arrangements with the DBS to have a system where they could allow people to start working while they were waiting for their full application to come through. So, the certificates will still be obtained, but it's about being able to let people start helping straight away while the certificate process is being looked at.
Okay. Any other questions on this first area before we move on to the second area, team? No. Right. The second part of the Bill, in terms of the five key areas, is easing the burden on front-line staff. Angela.
Thank you very much for this briefing. Of course, all of the science says that this is a long-running situation that we're in, so we've got to make sure that we don't leave other very important things behind in the mix, and the area that I just wanted to talk about was the proposed amendments to legislation over, for example, mental health, continuing care, prioritising the care needs of individuals, and over needs assessments and things like that, because whilst everyone is focused on dealing with COVID-19, we still have the rest of our lives to try to run. So, for example, when implemented in Wales, there's the power, for a start, to detain and treat patients who need urgent treatment for a mental health disorder with only one doctor's certificate. Is there a sunset clause on that kind of thing? Would those decisions be reviewed? Shall I fire off all my questions on this little patch for you?
The second area would be on the continuing care. It says here,
'allow NHS providers to delay undertaking the assessment process for NHS continuing healthcare for individuals being discharged from hospital'.
So, will there be a presumption one way or the other? Because, of course, those people will be discharged from hospital, they will be going into care homes, there will be payments having to be made by families, so they won't know which way to go or which way they're supposed to turn. Will you be presuming that they will get it, or a presumption that they won't get it? Because there needs to be a clarification so that families know how to move forward. And again, is there going to be any feeling for when we might look at when you would re-establish the assessments, in particular for more urgent carers? I completely understand why, if you've got a couple of people who are looking after, say, 20 people, caring for them, there will be some in that 20 mix who will need far more support than others. Therefore, if your two people looking after them goes down to one, they're going to prioritise, obviously, the most severe ones. I totally understand that, but what I am very keen to do is ensure that people who are either facing financial obligations or who are having their freedoms and rights curtailed, such as mental health patients, that there is a really clear moment when we know that we will go back to normal and that everything will be reviewed in an appropriate manner.
I'll make a couple of general comments and then perhaps I'll ask Neil to give you some examples of some of the specifics, and maybe legal colleagues. So, at the outset there's a two-year provision in the Bill, so for the first couple of years—it's a two-year sunset clause on the Bill, but some of those, of course, will be measures that will only be turned on at specific points in time. I think it might be helpful if we give you a couple of examples of the sort of areas where you can only exercise powers if you've got advice from the chief medical officer or the deputy or other persons about the need to change the way in which our services will work. That might help with your example around mental health, Angela, as well. So, if we really do find that we're in a position where we have fewer staff, then sticking to the same ratios may mean the system can't work at all, and that's the rationale. I hope people can pursue the logic in that, but I also understand why it's more of a safeguard. So, hopefully the initial two years is helpful, about the sunset clause in any event, but also I'll ask Neil and the team to maybe give you a couple of examples of areas that we think will require the additional safeguard of having a direct response, that it's a provision to be switched on at that point in time.
The point about continuing healthcare—again, because the note you've got is a note that covers the nations, some of this is more directly aimed at England. We know that there are some particular differences about the way that continuing healthcare works and about people being discharged, so I think it would be helpful if we could send you an update on some of the differences between the process in England and what happens in Wales and what that would mean. I think it might be helpful for us, within the next couple of days, before we get to next week, if we can, to set out not just the note that we've got with some of the more detailed policy instruction, then the Bill will be published, and to be able to set out how different things work differently in different parts of the UK. That might help with the narrative that you've got as well.
The same goes about the care needs assessment and our ability to have staff able to do their job and to be able to move people out of part of our system where their needs no longer require it, but we're confident we'll have lots of other people who will need to be in that setting. None of this is easy, because we're asking lots of our front-line staff to work in a different way and to make choices about how to assess need in a way that is wholly extraordinary and has, potentially, far-reaching consequences.
Neil, do you want to add to that?
In relation to the clauses in the Bill that can be switched on and off depending upon the circumstances and the need that arises, the changes to mental health legislation, for instance, is one of those. Of course, we've already done an analysis on our understanding of the current Bill—we're yet to see the final version—of both what provisions are devolved and non-devolved, which provisions involve the exercise of concurrent functions and powers and which amongst all of these clauses could be turned on or off. There is a sharp distinction in the Bill and we have sought with, again, UK and other devolved Government colleagues, to present it in such a way that it's a Bill of two halves, almost. There are those provisions that will have a life for the two-year period of the Bill until it sunsets, and those are the provisions that are enabling and supportive of the types of interventions that the committee expressed an interest in a little earlier.
So, where we're seeking to be helpful, to remove restrictions, to provide compensation and other types of support, those provisions will be in play for the life of the Bill—hopefully the Act. There are many more, though, such as those you've just described, that involve potentially quite significant infringements on individual liberty and freedom, and those provisions we very deliberately want only to be exercised on the basis of a turn off, turn on, when they're needed under the advice in Wales of the chief medical officer or other qualified professionals so that Ministers are properly advised on the appropriate circumstances when such drastic action might be needed. But it is not the intention that these things should apply throughout the course of the next two years.
Okay. I've got a lot of questions following on from this. Lynne first, then Carwyn, then Rhun.
Mine are similar questions to Angela's, but I also wanted to specifically ask about the provision to make changes to the Social Services and Well-being (Wales) Act 2014 to enable local authorities to prioritise the services they offer in order to ensure the most urgent and serious care needs are met. Clearly, we're going to see a huge focus now on adult social care, but there will still be vulnerable children who will need protecting, so I was wondering if it would be your intention to issue any guidance underneath that in order to make sure that the needs of our most vulnerable children are also protected.
Yes, lots of our concern has been around making sure that we don't lose sight of the needs of people who are vulnerable, whether adults or children, and it's part of the conversation around schools—what provision is available and what the closure of schools means for a range of children.
As well as wanting to pass a Bill to give people extraordinary powers, we will need to have a framework conversation about how we guide people and help people, because apart from anything else, the last thing we'd want to see is 22 different sets of decisions being made that don't make sense and aren't consistent with each other and, actually, I think local authorities are in a position where they would welcome having a more consistent approach as well. I don't think Conwy want to be in a position where they're doing something entirely different to Denbigh next door, and you've got families that are potentially straddling the border. That wouldn't be helpful. That's a conversation that—. It really highlights the pace at which we're working, because normally we wouldn't be talking about legislation of this type coming in at all, we wouldn't be talking about needing to do this at the pace we've done it or need to do this before we've actually had that conversation with local authorities about the policy intent behind it and how we actually get that guidance in place. But we are literally running to be able to make this part of it work and then to think through what else we do.
So, yes, I agree with your broad point, and we'll pass some guidance to help local authorities but also help the public to understand what's being done, or potentially being done. We're not at that point yet, but we don't have ages and ages to think this through. So, all of the directing we're having to give local authorities on a wide range of things is really important, and this is just one of them, Lynne.
Carwyn Jones nesaf.
Carwyn Jones next.
Thank you, Chair. I wanted to ask about ports and airports if I could, just to clarify the situation. I know this has been done very quickly, and inevitably there will be some areas that are not completely clear in terms of how they'll operate. But I notice that in a briefing from the UK Government they talk about the contents of the Bill and they talk about talking the power to suspend individual port operations. Now, that to me would mean being able to close any port. That creates a problem in the sense that Welsh ports are not under the control of the UK Government; all the Welsh ports, apart from one, are under the control of the Welsh Government.
If we go on then to—. I trespass a little bit into another area. Where does that power lie to close? Because if we look further on in the next section—I'm going to wander on to there for a second, but it's important—it talks about closing individual ports, but it also suggests that the Home Secretary will be given power to request the closure of ports. That's a bit of an odd thing to say: 'request' the closure. 'Demand' the closure or 'require' the closure is another thing.
What I'm trying to work out is: which ports are affected? Are they just those ports where there are Border Force agency personnel? Are we talking about all ports? And does that mean that the Home Secretary could shut any port? Or is this just a drafting inconsistency? Are we really saying here that what the Home Secretary will be able to do is to close ports or require the closure of ports and airports where there aren't enough Border Force personnel, and other ports wouldn't be affected?
Well, there are a number of questions, aren't there? So, the starting point is that powers of Welsh Ministers remain the powers of Welsh Ministers. So, we're not looking to surrender powers during the course of passing this legislation. We are talking about how we make use of concurrent powers. So, if there was a choice made, for example, at once to close all ports, then there is an ability to make a UK-wide decision that would require the consent of devolved Ministers. That is familiar in a number of areas, as you'll recall from your time both in Government and on the Legislation, Justice and Constitution Committee, about the use of concurrent powers.
As I said, the starting point is we still have the powers that we have available to us. There is a challenge that, where there are Border Force operatives, the powers that they have been given—for example, the powers of arrest that they don't have in the same way that a constable has. There's a provision within the Bill for them to be able to exercise those powers as well. Now, that's largely about the ability to detain people in the quarantine sections of the Bill.
But again, I think when we actually get the Bill published, we'll be able to give you some more certainty on that. I'm not trying to be evasive; I just think that it would be really difficult to be able to talk through it without the Bill in front of you to set out what that means. Again, they explain that they'd like to provide what does this mean for Wales: which services are reserved, which services are devolved, what does it mean in practice? I think would help to answer your question properly. But I don't think I can do that without the Bill itself being published.
Neil has got some thoughts.
I just wanted to observe that this is one of the provisions in the Bill where there has been some discussion about the extent of devolved competence, and there's not necessarily yet a meeting of minds between us and UK colleagues as to where that line falls. So, I think it would be helpful to committee if we can follow up with a note once we see the final provisions of the Bill later today on this specific point, but also on the wider provisions of the Bill as they relate to Wales.
The reason I ask these questions is that experience teaches that it's best to have these questions dealt with now, rather than when they have to be put into operation. If we take Holyhead, for example, Holyhead is the responsibility of the Welsh Government, but any Border Force personnel there or customs officials are the responsibility of the UK Government. I'm assuming in practice what would happen is the UK Government would say, 'Look, we need to Holyhead to close'—shall we say—'can we ask you to do that?' Practically, there shouldn't be a problem if that were to be the case, but it's not clear who has responsibility for what at this stage. As I say, it's a fast-moving situation, and I don't offer that as a criticism, but clearly we'll have to keep an eye on that.
The second point: on front-line staff. The suggestion that the Home Secretary could request that port and airport operators temporarily close or suspend operations if Border Force staff shortages result in a real significant threat to the UK's border security: I don't argue with that, I think that's sensible. But, again, it ignores that fact that the UK has a land border with the Republic of Ireland, where there are no Border Force personnel at all. If the protection of the UK border is the objective, that's just not going to work.
So, the practical way of dealing with that is obviously to work with the Republic of Ireland. So, are you aware of what kind of role the Republic of Ireland or what sort of input the Republic of Ireland has had into the development of that policy? Because you can't police that border between Northern Ireland and the Republic.
I don't think these provisions are really aimed at trying to resurrect a border on the island of Ireland. It's actually about the ports we have where there's traffic and transport between different parts of the UK and mainland Europe. You'll have seen the developing picture within Europe about the imminent ending of the Schengen arrangements in any event. So, we're really talking about what happens with our ports that don't directly face the Republic.
And of course, our colleagues in Northern Ireland are particularly excited about this and the range of arrangements for getting goods into and onto the island of Ireland, and their particular reliance on ports, for example, for a wide range of goods that come in as well. So, if you want to me to talk through the conversation between the UK Government and the Irish Government, and the Northern Irish Executive and the Irish Government, we haven't directly had that conversation.
Okay. Angela on ports, as opposed to port.
It's on police and immigration officers and their ability to detain people for a limited period who may or may not be infectious and take them to a suitable place. That power—will that be switched on by UK Government or Welsh Government, and will it be switched on at the very beginning, or if there was evidence that members of the public were not being prudent and were not self-isolating when they were infectious?
Police and immigration officers aren't devolved.
I know they're not devolved, Vaughan, that's why I asked whether it's going to be part of the Bill from day one. Because you could have a situation where actually we may have a particular problem in a certain area within Wales, but if it's not a provision of the Bill from day one then how would we persuade some people who were perhaps infectious, refusing to isolate—what powers would be have? That's why I asked whether it would be a provision of the Bill from day one, or whether it's something you'd have to go and say to UK Government, 'Please can you now let the police go and arrest this bunch of people and stick them into isolation?'
The powers of compulsion— and I think it might be helpful for officials to give you some more detail on this—you'll be aware, the committee kindly tweeted about it, about the regulations we've made today on enforcing quarantine provisions, the Bill when enacted will revoke those regulations, because it will enact new provisions from the start in the Bill.
Just to give you a little bit more information. The way it will work, that power to detain will also be exercisable by public health officers who will be designated by the Welsh Ministers. There's also scope for immigration and constable officers to also have those powers. But in terms of how the Bill will work, it will be something that will come on—. They're having Royal Assent, so those powers will be available immediately. But we will have the switch on, switch off—
The Welsh Ministers will be able to exercise them.
For the Welsh constabularies?
Okay, thank you.
Okay. Rhun next.
Two questions—one arising from that. Why are the regulations that are being put in place now having to be revoked?
I can answer that—if I can clear my throat. It is not a new, persistent cough, I promise.
England took steps in the middle of February to introduce new regulations extending the quarantine and isolation powers available to English Ministers. Both in England and Wales, previously, we were reliant upon the Public Health (Control of Disease) Act 1984 powers and so called Part 2A Orders, which are exercisable through justice of the peace, by local authorities. England introduced regulations to deal with the specific circumstance where there was at the time a threatened—
Yes, abscondment—that's the word I was looking for, Minister—from one of the supported isolating facilities in England. So, they introduced new regulations so that the Secretary of State could act to prevent that happening without the need to go through the justice of the peace procedures. Those procedures remain in place, however, so there's a dual track available in England at the moment.
Our Minister took the view that the circumstances in Wales did not then necessitate the need for us to regulate in a similar fashion. However, we stood ready to regulate, should the threat of the outbreak increase. The UK CMOs declared the risk level this week to be high—up from moderate—and so we have regulated on the same premise as in England. But of course, the English regulations and the Welsh regulations, when the Bill is made law, are being subsumed within the Bill. So, they will be revoked for that purpose.
But there'll be no difference in who has the power to make a call under the new legislation compared with the regulation now. And, maybe a daft question: given that it was quite possible that we would need to take this step—I'll ask this to the Minister—why was the decision taken not to press the button then, and to wait until now?
Well, if I'd made the decision at the same time as England, when we didn't have the same particular issue, I'd have been taking anticipatory power, and we weren't certain at that point what was necessary. And in all of this, it's about what are proportionate steps to take. The fact that there wasn't any risk at that time—I've been keen not to get our lawyers and our own resources drawn into measures they don't need to take. Now, we're at a different point with the progress of coronavirus. So, as I say, the evidence has changed, and so my decision has changed.
Okay. We don't have to dwell on that, really. On the elements of the legislation that will need to be applied, rather than them being in existence for the duration of the life of the legislation, are there elements of it for which there will be a need for further parliamentary approval before they are enacted, as opposed to ministerial approval? For example, the passing of a regulation in the National Assembly for Wales for enacting a part of the legislation, the passing of a regulation, or whatever the equivalent is, at a UK parliamentary level.
I'm not aware that there is.
We can provide a note on the procedures, because we've got the detail of the Bill, to help with that. Obviously, there is a power to switch on, switch off. So, there'll be legislation to do that, but there'll be no set procedure attached to it because of the circumstances, but we can give you more information about that.
Right. But some parts of this will or could come back to us as parliamentarians within the next two years for approval of switching on, rather than it being in the hands of the Minister alone.
I think so, yes.
Did you want to add to that, Minister?
No. Right, that's okay. David Rees.
Just to come back to the issue of amendments to the Social Services and Well-being (Wales) Act 2014. Lynne has asked a question about guidance to local authorities. Can you ensure that that guidance includes all aspects? Because, whilst you indicate that it will not remove the duty of care they have towards individuals' risk of serious neglect or harm, there are going to be situations where carers will be affected by this. They may not initially appear to be at risk, but because of the demands placed upon them by the additional caring duties they will undertake, and the fact they may not even have respite as a consequence as well, they will become themselves at risk. So, it is important that the guidance ensures that local authorities take a review of each case, on a regular basis, to ensure that those individuals do not fall through the gaps, and we do not put people at risk as a consequence of this. Can you ensure the guidance does that as well?
I understand the point you're making, Dai, but this is actually really difficult in practical terms if you think through where we are now. In normal times, we'd of course expect people to have an amount of process and detail in the way they consider staff well-being, and wanting to enforce some gaps in that—it's why we've invested so much in respite provision. If we get anywhere near the worst-case scenario and we have 20 per cent of our staff out of the workplace, and we have significantly increased demand, we're going to be in an entirely different position.
Now, that doesn't mean that employers at any and every level should ignore staff well-being, because as I said near the start of this session, we are going to be asking an incredible amount more from our front-line staff—even more than we've asked already in the last few weeks. And actually it's in all of our interests to keep those people going to make sure that they're not just physically cared for, but that actually their emotional well-being and support is catered for as well. And that will certainly matter in social care, because lots of the vulnerable people who we're telling to stay at home will have social care needs. So, looking after the people who go into care for them, making sure they can go into care for them, is absolutely part of what will be considered, but, in any guidance we give, there just needs to be a sense check about the fact that it's achievable and commensurate to the position that we think we're going to be in. I think it’s something that might get highlighted when we’re talking about the last section on the potential outcomes in very hard terms from the outbreak.
I want to reflect also upon the needs of the unpaid carers in our society, who will have a tremendous burden put upon them as a consequence of this. There will be many families who have got someone who they will look after—their loved ones. As a consequence, their needs might be de-prioritised—understandably, because they might not be seen as a challenge—but, without that support, without that respite, their needs also become increased then. So, it is important that the guidance reflects upon the fact that we do not forget about them.
Yes, I completely recognise this. It's been a large part of our discussions about what to do and things to consider. If you think about both ends of the age range as well, there are lots of people who are in a risk category because of a healthcare condition who are unpaid carers; there are quite a lot of people over the age of 70 who are unpaid carers, either for partners or indeed for parents as well, and we also then have lots of young carers as well. So, the consequence of each of the choices we make isn't just a simple, neat, 'There is one easy answer with no consequences'—we are having to think through all of the different consequences of the choices we make. And the danger, I think, is that we can have guidance that ends up being a telephone directory to try to cover every single eventuality, as opposed to some principles that we want to help people, to guide how they're going to need to make choices, and how that support is provided. But I recognise the concern you have, because it's a concern that officials and Ministers have too.
Okay. The last question in this section—Carwyn.
Yes, just two questions from me, really. Angela raised the issue of the ability of police and immigration officers to detain to enforce the measures that will be put in place. I don't expect answers, but a few observations, because what we have here is the wording that says:
'the bill will enable the police and immigration officers to detain a person, for a limited period, who is, or may be, infectious and to take them to a suitable place to enable screening and assessment.'
Just some observations: detention is not the same as arrest. So, people can't be arrested, because there's no offence on the face of it. Presumably, if somebody absconds, having been detained, that would then create an offence that would enable them to be arrested and then taken to a place of screening and be charged with an offence at the same time. And then, what's not clear—. Again, this may all become clear when the Bill is published, but if the police can detain somebody and take them to a suitable place to enable screening and assessment, it's not clear whether they then have to remain at that place of screening and assessment or whether they're able to leave. So, I think those are points that are worth bearing in mind when we finally see the drafting here. Saying to a police officer, 'You can take this person to that screening centre and then leave them there and then they leave'—you have a game of cat and mouse after that, don't you? So, there are a few things there that I think may need to be clarified or possibly tightened up.
And the second point, then: we know the Bill will provide a temporary power to close educational establishments or childcare providers—clear and devolved. But we also know that the Bill—and this is the way it's phrased in the Bill—will,
'enable the government'—
'to restrict or prohibit events and gatherings during the pandemic in any place, vehicle, train, vessel or aircraft'—
and it goes on—
'and, where necessary, to close premises.'
Well, cars are not devolved, nor are trains, but buses and taxis are. Some ships are devolved, some are not. So, there's some complication there, I suppose, that would need to be sorted out. But I'm assuming that power will rest with the Welsh Ministers—the power to close premises, where that's required. Of course, then we have the complication, which doesn't exist in Scotland and Northern Ireland, where—does that power extend to closing licensed premises, given that licensing isn't devolved? I don't expect answers, but I think these are issues that need to be considered carefully so that we have a seamless system across Wales. But there are complications in Wales that don't exist in Northern Ireland and Scotland, because of what's been devolved.
Minister, do you want to give a philosophical answer there?
Well, it might not be philosophical—
Or it could be legal.
Well, it might be practical and—[Inaudible.] That's the problem.
There are practical questions there about behaviour. So, on the powers of detention, it is going to be to then compel people to stay somewhere as well. That's the policy intention behind where we are. On your broader points about the powers, for example, about licensed premises and others, in reality if people are told, 'You must shut' not 'We'd like to you to shut', that's a very different position. Anything where we get into the formalised power, we will, of course, need to think about that, but there are powers in terms of local authorities' and police powers already to close licensed premises, and we want to make sure there's a consistent settlement to make sure we don't end up taking decisions that we all want to at different points in time because of the settlement on powers.
But, in practical terms, of course, on large events, because we essentially have withdrawn emergency services, even just the devolved ones, from Friday of last week, those large events can't take place in any event that require emergency services to attend them anyway. So, we've already made progress on that in practical terms, but these are powers to allow us to require that, if requirement is actually needed and people aren't doing what the very clear advice from Governments across the UK is to do in light of the challenge that we face.
Ah, so you anticipate that these powers—. Final point. These powers—and I think it's a sensible approach, in fairness—these powers would be exercised concurrently or jointly by the different administrations. So, for example, if a decision was taken to close pubs, restaurants and cafes, then it would be sensible for that to be done across the whole, at least, of GB and not just in one part of the UK.
Well, those are conversations that we have between the Governments about what to do, when and where and the basis upon which to do that. So, if we really are going to enforce the closure of all of those premises, then that is going to be a conversation that the Welsh and Scottish Governments are involved in, and not just a matter to come out from a department within the UK Government.
Sorry, I made that point as someone with experience of having to deal with a crisis and not having the legal power to deal with it, and how complicated how that became.
Point taken—on a previous epidemic. We've reached the third section, which I think we've partially covered, really, in terms of containing and slowing the virus. Has anybody got any other questions on this section that haven't already been covered? Because time is marching on and my call for agility is out there now, team. Are we okay? There's the fourth section, on 'Managing the deceased with respect and dignity'. Angela.
Yes. I just wanted to know if the Bill will actually have the ability, then, when we're in the thick of it, to prevent funerals from taking place, gatherings of people, or limit a funeral to maybe the nearest and dearest or whatever? Or indeed to—. Because it says here that the state—I think it said, if I read it rightly—can take control of any, or can direct local authorities to take control—. To
'have the ability to take control of a component or components of the death management process in their area.'
Are we likely to see a curb on numbers of people or numbers of funerals and a push towards cremation with, I don't know, memorial services in the months to come?
All those things are possible.
Right. Thank you.
I've had a query off constituents around funeral poverty, really, and what the implications will be if someone is struggling to pay for a funeral—and obviously the normal processes don't apply, there's not the time factor. I was just wondering if there was likely to be any help for people in that situation, really.
Yes. It's—. It's part of the consideration, because it's about meeting the challenges that we think we might face and the overall objectives in what we're trying to do. So, if we really are seeing a level of mortality that means that the normal process can't cope then we'd have to make changes. And the initial part could be about increasing storage of the deceased and powers for local authorities to acquire places to store bodies, and then we have to consider what that means, in terms of whether it's burial or disposal and whether it's possible that single disposal may not be possible at the top end of the reasonable worst-case scenario. And, if that's the requirement, because of the public health crisis that we'd be facing at that point, then, of course, we need to be able to direct parts of the system and the finance for that so that you don't end up having an inability to deal with a practical challenge of large numbers of excess deaths because of the financial means of some of those people. So, I take seriously the point you made, Lynne—it's one of the most difficulty things that we may face if coronavirus does get towards the top end of the reasonable worst-case scenario.
Although the Bill says that it will allow local authorities to take control, will you, actually, as a Government, be saying to all local authorities, 'This is how we're doing it', so that there's consistency no matter where, if we were to get to a very serious point?
Well, we've revised our excess deaths guidance. It's one of those documents that will not get any attention at all in normal times, but it actually really matters. So, there's the guidance and we may end up directing local authorities rather than asking them to consider matters. So, that does really underscore the extent of the practical challenge that we're having to prepare for.
Okay. Carwyn Jones.
Very quickly. Where local authorities might be required to do something that carries a cost to them, how will that be financed? Now, I know in England, for example, there's the Bellwin scheme. In Wales we have a similar process, but, just really looking to avoid a scenario where a local authority has to take steps to deal with a larger number of deaths but says, 'We haven't got the money to do it', will that money be made available upfront, or will it be compensation further on down the line?
I don't know all of the process points about whether money would be provided in advance or after the event, but we know that, if we get anywhere close to that, we're going to need to think about how money goes through the system to make it work. Again there's a point about powers in the Bill about making payments. But, look, I think we're going to get to a position where we're going to have to make very clear that, for coronavirus, we'll make resources available, and we're going to have to call in the commitments that were made on a headline level from the UK Government about money not being an object to deal with the threat that coronavirus places upon us, and that was a pledge that wasn't made for one of the four UK nations—it was made for the whole of the UK.
Neil has got some detail here.
I just wanted to add that there are provisions in the Bill for compensation to be paid, but those would need to be considered, of course, alongside the existence of other relevant powers that Welsh Ministers might already have available. So, we would need to look at this. But there are certainly provisions in the Bill for compensation in specific instances.