|Angela Burns MS|
|Dai Lloyd MS||Cadeirydd y Pwyllgor|
|David Rees MS|
|Jayne Bryant MS|
|Lynne Neagle MS|
|Rhun ap Iorwerth MS|
|Annwen Morgan||Cyngor Sir Ynys Môn|
|Isle of Anglesey County Council|
|Barry Rees||Cyngor Sir Ceredigion|
|Ceredigion County Council|
|Dr Giri Shankar||Iechyd Cyhoeddus Cymru|
|Public Health Wales|
|Dr Quentin Sandifer||Iechyd Cyhoeddus Cymru|
|Public Health Wales|
|Dr Tracey Cooper||Iechyd Cyhoeddus Cymru|
|Public Health Wales|
|Eifion Evans||Cyngor Sir Ceredigion|
|Ceredigion County Council|
|Jan Williams||Iechyd Cyhoeddus Cymru|
|Public Health Wales|
|Claire Morris||Ail Glerc|
|Dr Paul Worthington||Ymchwilydd|
|Lowri Jones||Dirprwy Glerc|
|1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau||1. Introductions, apologies, substitutions and declarations of interest|
|2. COVID-19: Sesiwn dystiolaeth gydag Iechyd Cyhoeddus Cymru ynghylch y strategaeth Profi, Olrhain, Diogelu||2. COVID-19: Evidence session with Public Health Wales about Test, Trace, Protect strategy|
|3. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o'r cyfarfod ar gyfer eitem 4||3. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from item 4 of today's meeting|
|5. COVID-19: Sesiwn dystiolaeth gydag awdurdodau lleol am y dull o olrhain cysylltiadau||5. COVID-19: Evidence session with local authorities about contact-tracing method|
|6. Papurau i'w nodi||6. Paper(s) to note|
|7. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod||7. Motion under Standing Order 17.42 to resolve to exclude the public from the remainder of this meeting|
Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.
The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.
Cyfarfu'r pwyllgor drwy gynhadledd fideo.
Dechreuodd y cyfarfod am 09:31.
The committee met by video-conference.
The meeting began at 09:31.
Croeso i bawb i'r cyfarfod diweddaraf o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma drwy gyfrwng rhithwir o dan yr amgylchiadau heriol rydym ni i gyd yn cyfarfod ynddyn nhw. O dan eitem 1, o dan gyflwyniadau, ymddiheuriadau, dirprwyon a datgan buddiannau, a allaf estyn croeso i'm cyd-Aelodau o bedwar ban Cymru? Yn naturiol, nodi taw cyfarfod rhithwir ydy hwn ac mae pawb yn cymryd rhan drwy gyfrwng cynhadledd fideo. Hefyd, mae'r cyfarfod yn naturiol ddwyieithog. I'r sawl sydd yn defnyddio cyfleuster cyfieithu ar y pryd, mi fydd yna ychydig bach o oedi ar ôl i rywun fod yn siarad Cymraeg o ryw bum eiliad, felly jest cofiwch am hynny. Does dim eisiau rhuthro. Mae'r meicroffonau yn cael eu rheoli tu ôl y llenni yn awtomatig, felly does dim rhaid cyffwrdd dim byd, oni bai pan fo'r sawl tu ôl y sgrin yn dweud wrthych chi am bwsho botwm bach i wneud yn siŵr i ddiffodd ac i agor eich meicroffon.
Os bydd yna ryw heriau efo'n system rhyngrwyd i, rydym ni cyn hyn mewn cyfarfodydd blaenorol wedi ethol Rhun ap Iorwerth fel dirprwy Gadeirydd os bydd fy rhyngrwyd i yn ffaelu. Os bydd un Rhun hefyd yn ffaelu, yn naturiol, fe wnaiff rhywun arall gamu i'r bwlch ond, yn naturiol, rydym ni'n gobeithio gwnaiff hynny ddim digwydd. A allaf i ofyn cyn i ni ddechrau a oes yna fuddiannau i'w datgan gan rywun? Nag oes.
Welcome to you all to this latest meeting of the Health, Social Care and Sport Committee, being held virtually given the challenging circumstances that we are all facing at the moment. Under item 1, introductions, apologies, substitutions and declarations of interest, may I welcome my fellow Members from all parts of Wales? I would state that this is a virtual meeting and everyone is participating via video-conference. The meeting, naturally, is being held bilingually. Now, those of you requiring simultaneous interpretation, there will be a slight delay after one has contributed in Welsh before the volume comes up. It's about five seconds, so do bear that in mind. There is no need to rush. The microphones are controlled centrally or automatically, as it were; you don't need to touch anything apart from when our controllers ask you to accept the unmuting of your microphone, and to open that microphone.
If there are any challenges with my ICT system, we have previously decided that Rhun ap Iorwerth will temporarily chair if my internet fails. If Rhun's internet also fails, then naturally someone else will step into the breach, but, of course, we hope that won't be the case. And before we start, may I ask whether there are any declarations of interest? No.
Felly, rydym ni'n cyrraedd eitem 2, parhad o'n hymchwiliad ni a'r craffu i mewn i'r pandemig COVID-19. Dyma sesiwn dystiolaeth gyntaf y dydd efo Iechyd Cyhoeddus Cymru. I'r perwyl yna, dwi'n falch iawn i groesawu Jan Williams OBE, cadeirydd Iechyd Cyhoeddus Cymru, ac mi fydd Jan yn gwneud cyflwyniad byr nawr yn y funud. Hefyd, dwi'n falch iawn i groesawu Dr Tracey Cooper, prif weithredwr Iechyd Cyhoeddus Cymru; Dr Quentin Sandifer, cyfarwyddwr gweithredol gwasanaethau iechyd cyhoeddus a'r cyfarwyddwr meddygol; a hefyd Giri Shankar, arweinydd proffesiynol ar ddiogelu iechyd a chyfarwyddwr digwyddiadau ar gyfer ymateb i COVID-19.
Rydym ni wedi derbyn eich tystiolaeth ysgrifenedig ymlaen llaw. Diolch yn fawr iawn i chi. Mi fyddwch chi'n gwybod bod gennym ni restrau o gwestiynau i'w gofyn i chi mewn gwahanol adrannau, a dwi hefyd wedi cytuno i Jan Williams wneud datganiad byr ar y dechrau cyn i ni fynd i mewn i gwestiynau. Felly, Jan Williams.
Which brings us to item 2, our inquiry and our scrutiny into the COVID-19 pandemic. This is the first evidence session of the day with Public Health Wales. To that end, I'm very pleased to welcome Jan Williams OBE, the chair of Public Health Wales, and Jan will make a brief opening statement in just a few moments' time. And I'm also pleased to welcome Dr Tracey Cooper, chief executive of Public Health Wales; Dr Quentin Sandifer, executive director of public health services and medical director; and Dr Giri Shankar, professional lead for health protection and incident director for the COVID-19 response.
We've received your written evidence, and thank you very much for submitting that. You will know that we have a whole host of questions to ask you covering different themes, and I've also agreed that Jan Williams can make a brief statement at the outset before we go into questions. So, Jan Williams.
Diolch, Cadeirydd, and bore da, gyfeillion.
Thank you, Chair, and good morning, colleagues.
I am having trouble with the translation, so I will need to resolve that after I speak, but thank you for the opportunity. So, Public Health Wales is always mindful that this is an unparalleled global public health emergency. It's not like another flu pandemic and we are learning all the time about how COVID-19 behaves. We got off to a very strong start in Public Health Wales. We mobilised early and we alerted the system to what the impact of events in China could be. In March, the end of community testing and contact tracing, plus lockdown, meant that we found ourselves operating in part outside our core role, and subject to forces totally outside our control.
Significant delays and turbulence in the normal global and domestic supply chain arrangements had a major impact on profiling increases in testing capacity. We got involved in setting up and running Cardiff City Stadium drive-through, and in the setting up of other sampling centres and mobile testing units. As ever, the remarkable staff of Public Health Wales rose to the challenge, but this was outside our core role. Also, our draft public health protection response plan made its way into the public domain without us having the opportunity to contextualise the numbers in it.
Throughout these challenging times, Public Health Wales staff have continued to deliver day in and day out. I'll just give the committee two examples. The microbiology laboratory team has processed to date 126,844 tests, with a void or indeterminate result rate of 0.2 per cent. Laboratories outside Wales are running at 3 to 3.5 per cent. The pathogen genomics unit has developed a world-leading sequencing service. Wales is ranked third in the world in the number of COVID-genomics sequenced. So, our final public health response plan has been published, and we are proud that it formed the basis for test, trace and protect.
We've taken the learning from earlier months. We're back fully in our unique role, and we are focused on delivering that role as set out in test, trace and protect. And we look forward to providing the committee with evidence on that in this session. Diolch yn fawr.
Diolch yn fawr, ac awn ni'n syth mewn i'r cwestiynau. Wrth gwrs, heddiw dŷn ni'n canolbwyntion ar brofi, olrhain a diogelu. Mae'r cwestiynau cyntaf ynglŷn ag amcanion cyllid a strwythur, ac mae Lynne Neagle yn mynd i'w gofyn nhw. Lynne.
Thank you very much. We'll move immediately into questions. Today we will focus specifically on test, trace and protect. The first questions are on objectives, funding and structure, and Lynne Neagle will lead on this. Lynne.
Thank you, Chair. Good morning, everyone. Jan, you mentioned learning in your statement then. Can you tell us what learning there's been from the pilot projects, and how this learning is being adopted and scaled up across Wales, please?
These are the pilots from the contact tracing. I'll hand over to the chief executive, Tracey Cooper, on this, Lynne.
Thank you, Lynne. Bore da, everybody. We've been working very closely with the system in supporting the pilots and preparing for the next stage. Giri, as our incident director, is leading on that, so, Giri, would you like to update the committee?
Thank you very much, Tracey. Bore da. Good morning, committee members. The pilot project initially commenced on 18 May, and it commenced in four health board areas. In preparation for the launch on a national scale, on a wider scale, we called that the pilot phase where people in health boards could undertake contact tracing in whatever limited capacity they could to understand the practical aspects of the implementation of it. Within that period, the main learning has been around whether the scripts that the contact tracers were using were fit for purpose, what modifications needed to be done, how to undertake contact tracing in a care home setting, what the challenges were there, how to identify issues with contacts—for example, early in the pilot period, we recognised that there were a number of results that were coming through the lab systems that did not have telephone numbers for the contacts. So, that was fixed, and so we're now getting higher proportions of contacts with telephone numbers, which makes it easier to contact.
The scripts underwent a revision following very good feedback from the local authority colleagues and health board colleagues. We were able to undertake the specification for the development of the database that is now currently used, and then it also gave us an indicative time of how long it will take to interview a case, how long it would take to interview a contact. So, these are all the main learning points that we took in the pilot phase, which we have been able to implement in phase 1, and now, currently, in phase 2 of the contact-tracing process.
Thank you. And can you tell us who is ultimately responsible and accountable for managing the process and ensuring that the objectives are met, please?
In terms of the overall governance for the process, Welsh Government's strategic oversight group, which is chaired by Jo-Anne Daniels, is the group that is overseeing the delivery of the test, trace and protect strategy. In terms of the operational implementation of contact tracing, it is organised at three levels: the national tier, the regional tier and the local tier. The regional tiers have taken responsibility for the delivery at the region. That is a joint effort between the health boards, as well as the local authorities, with specialist input from Public Health Wales as expert health protection staff. And at a national level, Public Health Wales is undertaking a co-ordinating function of providing the necessary support, as well as the expertise, as well as the human resources to these structures. And where there are complex situations, and where contact tracing is needed in, for example, prisons, we are undertaking that role.
Rhun has got a supplementary here. I'll come back to you now, Lynne. Rhun.
Na, dŷn ni'n dal ddim yn dy glywed di. Na, dal ddim yn dy glywed di.
No, we still can't hear you. No, we still can't hear.
Sorry, I thought we were waiting for Lynne. Apologies. All I said was I'm happy to come back at the end of this section with Lynne, rather than come in with a supplementary on that point. Apologies.
Thank you. You mentioned Jo-Anne Daniels. Jo-Anne Daniels doesn't normally do this, does she, so she's been moved from somewhere else to do this, yes?
Thank you. She joined the department of health and social services group a number of months ago as the lead around governance for them. So, with her background, before she went into health, around communities, and the relationship with local authorities, and then moving into that governance role—it's helpful for her to be co-ordinating it because of the challenges and complexities around governance, but also the relationships with local government as well.
Okay. Thank you. Can you then tell us about the partnership and joint-working arrangements—what they are at a local level for delivering this work? You've already referred to local government.
Giri, would you like to—?
Yes, thank you. So, the contact-tracing teams are organised at the three tiers, as I said. So, the contact tracers currently operating at the local authority footprints are composed of individuals who have been more predominantly local authority staff who have been redeployed for this purpose. And then, at the regional level, there are health board, as well as local authority colleagues, as well as Public Health Wales colleagues. So, each of the regions have a daily catch-up call with Welsh Government and ourselves, and with the regional leads, at least in phase 1, and now, continuing into phase 2, where the partnership discussions happen, which includes troubleshooting, solving emerging teething problems, looking forward to the future, identifying the metrics for monitoring, putting together governance systems. Locally, regionally again, they are again co-ordinated through their own daily catch-up mechanisms within the regions, and then linking closely with the local teams. Public Health Wales has got its specialist health protection staff embedded into each of the regional teams, both at a consultant-level input and at a specialist health protection nurse or practitioner-level inputs.
At the weekly meetings—.
Okay. Thank you. And you're aware, I know, that testing has been an issue—the targets for testing have been an issue of some concern to this committee. Can you just tell us who's responsible for setting the targets and who exactly has been involved, please?
Can I respond to that? Thank you. The setting of the targets is obviously a Welsh Government function, and perhaps if I could just bring the committee up to speed with where we are on capacity. As the Member of the Senedd rightly said, testing is absolutely fundamental. So, as of the beginning of this week, we've reached 12,374 tests per day, and we hope, in the next couple of weeks, we'll reach 15,000 test a day. So, in addition to accessing the UK Government testing capacity as part of the four nations, that puts us in a comfortable position, which we're fortunate—and comparable with the 200,000 tests per day that have been quoted from a UK level.
Thank you. And are you confident, then, that you've got sufficient resource to deliver this programme effectively, and also, given the fact that we've got a basically unknown timescale, haven't we, for how long we're going to be needing to do this?
Chair, if I may respond—
Certainly, from the testing capacity, it has moved—we've really moved into a position where we can actually breathe a sigh of relief with some flexibility and, as I say, with an untapped resource with the UK. So, from a testing perspective, I would say, hand on heart, a caveated 'yes'.
Obviously, we're now increasing our antibody testing. So, as the committee's well aware, that's testing people who've had it. We're not yet able to confirm whether people who've had it and are now immune. But we have started doing some antibody testing in clinical areas, emergency departments, critical care, and we will be part of a UK allocation to significantly increase our capacity over the next number of weeks and months, and we hope to be at around about 10,000 to 15,000 antibody tests during the back end of July. That is a very different market. It is much easier, fortunately, to get testing kits for antibodies.
As far as the resourcing, I think the Member of the Senedd asked the question about the resourcing for contact tracing and the finance around that. I'll perhaps invite Quentin in to respond to that.
Thank you. So—[Inaudible.]
I think you're—.
Thank you. So, obviously, there has been quite a bit of concern expressed by our local authority partners at the level of funding and deployed resource that we're going to need over what may be quite a considerable period—several months, perhaps into the early part of the next calendar year. So, Welsh Government has recently written to local government and has set aside a total sum of £1 million to be allocated between the local authorities in Wales to help them with the infrastructure costs, and the discussions are ongoing between the Welsh Local Government Association, local authorities and Welsh Government itself on additional cost and resourcing impacts.
We have produced workforce assessments at different levels of 'test, trace, protect' activity to help them with their forward workforce planning. Internally, we've mobilised a significant number of our own staff to support our specialist, national co-ordinating function, and working closely with the local health boards, we're ensuring that we have adequate resource to support the regional delivery.
I wanted to pick up on a couple of things that have been said already, actually, and you've been discussing who's leading on test, trace and protect in Wales, and it's Welsh Government, and you named a particular official. It's fair to say, though, isn't it, that, for Public Health Wales, this is your bread and butter? This is what you do and this is what you should be doing, it's what you prepare for. Is that a fair statement?
Shall I kick off before Quentin joins?
Absolutely, as a national public health institute, the expert health protection advice to the system and to the Government, as the Member of the Senedd says, rightly so is a key role for us, and actually we're delighted to be back in to doing what only we can do for this phase. This is a scale, however, that has not been achieved in any country, given that this isn't, for example, like a measles outbreak; it's the whole of the population. We have a small, beautifully formed expert group for health protection, but we need more people to do that contact tracing. In the first phase of the pandemic, as we were moving through, if committee members can recall, every week there was another country or another couple of countries, added. We were leading out and doing all of the contact tracing at scale, and then obviously we then moved into the next phase. But we can't cope with the whole of the population. So, what the team have been doing, led by Giri over the last number of weeks, and since we developed the public health protection response plan, is to develop job profiles, do e-learning, e-training packages that have been amended; we have been out to engagement, with walk throughs around an operating framework. So, if you like, we've set the framework for consistent, high-quality contact tracing, but we don't have the scale of the workforce to implement that.
But if we go back to the beginning of the pandemic—and we heard the chair there, Jan Williams, say that you were asked to work outside your core role—. So, you were asked to do things that weren't your main areas of expertise. Is that also a fair point to make?
We were, and I think it reflected the—as we've said previously—very fluid, rapid development of the pandemic. So, for an example, part of our team, when we could see probably a couple of steps ahead from other partners—. We could see what was coming down the line, because we were engaging with other countries. So, we knew we needed to set up facilities in Wales for mass testing, mass sampling, which we now have, and, of course, that wasn't something that was immediately recognised as a need locally. So, we were in a position and asked to get involved in providing advice, providing support, and actually ended up providing co-ordination with some of the UK Government activities. We would never have thought that that was our role. However, we were an all-Wales agency, and like many other parts of Wales and every country, you mobilise to support what's needed.
But you weren't able to do what you wanted to do, perhaps. I mean, the World Health Organization says, 'Test and trace, test and trace'— that's what you wanted to do, but you weren't able to do that because Government asked you to do things that weren't your areas of expertise, really.
Well, if I invite Quentin to talk to that because, obviously, as you say, it's the different phases we've gone through of the pandemic, where different actions have been taken or not.
Apologies, I'm struggling a bit with the sound, so I'm hoping you are able to hear me now. So, just to be absolutely clear, the point I was going to make a moment ago is that the sheer scale of what we're endeavouring to do requires a whole-system response. It can't be done by one organisation; it has to be co-ordinated and organised from Welsh Government right down to the local footprint, and we, I think, all recognise and understand that. I think your point that you're making is about, at an earlier phase—. It was quite interesting: our first case was in the last few days of February, and then, by the middle of March, it was already clear to us that, as an organisation, within our own resources, this was quickly becoming larger than we as one organisation could continue to do ourselves. Of course, Government policy then intervened, and you're familiar with that story now, and we were then, as Tracey said, drawn into other activities. We are doing now what we should be doing. It is our specialist function, our core bread and butter, as you rightly put it, but in—[Inaudible.]
Yes. Thank you, Chair. Just to follow on from my introductory remarks, the board is very mindful of our core role, as I said earlier, but we're in very unchartered territories. We're part of a system, we really pride ourselves on working as part of a system, and we took the opportunity to get involved in the sampling centres, the mobile testing units. We were very, very pleased to see the support come in from the military, with the logistics expertise that they had, and, as I've mentioned, we take learning all the time, but the board's very proud of the way the staff responded. I wouldn't want the committee to think anything other than that. We played the part we could play at the time, but now we're really appreciative of the fact we can get back to our core role.
Yes, I'm still not quite getting what I'm after. You say there, Dr Sandifer, that Government policy intervened, and that suggests to me that it intervened and meant that you, then, weren't able to do what you wanted to do, you had to go and do other things—i.e. Welsh Government was asking Public Health Wales to do things that Public Health Wales didn't necessarily think were the best things to do. Am I reading too much into that?
Sorry—[Inaudible.]—getting the sound. So, the circumstances, as I say, back in March meant that we were now, by the middle of March, experiencing evident community, sustained community, transmission. We were on an upward trajectory. Our resources were by then stretched, and the Government was also rightly concerned about ensuring that we were able to maintain the hospital services necessary to support people with COVID-19. We had—[Inaudible.] So, for a number of reasons, and as we entered into lockdown, our attention had to follow what was happening at the time, and that gave us the opportunity, as we were doing other things, which we've touched on here, to re-establish our future objectives, which we did and published in the public health protection response plan, in which we very clearly set out that our core priorities had to return to contact tracing, testing and population surveillance, and that's what we're now doing.
Yes. Thank you very much for that. Perhaps my question is a little bit more direct, which is: nobody is taking any issue with the fact that you now need to involve lots of other organisations in order to deliver your policy, and you've clearly listed the three things that Public Health Wales is all about, or the three big tasks that Public Health Wales is all about, and Jan Williams and Tracey Cooper have spoken about the objectives and set-up of Public Health Wales. So, my question is: right at the very beginning, when this first happened, did Public Health Wales issue advice to the Government that was superseded, or not taken, in terms of contact tracing, the availability of contact tracing, whether there should be whole-population contact tracing? The reasons why it may not have been taken, that advice, may be to do with SAGE, other factors, et cetera. I just wanted to know whether or not, as the public health specialists of Wales, as that guardian of public health, you had actually given that advice, even if it has not been taken?
Well, I'll start and—.
Okay. Yes, we provided ongoing advice and in those discussions with the chief medical officer and his team, we discussed the fundamental—[Inaudible.]
Perhaps Dr Cooper could answer, because we're struggling with Dr Sandifer.
So, we've worked very closely, as we've previously said, with Welsh Government daily around this. The four CMOs, equally, have worked very closely on a daily basis, and, as SAGE advice and analysis has happened, as you know, on a weekly basis, the four CMOs have tried wherever possible from a specialist public health perspective to stay in sync with each other. Obviously, it's up to Government if they choose to take that on.
So, from our perspective, we blend very closely with the chief medical officer's team, because we're another asset of expert advice, and I'm sure that the chief medical officer would have provided advice at that time, and the decision, as the UK went into the different phases, as we know, was done in sync.
Yes, I just want to come in and follow on from Tracey's point there. The board is always mindful of the fact that we are the national public health institute, we're the experts. We're one of a number of people and organisations providing advice to the Government around this pandemic and, of course, we do advise in line with others, but it's for Government to decide, and we're always mindful of that.
Ocê. Diolch yn fawr. Mae'n amser symud ymlaen i gwestiynau gan David Rees, yn benodol ar brofi. David Rees.
Okay, thank you very much. It's time to move on to some questions from David Rees, specifically on testing. David Rees.
Diolch, Cadeirydd, and good morning, everyone. Just to confirm, you just, Tracey, I think mentioned that you have currently a capacity of 12,374 lab tests available now, topping up to 15,000 in a couple of weeks' time. Plus I think, on top of that, you said the UK would add to that, and then you talked about approximately 10,000 to 15,000 antibody tests as well. Do you have sufficient resources to be able to do that and maybe even hit the 20,000 mark, which the Minister identified as being the top level he expected?
A really key question at the moment. We feel comfortable that we can get to 15,000, as domestic capacity. There are large, sustainable platforms that we have in place. We've got further pieces of equipment coming in from South Korea, going around Wales, which I'm sure we'll talk about. That, at 15,000, together with the additional capacity—. So, for example, around about 3,000 households a week are requesting home testing in Wales, and that is going to increase as we move through. So, there is an untapped additional capacity through home testing and through the lighthouse labs, where samples are sent over to England capacity. So, that gives us a comfortable space to get up to that 20,000. As far as the antibody—
Can I ask a question on the home testing? At the moment, we're requesting that from the UK, but is the testing being done in Wales?
No, it's not. So, if you go online and book a home test, Amazon delivers that test to you within 24 hours, and then that is couriered from Royal Mail over to, currently, lighthouse labs, which are the large factory labs, in other parts of the UK. There are discussions happening at the moment to see whether or not there's a potential for such a lab coming into Wales, but those are done not using our capacity, they're using additional capacity from UK Government, which helps us—it tops us up.
Do we have an indication as to what percentage of home-testing kits that are sent out are actually being returned?
So, interestingly—. I was asking that question. So, the 3,000 that have gone out—. And I'm not going to say the figure, because it's going to be incorrect, because I can't recall it, but considerably less have been issued—sorry, considerably less have then been returned. That may be because people decide they're not going to do it, rather than there's any problem actually with the process. They're measured on households, so somebody will request a number of kits—because it could be you and your two children or whatever—it doesn't necessarily mean that they return all of them. It's quite difficult to identify exactly the numbers around the household testing, the home testing.
I'm assuming that there's some system in place that actually does record those that go out and those that are returned.
It does, yes.
Yes. And in relation to your question around the antibody testing, you'll know, committee members who may have seen, had a chance to go through, the public health protection response plan—I know it's quite long, so apologies—the surveillance is really important. As we are in this phase, we need to be on top of, very rapidly, what the R rate is looking like in different parts of Wales and in different settings, and we have to do that through surveillance, and also the relationship with testing. When it comes to antibodies, antibody testing isn't as helpful for the current clinical diagnosis of a patient, although it can be used; it really gives us an idea of the amount of the population who have it, and also routine what we call sero-surveillance, which I'm sure Giri can update. There are large amounts, large volumes, of test capacity coming in from UK allocation and some domestic allocation, and at the end of the day, it will depend on what the policy decision of how we use that for surveillance will be.
I just want to make sure that we have sufficient capacity to do both the antibody and the testing capacity to be able to do the test, track, trace, contact and protect. On the 12,300, can you give me the latest figures as to how many tests were actually carried out maybe yesterday or Wednesday? Because I've got a figure, I want to see if you've got a figure.
Yes. The tests that were carried out yesterday, up until 1 p.m. yesterday, were 126,000—
Oh, sorry, daily tests. So, yesterday, we tested, if I can read—3,681 tests were performed. The figure you've provably got is 3,304, because we haven't quite published the latter ones.
It is. It is. And interestingly, the labs across the UK are similar. In fact, we're probably doing more volume per day, relatively, than many other parts of the UK. That's the demand. So, we're there to meet the demand. The substantial amount of tests that are happening per week are the care home sector. So, just to give you an idea, from the care home perspective, just last week alone, we did 12,280 tests for care home residents and care home workers, which comprise about 80 per cent of our testing at the moment. I think it's fair to say that—
I appreciate that and I understand that. My question then probably comes to: there is a huge gap between demand and capacity, who sets the strategy as to how you may wish to increase the demand? For example, the care homes strategy: all the care home workers have been told that they can have home tests, which are not, therefore, going to form any part of that capacity because they're going to go to England. So, who sets the strategy as to how you can increase demand so that you utilise as much capacity as possible?
Yes, so if I maybe start with—the activity or the demand at the moment is steadily, slowly increasing, so we're at about 3,000 per day. The maximum we've done is about 3,890 last week. The reason why I say that that's very similar across UK countries is because, in some respects, that's showing that, actually, the slightly protracted lockdown in Wales is keeping that transmission low. So, we don't have the number of people with symptoms in Wales who are seeking tests, which is a good position to be in. We would expect, as we relax the measures, that demand to continue to go up and up.
As far as setting the strategy, obviously, that's Welsh Government perspective, they have a testing plan. Obviously, as far as the care home sector is concerned, I'm sure that Members of the Senedd will be familiar with the changes that have happened around care home testing.
As far as the home testing is concerned, I think that's an interesting one, because early on in this when Welsh Government were including care home workers obviously for testing, there were quite a lot of messages of people being concerned that they couldn't drive or didn't have access to be able to drive to somewhere to be tested. So, the care home portal works in a similar way to that I've just said; it actually uses, back to the lighthouse or the UK Government testing capacity. But as far as the demand is concerned, that is a similar factor as the rate of spread of infection across Wales at the moment.
The ability to take the sample, which is the sampling capacity—Members of the Senedd will know that there are some large mass testing centres, the last of which was opened in Deeside up in north Wales—[Inaudible.]—border capacity yesterday, and we hope that there'll be another open in Abergavenny during next week. There are also the coronavirus testing units, the small units that the health boards also run, and the mobile testing units that the military have provided—eight across Wales. They work on three vans and they can do 300 testing capacity per day, and we hope to get another 10 of those in over the next month or so.
So, we are continuing to invest in the infrastructure—or, Wales is continuing to develop the infrastructure to do exactly what you say, which is ramp up the demand and that will come; as we start to relax the measures, more people are contact traced, more people are tested.
So, I just want to make clear, you have identified the testing capacity, the Welsh Government sets the strategy as to who can be using that capacity.
I wanted to make sure. And the turnaround time—where are we now? Because, obviously, everybody wants—. Let's take the Prime Minister in the UK, who's indicated 24-hour turnaround. We are not there yet on a large proportion of our tests. Where are we on the proportion of tests you can turn around in one day, and when do you expect to have, let's say three quarters, at least, turned around in one day?
Thank you. We've put some tables in page 17, actually, of the submission, and, apologies, it was a long submission that we sent in late yesterday, and I appreciate if you've had difficulty in reading it.
There are two things that we measure. One is the bit that we are specifically responsible for, which is the laboratory turnaround. So, we have machines across the whole of Wales, and I'd like to come back to that, just to give you an idea of how those are increasing. So, from the point that a swab or a specimen gets to us to the time it takes to turn around a result—it's what we call the lab turnaround time that you have in your pack—at the moment, for that specific bit that we're responsible for, within 24 hours across Wales—and I have some details, if it's helpful, for different parts of Wales, and we can send some more detailed information into you subsequently. So, for the 24 hours for us across Wales, the lab turnaround time is 84.3 per cent, as of 10 June, and the 48 hours was 97 per cent. That has actually improved over the last few days on that.
The end to end, which is probably the one that you're most interested in, though, is the point at which a swab is taken, so the point at which someone appears at a mass testing centre, their details go on to an electronic test request. That time stamps them from that point. And then, obviously, that swab has to get transported to the labs in Wales and then we process that lab turnaround time. So, that is improving, and I can give you some actions as to what we're doing to make it even better. So, the end-to-end time in Wales within 24 hours, as of 10 June, is 52.1 per cent, and within 48 hours, was 85.6 per cent. And I would say that that is more favourable than in other parts of the UK on some of the UK testing.
What we're doing to improve that—firstly, health boards are responsible for the sampling sites, so it's the health board management. But what we're doing to improve that is, we hope by the middle of June and by early July, we will have six new pieces of equipment coming in from South Korea. Two will be going into north Wales, a couple into west Wales, and then a couple in south Wales. They will considerably improve our local turnaround time, because it will reduce the reliance of a swab or a sample having to be transferred to different parts of Wales. They'll be able to be done locally. And I know that north Wales has been a challenge, and I have some figures, if that's helpful.
So, for us, early on in the pandemic, we realised that we can't just have large labs processing; we've got to disperse that capacity, and we hope that that will continue to improve over the next number of weeks.
And, finally, obviously, we continue to review our internal lab testing processes to make sure that they're as efficient as possible, and also, investing in some machines that remove some manual elements to the process so that they can be automated.
Can you just confirm that the time you mentioned—from end to end—is time from swab taken to the time the individual gets the result?
Yes, as much as we're able to. I mean, what I would say is that sometimes, where there are delays, it isn't just the logistics of transporting. If there's inaccurate information, an inaccurate mobile phone number inputted on an electronic test request, we then have to, instead of—. Everyone who has a test in Wales at the moment, as we put in the submission, and all key workers with the exception of those in Cardiff and Vale sites and Powys that we're just concluding now, have text results. So, we text them, but if we don't have the right mobile phone number, we issue that to the health boards for them to individually contact those people. So, on occasion, that can incur additional delays.
We do. So, as far as what we call 'void' numbers or 'indeterminate' numbers, I can give you some figures. So, for us, looking at the number of tests that are conducted, what 'void' means is either there's insufficient sample to be measured or that we need to, for whatever reason, run it again. So, we're talking about 0.3 per cent of the void rate for us in Wales, and it's about 3 per cent, 3 per cent to 3.5 per cent in other parts of the UK.
Just one final question: how easy has it been, or what type of challenges are you facing? Obviously, there's a change of strategy; what does that mean for a change of testing as well? Has it implied major changes for you or challenges that you have to address?
Not so much around, if you like, the physicality of sampling, because we've been supporting the system very early on, seeing what was coming down the line to create that infrastructure, and it has continued to be created. Regardless of the policy, we know that we need to have a lot of people going through testing—we know we need that.
Where it has been a little bit of a challenge, I would say, is where we've needed, with our other function, for health protection advice, to provide advice when something has changed and trying to get on top of that quite quickly and making sure that that's consistently applied across the system. I think it's been probably more of a challenge for health boards, to be honest, that need to go and—actually, they manage the sampling. That includes them going to venues, going to settings, on occasion, to do that, and sometimes, the individual staff members in health boards, the capacity for them to move out, I think it's probably been more of a challenge.
Obviously, the supply chain, early on, I'm greatly relieved that we've gone through that. That was an enormous and out-of-our-control challenge, but we've got there now.
Finally, you just mentioned that you were getting machines from South Korea. In your previous—no, the Minister has indicated previously that some of the figures were based upon anticipated machines coming here that didn't come.
Are you confident, therefore, that these machines will be coming and therefore the projections that you've given to us will be realised?
Everything is caveated in my world. Everything is caveated. Earlier on, we had protracted weeks of delays on things coming out of South Korea, and, in fact, they came out because we worked with Scotland for air freight coming in on behalf of the UK that Scotland co-ordinated, because there was not the freight coming out of South Korea. So, I would always caveat everything. We hope that we're in that position to have those coming in, a couple are coming in at the end of June, and then the rest are coming in mid July. That may slip. We hope, and with a fair wind, it's more secure than it isn't, so, on the balance of probability, we hope that will land.
To add to that point, the board gets together weekly, and because of the importance of testing capacity, the board takes a situation report every week that literally breaks down all the suppliers and the state in terms of delivery of equipment, reagents or whatever. Early on in April, we produced a sitrep—the Minister and I agreed that we would produce a stirep weekly that would set out for everybody who needed to know the position of delivery of equipment and reagents. Obviously, it has to be on a confidential basis, because it names suppliers, but we're quite clear where we are at any time, and that's checked on a weekly basis, because we have people working on this day in, day out. So, it's just to assure the committee that the board assures itself on where we are at any given point, and we track things from week to week and we put that information on a confidential basis into the system.
Reit. Symud ymlaen at fater sy'n gysylltiedig, sef olrhain cysylltiadau. Angela Burns.
Moving on now to a related issue, which is contact tracing. Angela Burns.
Thank you very much, Chair. I'd just like to step back for a moment, though, and just finish off a conversation that we were having in response to questions asked by Rhun. I wanted to pick up on a comment made by Jan Williams. I absolutely agree, without any equivocation, that it is the Government's responsibility to take the advice that they are given and to interpret it as they see fit and to make the political choices that they are required to make. That's an absolute given of any Government of any country.
What I was trying to understand was what was the advice that Public Health Wales was giving to the Government at the very beginning. Hence why I asked the question about, at the very beginning, given your surveillance role—. And I have read your paper, which came in yesterday evening, and you make much in it of the wealth of expertise that sits within Public Health Wales, and you make much about the fact that public health, the surveillance, the monitoring, the tracking, the understanding, is absolutely your bag. So, given it is absolutely your bag, right at the very beginning I'm very keen to understand what advice you gave to the Welsh Government in terms of surveillance, monitoring and tracking.
Now, whether they did take it or didn't take it, that's an entirely different ball game, and it could have been influenced by other factors. In your response to me, I'm afraid to say, I think you fluffed it marginally, in that you said, 'Well, we collaborated with SAGE', and so on. But right at the very beginning, those things weren't up and running. Right at the very beginning everybody was like, 'Oh, here we are, this is what we're facing.' So it's right at the very beginning, given that role that you have in protecting and monitoring public health in Wales, I particularly want to understand what advice you were giving, and if you're not able to tell us now, I wonder if it would be possible to have a copy of that advice.
If we try going to Quentin, and then I think Giri has been very pivotal in engaging and advising from the technical advisory side as well. So, Quentin, do you want to try again?
Yes, so, right at the very beginning, back in January, we were, I would suggest, amongst the earliest people within Wales to alert the system, Welsh Government and the NHS system, that we were dealing with something very significant. At that stage, the sheer scale wasn't entirely obvious to us. From the middle of January we were telling Welsh Government that we are dealing with something extraordinary, and we stood up our emergency arrangements on 22 January to reflect that. With that, again advising Welsh Government, we said that we would prepare for the first confirmed case, which came about a month later, and in preparing ourselves, we established our internal contact tracing arrangements.
But, in advance of that, we were already, again, advising the NHS that they needed to prepare themselves to undertake testing. At that time, as I think the committee know, the testing was all being done in a single laboratory being managed by Public Health England, and at the end of January, we advised Welsh Government that we should undertake that testing in Wales. We proceeded to put forward technical arguments, which were accepted, and by the beginning of February, we started testing in Wales—the first part, if you like, of the United Kingdom for a laboratory outside of Public Health England's core laboratory in London to start doing that. We worked closely with health boards to get them up and running. At that stage, we were doing all the testing ourselves—90 per cent of it in the home setting—until such time as, in February, the health boards increasingly got on and sorted out the coronavirus testing units.
So, right from the very beginning we have been proactive. We have acted ahead, I would suggest, of other parts of the system in Wales in many respects in response to this outbreak, and indeed at least in respect of delivering the testing service in Cardiff ahead of other parts of the United Kingdom.
May I just stop you there? I absolutely thank you for that, but one further little bit of clarity that I now seek is: in the Public Health Wales assessment of the pandemic right at the very beginning, did Public Health Wales ever advise the Welsh Government with partner organisations that we should have community testing and tracing right from the start, or extensive testing right from the start, and tracing?
Of course, looking back, we're using slightly different terms than we were using at the very beginning. At the very beginning, we were saying to Welsh Government, 'We have an unprecedented event in China.' At that stage, it hadn't yet impacted in Europe or, indeed, in the United Kingdom, and we were saying, 'We need to organise ourselves to do testing in Wales', which we did, to sample in the community through local health boards, both home testing initially and then the coronavirus testing units, and we did that. And we organised ourselves immediately to start contact tracing as soon as we had our first confirmed case, which we did, and we made all of that very clear to the system—Welsh Government and the rest of the NHS—and we delivered on all of that.
Thank you very much indeed. Talking about the current contact tracing, a lot of the points that I was going to raise have already been discussed, rightly so, in the appropriate areas, but I do want to just talk about modelling. Dr Shankar will know that it's one of my favourite topics, and I just wondered if you could give me a little bit of an update on how the modelling for how we should be testing, and the modelling for how we might plan, if we need to go back into lockdown, is looking—what the modelling is looking like. And has there been a further development? Because we were told that there would be development of modelling on a regional basis, because the modelling for Cardiff may be entirely different to, for example, the modelling for west Wales or north Wales.
Yes, sure. Thank you very much for the question. On the aspect of modelling where we are in contact tracing capacity, if I try to summarise that in a succinct way, and I'm happy to take any additional questions after that. So, where we are currently is that as of 5 June, when the estimates of the R number have been estimated for Wales, we are in the region of 0.7 to 0.9, with a midpoint estimate of 0.8. So, that means, as we have heard a number of times in the discourse during the pandemic, the R value remaining below 1 is of crucial importance for us to keep the pandemic under control. That means the leeway that we have is very limited. So, all the lockdown measures that we are proposing to ease have to be careful, cautious and controlled, and be evaluated at every step of the way.
So, once the contact tracing commences now, what we know is that in the pre-delay phase, in the containment phase that Dr Sandifer mentioned up until 12 March, the number of contacts that each case had was anywhere in the region of 25 to 50 people, because there was widespread societal movement, as before. Now, with the application of the lockdown measures, the number of contacts per case has significantly reduced. In a large proportion of cases, those contacts are limited to the household contact, so we are talking about four or less. When the lockdown really eases, we estimate that that will go up to between five and nine at some point, and then between 10 and 15 depending on further momentum.
All of this is obviously very much caveated by how population mixing happens, how much people are compliant with social distancing measures. So, the modelling for contact tracing takes into account the different phases: contacts of fewer than five contacts per case, five to 10, 10 to 15, appropriately. So, the technical advisory cell of Welsh Government looks at not just the R value, but a number of other factors, such as what is the case halving time, the proportion of admissions to intensive care, the proportion of cases in care homes and how many beds are available, and for all of that taken into account, we have got a list of early warning indicators and circle breaker indicators.
So, when the current monitoring happens on a weekly basis for estimation of R, at some point in the future we predict—again, I caveat it; this is not a definite possibility, but it's a prediction—that the R value can go as high as 1.7 in Wales. And if that happens, there'll be significant additional admissions to hospital and, consequently, inevitably, sadly, a small proportion of excess deaths as well. So, it's really important to keep that R number, and then that will decide what control measures have to be reapplied to bring the number back under 1.
In answering the second part of the question about how this happens with the different regional teams, we have now got estimating templates where you plug in the numbers for that particular region. It will give you an indicative number of how many contacts will arise, based on the three phases that I mentioned. So, local contact tracing teams are able to use that as a real practical tool, to not only plan for the future but also to readjust the workforce requirements for their contact-tracing workforce as we move through these next phases.
Added to that then is the movement of people across borders, et cetera, and how the release of lockdown in other parts of the UK might have indirect effects. This can also be estimated by closely working with Public Health England, for example, or Public Health Scotland, to estimate what the R values there are, and how many out-of-area contacts we are getting for each case; similarly, how many contacts of Welsh residents for English or Scottish index cases. So, it's a combination of all those, which we think will be helpful for us to keep a close eye on that.
Thank you for that. So, on the R number and the modelling, I have two further questions, really. One is: do you foresee, perhaps, a situation where we might say that we have to have a different element of lockdown in one particular area, but other areas can be more open, because the R number here is higher, and the R number there is lower?
My second question is: how much of the R number is—? If you were to take away from the R number the cases in care homes, would that decrease the R number significantly? Because, of course, people who are in care homes are—. When they recover from COVID, they are still going to remain in care homes; that is where they live. Therefore, they are not part of that general population mix. So, is there any thought that, perhaps, a way forward would be to say, 'The general population R number is this. If you take out care homes it's that. Therefore, because the care homes are protected environments anyway, we can make some different choices with the rest of the population'?
Yes, sure. If I answer your two questions in the order you asked them. The first one is that the R number is an average number. It's an estimation that takes into account four key things: the number of new cases, the probability of a case being in contact with a second case, the duration of infectiousness, and the possibility of susceptibility of the population. So, it's a product of those four things. What that means is, the smaller the geography—[Inaudible.]—make it more focused, the more uncertain it will be. So, if it is at a larger population level, it is a better estimate. So, if you try to narrow down the estimation of R to very, very small geographical areas, then the confidence intervals around the midpoint estimate will be wider. Therefore, you can't conceivably think—. For example, let's say that one local authority area had an R value of 0.8 and the other one had 1.2. Does that mean that we can apply the lockdown measures only in the one that has over 1 but leave the other? The uncertainty estimates around that are great, so it won't really lend itself to such focused lockdown measures.
The second thing is that you are right in saying that care homes are a sort of closed setting, and there is not so much interconnectedness and social mixing as happens in the general population outside that. But, the infection transmission and the dynamics of transmission do not respect the watershed compartment around a care home. So, inevitably, there is movement of people from care homes into hospitals, and back from hospitals into care homes. Then, the care workers who move from one place to the other, and the residents and the visitors and the family members. So, there must always be some amount of influx and interconnectedness that will inevitably lead to the spilling of infection from one compartment to the other compartment. Therefore, again, I think that the overall message is absolutely the key thing, that care homes have vulnerable individuals who need to be protected and shielded, and any and every measure that we can put to protect them is something we should absolutely do. But we shouldn't go down the route of subtracting the R value from an overall population from a care home and then use it, because it might give the wrong message and it may still not help us in controlling the infection.
Thank you, that's really helpful. And then, back on contact tracing per se, and you talk about, and other people have mentioned about, do we have enough people, enough funding, enough resources, et cetera, when you actually look at when you're going to contact trace from—so, somebody is symptomatic, they request a test, the test comes back and it's positive, you then start contact tracing—do you plan to also do any backtracking and look back at who they were in contact with maybe two days before? Because, of course, some of these people may be not people who reside in a home; it could be a supermarket worker or a delivery driver or a post office worker or whoever it may be, who's got a much more public interface.
Yes, absolutely. We know now—which we didn't know back in January and February—that an individual can be infectious up to 48 hours before their symptoms start. So, they can be absolutely normal, not showing any symptoms, still shedding the virus and passing it on, effectively, to other people. So, the time point where we actually start to determine the period of infectiousness is 48 hours before symptoms start. So, any individual that they have been in close contact with—as defined in our list of contacts—will be considered for contact tracing.
Absolutely. Absolutely, yes.
Thank you. I think, probably, I do not—. Oh, finally, do you have any targets that you intend to set for contact tracing?
In terms of targets, am I to take your question to mean how many contacts will be traced and—?
Contacts might be traced, or your timescales, or the development—just the general targets; your development of the scripts, and—
Generally, I think it is absolutely vital that as many contacts are traced in as quick a time as possible. It's crucial for the effectiveness of contact tracing. It will be difficult to put a quantitative target on it, but I think it would be helpful to try and reach as many contacts as possible in quick time.
Thank you. Actually, sorry, there was one more question from your paper, which we got last night. It says that, obviously, Public Health Wales has been really involved in developing the job profiles, e-learning packages, scripts, user stories, work flows with local—. Is that the same throughout the whole of Wales? Is there consistency and uniformity, or are different areas choosing to flex the script differently for various reasons? Or is it just a system that everybody's going to do, that you've put together?
We are very clear that we want to offer consistent advice, a consistent approach. So, we are very clear that those are the scripts, that, irrespective of where an individual is in Wales, they will get the same protocol, the same definitions, the same advice.
Ocê. Mae amser yn cerdded ymlaen, fel mae o fel arfer. Dŷn ni'n troi rwân at agweddau technegol, y gefnogaeth dechnegol. Mae rhai o'r atebion wedi cael eu rhoi yn fan hyn, ond mae Rhun yn mynd i arwain ar hyn. Rhun.
Okay. Time is pressing, as per usual. We're now turning to technological support. Some of the responses to these questions have already been given, but Rhun is going to lead on this section. Rhun.
Diolch yn fawr iawn. Yes, just some quick questions on the development of digital platforms—two of them, I guess. The first one is: the platform that has been rolled out Wales-wide now for the testing process itself, the programme that is used—what's been your role in the development of that, and how's it bedding in?
Can I answer?
Thank you for the question. So, a little bit of back context to that: from about 2016, Public Health Wales has got its own in-house-built case and incident management system, which we call Tarian, which has been developed and used for health protection work. So, we have been able to build on the four years of experience of using Tarian, which has then helped us to specify what are the key data fields we need, how the information flow has to happen, how can we better capture data. So, our role has been to provide the technical specifications of what the system should look like, and we provided the requirements to colleagues such as NWIS, who were then able to receive that and then translate it to how the programming and the building of the architecture of the tool goes with the developers who have developed it. So, that's been the main role for us—input into specifying the system.
And it's been in operation now for a week or so—any observations? I hear that it's quite intuitive, that it's fairly simple, that it's working well. Are there any other comments that you'd like to make?
As with any new digital technology software that is launched at a national scale, such as this, and that has been produced at tremendous speed—and credit to all the colleagues who have been involved in doing that in a record time of four weeks—we do expect and we did have some teething problems. So, it was mainly about—. We've got currently 2,000 users registered to use that system in that time, but it's about people being able to be comfortable navigating the system, rather than any technical glitches within the system itself. So, there were some issues that were identified, they have been resolved, and still, going forward, every day we are holding a walk-through surgery, a virtual surgery, with the users who have been able to give their troubleshooting issues, and between ourselves, NWIS and the developer we've been able to address those adequately so far. Going forward also—if I just finish off—we will have a programme management board that will be looking at all the advisories and all the suggestions that come from the local teams, the regional teams, to further incorporate additional functionality into the system to make it even more user friendly going forward.
Is what we've been talking about now linked at all to the testing technology as well, and the issuing of barcodes to people who've been tested? Because I've heard of terrible problems with that: people going in for testing to the Llandudno centre, phoning a few days later—maybe three days later—asking for their results, they're asked, 'Okay, what's your barcode?', 'We haven't been given one'. Potentially a significant number of people, one of them I've just heard this morning being told then, 'Ooh, you'll have to go to Wrexham to get a second test', that kind of thing. Are we confident that that kind of technological problem has been resolved? Was that a teething issue?
There are two elements to it. One is the accessing and booking of the testing to the online portal and then the use of the CRM—the database for the contact tracing. The feed that comes into the CRM is a feed that comes from lab-confirmed cases. So, as soon as the results are authorised in the system, on an hourly basis, the feed comes into it. So, the contact tracers in the local team will get a constant flow of people into the system as and when they're booked. The issue that you were referring to earlier, it relates to the booking of the test. That, again, relates to the technology, and, as far as I know, it has been addressed so far.
Okay. The other—. We could go into more of that, but we're running out of time a bit. But the other element of digital platform development has been the app, or a number of different apps. Talk has gone quite quiet on that, I think. Do you think there is still a role for an app-like element of technology to help with the tracing process, be that the Isle of Wight's piloted one developed by UK Government or the Apple/Google-type universal platforms?
So, definitely there is a place and a role for such apps, but it is absolutely important for us to realise, and then communicate this to our population, that the app in itself cannot be the answer for contact tracing. It can be a supplementary tool. So, if I give two examples: we currently use a ZOE symptom tracker app, which is absolutely well received and we get on a daily basis reports from up to 70,000 users in Wales, and that has been really helpful to monitor the symptom progression. And if you look at the interactive maps, early in April, we were seeing pockets in Wales where there was 4 per cent to 5 per cent to 6 per cent of the population were showing positive symptoms. Now, if you look at today's map, you'll see that that number has gone down below 2 per cent: 0 per cent to 0.5 per cent. So, that is really helpful to gauge how the symptoms are in the population.
The second app that you referred to, the Isle of Wight and the other, that is sometimes mislabelled as a contact tracing app but, in effect, it is a proximity tracking app. What it actually does is, if there is a smartphone or a device that has got that app, it kind of digitally sends the signal to another user of the app, and it provides what we call a digital handshake, so that it recognises and retains in its memory all those individuals who have come in 2m contact for more than 15 minutes, and, if the individual then subsequently tests positive, through that signal, it will automatically alert all the people who have been in contact, so that they can take precautionary actions and, if they are themselves symptomatic, ask for a test, then self-isolate. So, we see that to have benefit in areas such as, if you are on public transport, you will not know who you've been in contact with; if you are in a large public building, you won't know where you have been. So, in such locations, these apps will actually help provide that signal, but as I said, again, the app in itself is not the answer; it's a supplementary tool to our other contact tracing systems that we have.
Okay, thank you. Chair, if there's a minute or two at the end, I've got another—just one—question, but I know we need to press on.
Diolch, Rhun. Dŷn ni'n symud i Jayne efo'i chwestiynau hi. Jayne Bryant.
Thank you, Rhun. We'll move to Jayne with her questions now. Jayne Bryant.
Thank you, Chair. We've heard today, and we're aware from international evidence as well, how important the role and involvement of the public is in ensuring delivery and the impact of programmes like test, trace and protect, and so clear communications and clear messages are crucial. What do you see Public Health Wales's role is in ensuring this happens?
[Inaudible.]—may come in. Can I just say thank you for asking that question? We've been—from the outset, I think, two main, or three main, approaches. Firstly, very early on in the pandemic, it was very clear there needed to be a consistent messaging to the public to update people on a daily basis that everyone else could refer to—if you like, one single point of information. So, we began, very early on, the press statement, which, sadly, also incorporates the number of people who have died, but also additional information. So, I feel like that's a kind of basic transmit of information.
But also, early on in the pandemic, we wanted to know how our people of Wales were feeling, so we began weekly surveys, which we publish every week—we published the last one yesterday. So, every Thursday afternoon, we publish an engagement with households—between 500 to 1,000 households a week, which are statistically modelled; there's no bias in there—and we ask them questions. They're all available on the website. And it allows us to map how the public is feeling, and then, every week, we ask some standard questions about how people feel about lockdown and whether the response is appropriate, but we start to add in things like how many people think that they would consider wearing facemasks, or, around well-being, how many people are feeling very isolated or are concerned about their children. And so, through that time we have done a themed one, so we've also looked at ethnicity in that, to supplement further work—and Giri can talk about a lot of the work that we're doing to analyse the impact of COVID on different parts of the population.
But maybe just to give you a little bit of an idea, week 9, last week, we can see the percentage of the people worried about getting COVID has reduced and the percentage of people wanting to stay in lockdown until it was all sorted has started to reduce, so public confidence is starting to improve. But what we also know is that people are wary about accessing health services, for example, so we were looking at that.
We also know that, around the relationship with deprivation—so, we looked at inequalities as well, and we know that the people who are living in the most deprived parts of Wales are the most likely to feel self-isolated, the most likely to feel anxious and isolated as individuals. They've got the most concerns, probably understandably, around household income, and they've got the most concerns about losing someone.
On young adults, we've done a theme looking at young people, which is a concern for all of us at the moment, and we know that young people are more worried about their mental health, their well-being and feeling isolated than any other group. We also know that younger adults are consuming more alcohol than any other group, but they're also exercising more.
So, every week we engage with the public; we've looked at mental health and well-being. We know that 22 per cent of people are feeling worried about their well-being, and 30 per cent of those are in the most deprived areas, which is a concern. So, there's an inequalities element here, and similarly around isolation. So, I would urge committee members to please have a look at that survey, because it does give us a flavour of what's happening. An interesting anecdote that we have—it's our people who make the phone calls, so it's a one-on-one phone call with people. There have been times where they've been on the phone for two and half hours with individuals, because it's the only contact that that individual has had with somebody for a matter of days, so there's an unintended contribution there.
And then the final point that I would add is around health impact assessments. So, committee will be aware, I think, that we do health impact assessments. We did the Brexit health impact assessment. So, we're doing very rapid HIAs, which also involves engagement with the public. We will be publishing shortly the health impact assessment on staying at home and social distancing, which will be a very interesting read. But we also, within that, looked at the impact on mental health, we looked at the impact on violence and the potential impact on adverse childhood experiences. So, it gives us wisdom and an understanding through those weekly surveys, but also looking at what does that look like for Wales.
Thank you, Chair. When you're looking at that evidence as well, does it help you develop your targeting messaging in those clear ways to young people, or people whose language is not first-language English, for example, and how are you learning and developing your messaging on that?
So, yes, thank you. We commenced what we called a 'How are you doing?' campaign a number of months ago, which was to provide support for individuals around physical well-being, mental well-being, activity, et cetera, with a load of resources. We're been able to tailor that as to what's come through the weekly surveys and adapt that accordingly. We also know that Welsh Government—. You may or may not have heard officials refer in committee sessions, or indeed in ministerial statements, but we share that—obviously Welsh Government often ask us to add questions in. So, it was interesting looking at the thoughts of the public, the public's views, around face masks in advance of considering what a policy would look like. So, not only does it help shape our work and also our broader population health work, which we want to start switching back on now, because there are obviously the negative impacts of COVID, but there are also some positive impacts of COVID, like air quality, like physical activity, that perhaps we wouldn't want to lose in this. So, it informs our work, but it also informs Welsh Government as well.
Okay. Thank you. One of the other issues that I'd like to raise is—and it has been touched on by Dr Shankar, I think, around cross-border issues, and how we move forward in the next stage, and potentially different public health messages and approaches throughout lockdown. Obviously, there will be quite a few people who live in Wales but work in England and vice versa, and perhaps even when it comes to visiting people in the future, how do you see that impact, and the differences in test, trace and track programmes and protect programmes, and the data sharing, which is going to be crucial?
Can we try Quentin?
I think—. I'm not getting paranoid, Chair. [Laughter.]
We switch him off all the time. [Laughter.]
Thank you. So, you're right. Can you hear me now, sorry, can I just check?
Thank you. You're right—I think it is a challenge for the public to make sense of the different messages, the different approaches that they are seeing at the current time, and particularly those people who cross the border, as you have just said. I think what we have to—of course, we have four UK countries, those countries have devolved competency, and I think it's fair to say that the precautionary and cautious approach that we've taken in Wales actually is consistent with the advice that we, Public Health Wales, favour. As Dr Shankar said, we have an R number that is only just below 1. We know that that number will go up as restrictions are lifted. We obviously are anxious to make sure that we're not only able to observe any trends upwards, but able to respond quickly. So, I think that we are right to take a cautious approach, and that does present sometimes a challenge for all of us in communicating to the population.
I have to say, in the course of managing my sound problems, I can't quite remember any other part of your question, but please—
No problem. I was just asking about the importance of data sharing between health services in Wales, England, Scotland, Northern Ireland.
Yes, and you're right, in contact tracing it is essential, and indeed we have been working with Public Health England to ensure that we—. There are two parts there. In the contact tracing, we are sharing information across the border; we have already established arrangements in normal public health protection practice to ensure that we share information about cases and contacts across the border, and we've made absolutely sure that those robust arrangements are established, and indeed that any available technologies that can support us are deployed to enable us to do that. So, you're right.
So, there shouldn't be any additional delay in contacting people, any more than if you lived in Wales—there wouldn't be any extra delay, really.
Well, hopefully not. As I say, we've got good systems in place already and our public health colleagues in Public Health England want equally to ensure that contacts are contacted are quickly as possible, regardless of where they're located, and that information is therefore communicated to their counterparts in other parts of the UK.
Thank you. Can I just ask a final question, Chair, just relating to the number of people who are contacted and traced? Will there be a breakdown in the numbers of people who will then test positive? Will that number be broken down, or will it just be the number—in the future, because I know it's only early days?
Sorry, it's taken a while to unmute. So, yes, in the new database that we have developed, it has got within it an in-built functionality that will capture those contacts who eventually become cases in their own right, and then any other further contacts of those. So, we will be able to map generation from index case, secondary case to tertiary case and we can link them. It is possible and it is something we will be absolutely doing.
Ocê, fe wnawn ni wasgu cwestiwn olaf gan Rhun.
Okay, we will squeeze in another question from Rhun—the final question.
Diolch yn fawr iawn. Just quickly, yours is a health not an economy remit, but it's a question about the issue of business continuity and the problems that could arise for businesses if a number of their employees are traced at the same time and asked to self-isolate. Are you looking at ways of adapting your tracing system in that kind of context? For example, rather than tracing people and telling them to stay at home, if there's a significant number within one organisation, you then test them perhaps, so that they can be cleared and then are able to return to work and help that organisation or business or whatever it is with their continuity.
Can I respond to that?
Thank you for the question. So, obviously, what we're absolutely needing to do is that—you know, contact tracing is really crucial, and we want to make sure that that happens in all settings and that the benefit of contact tracing reaches all people, irrespective of where they work or what—. But I completely take the point that, sometimes, if the level of close contact is such that the whole team have had to isolate or take time off work, it has significant impact on that. So, I think we will not be recommending any diluted approach to contact tracing. The scientific rigour for contact tracing will remain the same for everywhere.
Rather than that, we would encourage employers to see how best they can maximise the social distancing measures that they can put in their workplace, so that people don't become contacts in the very first place. I know it is challenging in certain work environments, but I think, as far as possible and as much as possible, employers have to ensure that their workers are able to work in a safe way, and, where necessary, where the 2m social distancing between employees is absolutely not possible for the nature of the work, then other measures, such as use of personal protective equipment, early recognition of symptoms, would be helpful. But mass testing, as one of the options that you suggested, in itself, will not help, because we know that sometimes people who are actually infectious—depending on the timing of their test, they may throw up a false negative test. So, it doesn't, in itself, give a comfort for that. So, I think we would still want to adopt a very effective contact tracing, irrespective of the occupation or the setting.
Diolch yn fawr. Dŷn ni allan o amser, rŵan, felly allaf i ddiolch yn fawr iawn i'n tystion i gyd y bore yma am eich presenoldeb rhithwir, felly? A hefyd diolch ichi unwaith eto am y dystiolaeth ysgrifenedig a gyflwynwyd ymlaen llaw. Yn ôl ein harfer, mi fyddwch chi hefyd yn derbyn trawsgrifiad o'r trafodaethau yma er mwyn ichi allu gwirio eu bod nhw'n ffeithiol gywir. Ond dyna ddiwedd yr eitem yna, felly diolch yn fawr iawn ichi a hwyl fawr i'r pedwar ohonoch chi.
Thank you very much. We are out of time, so may I thank our witnesses very much for your virtual attendance? And I thank you once again for the written evidence submitted. As per usual, you'll receive a transcript of these proceedings so that you can check them for accuracy. But that brings that item to a conclusion, so thank you very much and all the best to all four of you.
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o eitem 4 yn unol â Rheol Sefydlog 17.42(ix).
that the committee resolves to exclude the public from item 4 in accordance with Standing Order 17.42(ix).
Cynigiwyd y cynnig.
I'm cyd-Aelodau, dŷn ni'n symud ymlaen i eitem 3 a chynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o eitem 4 o'r cyfarfod yma heddiw. Ydy pawb yn gytûn? Pawb yn gytûn, felly awn ni i mewn i sesiwn breifat i drafod eitem 4. Diolch yn fawr.
For my fellow Members, we move on to item 3 and a motion under Standing Order 17.42(ix) to resolve to exclude the public from item 4 of today's meeting. Is everyone agreed? Everyone is agreed. We will, therefore, enter private session to discuss item 4. Thank you.
Derbyniwyd y cynnig.
Daeth rhan gyhoeddus y cyfarfod i ben am 11:02.
The public part of the meeting ended at 11:02.
Ailymgynullodd y pwyllgor yn gyhoeddus am 11:30.
The committee reconvened in public at 11:30.
Croeso nôl, felly, i bawb sydd yn gwylio trafodaethau'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma ar gyfrwng rhithwir drwy fideo gynadledda. Rydyn ni wedi cyrraedd eitem 5 rŵan ar ein hagenda, parhad efo'n sylw a'n craffu i mewn i ymateb pawb yn benodol i bandemig COVID-19, yn y bôn. Rydyn ni wedi cyrraedd yn fan hyn y sesiwn dystiolaeth efo awdurdodau lleol, yn benodol awdurdod lleol Ceredigion a hefyd Ynys Môn. Felly, gwnawn ni fanylu ar a rhoi enwau i bawb ar gyfer ein cynulleidfa fyd-eang ni. O'n blaenau ni mae Eifion Evans, prif weithredwr Cyngor Sir Ceredigion; Barry Rees, cyfarwyddwr corfforaethol Cyngor Sir Ceredigion; ac Annwen Morgan, prif weithredwr Cyngor Sir Ynys Môn. Croeso i'r tri ohonoch chi. Allaf i bellach ddatgan bod y meicroffonau i gyd yn gweithio yn awtomatig, tu ôl i'r llenni, megis. Fe fyddwch chi'n derbyn cyfarwyddyd, os bydd angen, i bwsio rhyw fotwm ai peidio, ond does dim eisiau mynd i mewn i ryw elfen o banig oni bai am hynny.
Wrth gwrs, rydyn ni wedi bod yn ei chanol hi fel pwyllgor iechyd ers rhai wythnosau rŵan, yn trafod y dystiolaeth fel mae'n digwydd, a chraffu ar y Gweinidog bron bob wythnos. Mae yna doreth o dystiolaeth fanna, a bydd Aelodau yn seilio eu cwestiynau ar y dystiolaeth rydyn ni wedi'i derbyn, gan gynnwys y dystiolaeth o'ch siroedd chithau. Felly, awn ni'n syth i mewn i gwestiynu. Yn nhermau'r cynlluniau peilot, mae'r profi, olrhain, diogelu—dyna beth rydyn ni'n cysidro rŵan dros yr awr nesaf, a dyna pam rydych chi yma, yn y bôn. Rydyn ni'n mynd i edrych yn gyntaf ar amcanion a strwythur y cynlluniau peilot yma yn benodol, ac mae Lynne Neagle yn mynd i ofyn cwestiynau i chi. Lynne.
Welcome back to everyone viewing the proceedings of the Health, Social Care and Sport Committee as we conduct another virtual meeting. We've reached item 5 on our agenda, which is the continuation on the response to the COVID-19 pandemic. This brings us to an evidence session with local authorities, specifically Ceredigion County Council and the Isle of Anglesey County Council. So, we will provide some names for the faces for our audience. Joining us is Eifion Evans, chief executive of Ceredigion County Council; Barry Rees, corporate director of Ceredigion County Council; and Annwen Morgan, chief executive of the Isle of Anglesey County Council. A very warm welcome to all three of you. I will inform you that the microphones will be operated behind the scenes. You will be asked to unmute, but you don't need to panic about that.
Of course, we as a health committee have been dealing with this issue for some weeks, and we've been scrutinising the evidence and the Minister on virtually a weekly basis. We have a whole host of evidence that Members will have based their questions on, including the evidence from your counties. So, we will move immediately to questions. In terms of test, trace and protect, which is what we're going to be considering now, and that's why you're here. We're going to look first of all at the objectives and structure of these pilot schemes specifically, and Lynne Neagle is going to lead on this. Lynne.
Thank you, Chair. Good morning. Can I just ask you to tell us a bit about the process that took place with Welsh Government to agree to establish these contract-tracing pilots and what issues had to be addressed in order to get the pilots in place, please?
Pwy sydd eisiau dechrau yn fanna? Annwen Morgan.
Who'd like to start there? Annwen Morgan.
Dwi'n meddwl ei fod o'n briodol ei'n bod ni'n dilyn Ceredigion, achos mae'n rhaid imi ddweud, yn Ynys Môn mi fuon ni gyfathrebu efo Ceredigion i sefydlu'n cynllun peilot ni yma ym Môn. Felly, mae'n briodol dechrau efo Ceredigion, ac rydyn ni'n hynod ddiolchgar iddyn nhw ym Môn am eu harweiniad. Felly, drosodd i Eifion i gychwyn, a dof innau i mewn wedyn.
I think it would be appropriate for us to follow Ceredigion, because we would have to say in Anglesey that we did communicate with Ceredigion to establish our own pilot scheme here in Ynys Môn. So, it would be appropriate for Ceredigion to kick off. We are grateful to them for their leadership on this issue. So, I will hand over to Eifion, and then I will contribute later.
Bendigedig. Cerwch amdani, Ceredigion.
Wonderful. Go for it, Ceredigion.
Diolch. Rwy'n credu beth wnaf i ydy rhoi'r cyd-destun yn gyntaf i chi gael deall o ble daeth y syniad, a pham daeth y syniad i fodolaeth. Wedyn gwnaf ofyn i Barry ymhelaethu ar y protocolau y gwnaethon ni eu dilyn.
Yr ysgogyddion a wnaeth inni edrych ar system o'r math yma oedd pan glywon ni beth oedd y niferoedd posibl o unigolion a fyddai'n cael eu heintio â'r clefyd yma, a beth fyddai'r rhagamcaniadau ar gyfer nifer y marwolaethau o fewn Ceredigion. Reit ar y cychwyn, fe nodwyd, os na fyddai unrhyw beth yn digwydd o gwbl, y byddai posibilrwydd o 80 y cant o'r boblogaeth yn cael eu heintio ac 1 y cant o'r rheini o bosibl yn colli eu bywydau. Wel, i drosi hwnna i mewn i ffigurau Ceredigion, roedd hwnna yn golygu ein bod ni'n wynebu colli 600 o drigolion y sir erbyn diwedd Mehefin. Penderfynon ni nad oedd hwnna'n opsiwn i ni ei ystyried o gwbl. Fe symudon ni'n gyflym iawn trwy nifer o brosesau, yn debyg iawn i bob sir arall, a hynny yw, cloi'r sir lawr, ac ar ôl gwneud hynny i gyd, ailadolygu'r modelu, a hyd yn oed wedyn byddai'r rhagamcaniadau dal yn darogan tua 200 o achosion o farwolaethau o hyd yn y sir. Felly, mi ofynnon ni'r cwestiwn, wedyn—a dwi'n mynd nôl nawr obeutu naw, 10 wythnos yn y broses—fe ofynnon ni'r cwestiwn wedyn, 'Wel, beth arall fedrwn ni ei wneud, achos mae'n rhaid cael y rhif yna lawr? Dyw colli bywydau ddim yn opsiwn gyda ni yn y sir.' Ar yr adeg honno, fe wnaeth Barry argymell, 'Beth obeutu datblygu system olrhain ein hunain a rhedeg ag e?' O'r eiliad yna ymlaen, fe benderfynon ni greu is-bwyllgor o fewn y cyngor, ac fe dynnon ni arbenigeddau reit ar draws rhychwant eang o staff cyngor. Barry oedd yn cadeirio'r panel, ac fe gawson ni gefnogaeth ardderchog gan fwrdd iechyd Hywel Dda; mae'n rhaid cydnabod y gefnogaeth gawson ni gan y bwrdd iechyd. Buon nhw gyda ni ar hyd y daith, wedyn, yn datblygu'r model. Felly, os gwnaf i drosglwyddo i Barry, fe gaiff e esbonio ichi, wedyn, sut wnaethon ni greu'r model.
Thank you. What I will do, perhaps, is to first of all provide the context, so that you can understand where the idea emerged from, and why it came into existence. Then I will ask Barry to focus on the protocols followed.
The drivers that led us to look at such a system was when we heard about the possible numbers of individuals who may be infected with this terrible virus, and what the forecast numbers of deaths within Ceredigion were. At the very outset, it was noted that if nothing at all happened, there was a possibility of 80 per cent of the population being infected and 1 per cent of those losing their lives. In terms of Ceredigion, that meant we were facing losing 600 residents by the end of June, and we decided that simply wasn't an option that could be considered. We moved very swiftly through a number of processes, very similar to other counties, in terms of lockdown, and having done that we reviewed the modelling. The forecasts even then were predicting some 200 deaths in the county, so we then asked the question, and I'm going back some nine or 10 weeks in the process, 'Well, what else can we do, because we have to get that number down? The loss of life is not an option within the county.' Barry recommended the development of our own track and trace system and that we should run with that. From that moment on, we decided to create a sub-committee within the council, and we drew in expertise from across the whole range of council staff. Barry chaired the panel, and we received excellent support from Hywel Dda health board; I do have to recognise the support we received from the health board. They were with us along the journey, then, in developing the model. So, if I can transfer to Barry, he can then explain to you how we developed the model.
Grêt. Diolch yn fawr. Barry Rees.
Great. Thank you very much. Barry Rees.
Mae hyn i gyd, wrth gwrs, yn ôl-ddyddio'r peilot, ac felly mae Eifion yn gosod y cyd-destun ar gyfer y system wnaethon ni ddatblygu ein hunain o fewn Ceredigion—y syniad cychwynnol a chael cyfle i wneud hynny, dan arweiniad Eifion.
I fanylu rhywfaint ar y cysyniad oedd gyda ni, ar sail tystiolaeth fyd-eang y byddai'r systemau olrhain cyswllt efallai'n medru cael effaith gadarnhaol arnon ni, gan ystyried bod ein niferoedd ni yn hynod o isel, ac felly mi oedd system olrhain cyswllt, o bosib, yn mynd i allu bod yn effeithiol, lle'r oedden ni ar y pryd â nifer o achosion—dwi'n credu bod hynny'n gyd-destun pwysig. Doedden ni ddim mewn crisis mode, ac roedd rhywfaint o le gyda ni i greu system, a chreu system cartref—home-made—oedd hwn yn gyfan gwbl, gan ddefnyddio ein cydweithwyr o fewn public protection. Mi oedd gyda ni swyddogion fan hynny oedd â rhyw fath o arbenigedd mewn systemau tebyg i olrhain cyswllt oherwydd eu swyddogaethau nhw, o ran olrhain pethau fel legionella, gwenwyn bwyd ac ati. Felly, mi oedd tipyn o wybodaeth gyda ni o fewn y tîm.
Ond hefyd, wrth gwrs, mi oedd ein cyfeillion ni o'r adran dechnoleg gwybodaeth yn cefnogi creu system i gasglu gwybodaeth a defnyddio a dadansoddi'r wybodaeth. A hefyd, wrth gwrs, roedd hwn yn ein symud ni i dir newydd o ran defnyddio data—defnyddio data personol pobl o bosib—er mwyn creu'r system. Ac felly mi oedd y bobl diogelu data o fewn y sir hefyd wedi cysylltu â swyddfa'r comisiynydd gwybodaeth er mwyn sicrhau ein bod ni yn gweithredu o fewn y Deddfau o ddefnyddio gwybodaeth ac ati.
Ac felly, unwaith roedd y system yma, system amrwd, byddwn i'n dweud, wedi cael ei greu ac yn weithredol, yn gyflym iawn mi wnaethon ni gael cyswllt â'n cyfeillion ni oddi mewn i Hywel Dda, ac mi oedden nhw eu hunain â llawer o ddiddordeb mewn bod yn rhan o'r datblygiadau. Ac o hynny, roedd ein cyfeillion ni o sir Benfro a sir Gaerfyrddin, a chyfeillion o Hywel Dda—roedden ni wedi creu uned er mwyn symud hwn ymlaen i'r cam nesaf, sef gweld a oedd ein prototeip ni yn gymwys ar gyfer cael ei ddefnyddio yn sir Benfro a sir Gaerfyrddin, fel ei fod e'n gweithredu ar ôl troed y bwrdd iechyd yn gyfan.
Ar yr un amser—i ateb y cwestiwn, efallai, yn fwy uniongyrchol—ar yr un amser â hynny, mi oedd symudiad tuag at system cenedlaethol o olrhain cyswllt. Felly, mi oedd yn rhaid inni newid rhywfaint ac addasu ein proses rhywfaint o rywbeth cyn-beilot i mewn i beilot cenedlaethol, a pheidio, i ddweud y gwir, datblygu'n hunain mewn i ryw cul-de-sac a mynd yn rhy bell fel ein bod ni ddim yn gallu camu nôl er mwyn cydymffurfio â'r system cenedlaethol. Felly, dyna le mae ein rôl ni wedi bod yn rhan o'r peilot, sef y phase cyn dechrau'r wythnos yma, i ddweud y gwir, lle'r oedd y system wedi cael ei rolio allan yn gyfan gwbl. Mi oedden ni'n peilota ar ddatblygu ein systemau a'n prosesau ein hunain.
Un peth eithaf pwysig hefyd yw'r dechreubwynt ar gyfer olrhain cyswllt. Yn genedlaethol, wrth gwrs, y dechreubwynt i hwnna yw derbyn canlyniad positif. Wel, oherwydd ein bod ni'n gyflogwyr mawr—y cyflogwyr mwyaf yn sir Ceredigion, wrth gwrs, â rhyw 4,000—mi oedd gyda ni wybodaeth dda ar ein system ni o unrhyw gyflogai oedd gyda ni oedd efallai yn arddangos symptomau—heb gael prawf o reidrwydd, ond yn dangos symptomau. Ac felly, gyda staff ein hunain roeddem ni'n gallu cael rhyw fath o short cut bach i'r system—yn hytrach nag aros am ganlyniadau'r profion, roedden ni'n gallu dilyn y trywydd olrhain cyswllt gyda nhw hefyd. Felly, o ran ochr beilota rhywbeth newydd, mae'r ochr ein bod ni'n gallu pigo pobl lan—rhai unigolion a'n staff ni yn yr achos yma—ar y pwynt symptomatig, yn hytrach na derbyn canlyniad positif—dwi'n credu bod hynny wedi bod yn fanteisiol hefyd i dorri'r oedi, efallai, er mwyn troi y broses yn ei blaen.
This, of course, postdates the pilot, and Eifion has set out the context for the system that we developed ourselves within Ceredigion—the initial idea and the opportunity to develop that, under Eifion.
To give you a little bit more detail on the concept that we had, based on global evidence that tracing systems could have a positive impact, bearing in mind that our numbers were very low, and therefore a contact-tracing system could be effective, given where we were in terms of the number of cases at that time—that's an important context. We weren't in crisis mode and we did have some scope to create a system and to create a home-made system, using the expertise of our colleagues within public protection. We did have officials there who did have some expertise in similar contact-tracing systems because of their functions in terms of tracing things like legionella, food poisoning cases and so on. So, we had some information within the team and some expertise.
But, of course, our colleagues from the ICT department also supported us in creating a system to gather data and to analyse that data. And also, of course, this was moving to new ground in terms of the usage of data, using personal data in order to create the system. Therefore, the data protection officers within the county had also been in touch with the information commissioner's office in order to ensure that we were operating within the pertinent legislation.
And once this raw system was in place, and once it was operational, then very swiftly, we had contact with colleagues within Hywel Dda, and they were very interested in becoming part of these developments. From that point on, our colleagues from Pembrokeshire and Carmarthenshire, as well as colleagues in Hywel Dda—we created a unit to move this on to the next step to see whether our prototype would be applicable for use in Pembrokeshire and Carmarthenshire, so that it could operate on the whole health board footprint.
To respond to the question more directly, perhaps, as we were doing that, there was a shift towards a national contact-tracing system. So, we did have to change and adapt our processes slightly from something that was a pre-pilot to a national pilot, whilst not developing ourselves into a sort of cul-de-sac and going too far so that we couldn't move back and comply with the national system. So, that's what our role has been as part of the pilot, which is the phase before the system was rolled out this week. We had been piloting and developing our own processes.
One important thing is that the starting point for contact tracing. At a national level, of course, the starting point for that is the receipt of a positive test result. But because we are major employers—the largest employers within the county of Ceredigion, with some 4,000 staff—then we had some good information on our system of any employees that we had who were displaying symptoms—not necessarily having been tested, but were showing symptoms. So, with our own staff, we had some sort of short cut for the system, so we could follow that contact-tracing route with them before they were tested. So, in terms of piloting something new, then the fact that we were able to pick up some individuals—our staff, in this case—at a symptomatic point, rather than awaiting a positive result—I think that had been very beneficial in terms of cutting any delays in turning this process around.
Diolch yn fawr am osod y cyd-destun gwerthfawr yna ac, wrth gwrs, wedi ysbrydoli pawb, mae'n rhaid dweud, ond yn benodol yn y cyd-destun yma wedi ysbrydoli Ynys Môn, fel rydan ni wedi clywed. So, Annwen, ydach chi eisiau dweud rhywbeth agoriadol?
Thank you very much for setting that valuable context, and it has inspired everyone, I think it's fair to say, but certainly in this context it inspired Anglesey. So, Annwen, do you have some opening comments?
Iawn, diolch yn fawr iawn. Rydyn ninnau, fel Ceredigion, yn sylweddoli, os am achub bywydau, mae hwn yn rhan o'r normal newydd, ac mae'n rhaid inni ryw ffordd neu'i gilydd allu gwerthu'r neges yna a chydnabod pwysigrwydd y cynllun profi, olrhain a gwarchod ymhlith ein poblogaeth a'n holl bartneriaid. Do, mi glywodd ein harweinydd ni, Llinos Medi, hwn mewn fforwm cenedlaethol. Roedd yna aelodau etholedig lleol hefyd wedi gwneud gwaith ymchwil ar y platfform byd-eang, ac roedd yna, felly, wedi clywed hynny, ymrwymiad a chefnogaeth wleidyddol lawn inni symud hyn ymlaen.
Sut aethon ni o'i chwmpas hi i greu'r peilot ym Môn? Wedi clywed hynna a sicrhau y gefnogaeth wleidyddol, mi ddaethon ni'n syth i gysylltiad efo Eifion, felly, ac mi gawson ni drafodaeth onest ac agored. Fe gawson ni lawer o gymorth, mi wnaethon ni rannu dogfennau, ac mewn dau ddiwrnod mi oedden ni wedi gallu sefydlu tîm bychan yma ym Môn, gyda, os leciwch chi, rheolwyr project, gyda mewnbwn gan sawl gwasanaeth iddo fo, a sicrhau bod ni'n gallu adleoli staff. Mae gennym ni 44 o staff mewnol wedi eu hadleoli. Cyfanswm ydy hynny o 17.5 o staff llawn amser.
Wel, rŵan, roedd hwn yn gyfnod byr inni wneud y cynllun peilot byr yma. Mi ddechreuon ni ar 26 Mai, gydag oriau agor ar gyfer y gwaith rhwng naw a phump, ond ar yr un pryd, mi oedd, os leciwch chi, y cynllun cenedlaethol rhanbarthol hefyd yn digwydd. Chawson ni ddim llawer o achosion yn yr wythnos gyntaf; mi ddechreuon ni efo'n staff ein hunain—staff gofal cartref, rhai ohonyn nhw—ond wedyn roedden ni'n symud yn syth, os leciwch chi, i weithio ar yr un cenedlaethol rhanbarthol. Ond roedd y gwersi y gwnaethon ni eu dysgu yn yr wythnos gyntaf yna, y saith diwrnod cyntaf yna, rydyn ni'n credu, wedi bod o gymorth i ddylanwadu wrth sefydlu'r platfform ar safbwynt rhanbarthol.
Fe gawson ninnau hefyd gefnogaeth lawn gan ein bwrdd iechyd a chan Iechyd Cyhoeddus Cymru, a dwi'n gwybod bod yr ochr wleidyddol hefyd ym Môn yn hollol gefnogol i hyn. Un tîm wnaethon ni ei sefydlu. Fe wnaethon ni sefydlu patrwm digidol dros dro a oedd yn seiliedig ar sgriptiau holiaduron Iechyd Cyhoeddus Cymru a'r bwrdd iechyd. Ac os leciwch chi, felly, am yr wythnos yna roedden ni fel pe baem ni'n rhedeg dau gynllun, ond roedd yn werth i'w wneud. Wedyn, rydyn ni'n gallu defnyddio'r staff oedd yn ein cynllun wythnos ni rŵan; maen nhw'n trosglwyddo, wrth gwrs, i'r gell ranbarthol ond yn gweithio yn lleol yn fan hyn.
Fel dwi wedi dweud—dim llawer o achosion mynegai ar y cychwyn. Do, fe gawson ni wersi a ddysgwyd o hynny o dreialu'r system ddigidol dros dro. Mi fuasai wedi bod yn help cael amserlen hirach ar gyfer y cynllun peilot yma ym Môn, ond roedd o'n ffaith ein bod ni wedi gallu cael y staff a'r bobl briodol yn eu lle, a phobl, os leciwch chi—. Mae hwn yn broffesiwn newydd i lot o bobl, a dwi'n eithaf sicr ar gyfer y dyfodol yng Nghymru mi fydd hwn yn broffesiwn ac yn wasanaeth newydd, achos pwy â ŵyr pa mor hir fyddwn ni angen y system yma?
A dwi'n meddwl mai'r peth pwysig i'w ddysgu, fel y dywedoch chi—. Do, mi wnaethon ni ddysgu drwy arwain, a chael arweiniad gan Geredigion. Mae hwn yn gyfle i ddangos, dwi’n meddwl, i weddill Cymru ein bod ni fel sector yn yr awdurdodau lleol yn fodlon cydweithio ac yn fodlon mynd yr ail filltir. Dŷn ni’n sôn am waith partneriaeth yn aml iawn, yn enwedig yn y blynyddoedd diwethaf yma, ac mae hyn yn profi, os liciwch chi, os ydym ni’n ymrwymedig i waith partneriaeth, dyma chi un maes lle gallwn ni brofi bod hynny yn wir.
Thank you very much. We, like Ceredigion, do realise that if we want to save lives, then this is part of the new normal, and one way or another we do have to sell that message and to recognise the importance of the 'test, trace, protect' message among our population and all our partners. Yes, our leader, Llinos Medi, heard about this at a national forum. Local elected members had also carried out some research on the global platform, and having heard that, there was a commitment and full political support for us to progress this.
Now, how did we go about creating the pilot in Môn? Having heard that and secured the political support, we immediately came into contact with Eifion, and we had an honest and open discussion. We had a great deal of support, we shared documents, and in two days' time we had been able to establish a small team here on Ynys Môn, with project managers, with an input from a number of different services, and we also ensured that we were able to redeploy staff. We have some 44 internal staff who have been redeployed, and that is full-time equivalent of 17.5 staff.
Now, this was a brief turnaround for us in terms of drawing up this pilot. We started on 26 May, with opening hours for this work between nine and five, but simultaneously the regional plans were also in place. We didn't have many cases in that first week; we started with our own staff—care home staff, some of them, yes—but then we moved immediately to working on the national and regional plans. But the lessons that we learnt during that first week, the first seven days, we believe assisted us in establishing the regional platform and the regional approach.
We also received full support from the health board and Public Health Wales, and I know that the political side in Anglesey was also entirely supportive of this. We established one team. We established a pro tem digital approach that was based on scripting of the surveys of Public Health Wales and the health board. And, if you like, for that week we seemed to be running two parallel programmes, but it was worth doing. So, we can then use the staff working in our week-long pilots; they can now transfer into the regional approach whilst still working locally here.
As I've said, there weren't many cases at the outset. Yes, there were lessons learnt in terms of trialling the temporary digital system. It would have been of help to have a longer timescale for this pilot in Anglesey, but the fact that we were able to get the appropriate staff and people in place—. This is a new profession for very many people, and I am quite sure for the future in Wales that this will be a new profession and a new service, because who knows how long we will need this system in place?
And I think the important lesson to be learned, as you said—. Yes, we learned from the leadership shown in Ceredigion, and this is an opportunity for us to show the rest of Wales that we, as a sector within local authorities, are willing to collaborate and willing to go that extra mile. We often talk about partnership work, and we have been doing so particularly over the past few years, but this proves that if we are committed to partnership working, then this is one area where we can prove that that is the case and that is working.
Diolch yn fawr. Wel, dyna osod y cyd-destun yn fendigedig. Yn ôl i Lynne am ragor o gwestiynau penodol. Lynne Neagle.
Thank you very much. That sets the context wonderfully. Back to Lynne for further specific questions. Lynne Neagle.
Thanks, Chair. Annwen, you mentioned the length of time that you'd had, and that it was short. I do pay tribute to all of you for what you've done in the amount of time that you've had. Is there anything that any of you would like to add about the difficulties the shortage of time has caused for your authorities?
Wel, roeddwn i yn cyfeirio at yr amser byr i ni fan yma ym Môn. Ond, mewn gwirionedd, roeddem ni wedi cael wythnos cyn mynd i’r platfform rhanbarthol. Dysgu ydym ni efo hwn, a’r peth pwysig ydy ein bod ni i gyd eisiau i hwn lwyddo i achub bywydau. Dwi’n meddwl bod tri maes—ac mae Barry wedi cyfeirio atyn nhw: yr her o rannu data, a dwi’n meddwl ein bod ni’n gweithio ar gael ffordd o gwmpas hynny; yr ochr ddigidol, a chael y platfform digidol i weithio; a’r trydydd maes, y buaswn i’n dweud, ydy’r hyfforddiant cymwys i rai unigolion sydd ddim wedi ymwneud â’r maes yma. Mae’n gallu bod yn faes sensitif—ffonio rhywun i ddweud, ‘Rydych chi wedi dod i mewn i gyswllt â rhywun sydd wedi cael ei brofi yn bositif oherwydd y clefyd’. Dyna’r tri maes. Buasai’n braf iawn cael llawer mwy o amser i gael y rheini yn tiptop. Ond, dŷn ni gyd yn dysgu, onid ydym? A dŷn ni’n trio cael yr atebion efo’n gilydd.
Well, I was referring to the short time available to us here in Anglesey. But, in reality, we had a week before moving to the national platform. We are constantly learning through this process, and the important thing is that we all want this to succeed in order to save lives. I think that there are three areas—and Barry has referred to them: the challenge in terms of data, and we are working on a way around that; the digital side of things and the digital platform, and getting that to work properly; and the third area is the training required for some individuals who haven't been involved with this area at all. It can be a very sensitive matter when you're phoning someone to say, 'You've come into contact with someone who has tested positive for this virus.' Those are the three areas. It would be wonderful to have a lot more time to get those in tiptop condition. But, we are all learning all of the time, and we're seeking solutions together.
Iawn. Dwi'n fodlon camu i mewn i'r gwagle hwnnw. Dwi bob tro yn ddigon bodlon cymryd yr awenau oddi wrth y prif weithredwr, wrth gwrs, ond dyna ni. [Chwerthin.]
Dwi’n credu mai’r rhwystredigaeth fwyaf gyda ni, drwy fynd drwy beilot mor gyfyng o ran ei amser, oedd rhyw fath o ddisgwyliad y byddai hwn yn cael ei rolio allan ar ddyddiad penodol, doed a ddêl. Ond, mae’r ‘doed a ddêl’ yna’n golygu boed a yw e’n barod neu beidio, ac roeddwn i’n eithaf petrusgar am hynny. Serch hynny, roedd llawer iawn o waith o ddatblygu systemau, trafod gyda chyfeillion rhanbarthol, ac yn lleol, er mwyn cael y maen i’r wal erbyn y dyddiad lle’r oedd hwn yn mynd i gael ei ddechrau go iawn.
Mae’n rhaid inni gyfaddef, o ran y recriwtio, yng Ngheredigion, tîm bach sydd gyda ni, ond mae maint timoedd wedi cael ei ddiffinio gan Lywodraeth Cymru, ac mae'r rheini, wrth gwrs, fesul USOAs—upper super output areas. Mae gyda ni ddau yng Ngheredigion. Wel, yng Ngheredigion, doedd e ddim yn gwneud llawer o synnwyr inni greu dau dîm o fewn sir mor fach—un ar gyfer gogledd y sir ac un ar gyfer de’r sir. Doedd hynny ddim yn gwneud sens i sut roeddem ni’n gweithredu o gwbl. Ond, mi oedd yn rhoi syniad i ni o faint o gapasiti oedd ei angen arnom ni er mwyn bodloni'r gofynion cenedlaethol, ac mae hynny yn her, yn enwedig pan fyddwch chi eisiau apwyntio pobl i’r swyddi hynny. Felly, i ddweud y gwir, mae hynny yn dal i barhau gyda ni.
Rŷm ni wedi apwyntio i nifer o swyddi yn barod. Mae’r rheini yn eu lle. Ond, rŷm ni'n dal i apwyntio er mwyn cael ein cohort llawn o bobl er mwyn bodloni disgwyliadau'r system yn genedlaethol. Mi oedd hynny ddim yn bosibl i’w wneud yn y cyfnod peilot erbyn y dyddiad cychwyn. Mae’n rhaid inni fod yn hollol realistig am hynny. Mae gyda ni broses apwyntio diogel o fewn y sir yr oedd rhaid inni fynd drwyddi hi, ac rŷm ni’n parhau i wneud hynny. Ond, mae’r scale-up yn parhau. Mae popeth yn weithredol yn genedlaethol, ond, mae’n rhaid cydnabod, dyw’r capasiti cyfan, gyda ni, ddim yno eto.
Okay. I'm happy to step into the breach there. I'm always happy to take the reins from the chief executive, of course. [Laughter.]
I think that the greatest frustration for us in going through such a time-restricted pilot was some expectation that this would be rolled out at a particular time, come what may. However, that 'come what may' means that it would be rolled out whether it was ready or not, and we were quite nervous abut that. However, there was a great deal of work done in terms of developing systems and discussing with regional colleagues, as well as local colleagues, in order to deliver our objectives by the date when this was going to be rolled out.
We have to admit, in terms of recruitment, because in Ceredigion we have a small team, that the size of the teams is defined by the Welsh Government, and that is according to upper super output areas. We have two in Ceredigion. In Ceredigion, it didn't make much sense for us to create two teams within such a small county—one for the south and one for the north of the county. That didn't make any sense for us. But, it did give us an idea of how much capacity we would need in order to meet the national requirements, and that's a challenge, particularly when you want to appoint people to those particular roles. Truth be told, that is still the case for us.
We've appointed to a number of roles already, and those are in place, but we are still in that appointment process in terms of getting our full cohort in place in order to meet the needs of the national system. That wasn't possible during the pilot phase by the roll-out date. We have to be realistic about that. We have a robust appointment process within the county that we had to go through, and we will continue to do that, but the scale-up is ongoing. Everything is operational nationally, but we have to recognise that the full capacity isn't in place as of yet.
Ie. Dwi'n cytuno efo Barry am y system ddigidol, fel gwnes i gyfeirio yn gynharach. Mae yna broblemau o hyd efo'r platfform digidol cenedlaethol. Beth rydym ni'n ei wneud ar y funud, yn fan hyn, ydy rhedeg ein platfform ein hunain hefyd.
Yes. I agree with Barry on the digital system, as I referred to earlier. Yes, there are still problems in terms of the national digital platform. What we're doing at the moment, here, is running our own platform alongside it.
Mae hwnna'n wir.
Ac, o ran yr ochr staffio, adleoli rydym ni wedi ei wneud ar y funud—y cyfwerth â 37.5 o staff—ond rŵan efo'r datgloi ac yn symud, o bosib, at y normal newydd, felly, o benodi staff, mi fydd honna yn her a bydd rhaid, wrth gwrs, cyllido hynny a chael y bobl gymwys i'w wneud. Mi fyddwn i'n dweud bod eisiau dechrau'n raddol a pheidio mynd i ofynion y swm mawr cenedlaethol sydd wedi cael ei ofyn. Mi fydd honna'n her inni gyd. Ac, wrth gwrs, yn yr ardal yma, y gofyn a'r angen hollol ddilys o gael pobl ddwyieithog i wneud y gwaith.
That is true.
And, in terms of staffing, we have been redeploying staff, that's been our approach. That's the full-time equivalent of the 37.5 staff, but now with the reduction in lockdown and moving to the new normal, then appointing staff will become a challenge and we will have to fund that too, and get qualified people in place. I would say that we would need to start gradually and not move immediately towards the high national numbers. That's going to be a challenge for us all. And, in this area, there is that valid need for having bilingual people available to do that work.
Os gallaf i ddweud—
If I can say—
Mae'n ddrwg gen i. Gei di ateb y cwestiwn nesaf, Eifion. Lynne.
Apologies. You can respond to the next question, Eifion. Lynne.
In terms of the partnership working, Ceredigion has referred to the good partnership with Hywel Dda. Can I ask how that's been working in north Wales with Betsi Cadwaladr?
Pan oeddem ni'n sefydlu ein system ni yma ym Môn—ein peilot bach ni ym Môn am wythnos—mi gawsom ni gydweithrediad llawn drwy unigolion penodol yn Betsi a, digwydd bod, yr un person hefyd yn gwneud y gwaith ar ran Iechyd Cyhoeddus Cymru. Mi gawsom ni gefnogaeth ac mi gawsom ni enwau unigolion, os liciwch chi, fel y clinical lead ond, wrth gwrs, mae'r clinical lead yna rŵan yn trosglwyddo i'r ochr ranbarthol. Mi gawsom ni gydweithrediad llawn yn fanna, a dwi'n credu, oherwydd yr unigolion sydd o gwmpas y bwrdd yn arwain ar hwn, o ran yr ochr tracio yma, mae'r awydd i ni gydweithio ac iddo fo lwyddo yn y gogledd. Ar y funud, does gen i ddim byd negyddol i'w ddweud.
When we established our system here—in establishing our week-long pilot in Anglesey—we had full co-operation from specific individuals within Betsi and, as it happened, one person also carried out the same function on behalf of Public Health Wales. We received support and we were given the names of individual contacts as the clinical lead, but that clinical lead now will transfer to the regional side. There was full co-operation and collaboration, and I think, because of the individuals around the table leading on this, from the tracking perspective, then the desire to collaborate and for it to succeed in north Wales exists. We have nothing negative to say at the moment.
Os gallwn i ychwanegu pwynt bach fan hyn, wrth ichi fynd ar hyd trywydd gofyn amboutu'r pwysau amser ac yn y blaen, un ffactor sydd yn dylanwadu'n gryf ar hwn yw'r elfen brofi, ac mae'n rhaid inni dderbyn bod y gofyniad sydd wedi glanio yn yr wythnos diwethaf ar gyfer profi ar gyfer y prawf yr antibody wedi ychwanegu pwysau anferthol ar ochr y byrddau iechyd ar draws Cymru gyfan. Nawr, y peryg yw, pa brawf sydd bwysicaf? Yn fy marn i, y prawf pwysicaf sydd angen inni ei wneud ar hyn o bryd ydy profi a ydy pobl wedi cael eu heintio ai peidio. Ac os ydym ni yn arafu'r broses o brofi hynny, ar draul derbyn prawf antibody, dyw'r system olrhain ddim yn mynd i fod cystal ag y dylai fe fod ar draws y wlad.
Mi ddaw amser pan fydd y prawf yna yn bwysig ond, yn fy marn i, dyw e ddim nawr. Mae angen ystyried hynny, achos dim ond hyn a hyn o gapasiti sydd ar gael yn y system, ac mae yna beryg, wrth ofyn gormod oddi wrth y byrddau iechyd, y gwnawn ni grogi'r system. Mae'r system, os ydy'n cael ei gweithredu'n iawn, yn gweithio. Mae'r dystiolaeth gyda ni i ddangos yn barod. Felly, mae angen bod yn ddewr fan hyn, ac efallai i Gymru gyfan ddweud, 'Dewch i ni gael gwneud yr antibody prawf yma mewn pythefnos neu dair wythnos a pheidio ei wneud e nawr?' ac wedyn, wrth gwrs, greu rhyw fath o rwystredigaeth o fewn y system ei hunan.
If I could just add a brief point here, in asking about the time constraints and the time pressures, one factor that strongly influences this is the testing element, and we have to accept that the requirement that was passed on just this week on the antibody test has added huge pressures for health boards across the whole of Wales. And the risk is that we ask, 'Which test is most important?' In my view, the most important test, at the moment, is to test whether people are infected or not. And if we slow that process—that testing—for the sake of an antibody test, then the system won't be as strong as it should be across the nation.
There will come a time, when that test is important, but that time isn't now, in my view. And we need to consider that, because there's only so much capacity available within the system, and there is a risk that we'll be asking too much of our health boards and, in doing so, we will smother the system. If operated correctly, the system is working, and we have the evidence to demonstrate that already. We have to be brave here and to say on a Wales-wide basis, 'Well, we should be doing this antibody test in a fortnight or three weeks' time, rather than doing it now' and then, of course, that could create frustration within the system itself.
Ie, digon teg. Mi ddown ni i fanylion y profion nawr, maes o law. Yn ôl at Lynne.
Yes, fair enough. We will focus on testing details shortly, but back to Lynne now.
Yes. Can I just ask you then, what you think the key lessons are for us, as a committee, from the pilots that you've been running, and how confident you are that that learning is going to be taken up and adopted across Wales?
Dyna chi. Pwy sydd eisiau—? Eifion.
There you are. Who wants to—? Eifion.
I'll answer you directly on that Lynne, and in English as well, just to be clear on it. The issues that we've got to address and the learning that's come out of it are partly to do with the testing; it's about capacity. We are running now across the country—. Every single authority, every single health board, everybody is working as hard as they can. We need to be crystal clear on the national strategy. What's important, and how do we get that delivered? And, as Annwen and Barry have already alluded to, with the national CRM system that captures this data correctly, we need to feed the information into the system effectively, quickly, and be as agile and as efficient as we can as a single nation to attack the virus in the right way.
By possibly falling into the trap of having too many expectations on elements of it, we could slow it down. We could stymie the whole process if we ask for too much too soon, and I think what we need to be absolutely crystal clear on is, 'Let's test for the virus at this precise moment in time, make sure that we invest in a national CRM system that is robust and is easily accessible to all, let's analyse that data very, very effectively moving forward, and get this contact tracing system well established, and get the skill set.' If we can get those component parts in place urgently at the right time, we'll not only suppress this virus, but we can eradicate it from Wales, because the desire is there to do so.
If we put too much—
Cytuno. Y system CRM—. Mae'r brys yn bwysig—brys ac eglurder—ond mae angen yr hyblygrwydd lleol. Dydy one-size-fits-all ddim yn gweithio. A dwi'n meddwl bod ymrwymiad yr awdurdodau lleol wedi bod yn hollol glir. Rydym i ar hyn o bryd yn symud ar hwn ar ein risg ein hunain, heb unrhyw gymorth cyllido. Os ydy hwn i lwyddo, mae'n rhaid rhoi'r cymorth a'r gefnogaeth cyllido. Os nad oes yna gymorth cyllido, mae pobl yn mynd i farw.
I agree. The CRM system—. Urgency and clarity are important, but we also need local flexibility. One-size-fits-all simply won't work, and I think that the commitment of local authorities has been entirely clear. We are now moving on this at our own risk, without any funding support. If this is to succeed, then we do have to have that funding support, because, if it isn't available, there will be deaths.
Thank you. Finally from me, who is ultimately responsible, then, and accountable for managing this process locally?
Ie, dwi'n ddigon hapus i ddod i mewn.
Yes, I'm happy to come in.
I think it differs very slightly from health board to health board. We've created a system. It's very, very clear. There are clearly three layers in this process: there's a national layer, there's a regional, and then there's the local.
In Hywel Dda, we're very, very clear that there's a regional overview. Not to ensure that we're doing things exactly the same across the three local authorities, operationally, but that it's all compatible, that we're all making sure that we've got the correct outputs and the outcomes from the process. So, there's a regional operating group, and they're the people who link in then to the national strategy.
They're also the clinical lead as well, so they would lead on—. Sometimes, you'll get very complex situations and contexts, where the answer for contact tracing comes up with more of a conundrum than a clear answer. Some of those clinical judgments there, resting in the centre, with the expertise, with the public health experts within the regional overview group—they're called a 'cell'—of professionals, so they can access the right clinical expertise, they have the judgment call there where it gets complicated.
But in terms of the local accountability, each of the local authorities will have, in the structure that's put forward by Public Health Wales, a local operational lead just to make sure that we are keeping an eye on the capacity, on the way that we send the work through to contact tracers and contact advisers and keeping that overview, and also interlinking with their colleagues across the local authorities to ensure that we've got an acceptable level of consistency.
So, the accountability—. The buck stops, really, with all of us, but in terms of clinically making those clinical judgments where we go with some of the information that we will have collected, that rests regionally because that's where the clinical expertise lies.
Diolch yn fawr iawn. Yn fyr, mae hwn, wrth gwrs, yn gysylltiedig â'r cynllun adfer sydd gennym ni. O ran yr arweiniad, mae hwnnw'n dod gan Iechyd Cyhoeddus Cymru. Mae gennym ninnau gell ranbarthol. Yn y fan honno mae'r arweiniad clinigol, a dyna lle mae'r expertise. Mae hwnnw wedi cael ei ddarparu gan Betsi.
Wedyn, yn symud ymlaen, bydd gennym ni ddwy gell leol, a'r awdurdod yn arwain ar hwnnw, ac yn adrodd, wrth gwrs, i'r gell ranbarthol, a'r rhanbarthol wedyn yn adrodd i Iechyd Cyhoeddus Cymru.
Ond dwi'n cytuno efo sylw Barry—rydym ni i gyd yn gyfrifol am hwn.
Briefly, this, of course, is linked to the renewal plan that we have. In terms of the lead, it comes from Public Health Wales. We have a regional cell. That's where the clinical leads sit, and that's where the expertise is, and it's provided by Betsi.
Then, moving forward, we will have two local cells, with the authority leading, and reporting, of course, to the regional level, and the regional reporting back to Public Health Wales.
But I would agree with Barry's comment that we are all responsible for this.
Symudwn ni ymlaen, felly. Dwi'n gwybod ein bod ni wedi cyffwrdd â'r pwnc olrhain cysylltiadau cryn dipyn eisoes, ond mae cwestiynau penodol ar olrhain cyswllt rŵan gyda David Rees. David.
Okay, we'll move on. I know that we've touched on the issue of contract tracing quite a bit already, but we do have some specific questions on this from David Rees. David.
Diolch, Cadeirydd, and, as you quite rightly say, we've touched on it, so I'll be appropriately brief. But can I go back to the staffing levels to start with, because I think Annwen has indicated that staff will be redeployed? I'm sure that's happened across all counties—it's happened in my own county borough council—but, as we move forward and as more services come back online, then that creates additional pressure for local authorities. Have you as local authorities had confirmation from Welsh Government as to whether additional funding will be in place to support staff either to replace the ones you've redeployed or to employ new staff in those positions? Because you also have to have training, because I'm sure some of your staff have been facing some challenging times in talking to people and therefore the training is really going to be quite important there.
Wel, dydym ni fel Ynys Môn a fel rhanbarth y Gogledd ddim wedi cael cadarnhad, ond rydym ni'n gweithio fel chwech sir am y cyllid ychwanegol yna.
We as a county council and as the north Wales region haven't had confirmation, but we're working as six counties for that additional funding.
Ocê. Arian yn bwysig yng Ngheredigion. Eifion.
Okay. Well, funding's very important to Ceredigion too, always. Eifion.
David, the only response we've had so far—there's been a national chief execs forum led by the WLGA, and Andrew Goodall was present in that meeting, and, as you can imagine, quite rightly so, I'd say Ceredigion is worried about money, but I think, in this respect, I think every chief exec across Wales is worried, equally so. We challenged, and Andrew Goodall's message to us, and I appreciate he hasn't got the powers to say this, but he said, 'This is priority No. 1 for the country', and he said, 'You need to get a system up and running and please trust the money will follow.' So, we've taken it on trust, but we haven't had any firm confirmation yet. The only thing we have received is a modelling document from Welsh Government that would enable us to populate our staffing levels against it. It's a very complex, complicated tool to administer, but there's no confirmation about what that would equate to financially at the moment.
Sori, Annwen. Cer di.
Sorry, Annwen. You go ahead.
Rydym ni wedi defnyddio'r tŵl yna a rydym ni'n gorfod cyflwyno'n ceisiadau, os leiciwch chi, erbyn dydd Llun. Cei di ddweud rŵan.
Yes, we have used that modelling tool and we will have to submit our applications, if you like, by Monday. Eifion.
We've done a very similar thing. We've used the tool; we've populated it as we have done. The tool will differ on a daily basis almost, and that's the complexity of it, because, as your outbreaks increase or decrease, it's dependent on the volume of staff that you require to intervene. So, it's going to be very variable across the whole of the country, and it's a very—you know, the analysis of all of this is quite complex. I think there's a danger we might have overcomplicated something here.
The evidence indicates around 80 per cent of contacts need to be traced to make it effective, in one sense. Have you identified what type of percentage you've been able to achieve during the pilots?
Yes, I can come in on that. It really depends on the information reaching us as local authorities, our contact tracing teams, in an effective way. From the information that we've got through the Tarian system, which is the established system for public health to send information through to us, and, since that's been well established, that's been running quite well, we've been able to get in contact with 100 per cent of the people that have come through the system and 100 per cent of our staff who've notified possibly their absence for COVID symptoms reasons. So, we've got 100 per cent there.
In general, I don't have a proportion for you in terms of how fruitful that first contact with the person has been, because some people can respond in quite a defensive way—they don't want to be contact traced, as it were—but the information anecdotally that's coming from our contact tracing team is that the vast majority of people welcome the intervention. They feel supported by it and feel it's their moral imperative to answer the questions from the contact tracing teams.
So, in terms of, in Ceredigion, acknowledging that we've got low numbers, that we've got a very favourable context in relation to sparsity of population—many people would quite genuinely and probably correctly say that we're at an advantage in having such low numbers, where we are able to go after every case that comes across to us—it could be very different and the challenge there would be to maintain or exceed that 80 per cent threshold of contacts from the information that comes to us. So, at the moment, 100 per cent, but we realise how fortunate we are in having a low number of cases to track and trace.
Yr un peth yn wir. Pawb dŷn ni wedi cael yr enw trwy Betsi neu Iechyd Cyhoeddus Cymru dŷn ni wedi gallu cysylltu efo'r person yna. Dyna sut mae wedi gweithio hyd yn hyn. Yn yr achosion cyntaf, wythnos gyntaf, pedwar oedd gennym ni yn wythnos y chweched ar hugain yna. Wrth reswm, mae'r niferoedd wedi cynyddu ar ôl hynny. Ac un gwers wnaethom ni ddysgu gan Ceredigion: dim mynd yn ôl i'r achosion—doedd yna ddim pwrpas, nac oedd—oedd ar y cychwyn, ond unrhyw achos newydd oedd yn dod drwodd trwy'r system o'r 26ain o Fai ymlaen.
The same is true. Every name that we've received through Betsi or Public Health Wales, we have been able to contact that individual. That's how it's worked to date. In the initial cases, during the first week, we only had four in the week of the twenty-sixth. Naturally the numbers have increased since then. And one lesson that we did learn from Ceredigion is not going back to the initial cases, but we were looking to any new cases that were coming through the system from 26 May onwards.
Can I ask—? Because, obviously, I appreciate the workload is dependent upon the number of cases within your own areas, I am assuming that, as consequence, it's also about whether you hit the 24- to 36-hour period in which you would want to get that result; is there anything you think, having done it, and with the numbers you've got, is there anything you think that we should be learning from, if there is a larger number in other areas, in how they may be facing this challenge, particularly if they're (a) hitting 80 per cent and (b) the 24 to 36 hours? Is it the number of people you have employed, or are there other things you should be looking at as to how we can make it more effective and efficient?
The critical thing to do, and we've alluded to it just now, is don't look back. You can't try and recover lost ground already, so, once you start introducing the new track and trace system, take that as your baseline and take any fresh new cases and attack those, and the more that you can attack those, and the earlier you can attack them, the better. We had an example about seven, eight weeks ago, when three cases came through all at once to us unexpectedly, and the critical thing was putting enough resource to be able to address those at that precise moment in time. And, at that precise moment, that was when the contact tracing system was set up, first and foremost. We already had other cases in the system; we didn't worry about those, because they were already proved positive, and, if there were new cases, they would already be infecting other people, so we wanted to go after those new cases to try and stop the spread further.
So, the learning is critical. If you take some of the largest infected areas—take Cardiff, as an example: Cardiff would never cope with going to address the 2,000 plus infections in Cardiff at this precise moment in time. But, if you look at their daily infection rates, their daily infection rates are down to single-figure numbers. That's a very manageable figure to deal with. So, go after those and keep going after the daily ones, and, if we're going to take that approach, I think our infection rates across Wales at the moment are low enough for the contact tracing system to work. But we can't look back; it would be a waste of a huge amount of effort and resource to go back after all the high numbers. Leave those alone. Go after the daily ones.
Another thing I'd say is about having back-up, really, when appointing to roles. However—you know, the training, if we overtrain people, then, when the needs arise, you are able to call on a wider resource. Now, possibly, some HR colleagues nationwide could be shifting in their seats by saying that, but what you could do—when the needs arise, this needs to be recognised as the No. 1 priority. So, at the moment, we've got some core services, front-line services, who are in critical roles; they are maintained. There are other, less critical roles and, in relation to accountability and audit, et cetera, colleagues across the board have been quite lenient, really, with deadlines, the expectation of business is as usual, where, in local authorities, we do have a big resource, a big pool of resource, that we could call on when required, and that means possibly overtraining, or having your defined capacity or core team but having a back-up there of people that at very short notice—because these things happen very quickly—you could call upon, because they've got the right skill sets, but also they have been trained. They might—. Hopefully, fingers crossed, they'll never be deployed to do this, but you need a back-up, possibly even bigger than the numbers that are suggested for the contact tracing teams. At least you've got back-up and you're building resilience, because, if this disease hits your own staff, of course, the resilience of your own contact tracing team could be compromised.
So, you need that back-up, training materials there, possibly overtrain people—overtrain numbers, then, of people—within the local authority, so you could deploy them at very short notice, or have people almost on standby in order to carry out the roles. So, possibly, yes, we're defining, and the defined capacity for the upper super-output areas, that's fine, and people are employing up to there, but sometimes—. If the worst of it hits us, then we might have to call on even more capacity, and we need to be able to be agile and responsive to that as our main priority, so I'd suggest train even more people than you need.
Yn fanna, mi fuaswn i yn dangos bod Ynys Môn dipyn bach yn wahanol; mae'n dibynnu beth ydy maint eich awdurdod chi. Mae dadleoli, adleoli yn iawn, efallai, mewn cynghorau mawr, ond pan fo'ch staff chi'n fychan i gychwyn, ac yn mynd yn ôl at eu priod rôl, does yna ddim lot o foethusrwydd i alw'r bobl—wel, dim y criw i gyd—yn ôl. Mi gawsom ni 17 a hanner o bobl yn ôl i helpu efo hyn—wrth reswm, un neu ddau. Mae contact tracing, yn tydi, yn gysylltiedig efo cael y prawf hefyd, a chael y prawf yn sydyn ac yn dod yn ôl yn sydyn, ac efallai yn fanna, yn enwedig mewn dinas fawr, mewn trefi mawr, ardaloedd poblog, mae hynna yn gysylltiedig â chael y prawf efallai ar yr un diwrnod a ddim yn gorfod aros dau neu dri diwrnod, a'i gael yn ôl yn gynt na 24 neu 48 awr, felly; wedyn mae yna fwy o gysondeb, fuaswn i'n dweud, o gael y prawf wedi'i ddychwelyd er mwyn gallu dechrau ar y gwaith yn syth.
Well, I would say that Ynys Môn is slightly different; it depends on the size of your authority. Redeploying is fine within large councils, but when you have a small number of staff initially, and they go back to their own roles, then you don't have that luxury of calling everyone back. As I mentioned, that 17 and a half full-time equivalents—we can't call them all back; of course, we can some of them back. Contact testing, of course, is related to testing—getting that test quickly and getting the result quickly, and, particularly in larger cities, in towns and highly populated areas, getting the test on the same day and not having to wait two or three days, and getting it back quicker; then there's more consistency in terms of getting the test returned so that we can start the contact tracing immediately.
Just a final question from me, and it's to Ceredigion, effectively—you just indicated that you were actually doing this for staff who had become symptomatic rather than positive testing, and, for yourselves, that's okay, and for local authorities that's okay, but we can't do it for the wider population; we don't all know everybody. But should we be looking at similar situations with combinations of local authorities and health boards, where you can identify staff who are symptomatic—should that be a more effective way in those particular public body areas?
I think, absolutely, yes it must be, because if you wait until somebody receives a positive test then the likelihood is the damage is already done. I think we need a phrase around being—. When we talk about being alert and being vigilant, I think we need an early alert system, so that if individuals—. This has to be part of the new culture of Wales: if people suddenly start to feel that they are symptomatic, they need to proactively self-isolate. Wait for the test, wait for the test result—if the test comes back negative, okay, they've just taken a personal responsibility to the wider community, that, you know, 'I could potentially be infectious here—I'm going to take no risks and move sooner than that.'
I think if we can move the nation to an attitude of where it's a civic duty to recognise that, if you are not feeling well, if you are symptomatic, you don't take any risks, self-isolate for an interim period—refer yourself for a test urgently, but you're already in the process then, you're already in the system. By waiting 24, 48, 72 hours until a test result comes back, if they're mingling in society during those three days, those are the days that they're infectious, and the disease will spread anyway, so it compounds the problem. So, the sooner we can come up with an early alert system—it's a very challenging thing to do, but if we can achieve it then, as a nation, we'll be a far safer place.
Mae Eifion yn ailagor beth ddywedais i yn fy mhwynt cychwynnol i: mae'n rhaid i gymunedau ddeall a chydnabod pwysigrwydd hwn. Mae Eifion yn sôn am y system rhybuddio cynnar, ond mae yna rywbeth hefyd i'r Llywodraeth ynglŷn â chyfathrebu'r neges yma. Mae'n gyfrifoldeb ar bawb i hunan gyfeirio.
Eifion has just repeated my initial point: communities have to understand and recognise the importance of this. Eifion mentioned the early alert system, but there is something for the Government in terms of communicating this message. It's a responsibility for everyone to self-refer.
I was just trying to add a point that perhaps, when you are doing your contact tracing of the early alert system, where people are symptomatic, you could put yourselves in a position, or bodies in position, where large numbers will then self-isolate until they get confirmation with a test or not, and that could actually put more pressure upon the organisations in delivering services, in that sense.
That's a very true point, but what we've seen is that, as people move forward, it has to be in the context of symptoms of COVID-19. This is about the education of the whole agenda. The more we learn about this virus, the more we can—[Inaudible.]—the virus, and hopefully, then, that civic duty will become part of it. I accept the point exactly, you know: if everybody suddenly decided they were symptomatic and shut up shop, we could have potentially half the country in self-isolation. So, there is a balancing act there.
Ocê, mae'n amser inni symud ymlaen. Mae Rhun ap Iorwerth, sy'n gwybod rhywbeth am Ynys Môn, mae'n dweud wrtha i, yn mynd i sôn am gefnogaeth dechnegol i'r broses o brofi, olrhain a diogelu. Rhun.
Okay, it's time for us to move on. Rhun ap Iorwerth, who knows a thing or two about Anglesey apparently, is going to talk about technological support for the test, trace and protect system. Rhun.
Diolch yn fawr iawn, Gadeirydd. Prynhawn da i'r tri ohonoch chi. Cyn imi ofyn cwpl o gwestiynau ynglŷn â phlatfformau digidol ac yn y blaen, a allai ofyn hyn i chi yng Ngheredigion yn gyntaf, a'ch llongyfarch chi hefyd am y gwaith dŷch chi wedi bod yn ei wneud—? Roeddwn yn falch iawn bod cyngor Ynys Môn—dwi wedi bod mewn cyswllt agos iawn efo nhw—yn cysylltu efo chi ers wythnosau lawer, felly mae hynny'n dda. Ond oeddech chi yn edrych ar weddill Cymru ac yn meddwl, 'Pam fod pawb arall ddim yn gwneud beth dŷn ni'n ei wneud?'
Thank you very much, Chair. Good afternoon to all three of you. Before I ask a few questions on digital platforms and so on, can I ask you this in Ceredigion, and can I also congratulate you for the work that you have been doing—? I was very pleased that Anglesey council, whom I've been in very close contact with, have been in touch with you over many weeks. But did you look at the rest of Wales and think, 'Well, why isn't everyone else doing what we're doing?'
Rwy'n credu, fel y dywedais i reit ar y cychwyn cyntaf, beth edrychon ni arno oedd—. Fel tîm, rŷn ni'n gweithio'n agos iawn at ein gilydd, ac fe gododd e bach o fraw arnon ni, pan welon ni'r ystadegau cychwynnol. Fe fuon ni hefyd, fel tîm, yn cadw golwg ar beth oedd yn digwydd, a'r patrwm oedd yn digwydd, ar draws y cyfandir. Pan welon ni'r effaith yr oedd hwn yn ei gael ar gartrefi gofal, er enghraifft, yn Sbaen a'r Eidal, fe drafodon ni hynny yn gynnar iawn yn y broses. Mewn tegwch, bydden i ddim eisiau awgrymu am eiliad fod Ceredigion wedi gwneud gymaint yn wahanol nag unrhyw awdurdod arall, jest dyma'r pethau a oedd yn codi braw arnon ni ar y pryd, yn codi ofn arnon ni ar y pryd, ac roedden ni'n teimlo bod yn rhaid inni ymateb yn gyflym.
Y manteision oedd gyda ni ar hyd y daith, pan oedden ni'n cael y sgyrsiau yma yn ddyddiol gyda'r tîm—roedd gyda ni arbenigeddau gwahanol rownd y ford. Mae cefndir gwyddonol gyda Barry, ac, wrth gwrs, pan ddywedodd Barry, 'Beth obeutu gwneud system olrhain?', lle cafodd hwnna ei gyfoethogi wedyn oedd bod gyda ni bobl o wasanaethau eraill â skill sets gwahanol a oedd yn gallu cefnogi'r awgrym yna. Felly, doedd e ddim yn fater o gymharu â gweddill Cymru. Dwi'n credu mai olrhain effaith y feirws ar draws Ewrop oedd y ffordd yr oedden ni'n edrych arni.
Well, as I said at the very outset, I think that what we looked at was—. As a team, we work very closely, and it did cause us great concern when we saw the initial statistics. We, as a team, also kept a close eye on the patterns emerging across the continent, and we saw the impact that it was having on care homes in Spain and Italy. We discussed that at a very early point in the process. In fairness, I wouldn't want to suggest for one moment that Ceredigion had acted very differently to any other authority, but just that these were the things that were concerning to us at the time, and frightening to us, and we felt that we did have to respond quickly to them.
The advantages we had along the journey, when we were having these conversations on a daily basis with the team—we did have different expertise around the table, and that was a strength for us. Barry has a scientific background, and when Barry suggested a contact-tracing system, then that was enhanced by the fact that we had people from other services with different skill sets who could support that suggestion. So, it wasn't a matter of comparing with the rest of Wales. I think that we considered the impact of the virus across Europe. That was our approach.
Mae pob cyngor yn gallu gwneud hynny, wrth gwrs, ond mae'r canlyniadau yn siarad drostyn nhw eu hunain.
At y cwestiynau technegol, felly. Gwaith papur a phensel, i raddau helaeth, oedd y gwaith olrhain yr oeddech chi'n ei wneud yng Ngheredigion—doedd yna ddim arloesedd digidol mawr. Ond pa mor bwysig oedd yr ochr honno, i wneud yn siŵr bod gennych chi system yr oeddech yn gallu gweithio efo hi yn effeithiol yn ddigidol ac yn gyfrifiadurol ac ati?
Every council could do that, of course, but the outcomes do speak for themselves.
If I could return now to the questions on the technological side, it was very much paper-based, in terms of the tracing system in Ceredigion—there wasn't some huge digital innovation. But how important was that side of things in terms of ensuring that you did have a system that you could work with effectively digitally and so on?
O'r cychwyn cyntaf, mi oedd gyda ni rywun o'r adran dechnoleg gwybodaeth yn rhan o'r grŵp tasg a gorffen, a dweud y gwir. Roedden ni eisiau cael hwnnw wedi ei osod lan cyn gynted â phosib. Mi gymerodd ychydig yn fwy na'r ddau ddiwrnod yr oedd Annwen yn sôn amdanyn nhw yn Ynys Môn. Ond mi oedd y rheolwr arweiniol o'r adran TGCh, ac mi oedd e'n gwrando ar y sgyrsiau—beth oedd yr allbynnau yr oedden ni eu heisiau; beth oedd y cynnyrch i fod. Yn syth, a dweud y gwir, dim papur a phensil—mi oedden ni wedi creu rhywbeth mor syml â Microsoft Forms, sef rhywbeth a oedd yn gallu cael ei gynnal ar blatfform gwe.
Felly, wrth i'r holiadur, i bob pwrpas—naratif i gyflwyno eich hunan ac wedyn yr holiadur—. Dyna beth yw olrhain cyswllt yn y bôn: echdynnu gwybodaeth drwy gwestiynau wedi cael eu cynllunio yn ofalus iawn. Mi oedd y platfform—yr host i hynny—ar Microsoft Forms, a chafodd hwnnw ei fabwysiadu gennym ni, fel bod yna rhyw gorlan fach o wybodaeth yr oedd pobl yn gallu mynd nôl ati, mewn ffordd go drefnus, a dweud y gwir, er mwyn cael gweld beth oedd y gwaith dilynol a oedd yn digwydd o'r alwad gychwynnol. Felly, mor syml ag yr oedd e, roedd yn arbenigedd yn fwy na'r arbenigedd y byddwn i'n gallu dod at y bwrdd—tynnu'r arbenigedd at ei gilydd, creu system. Felly, pan oedd y bobl yn ffonio ein contract tracers ni, i bob pwrpas, mi oedden nhw yn llenwi gwybodaeth i mewn yn fyw ar y ffurflen ar-lein, yn hytrach na'u bod nhw'n gorfod ailbrosesu'r wybodaeth yna mewn ffordd wahanol. Felly, system syml iawn, iawn, iawn. Fe allech chi enwi fe yn rhywbeth fel CRM system hollol syml, ond yn y bôn, homemade, quick and dirty, er mwyn sicrhau bod rhywbeth gyda ni oedd yn fwy hwyliog a mwy hwylus a mwy defnyddiol na jest papur a phensil.
Well, from the very outset, we had someone from our ICT department who was involved with the task and finish group. We wanted to get that established as soon as possible. It took a little longer than the two days that Annwen mentioned on Anglesey. But the lead manager from ICT was involved with that, and he was listening to the conversations and listening to the outputs that we were looking for. Immediately, we created something as simple as Microsoft Forms—it wasn't all paper and pencil, but it was web-based.
So, as the narrative survey—. That's what contact tracing is, essentially: extracting information through carefully crafted questions. The platform, or the host for that, was on Microsoft Forms, and that was adopted by us. So, there was an area of information that people could return to, and it was well ordered, so that people could see what the follow-up work was in terms of the initial calls and the initial surveys. So, it was quite simple, but we drew expertise in—expertise greater than I had—and we created a system. So, when people were phoning our contact tracers, then they would actually feed that information live into an online form, rather than having to reprocess that information in a different format. So, it was a very simple system. You could name it a CRM system, but essentially, it was homemade, quick and dirty, in order to ensure that we had something available that was more convenient and more useful than simply a paper-based approach.
A oedd trosi i'r un genedlaethol, o'ch profiad chi yng Ngheredigion, yn gyffredinol rwydd? Dŷn ni wedi clywed Ynys Môn yn dweud eu bod nhw'n dal, oherwydd problemau, yn rhedeg yr un lleol a'r un genedlaethol ochr yn ochr ar hyn o bryd—belt and braces, felly. Beth amdanoch chi?
Was the transfer to the national system, from your experience in Ceredigion, easy for you? We've heard Anglesey saying that they're still, because of problems, running the local and national side-by-side at the moment—belt and braces, therefore. What about you?
Dwi ddim yn ymwybodol iawn ein bod ni wedi adrodd ar yr un math o broblemau yr oedd Ynys Môn yn sôn amdanyn nhw. Felly, roedd y merger i symud draw o un broses i'r llall yn rhywbeth—wel, mae'n dal yn rhywbeth byw, rhywbeth yn ei fabandod yw e, a dweud y gwir. Dwi ddim wedi clywed am gremlins yn y system eto, ond, wrth gwrs, bydd hynny siŵr o fod yn dod lawr dwy'r system. Dwi ddim wedi clywed am yr un gofidiau yn lleol yng Ngheredigion o symud i'r system genedlaethol a beth mae Annwen wedi, ond efallai nad ydw i wedi cael y sgyrsiau yna eto.
I'm not very aware that we've reported the same kinds of problems that Anglesey talked about. So, moving from one process to the other was something—well, it is still live, it's still in its infancy at the moment. I haven't heard about any gremlins in the system as of yet, but I'm sure that will work its way through the system. I've not heard about the same concerns locally in Ceredigion that Annwen's mentioned about moving to the national system, but maybe I haven't had those conversations yet.
Annwen, ydych chi eisiau dweud mwy wrthym ni am y problemau dŷch chi wedi eu hwynebu yn Ynys Môn?
Annwen, do you want to tell us more about the problems you've experienced in Anglesey?
Diolch yn fawr iawn. Roedd y system yna i fod yn weithredol ar 8 Mehefin. Dydy hi ddim yn gwbl, gwbl weithredol. Fe rof i esiampl i chi: dydy'n uwch-ddefnyddwyr ni, fel ein project manager ni, ddim yn gallu cael mynediad i'r system, a'r bobl yma, wrth gwrs, sy'n rhoi'r trosolwg o bopeth sy'n digwydd. Mae'n iawn i'r tracker a'r tracers gael mynediad, ond y project manager uwch eu pen nhw—pethau felly dwi'n sôn amdanynt nad ydynt yn gwbl, gwbl weithredol. Dwi ddim yn amau y down ni dros hyn, ond os oedd hi i fod yn barod i fynd fel Rolls-Royce ar yr wythfed, doedd hi ddim. Doedd hi ddim yn gwbl, gwbl weithredol, ac efallai bod eisiau gwneud hynny'n hollol, hollol glir, Rhun.
Thank you very much. Yes, the system was to be operational on 8 June. It has not entirely been rolled out. I'll give you an example: the super-users, such as our project managers, can't have access to the system at the moment, and it's these people, of course, who provide that overview of everything that's happening. It's fine for the tracker and tracer to have access, but it's the project manager that needs also to have access. That isn't entirely operational as of yet. I don't doubt that we'll get over these problems, but it wasn't ready to go as a Rolls-Royce system on the eighth. It wasn't entirely operational at that point, and perhaps I should make that clear, Rhun.
O ran y data sydd wedi cael ei gynhyrchu gan eich systemau chi, fe wnaethoch chi grybwyll—dwi'n meddwl mai chi wnaeth, Barry—yn gynharach eich bod chi wedi gorfod gweithio efo'r comisiynydd gwybodaeth ac ati i wneud yn siŵr eich bod chi'n cydymffurfio â deddfwriaeth data. Oes yna issues mawr data wedi codi wedyn o ran sut i'w gadw fo, cyfrinachedd, a rhannu hefyd, wrth gwrs, efo systemau cenedlaethol?
In terms of the data that's been produced through your systems, you mentioned—I think, Barry, it was you who mentioned—earlier that you had had to work with the information commissioner in order to ensure that you were complying with data legislation. Have there been any major data issues that have arisen in terms of storage, confidentiality, and in terms of sharing data with national systems?
Rhaid cael y naratif yn glir ar y cychwyn. Oherwydd, i sôn am ein proses ni i ddechrau, mi oedd ein proses ni—mi oedden ni'n defnyddio data pobl mewn ffordd wahanol i'r hyn roedden ni wedi gwneud cyn hynny; mae hynny'n glir. Felly, yn y bôn, beth roedden ni ei angen wrth gyfeillion yn Hywel Dda oedd ein bod ni yn defnyddio data roedden nhw'n ei gynhyrchu, yn y bôn, trwy anfon y wybodaeth drwy'r system tarian aton ni, a'n bod ni'n hollol glir wedyn ein bod ni'n gwneud gwaith ar eu rhan nhw—gwaith proxy meddygol, a dweud y gwir, ar eu rhan nhw. So, newid ein rôl ni, i bob pwrpas, i rôl fwy meddygol, clinigol ac ati, nag oedd hi o'r blaen. Felly, roedd rhaid inni gael cyfarwyddyd gan ein cyfeillion ni yn Hywel Dda i wneud hynny. Ond beth wnaeth hynny ei wneud oedd 'prompt-io' sgwrs, a dweud y gwir, a bod y cefndir deddfwriaethol a diogelu gwybodaeth yn rhan o'r sgwrs oedd yn digwydd yn genedlaethol hefyd, fel bod hynny'n cael ei ystyried o'r cychwyn cyntaf.
Felly, mi oedden ni'n datrys yn lleol, ond wedyn wrth inni wneud hynny fe ddaeth y datrysiad cenedlaethol, a thrwy hynny ei fod e'n cael ei wthio lawr o Iechyd Cyhoeddus Cymru a Llywodraeth Cymru. Mae hwnna'n golygu i ni fod rhyw fath o presumed consent yn y broses—ein bod ni'n gwneud rhywbeth yn genedlaethol ar eu rhan nhw a gyda nhw. Felly, dŷn ni'n poeni tipyn yn llai nawr ein bod ni'n rhan o'r broses genedlaethol, o ran ein hochr ddefnyddio gwybodaeth, nag oedden ni ar y cychwyn yn ei wneud o ran gwneud hwnna ar ein pen ein hunain.
Getting the narrative clear at the beginning is very important. Talking about our process, first of all, we were using people's data in a way that was different to the way that we'd used data in the past. So, essentially, what we needed from colleagues in Hywel Dda was that we were using the data that they were essentially producing, by sending the information through the tarian system to us, and it was entirely clear that we were then doing work on their behalf—it was proxy medical work. So, it was a change in our role, to all intents and purposes, to a more medical, clinical role than it had been previously. So, we did have to have direction from our colleagues in Hywel Dda in adopting that approach. But what that did was to prompt a conversation, and the legislative background and the data protection issue was part of the conversation that was happening nationally too, so it was taken into account from the very outset.
So, we were resolving this locally, but in so doing the national solution emerged, and then that was pushed down through Public Health Wales and the Welsh Government. That means for us that there is presumed consent within the process—we are doing something nationally on their behalf and with them. So, we are less concerned now that we are part of that national process in terms of data usage than we were at the outset and working alone.
O'n safbwynt ni, cyn i'r system fynd yn fyw ar yr wythfed, mi oedd yna drafodaethau helaeth yn digwydd, ac mi gawson ni ddatrysiad am wythnos trwy ein swyddogion monitro ni yn y gogledd. Mae'n ymwneud â therminoleg: a ydyn nhw'n data users ynteu'n data—mae yna derm arall, ond dwi ddim yn cofio beth ydy o rŵan. Ond mae'r trafodaethau yna yn dal i fynd rhagddynt. Dydy hynny ddim wedi ei ddatrys 100 y cant o ran yr ochr rhannu data, ond dwi'n gobeithio y bydd yn fuan iawn wedi cael ei ddatrys.
From our perspective, before the system went live on the eighth, there were lengthy discussions, and we found a solution for a week through our monitoring officials in north Wales. It involves terminology: whether they are data users or data—there's another term, but I can't quite remember what it is off the top of my head. But those discussions are still ongoing. That issue hasn't been 100 per cent resolved in terms of data sharing, but I do very much hope that it will be very soon.
Diolch. Un cwestiwn olaf gennyf i. Dwi'n cofio pan oedd yna dipyn o chwilfrydedd ynglŷn â beth oedd yn mynd ymlaen yng Ngheredigion. Roedd yna rai yn meddwl, o bosib, 'Maen nhw'n datblygu ap eu hunain, fel maen nhw'n gwneud â'r ap Ynys Wyth yma.' Wrth gwrs, nid dyna oedd yn digwydd—platfform digidol gwahanol i hynny oedd yna. Ydych chi, serch hynny, yn gweld bod yna le i ddefnydd o ap o'r fath sy'n cael ei arbrofi ar bobl yn Lloegr, neu'r un rhyngwladol gan Apple a Google, i redeg ochr yn ochr â'r gwaith caib a rhaw, os liciwch chi, rydyn ni'n ei wneud drwy'r awdurdodau lleol yma yng Nghymru?
Thank you. One final question from me. I remember when there was some enthusiasm as to the approach in Ceredigion. There were some people thinking that they were developing their own app, as they were doing on the Isle of Wight. But that, of course, wasn't the case—it was a very different digital platform. But do you believe that there is scope for the use of a proximity-testing app, of the kind that's being experimented with in England, or the international approach by Apple and Google, to run alongside the spadework that we are doing through our local authorities here Wales?