National Assembly for Wales

Welcome to this Plenary session. Before we begin, I want to set out a few points. This meeting will be held in hybrid format, with some Members in the Senedd Chamber and others joining by video-conference. All Members participating in proceedings of the Senedd, wherever they may be, will be treated equally. A Plenary meeting held using video-conference, in accordance with the Standing Orders of the Welsh Parliament, constitutes Senedd proceedings for the purposes of the Government of Wales Act 2006. Some of the provisions of Standing Order 34 will apply for today's Plenary meeting, and those are noted on your agenda. 

The first item this afternoon is questions to the Minister for Health and Social Services, and the first question is from Sioned Williams. 

Thank you very much. We are working on system reform in dentistry and moving forward collaboratively with the primary care reform programme in 2022, and this includes working in partnership with the dental profession to improve access to, and experience and quality of, dental care. 

Diolch, Weinidog. Swansea bay community health council's new report 'Accessing NHS Dental Care: Getting to the Root of the Problem' paints a damning picture of dental services in the Swansea and Neath Port Talbot areas. It emphasises these issues were present before the pandemic exacerbated them. Patients have had to wait years to see a dentist, many not having been able to get an appointment at all. The report found that 70 per cent of people feel pressure to seek private dental care in order to get an appointment. They can't access NHS dental services, including pregnant women and children. And patients with serious medical issues that require regular check-ups are being denied vital appointments. One patient said, 'My bridge fell out at the beginning of 2020, I'm still without it. It affects my confidence. I can't smile. I can't laugh.' In another case, a man was left to pull his own tooth from his mouth, and we know there are cases reported of this. And I heard similar accounts from hundreds of my constituents in response to a survey I conducted. One patient also told me he'd been automatically de-registered as he hadn't been seen in two years, although he'd been shielding for most of those two years. So, I welcome the Government's recently announced plan to improve dental care, but I'd like to know how the contract reform is going to adequately and urgently address all of the concerns reflected in the report, which are replicated all over Wales, and have been raised by many Members in this Chamber. Is there sufficient funding to increase NHS capacity to end this unjust postcode lottery, and ensure those who cannot afford to pay, or who cannot find an NHS dentist, receive the care they're entitled to?

Diolch yn fawr, Sioned. And you'll be aware that there has been a particular issue in relation to dentistry because of the need for infection control measures to ensure that people remain safe, including patients and the dentists themselves. And that's why we've seen a 50 per cent reduction in the number of people who have been able to access NHS dentistry. We have, of course, put measures in place to try and mitigate this, including substantial investment in helping dentists to allow air flow better in their surgeries. 

I'm sure you'll be pleased to hear that, because of the new dental contract that we've introduced, in Swansea bay health board, 88 per cent of practices have opted in to that new system. So, we are hoping to see a transformation now because of the way that those dental units are counted. So, they were counted as dental units before. Now we'll be moving much more into the area of prevention, and part of the contract will also be about asking new people and making sure that they get to see new people in dentistry. 

We have put in an additional recurrent pot of funding—£2 million. As you'll be aware, what we can't do is to conjure up new dentists overnight. And that's why what we're trying to do is to make sure that we train hygienists and therapists, and I can assure you that there are about 20,000 people who are being seen each in week in Wales. 

Good afternoon, Minister. Minister, it is a worrying fact that many dental practices have struggled to return to normal as we emerge from the pandemic. Routine check-ups are not being offered. People are reluctant to bother their dentists for an appointment because they feel that a check-up might not be seen as important enough. And many people cannot access an adequate out-of-hours service for emergency advice and appointments. A check-up is, however, vital to the patient: problems can be identified earlier and a dentist is qualified to advise on the wider questions of oral health. Can the Minister outline what discussions she has had with the British Dental Association about the capacity of our dental services, and what plans does she have to ensure we have the right number of dentists working in Wales? Thank you.

Thanks very much, Altaf, and I would like to assure you that if dental treatment is urgent or the patient is in pain, it is expected that health boards will have provision in place to provide care quickly. And one of the things that I'm doing at the moment is I'm going through the details of the integrated medium term plans for each of the health boards and I'm making sure that every one of them has a proposal and a plan that are adequate to address the issues in relation to dentistry.

You'll be pleased to hear, I'm sure, that we have recently appointed a new chief dental officer. I'm very aware that this is an issue that is exercising a lot of the public in Wales, and I have now requested that we have monthly meetings to make sure that we get some real pace into the system. We did have a period of time where there wasn't a chief dental official in Wales in post, and so I'm really delighted now to see that we have appointed somebody and that that focus, I hope, will be brought to bear on the system.

We are still in a situation, of course, where aerosol-generating equipment could cause infection and so we do have to understand that there are still restrictions in relation to dentistry that may not be quite the same as in other NHS facilities.

Tackling the backlog of patients is a key priority for this Government. Last month, I launched the planned care recovery plan that sets out our approach to reduce waiting times in Wales so that patients get the care and treatment they deserve, supported by an additional recurrent investment of £170 million.

Thank you, Minister. I have many e-mails in my inbox, as does everyone, I'm sure, about the fact that waiting times are just becoming worryingly long now. I've also had an e-mail from a constituent recently who's a teacher and was involved recently in an accident at work, resulting in a head injury. Due to sickness and head pain, she was told to go to the Grange hospital. She arrived at the Grange hospital at 5 p.m. and left untreated at 5 a.m. the following morning. She told me that she could only describe the scene inside as chaotic: patients clearly unwell; elderly and vulnerable people waiting for over 16 hours for care; wheelchair users could not access the department safely; elderly, ill patients crammed up against toilet doors; dirty plastic cups littered and empty water dispensers; ambulances backed up in the car park unable to move their patients inside. She told me that there was a complete lack of communication in the ED and, at times, a lack of empathy for others. All this with a wait, for most genuinely ill patients, of over 12 to 14 hours.

This cannot ever be acceptable, Minister. My constituent told me that she feels that the system is clearly failing and is now becoming dangerous. The Grange hospital is clearly at breaking point. We know the challenges, but the public are fed-up with excuses. There needs to be an urgent plan and we've got to a point now where we need to be urgently updated in this Chamber regularly as to what has been achieved. The NHS staff in the Grange are working tirelessly in extremely stressful circumstances. They are incredible, but they also need to know that change is happening. This appears to be a hospital fully in crisis, and whilst everyone continues to apologise, no-one is truly listening to measured feedback from the community and, indeed, staff. 

My question—

Question, yes. Thank you.

So, Minister, what steps is this Government taking to stop this from becoming a full-blown crisis in my region, to cut extortionate waiting times, and can you commit to updating the Senedd on progress being made, going forward?

Well, thanks very much, and I'm very aware of the incredible pressure, in particular, that patients are seeing in our emergency departments. We are clearly in a situation where those pressures are boiling over at some points, and one of the things that I've been doing is making impromptu visits to some of our accident and emergency departments just to see for myself the pressure that they're under. I've already been to visit the Heath, Withybush and Morriston, where I was able to speak to people on the front line—so, not getting a filtered view of what's going on. And I think what is clear to me is that there is a massive increase in demand. And if you just look at what has happened in the Grange, we've seen a 14 per cent increase in daily attendance compared to March. That's just this month. So, that is a significant increase. So, obviously, when we're still in a situation where, let's face it, the Office for National Statistics figures are telling us that one in 25 people have still got COVID and are suffering from it, that affects the staff that are working in those emergency departments. So, that explains to some extent why the pressures is so great—because we are still living with COVID. But I can assure you that we do have plans in place. We have urgent plans, we have a six-priority-point plan, and I'm very happy to send you a copy of that if you'd like to see it, where we set out and make sure that people have an understanding that what we're talking about here is a whole-system approach that we need to address. And we will be discussing the planned care issue later on this afternoon, and obviously you're welcome to listen in on that debate.

Questions now from party spokespeople. The Conservative spokesperson first of all, and these questions are to be answered by the Deputy Minister for Mental Health and Well-being. James Evans.

Diolch, Llywydd. Deputy Minister, this week is Mental Health Awareness Week, and I'm sure that you'd like to join me and others in this Chamber in recognising the importance of this week of raising the profiles of those struggling with their mental health, and to help those to access the support that they need from organisations whom they need to hear so we don't have people across Wales suffering in silence. Minister, can you confirm what support has the Government given to third sector organisations to help them to promote and raise awareness of this week, and what action is your Government taking to tackle this year's theme of loneliness?

Thank you, James, for that question. And I'm very pleased as well to place on record my recognition of the fact that this is Mental Health Awareness Week, and I'm aware that there are lots and lots of activities going on, and efforts, to raise awareness. You'll be aware that we provide funding to quite a number of third sector organisations—some directly, others through the funding that we give to health boards. You're probably also aware that we announced further funding for Time to Change Wales a few months ago. We are now the only part of the UK funding Time to Change. So, we are investing significant sums of money—it was £1.4 million that we announced—to enable them to continue their really important anti-stigma work. And of course, we've all got a role to play in raising mental health awareness and encouraging people to talk about their mental health and to come forward for help. And our whole approach in Wales has been based on ensuring that people can get that help really quickly, without need for referral through things like CALL helpline, through SilverCloud, and to ensure that that help is available at the earliest possible opportunity.

Diolch, Deputy Minister. Body dysmorphia is a huge problem facing many people across the country. Many young people cite the problem of the consistent bombardment on social media of highly edited images and filtering, giving many young people a warped perception of what is reality. The online safety and harms Bill proposed by the UK Government will hopefully go some way to addressing these issues. I know that digital is not a devolved competency, but all the support services for those young people are. So, can you confirm what support the Welsh Government is giving to young people who are struggling with body dysmorphia, and whether the Welsh Government is supporting the online safety and harms Bill that is progressing through the UK Parliament?

Thank you, James. Clearly, the online safety and harms Bill is an important vehicle to try and tackle some of the problems that you've alluded to, which I know you've raised before in this Chamber. You are right in that digital is not devolved to us, but there are discussions that take place between officials in Welsh Government and officials in Westminster, and I'm in particular looking at the opportunities that we can build on that Bill to enhance our work around things like suicide prevention. I think it's also important to recognise that the Welsh Government has invested considerable resources in ensuring that young people can access support in a way that's suitable for them—for instance, our young person's mental health toolkit, which has recently been revised, which is enabling young people to access support in the way that suits them, doing it online. We're also looking at bystander interventions with things like bullying, and all our responses are geared towards making sure that we are supporting young people where they need to be supported, and, of course, our new curriculum has a really important role to play in that. We've got a health and well-being area of learning in the curriculum that is going to be embedded across the whole curriculum, alongside the work that we're doing to have relationships and sexuality education for children and young people, and I think it's really important that those issues are tackled as a part of that across the whole curriculum, and hopefully from a younger age as well. But, as you say, it's not devolved, what's going on in social media, but we all have a role to play in supporting young people and making sure that they can access the support, so that they know that the things that they see on social media are not real things.

Definitely, and thank you for your answer, Deputy Minister. It's very important that you work very closely with the Minister for education around that to make sure that our young people are educated in schools around that. And you talked about accessing support, and many of those young people who are struggling need the appropriate support through their troubles, but a lot of that, Minister, is lacking across Wales. Many young people cannot access initial child and adolescent mental health services assessments: 60 per cent of children wanting specialist CAMHS pathways are waiting over four weeks for an initial assessment; it's nearly doubled since March 2020. And I know you and I both agree that that's just not good enough. As someone recently told me, Deputy Minister, 'You need to be on the verge of doing something extremely silly to get the support you need.' I know that's something you don't want to hear, and that's something certainly I don't want to hear. So, can you, please, outline how you're going to work to speed up CAMHS referrals, and how you are going to ensure that, when a young person is struggling and they do present in those early stages of their mental health problems, they get the support they need and they're not left until they hit the crisis point? Diolch, Llywydd. 

Thank you, James. And what you've said is really important, because obviously we don't want young people's problems to escalate. That's why our whole emphasis in Welsh Government is on early intervention and making sure that children and young people have the support at an early opportunity, preferably in the environments where they live their lives, such as school. So, we've got a whole-school approach, which we're continuing to invest very substantial sums of money in, and which myself and the education Minister are driving forward. We're taking forward our NEST framework, which is our early help and enhanced support mechanism, across Wales. But we also recognise that, for children who need specialist support, they need to have quick access to specialist CAMHS.

Clearly, the pandemic has had an impact on CAMHS waiting times, and we are aware of that and working really closely with health boards to improve waiting times. I should say that, as I highlighted in my last questions, four fifths of the children and young people who are waiting for CAMHS appointments in Wales are in Cardiff and the Vale. So, that is distorting the situation slightly. But, just to reassure you, we've announced, out of the £50 million extra that we secured for mental health services in the budget, there is £10 million of service improvement funding going out to the health boards. All of them have been told that improving CAMHS waiting times is a priority and they'll all be expected to set out their proposals for driving down those waiting times. 

In addition to that, we've asked the delivery unit to do a review of specialist CAMHS in Wales, which will look at the whole piece of specialist CAMHS and, in particular, look at the data as well, because what we're finding is that we're not measuring the same things. Different health boards have different structures, and it's really important that we know exactly what is happening so that we can have a consistent approach in Wales. But just to assure you that making sure that things don't have to reach crisis point is a top priority for me. 

Questions now from the Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Thank you, Llywydd. It's Nurses Day tomorrow, and I'd like to thank nurses in all parts of Wales for their care and dedication. But I want to draw the Minister's attention to concerns that have been raised with me by a nurse, who tells me that they represent a significant number of nursing staff in Ysbyty Gwynedd. I was saddened to hear the nurse describing the working environment, describing bullying, pressure and unreasonably long working hours, a poor relationship with matrons and senior managers; they say that morale is low, high numbers are leaving—out of 20 fully trained nurses in one department, I was told that five had left in the past three months. One specific concern is that nurses are moved often from their specialist areas to other departments, and that places a strain on nurses, who are afraid of making mistakes, and they're concerned that this is contrary to the guidance of the Nursing and Midwifery Council. Why are they moving? Because agency nurses are refusing to move. There's clearly too much dependence on agency nurses. Minister, I'll write to you on this, and to the health board. Why am I raising this here in the first instance? Well, to try to give confidence to the nurses that their concerns will be taken seriously. They don't have any confidence in the whistleblowing process. Can I have an assurance, therefore, that the Minister will be following up in detail the way that the health board will be responding to these concerns?

Thank you very much, and I'm very sorry to hear that. Clearly, that's a cause for concern. I did meet with union members in north Wales recently—members of the RCN and Unison—and this wasn't an issue that they raised with me. So, clearly, we must ensure that there are other routes by which they can raise such concerns. I do think it's important that everyone can be open. If we can't be open, we can't improve the situation. Certainly, I would be willing to speak to the chair of the health board to see if there is anything that we can do so that they feel that they can be more confident in raising those kinds of issues. We are doing a great deal, as you know, to try and recruit nurses, and have seen an increase of 76 per cent in the number of nurses that we train. But there's no point doing that if we're losing people from the other side of the system. So, certainly, I will raise these concerns with the chair.

I appreciate that. This nurse certainly was concerned about the staffing levels in general, and clearly the over-dependency on agency staff. I was told that the majority of nurses that came from Spain a few years ago, after a recruitment campaign, have returned to Spain. There are major gaps in the workforce. The Minister, I know, will have received a copy of the latest report by the Royal College of Nursing on staffing levels. Two of the recommendations in this: (1) that there is a need for an international recruitment strategy, which echoes what this nurse said; and also that we need to develop a retention strategy for staff, and that has to be a priority. But, to the first recommendation I turn with a simple question: the royal college says that the Welsh Government, during this current parliamentary term, needs to extend section 25B of the Nurse Staffing Levels (Wales) Act 2016 to community nursing and mental health in-patient wards. The Minister knows that this is a call that has been heard time and time again; we know that staffing levels that are too low endanger the well-being of patients. Can we have that promise, please?

Thank you very much. Certainly, Brexit hasn't assisted the situation in terms of the number of nurses working in our communities and in our hospitals. Of course, we would prefer to see people working full time for the NHS and not working for agencies, so we do have to continually strive to improve that situation, and the way to do that is to ensure that there are more people within the NHS. But the trouble is, of course, when people fall ill—and many nurses are becoming ill because of COVID—then you do have to call on agency nurses too. I'm sure you'll be pleased to hear that there will be an announcement tomorrow on international nurse recruitment. Certainly, I am highly aware of the RCN's demands, and we have regular discussions with them, and this is an issue that is raised on all occasions I meet with them. Clearly, we've made it clear to them what we think needs to be done in this area before we move to the next phase.

Thanks very much. Tackling the backlog of patients is a key priority for this Government. Last month, I launched the planned care recovery plan, which sets out our approach to reducing waiting times in Wales so that patients get the care and treatment they deserve, supported by an additional recurrent investment of £170 million.

Thank you for that answer, Minister. I've been contacted by a resident who's been waiting for an orthopaedic consultant for nearly two years, during which time their arthritis has moved from moderate to severe. The resident is understandably concerned that longer waiting times for elective surgery will mean their condition will continue to worsen. They've received conflicting advice from their health board as to whether the NHS in Wales is still offering operations through the S2 certificate. Would the Minister be able to clarify for the resident whether the S2 certificate is still an available option for residents in Wales, and reassure them that all steps necessary are being taken to improve waiting times for elective surgery? Thank you.

Thanks very much. I'm very troubled to hear that yet another person is suffering and is in difficulty because of the waiting lists. Certainly, I'm very concerned about, in particular, people who I know are waiting for hip operations. I know somebody in this Chamber whose mother has recently undergone a hip replacement and was certainly in a lot of pain until that point. So, I'm very keen to get through this backlog as soon as possible. Obviously, I can't talk about any individual cases, but, if you would like to write to me about this case, I'll certainly look into it.

We have published a planned care recovery plan, and there are some very key targets that we're not hoping, but we are expecting, health boards to meet. So, I'm having regular meetings now with my officials just to make sure that we hold health boards' feet to the fire in terms of what we expect for delivery, making sure that they're keeping on track.

Just in relation to the S2 certificate, patients in Wales can still apply to their local health board for planned treatment in the EU and in Switzerland under the S2 route, but obviously they have to get permission from their health board before, if they expect the health board to underwrite that for them. So, there is a process to go through, and I'm very happy to write to you about the detail of that if that would be helpful.FootnoteLink

Minister, I'd like to welcome your comments today in terms of some of the additional investment taking place to see waiting times reduce, and you referred to your planned care recovery plan as well, which I would hope would be beneficial to some of my residents in north Wales. Certainly, this is very timely, because we do continue to see an administration presiding over some of the worst records we've seen in our health service, with one in five people in Wales on a waiting list, compared to one in nine across the border, and one in four people expecting to wait over a year for treatment, compared to one in 20 across the border. Again, what this does is it feeds into a lack of trust, perhaps, from many of my residents, in being able to see targets being achieved, because so many targets in the past have not been achieved. Of course, behind each of those statistics I just quickly read out is a person in pain who needs support quickly. Carolyn Thomas referred to a case from her, and many of us have very similar cases in our inboxes every day. So, Minister, what assurances can I give to my constituents today that are waiting on those waiting lists that those targets will be met, and that that trust can be built back up so they can have that elective surgery met as quickly as possible?

Thanks very much. We developed the planned care recovery plan with clinicians and with the health boards. They are stretching but realistic targets, and we'll be making sure that they keep to those. I would like to correct you on one thing, and that is this constant refrain that 20 per cent of the population of Wales is waiting for treatment. Well, that is the number of people on pathways, and there are sometimes people who are on multiple pathways at the same time. I think the other thing, when you're comparing England and Wales, is it's really important to understand that we're not comparing apples and pears. We try and be transparent in Wales in the way that we count, so we count, for example, waits for diagnostic treatments, and there are a huge number of people waiting for diagnostic treatments—in fact, 60 per cent of the people waiting are waiting for their first out-patient appointment. Now, we've got a target on that. We're hoping that nobody will have to wait longer than a year for their first out-patient appointment by the end of this year. So, that is the assurance you can give. And the other assurance, of course, is that we're doing everything we can to increase capacity, to prioritise diagnostics and treatment, and we are transforming the way that we provide planned care and also helping to make sure that the patient is going to be informed and supported while they wait. 

Question 4 is to be answered by the Deputy Minister for Mental Health and Well-being. John Griffiths.

Action to target strong public health messaging to Wales’s black, Asian and minority ethnic communities is embedded across our public health prevention work, to help people maintain a healthy weight, stop smoking, and support their mental well-being. We are committed to tackling the health inequalities that we know these communities experience.

Thank you for that, Minister. During the pandemic, I think it became ever more clear that there are very considerable health inequalities within our ethnic minority communities. There were issues with getting messaging across with vaccination rates and a host of economic and social conditions. And thankfully, Minister, Muslim Doctors Cymru stepped forward—and a constituent of mine, Dr Kasim Ramzan, was part of that—to help get messages across in community languages, to raise awareness, to hold vaccination clinics in mosques, to hold Zoom meetings, to link relevant professionals together. They did a tremendous amount of work, Minister, as I know you're aware. Now that we're hopefully coming through the pandemic, I'd like your reassurance, really, that Welsh Government will continue to work with Muslim Doctors Cymru to address the ongoing health inequalities in our black, Asian and minority ethnic communities, because there's still a lot of work to do.

Thank you very much, John, for that question. As you've highlighted, the pandemic laid bare, really, the health inequalities faced by black and minority ethnic communities, and that's why the First Minister established the group to look at those health inequalities, which are a priority for us. I'm really grateful to Muslim Doctors Cymru for the work that they did. I know that they helped us with webinars, that they did Q&As with the community and have been really, really active. So, I'm very happy to place on record my thanks to them for what they're doing.

You'll be aware that, as part of our COVID-19 response, Welsh Government set up a network of 11 community outreach workers to try to tackle the issues around engagement in black, Asian and minority ethnic communities. And, although the focus of test, trace, protect is now changing, those community outreach workers will be continuing to work with ethnic minority communities to try to tackle those health inequalities. And I think it's really important, going forward, that when we do tackle those health inequalities, that we are doing that in a co-produced way with the very communities that we are trying to reach.

I'd like to thank the Member for Newport East for raising this really important question here in the Chamber today. Deputy Minister, it was no secret, as the Member for Newport East has said, that people, particularly from ethnic minority backgrounds, faced severe health inequalities during COVID-19, and that was quite prevalent and at a much higher rate for those people from the Bengali, Indian and Pakistani ethnic groups, who are more likely to live in multi-generational homes with high exposure to the virus due to the nature of their jobs and also their lifestyle.

A study by the National Institute for Health and Care Research found that when it comes to understanding public health messages, people from ethnic minority groups face specific barriers that prevented them from engaging in behaviour that protected them from the virus. Minister, prior to being elected, my day job was actually working for a PR agency called Mediareach, which was hired by the UK Government, and my role was to oversee the creation and production of 20 advertisements in more than 15 languages, such as Urdu, Hindi, Punjabi, Mandarin, Arabic—these are just to name a few. Now, all of these were aired on numerous various Asian channels, or ethnic minority channels, with known faces and celebrities representing these channels. And, as much as I appreciate the work of Dr Kasim Ramzan from Newport East, as well as other members of the ethnic minority communities who did everything they could, the three UK Government campaigns that were spearheaded went down incredibly well with the ethnic minorities across the spectrum. So, as health is a devolved matter here in Wales, do you agree, Minister, that there is a need to develop and provide access to clear, accurate, targeted and visible educational materials for the ethnic minority groups that live here in Wales? Thank you.

Thank you, Natasha, for that question, and absolutely I agree that we need to have tailored messages. Our engagement through the pandemic was very proactive in that regard. We contracted a specialist ethnic minority engagement agency. Materials for specific communities were co-produced with individuals from those communities, with quote card images of community leaders explaining about things like vaccination. We've already discussed the work of Muslim Doctors Cymru. We're also committed to doing this work in a range of languages, using a multilingual street team, key documents and information translated into more than 35 languages. And all focus group activity that we undertook has contained a group specifically from ethnic minority communities. So, this is an issue that we are taking very seriously, and we're doing that across the public health arena, because we recognise there are particular challenges across the board with things like promoting healthy weight, mental health, keeping people in employment, and we are very committed to making sure that we do reach the communities that we really do need to reach.

We don't hold the data on percentage of contacts that took place on a face-to-face basis. Throughout the pandemic, most health visitor contacts took place using telemedicine to help reduce transmission rates. Data on the Healthy Child Wales programme is published quarterly, most recently for the period July to September 2021.

Last week was Perinatal Mental Health Awareness Week. Untreated perinatal mental health problems can have a devastating impact on women, their families and children, and remains the leading cause of maternal death in the first postnatal year. One in five mums and one in 10 dads are affected by perinatal mental health problems, and this has unfortunately increased as a result of COVID. During the perinatal period, health visitors are the ones uniquely placed to identify women experiencing maternal mental health problems and infants not reaching their developmental milestones. They also ensure that women and their families receive the care they need at the earliest opportunity. Given this, what progress has the Welsh Government made in reaching a position where we have a specialist health visitor in perinatal and infant mental health in each health board area, and what progress has been made in appointing maternity and neonatal champions across Wales?

Diolch yn fawr, Buffy. I'm sure you'll be aware that the Deputy Minister for mental health has been absolutely committed to this issue, certainly when she was Chair of the committee before, and obviously now is responsible for making sure that that's enacted in practice. I think she visited the new Tonna centre that was opened only very recently, the first of its kind in Wales where we can give that perinatal mental health support that people are looking for. Now, that continues to be a priority for the Welsh Government, and I'm sure that the—. I think the Deputy Minister will be writing to the Children, Young People and Education Committee on an update against the recommendations of that committee and that inquiry that the committee had into perinatal mental health.

And in relation to the maternity and neonatal safety support programme, we're finalising agreements at the moment with Improvement Cymru in order to recruit into the programme posts at national and health board levels to commence the work on the diagnostic phase of that programme. So, there's more to come.

Health Minister, obviously, one of the key things about community support from the health profession is to have the right quality of staff and quantity of staff in the community. It's International Nurses Day tomorrow, as I understand it, and one of the measures that a previous Welsh Government took on board was that it brought forward the Nurse Staffing Levels (Wales) Act 2016 that is specific to certain hospital ward settings. Are you minded to support the extension of that Act into the community, so that on issues raised by the Member for the Rhondda we can have confidence that community support staff, and nurses in particular, are adequately resourced and in place to advise families when they face these critical positions when a newborn baby is born into the family?

Thanks very much. Well, we were really pleased that we brought in a safe level of nursing staffing in Wales—the first in the UK to do that—and we're very pleased that that is being assessed and being considered at the moment. Obviously, then, we are looking to see what more we need to do in this space. Now, I have regular discussions with the Royal College of Nursing, and they come up with this on a regular basis; it's always top of their agenda. It is more complex to ensure that this is delivered within the community, because how do you assess that? A community is not the same thing as a ward, so there are very different things to measure. It's much more complex a situation to assess what a safe level of nursing staffing would be. So, we are in the process of further discussions all the time on this issue, but it's far more complex than it was in relation to that, compared to introducing it in a hospital situation.

We are developing an all-Wales framework to support local action to increase the use of social prescribing. My officials are engaging with a range of stakeholders on the proposed model, which will be published for consultation next month.

Thank you very much, Deputy Minister, and I'm pleased to hear you referring to the framework, which of course is part of the programme for government. I'm sure many of us could refer to projects that we're aware of in our regions and constituencies that show the value of social prescribing in terms of the health and well-being of those that we represent, and not just those who feel isolated, as is referred to in the programme for government. But clearly, it's not just health boards that are involved here. Organisations such as the Welsh National Opera, National Museum Wales, Theatr Clwyd and so on, have excellent projects and partnerships in this area. So, can I ask you, as you develop this framework, how central will the bodies outwith the health sector, such as cultural bodies, be in delivering the full potential of social prescribing in all parts of Wales?

Thank you very much, Heledd, for that supplementary. As you've highlighted, social prescribing is a really good way of linking people to community-based, non-clinical support, and that needs to be a holistic approach that recognises that people's health is determined by a range of social, economic and environmental factors, and as you've highlighted, that's not just about tackling loneliness. So, as part of the framework that we are developing, we are looking to set out what an accepted Welsh model of social prescribing would look like, but won't be dictating how it is delivered in different communities. And the task and finish group on social prescribing, which I chair, is working with primary care, health boards, the third sector, and, I'm pleased to say, cultural and sporting sectors, to develop that national framework, and that will include, then, an agreed model of social prescribing for Wales and identify several core themes where we in Welsh Government and our partners can take action to support its implementation. But just to be really clear, I don't think that that framework should dictate how that looks in different communities, because all communities are different, and it will be about drawing on the strengths and the needs of particular communities, but making sure that there is a consistently good offer throughout Wales.

I have regular meetings with the chair and vice-chair of the health board, and during these meetings we discuss access to GP services. My officials also meet with health board, GP and patient representatives to discuss GP services. I know that GPs are responding to increasing patient demand, despite higher absence rates.

Thank you very much, Minister. Now, last week, plans were confirmed to turn the Corporation Road surgery in Grangetown into residential properties, unless a doctor can be found to take over that practice. With the closure of that surgery and others, over 1,200 additional people have joined the surgery in Dinas Powys. I know that you've announced an additional £10 million to train the medical workforce in Wales, but according to the BMA, that will only sustain that new number of 160 every year, not the 200 in addition that we need every year to meet the needs at present. So, how is the Welsh Government going to increase the number of GPs in Wales? Thank you.

We are monitoring the implementation of the Act through a range of mechanisms. We are collecting data as part of the performance and improvement framework and undertaking an evaluation of the Act. I will be publishing the final evaluation report later this year.

The Social Services and Well-being (Wales) Act 2014 places a specific duty on local authorities to promote the involvement of people in the design and delivery of care and support services. However, almost daily, I receive cases where public bodies have dictated how they will communicate with autistic and neurodiverse people and their families and carers, regardless of their individual communication and processing needs.

I also note that the report following February's Wales carers summit states that the key themes covered the need for general improvements in carers accessing and benefiting from their rights within the social services and well-being Act, and that in response to a statement, carers have told us they're often ignored or seen as unimportant by health and social care professionals, despite providing the majority of care in Wales and having rights under the Act. The chief executive of Social Care Wales recognised that the implementation of the Act is challenging and said a programme of work is also under way on strength-based approaches and person-centred planning to try and embed the aspirations of the Act.

How and when in practice will the Welsh Government therefore begin monitoring the Act's implementation by public bodies accordingly, to ensure that the Act's aspirations are embedded within this, eight years after the voice of the people concerned was supposed to be at the centre of this?

I thank Mark Isherwood for that very important question. As I said in my response, we have commissioned a large-scale evaluation of the 2014 Act carried out by the University of South Wales. There have already been several reports about the process and the experience of implementation, and I think the conclusion from all the work that's been done is that the principles and what's behind the Act are absolutely right. Everybody agrees that we've got the right legislation, and that the implementation is going on effectively.

But I think, as Mark Isherwood highlighted, in terms of the implementation of the Act and people's experiences on the ground, we still have a way to go, and I think what we'd have to say is that full implementation of the Act is not yet complete. So, the next steps and recommendations for improvement will be provided in the final impact report, and that will be published towards the end of this year.

We are monitoring the effectiveness of the Act very carefully, as are Care Inspectorate Wales, Social Care Wales and Audit Wales, and we absolutely accept that the experience of carers, for example, on the ground, is not yet where it should be. However, progress is being made. Incidentally, just before this Senedd meeting, I was very pleased to meet the UK chief executive of Carers Trust, who has come to visit Wales, who was very complimentary about the efforts that we are making to try to help unpaid carers in Wales, and is very keen to work with us as a Government.

I thank the two Deputy Ministers and the Minister for those responses in that session.

The next item, therefore, is questions to the Minister for Economy, and the first question is from Laura Anne Jones.

First question. To the Minister of the economy. Any other hints you need?

Thank you for the question. I understand, Llywydd, that you have given permission for questions 1 and 8 to be grouped.

The draft regional economic framework highlights how the Welsh Government and its partners will continue to attract major investment to the Newport area. In addition, my officials work closely with both Newport council and the capital region to provide the infrastructure and support to businesses in order to further develop the economy of Newport.

Thank you, Minister. The city of Newport has been crying out for inward investment now for far too long. Sadly, under years of Labour mismanagement, they have reigned over a period of stagnation for the area. Only now, with the shared prosperity fund, the community ownership fund, and others, are places like Newport getting a look in. Whether it be a free port or redevelopment of the Newport river barrage, there's a whole host of fresh ideas, being put forward recently by the Newport Conservatives, that are waiting to be developed and made into a reality to attract economic investment into Newport and create those well-paid jobs that the people in our city, the Member of Newport over there, are crying out for. And for years they've been crying out for it. [Interruption.] If the Member can sit there and say that the city of Newport has the investment it needs, that the city centre is thriving, that there are numerous jobs for everyone in the city, I'd be very welcome to hear it, because it's not the case. That would be lies. The city is crying out for inward investment, and any sort of investment. It's often a city left out. You concentrate on Cardiff, you concentrate on Swansea, but Newport is always going without. What, Minister, are you doing to ensure that the people of Newport are looked after and it gets the investment that it needs?

I have a very good and constructive relationship with the newly re-elected leader of the council of Newport, Jane Mudd, leading the Welsh Labour team to victory with the endorsement of the people of Newport. And, indeed, they rejected a range of the interesting and yet wholly unfunded and unachievable suggestions in the Welsh Conservative manifesto, including the barrage, of course, which was a proposal many years ago, and actually rejected by the then UK Conservative administration.

I do think that Welsh Conservatives really need to think long and hard before they celebrate the shared prosperity fund. It is a reduction in funding to Wales of more than £1 billion. It is staggering that you continue to come to this place and claim that it should be a cause of celebration. We have lost £1 billion in a straightforward breach of a manifesto pledge. And to demand that we make up the deliberate undermining of that fund and what that could do for the economy of not just Newport but across wider areas of Wales, I think, really does speak volumes about where the Tories are. In contrast, there is a level of ambition and renewal led by Newport council, in partnership with colleagues across the region, and, indeed, the Welsh Government.

When it comes to major investment, of course, it's public that Microsoft are investing in Newport. We have high hopes for further investment and progress with the semiconductor cluster, which is unique not just within the UK, but on a global level. I think that the prospects for Newport are good, and I look forward to working with elected Members in Newport, including, of course, Councillor Jane Mudd.

Question—. Jayne Bryant, I apologise. Question—. No, not a question. Jayne Bryant. Focus, Elin. Jayne Bryant.

Diolch, Llywydd. In Newport, we've just seen Europe's biggest indoor market regeneration project, led by Simon Baston of LoftCo, a grade II listed building that first opened in 1854, and which is, once again, thriving in its new lease of life. Alongside other city centre developments, such as the Chartist Tower's new Mercure hotel, which is due to open very shortly, the old Royal Mail sorting office, the market arcade, and a new-build leisure centre on the way, there's really a lot to look forward to. These are all exciting projects led by a Labour council—a Labour council that understands that a reliance on retail alone can no longer be the only way forward, and a Labour council that has just been unanimously re-elected. Newport is proud of our rich cultural, arts and sports scene, and events like the Ffoto gallery's exhibition on Saturday, with renowned photographer David Hurn, helped to bring people into our city centre. I can assure all Members that, as someone who was in the city centre, I could see that it was thriving. Minister, what is the Welsh Government doing to build on and support the current plans of reinvigorating Newport city centre, and how can we tap into the economic benefits through improving Newport's unique cultural and historical offer?

I've visited a range of the projects that Jayne Bryant has mentioned. Indeed, it was just a few weeks ago that I was with Councillor Mudd and Jayne Bryant in the indoor market, and it's a fantastic new offer—really full and more to come. I indeed look forward to the Member opening her own office as part of that development as well. I think that there are good reasons to be positive about the future for Newport, not just the music scene that we visited and we've supported through the pandemic to survive, but obviously, there is a really positive creative media scene around Newport as well. Of course, one of the stars of Sex Education is going to be the new Doctor Who, and I'm very much looking forward to seeing him become the new doctor.

But more about Newport. I think we have lots of plans. I'm thinking about the money that the Welsh Government is putting in around the transporter bridge and a new visitor centre, I'm thinking about the commitment and the partnership with the council on new hotel developments, and further work to further develop and reinvigorate the city centre. There's a challenge that the council recognises. One of the strengths that I think Newport has is its built environment and lots of the history around that, to give a unique feel to what Newport city centre will look like in the future. I look forward to working with the Member and Newport council to do just that. 

I thank you for the question. As the Member will know, credit unions are the lead responsibility of the Minister for Social Justice. The Welsh Government has invested £0.5 million annually in credit unions. During the pandemic, we provided £2 million of capital funding to ensure that credit unions could continue to support the financially vulnerable. Since December of last year, we have provided an additional £680,000 to help with marketing, expand membership and increase lending.

I thank the Minister for that response. As a Member elected for the Co-operative Party, I thought that you would be particularly interested in credit unions. But, there is an economic purpose to the question too. Credit unions have huge potential in turning around the Welsh economy. Already, they have almost 80,000 members here in Wales, lending £23 million per annum. But this is nowhere near the situation in Ireland, where 61 per cent of the population are members of credit unions. As a result, in Ireland, they can use the power of credit unions to boost the economy. There, the credit union alliance has contributed billions of euros to help the Government build thousands of homes, ensuring jobs in the industry for six years. So, do you believe that credit unions have a role to play in boosting our economy? And what steps can the Government take to ensure that they do play a more central role in developing the Welsh economy?

I should say that I'm a member of the Cardiff and Vale Credit Union myself, as well as being a proud Welsh Labour and Co-op Member. I've previously had ministerial responsibility for credit unions, and they do provide additional access to financial services for vulnerable individuals and families, but more than that, they also provide facilities for businesses too. They're part of the infrastructure that we have, but it's not as well developed or as embedded as in Ireland, where they are a mainstream part of normal financial services. You can expect, in most towns, to find credit unions with offices and facilities though the Republic, a position I know well from the other side of my family.

I do think, though, that part of our challenge is how we continue to support credit unions with the mission to help provide financial services to people who are often excluded from traditional banking, alongside what we're doing in creating a new community bank to make sure that there are viable lines of credit for individual community and business use. That's what this Government is committed to, and I'm sure that the Minister for Social Justice will be more than happy to update the Chamber on the work that we are doing to do just that.

Questions now from the party spokespeople. Questions from the Conservative spokesperson, to be answered by the Deputy Minister for arts and sport, and to be asked by Tom Giffard.

Diolch, Llywydd. Good afternoon to you, Deputy Minister. I wanted to start by drawing your attention to yesterday's comments by former Welsh Rugby Union chief executive, David Moffett, who said in an interview with the BBC that Welsh rugby was a laughing stock. He's also the man responsible for the regionalisation of the rugby structure in Wales and also said that the concept had not worked, and he called for one of the four rugby regions in Wales to be cut, which obviously mirrors a report commissioned by the professional rugby board, where one of the recommendations was that a region be cut as well. I understand the next meeting of the PRB is set to be held today, where that report is to be considered. So, I wonder what discussions you've had with the WRU in this area. Do you think regionalisation of rugby in Wales has been a success? Can Wales sustain four rugby teams and, if so, what steps are you taking to ensure that that model can be successful going forward?

Can I thank Tom Giffard for that question? Certainly we're aware of the reports in the press that the WRU is exploring options for a change in their structure. You'll appreciate that I and my officials meet with the WRU on a fairly regular basis and one of the things that we do talk to them about is the ongoing financial sustainability of the WRU and the regions. But as you've already said, the reports in the press are based on an independent report commissioned by the PRB and it's not yet been considered by the PRB or the WRU. So, it's purely a matter for the WRU, as the governing body for the game, to work with the PRB and make those decisions for the benefit of the game in Wales.

As you know, we have provided a significant loan to the WRU to help manage the impact of COVID and to support our regional teams, and any discussions around changes in the structure or the number of the regions won't affect that arrangement. But I would certainly want to have further discussions with the WRU, once they make their decisions and once they've considered that report, about the future financial viability of the regions, which is so important to the future of the game in Wales.

Thank you, Deputy Minister, for that answer. Turning to another topic, since the last time you and I did spokespersons' questions together, we've seen the welcome news of a new appointment of the chief executive of the National Library of Wales, with Ashok Ahir taking up the new role. And as part of that process, he came before the Culture, Communications, Welsh Language, Sport and International Relations Committee, of which I'm a member, for a pre-appointment hearing, and I'm pleased to say I endorsed him to that new position. However, when asked by my colleague Alun Davies about the future financial stability of the library, he said that whilst he recognised that public bodies needed to look after their own finances, he also said, and I quote:

'you can always expect the Welsh Treasury...to bail you out from time to time'.

Is he right?

Sorry, I didn't catch the last bit of your question. Sorry.

He said:

'you can always expect the Welsh Treasury...to bail you out from time to time'.

Is he right?

Well, you know—. Bail him out? I mean, what we want to do is ensure the sustainability of our national organisations, our cultural organisations, and one of the things that we've committed to in the co-operation agreement with Plaid is that we will do just that. The national library is one of those organisations that we want to ensure will be sustainable going forward. So, I don't look at it as bailing anybody out. What we are looking to do is to work with all of our national sponsored bodies and governing bodies to ensure that they are financially sustainable going forward. And our investment in the budget over the next three years gives a clear indication that we propose to do that and intend to do that with the national library.

Thank you, Deputy Minister. I agree that it's really important that these institutions are financially solvent, but it is worrying that that might be the attitude in some of these organisations, and that's probably something that comes from you, as the Deputy Minister, to bring in that change of culture.

Finally, turning to another institution for which you're responsible, I wanted to ask about the ongoing situation with Amgueddfa Cymru. Two months ago, WalesOnline reported there was a significant rift at the heart of its senior management team. The relationship between the president and director general of the organisation was reported as being at rock bottom and it was having a real impact on the ability of Amgueddfa Cymru to function properly, with the auditor general noting significant concerns about it too in their financial report. But since the publication of that article two months ago, I've seen no clarification from the organisation that any of the claims are untrue and there hasn't been a written or oral statement from you, as the Minister responsible. Why hasn't that happened? And surely you must agree with me that this is a situation that requires your intervention.

Can I just assure the Member that I am fully aware of what is going on in Amgueddfa Cymru and that I'm having regular discussions with officials and with the museum itself? However, what you would also appreciate is that it wouldn't be appropriate for me to bring to the floor of this Senedd internal staffing issues that are currently being considered. There are various legal processes in place and there are internal processes that are being pursued. And whilst those are ongoing, it would not be appropriate for me to bring that to the floor of the Senedd or to make any statement, but I will do in due course when those issues are resolved.

In terms of the wider governance issues of Amgueddfa Cymru, then we are working closely with them to determine the scope of the upcoming tailored review, which was identified as being necessary by the auditor general. And when I have the proposals finalised for that, I will be bringing that to the floor of the Senedd for your information, and that should be done in the summer at the latest.

Plaid Cymru spokesperson now, Heledd Fychan.

Diolch, Llywydd. A year ago, shortly following my election to the Senedd, and your appointment to your role, I asked how you would ensure a more central role for the arts and culture in the Government of the sixth Senedd, as compared to the fourth and fifth Senedd, and how you planned to tackle the underinvestment that has been seen for over a decade. I'm sure you will recall that I thought, and still do, that your portfolio merits a ministerial post, not just a Deputy Minister post. You responded by noting that you would work alongside the economy Minister to make sure the cultural sector was adequately funded, and that the cultural sector plays a key part in economic recovery. However, since then, I believe that we have seen a sidelining of the cultural portfolio and the cultural sector in Wales by Welsh Government, despite your personal effort. For example, since the Senedd election in 2021, up to 6 May this year, there have been only 46 arts, culture and sport announcements from Welsh Government, of which only two were orally delivered in this Chamber—the fewest of all portfolios, according to an analysis of all announcements and statements. Why is this?

First of all, Heledd, thank you for those questions. And I would say that I'm not 'just' the Deputy Minister for Arts and Sport, I am the Deputy Minister for Arts and Sport and I have an integral role in the Government of Wales, and my views and my input into Government is as valuable as any other Minister's. But in terms of the cultural announcements, I can assure you culture is not being sidelined. But there are things that we have to do—we take forward operational plans for all of our national governing bodies and sponsored bodies. And so part of those discussions will now be that we're waiting—. They've all had their remit letters, they know what they have to do, and we're now waiting for their operational plans. And there will be significant things in those operational plans that will come out and will be announced on the floor of this Senedd. But again, a lot of the work that we do is ongoing on a daily basis. It is work as usual, it's business as usual, it's the things that we do. And I have made announcements, on creative skills and other issues, and I will continue to make announcements, supporting the cultural sector, which is hugely important to Welsh Government, and certainly to me.

Thank you, Minister. I very much look forward to hearing more announcements over the next year. But the facts do speak for themselves at the moment, when we do compare to the other portfolios. Obviously, as you would expect, we have seen 301 coronavirus announcements, but 51 on communities and regeneration. Culture and sports and arts do deserve to be heard here, and if we are not vocal and discussing them here, then they are not being seen as central, as I know that you believe they are, to growth and recovery post pandemic.

I was lucky enough this morning to visit Bad Wolf studios and Screen Alliance Wales. It was fantastic to hear about all the work that is being done to provide a gateway between the film and tv industry and its workforce, alongside providing alternative pathways. So, how is Welsh Government working with organisations such as Screen Alliance Wales, to maximise opportunities for people from across Wales, and from every background, to work in the creative industries and the cultural sector?

That is absolutely right and very important as well, because that is exactly what the establishment of the creative skills board is about. The creative skills board will be working with all the creative industries across Wales—and Screen Alliance is very much one of those bodies that is involved with that—so that we do reach out to people across the country, and get them to look at creative industries as a viable career choice. One of the things that I found when I last spoke to Screen Alliance Wales was how they get young people to think about the creative industries as being a career choice, not just as an actor or not just as lighting and photography technicians and so on, but plasterers, carpenters, plumbers—all these people. The work of a film set, as you probably know, is like a small town. And we have a great film industry here in Wales, particularly in the south-east of Wales—the third largest film production area in the United Kingdom. So, all of that work is about reaching out across the country, to try to encourage more people to come in to the creative industries—one of the fastest growing industries in Wales, currently employing in the region of 56,000 people. So, that is very much on the top of my list as well.

Question 3, Janet Finch-Saunders. 

Diolch, Llywydd. And I refer Members to my declaration of interest form in terms of property ownership. 

The Minister for Finance and Local Government held a round-table meeting with all Ministers with a portfolio interest in February, and then again earlier this week, to discuss the outcome of both consultations on local taxes for second homes and self-catering accommodation. The Minister for Finance and Local Government will be announcing the outcome of the technical consultation shortly.

Thank you, Minister. And I can advise I have participated in the consultation on the Draft Non-Domestic Rating (Definition of Domestic Property) (Wales) Order 2022. But I am deeply concerned that this Welsh Labour Government, but, let's be honest, propped up by Plaid Cymru, is ignoring all reasonable objections to this Order. Now, if you are unwilling to listen to Members here and, indeed, those people—[Interruption.] I beg your pardon? [Interruption.] I've actually declared my interest. How dare you. 

Janet Finch-Saunders, carry on with your question. 

Thank you.

You're perfectly entitled to do so. 

So, if you are unwilling to listen to all those voices in the tourism sector, would you consider the findings of the chair of the Wales Tourism Alliance, chair of the Professional Association of Self Caterers UK and executive director for Wales of UKHospitality Cymru? The change to 182 days is expected to drive very many legitimate small businesses to close. For example, one genuine business in Aberconwy has stated:

'The proposed 182-day threshold will have a drastic effect on our businesses. We are open all year round, but not being on the regular tourist trail, we can never achieve six-months occupancy, even when we apply discounts.'

So, Minister, as this is not just going to impact these businesses, it's actually going to impact the economy of Wales, will you now step in and save this key sector of the economy, and join with me, and other Members and other people in the hospitality industry in Wales, and set the threshold more reasonably at 105 days? Diolch, Llywydd. 

Thank you for the questions and the comments. As you know, this Government was elected by the people of Wales, just over a year ago, and we have an open co-operation agreement we published with Plaid Cymru on a range of sectors, and we're committed to doing what we said we would do within that agreement. We have had a consultation. The original consultation, last autumn, had almost 1,000 responses, and there isn't unanimity in this sector. Part of the challenge, as ever, in making choices is, if you want the unanimous view, you will hardly ever get anything done. We've had to listen to those people who take the view that Janet Finch-Saunders proposed, and those who also say that there's a different level of competition not on the same playing field, for people who have a much smaller range of lets through the year. And so, what we're looking to do is to have an answer to that, and the Minister for Finance and Local Government will confirm the response to the consultation in the coming days and weeks to give clarity to the sector, because for the change to take place on 1 April it's important to give people time to get used to the new criteria. A summary of the responses will also be published and, indeed, the next steps to be taken forward. 

Thank you for the question. Our strategy, 'Welcome to Wales: Priorities for the visitor economy 2020-25', sets our vision and ambition for the sector across Wales. The Valleys of south Wales feature prominently in Visit Wales's promotional activities and, indeed, in our capital investment programme for tourism.

Thank you for that answer, Minister. For over 70 years now, Aberdare park has been home to the world-renowned national motorcycle road races. These races are incredibly important to Aberdare and to the Cynon Valley, injecting many thousands of pounds into the economy and bringing in around 5,000 visitors annually, a figure that can actually double in some years. Minister, I know that you and your Government are as keen as I am to see tourism in the south Wales Valleys flourish, so could you arrange for officials from your department to meet with directors of this key event to discuss how Welsh Government can best continue to support it? 

Yes, it's a specific question, and I'll be more than happy to work with the Member's office to ensure that my officials do that. Given she has asked the question, we'll keep her in touch with developments that do take place once a meeting is arranged. But, as I say, I'll be more than happy to make sure those arrangements do take place.

Minister, I recently had the fantastic experience of visiting the Rhondda tunnel project in Blaencwm and learning about the tunnel's history and contribution to life in the Rhondda Valleys. You may be aware that there's an ongoing discussion with the UK Government concerning the transfer of the tunnel to the Welsh Government, and I'm interested to know your thoughts about its capacity to be opened as a major tourist attraction for the Rhondda and for the south Wales Valleys if it was eventually transferred. The tunnel has the potential to provide an extensive cycle and walking route, which I understand would be the longest in Europe if it was to open, as well as being able to house several stand-alone tourist attractions. The tunnel could also act as a focal point for other tourist attractions that could be set up in the area, such as mountain biking, all of which would create much needed jobs. Minister, what plans does this Government have to aid the start-up of tourism businesses in the Rhondda and south Wales Valleys, and what support schemes could be made available to specifically develop tourist attractions to support the Rhondda tunnel project? Thank you.

As Members across parties will know, this has been the subject of much comment and discussion over a period of years and more than one Senedd. I welcome the Member's interest in it. As he's pointed out, it is owned at present by the UK Government and it's managed by National Highways. We expect a robust business case to be made for lottery funding and led by key stakeholders, including of course the two councils, Rhondda Cynon Taf and Neath Port Talbot, together with the Rhondda Tunnel Society, and we look forward to seeing the business case to see what role the Welsh Government could have. This is an area where we're looking for that business case to be made and to have clarity from the UK Government about their own role, as well as what we may be able to do behind it, but there is widespread recognition this could be a significant tourism project for the region in the future. 

Thank you for the question. My officials, along with counterparts from the local authority and the Department for Work and Pensions, are working with the nominated administrators to ensure that, as far as possible, we are able to protect the interest of all concerned, including of course the future employment prospects for the site.

It really is hard to over-emphasise the importance of the site. Anglesey Aluminium provided very good jobs for thousands of people over four decades. We have to ensure that sustainable economic activity—a new era of good jobs, if you like—is brought to the site. Quite rightly, the priority of all of us after the collapse of Orthios was to support those who'd lost their jobs, and that support has to be ongoing, but we have to look to the long term. The potential is enormous, perhaps in developing plastics-to-oil further. It's good to see genuine interest in that, but also alongside that a range of other sectors—hydrogen, for example, which I think perhaps could be the most important of all industrial sectors in Anglesey in years to come. My appeal to the Minister is this: will he make it clear that an overarching priority of Welsh Government would be to ensure the integrity of this site? I would ask Welsh Government to do all it can, show willingness to take an equity stake in the site, even, with potential developers, for example, perhaps bringing in other local agencies too. This site has to succeed and we need control over its future in order to assure that. 

I thank the Member for the question and I know he has a genuine interest in the future of the site. It really is a significant employment site, not just for Ynys Môn but for the wider region as well. The position is we don't have control of the site, but we want to try to influence as far as we can to ensure that that economic potential with employment in decent numbers and on good rates is provided. The administrator has had a wide range of inquiries, which is good news, and they're looking at a process to sort through those that are speculative and those that are more serious. I can confirm that they expect to have people who are genuinely interested and have a first round of proper bids to be indicated and provided to them in the middle of June. So, we expect to know more about this, but my officials do remain in regular contact not just with the taskforce around getting people into work who have lost jobs, and many of those are now positively in work, but also in continued conversation with the administrator on the future of the site, and I'd be more than happy to provide updates to the Member as that work progresses.

I'd like to put on record also, and agree with lots of what the Member for Ynys Môn has said, in terms of the importance of the former Anglesey Aluminium site not only to Anglesey, but also to the north Wales region as a whole. It can make a huge amount of difference if that site is properly developed, and I've mentioned that a few times in this Chamber before, and it is regretful that we haven't seen it realised yet, for all sorts of different reasons, I understand. In addition to the comments made by the Member for Ynys Môn, some of the resources we do have in north Wales and the opportunities that we do have around energy, in particular on wind, solar, marine, nuclear, energy projects, and possible manufacturing projects that would support a greener economy and create those well-paid jobs, are there ready to be taken as opportunities, and this site, I believe, could play a key part in that future development. So, in light of this, and in light of the comments you made a moment ago, Minister, in terms of future development of the site, I wonder what action you're taking to highlight and advertise the opportunities of this site to investors and developers, to encourage them to come over to Anglesey and to see them develop the former Anglesey Aluminium site.

Actually, as I indicated in response to Rhun ap Iorwerth, there's already significant interest in the site, with the dozens of enquiries about the site that have been made. And, as I say, the real point is when we get to those people who are not speculative but are serious and are prepared to put in proper bids for what the site could be in the future, we'll maintain an interest, because, as I say, this is a significant employment site for the region, not just Ynys Môn, and we have high ambition for our economic future and in actually making sure that there are jobs that have a long-term future on this site.

Yes. The SA1 development is now more than 60 per cent developed, with 90 per cent of the remaining development land sold. All major public infrastructure has been installed, and negotiations are taking place with two local housing associations for further residential development, and the University of Wales Trinity Saint David continues its new city-centre campus with a new collaboration development called Matrix, as I'm sure the Member is aware.

Yes, I'm very much aware. The SA1 development in Swansea has been a huge success, not just the University of Wales Trinity St David and housing, but also a number of high-technology, mainly start-up companies that have developed around the university. Like Swansea vale, this is an excellent example of mixed development, and I hope to see similar developments across Wales, because this really is a way of creating economic development and high-value jobs. But the issue at the moment is: can the Minister provide an update on the transfer of responsibility for highways, parking and footpaths in SA1 from the Welsh Government to Swansea Council?

Yes, the Member is right, I think—this is a good example of a successful mixed development, with a range of uses and a really positive outcome for Swansea and the wider area. He's right—there are good jobs being created on this site, where people from a slightly wider area will travel to and from them. So, I think it is a good a good example of how we would want to have further developments take place in the future.

In terms of some of the challenges that come with any site, we're working through those, and, actually, there's a constructive position between my officials and the city and county of Swansea, again with a positive outcome, with stability in the leadership of the council—and I congratulate Rob Stewart and his team. We are having those constructive conversations, and I will be more than happy to update the Member, and others with an interest, on where we eventually reach, because I do think that there's potential to have some certainty on the areas the Member highlights, and that's what I hope we'll be able to agree in conjunction with the council.

Minister, what's your assessment of the overall economic contribution to Swansea and the wider region of the SA1 development, and what opportunities are there to redouble our efforts on regional economic growth to build out of this pandemic?

Well, I think, as I said in response to the Member, and as the Member highlighted in his supplementary, this is a successful development. There is still some undeveloped land at SA1 in the ownership of the Welsh Government, and we're looking to ensure that is fully developed and finalised, in partnership, as I say, with the council—we're looking to resolve some of the other issues. I think, actually, when you look at the region and actually look at the ambition of the council, they have a number of areas. We've talked a lot about tourism during questions today, and, actually, the council have high ambition in a range of areas that will be projects not just for Swansea but more broadly—the old Morfa copperworks, for example, with significant investment proposals there that we expect to come to fruition. So, I think, actually, that Swansea is another good example of a local authority that is serious about economic development, working in partnership with the Welsh Government and a range of partners in a wide range of areas, including the private sector and, indeed, housing associations to do just that.

We are engaging with a wide range of partners to understand the impact of a tourism levy, including tendering for independent economic research. Individual local authorities will be empowered to decide if they will raise a levy in their areas, with the support of the Welsh Government and the proposal that the Member is aware of, indeed, and has asked previous questions on.

Thank you for that response. You'll be aware that there's a great deal of concern in north Wales about these proposals for a tourism tax on the economy. Many tens of thousands of jobs across the region rely on the tourism industry and visitor spend. One of the strange things that people have suggested that the Welsh Government need to listen to is the fact that the majority of spending is from overnight stays. Those who stay overnight spend more in the Welsh economy. What your proposals are actually going to do is to penalise people who want to stay overnight. It's not going to make much difference to the day visitor market. Do you accept that overnight taxing of individuals who want to visit Wales to spend in our economy could actually do a lot of damage to our tourism sector, and if the economic assessments that you are commissioning demonstrate that that will be the case, will you reverse this decision to introduce these appalling taxes on what is a very important part of the economy in my constituency and region?

As the Member knows, this was part of our manifesto that people in Wales voted upon just a year ago. It's also a part of the co-operation agreement we have with Plaid Cymru, and Cefin Campbell is indeed the designated lead Member on this. We're drawing on international experience as well as engaging with the local tourism industry, academics and experts to support the development of the levy. As we have gone through on previous occasions and, I know, in your previous questions, levies of this type are a common feature in a range of areas that Members across this Chamber will have visited, across Europe and North America. You probably don't know that you're contributing to a local levy and that that is then being used to invest in those local communities, to further enhance not just the experience of the visitor but also the impact upon the community itself.

A full consultation on the proposal is planned for this autumn to ensure that all voices are heard to inform the design and implementation of a tourism levy. I don't accept the Member's repeated doomsday predictions for a tourism levy and its impact on the economy. I have a great deal more faith and optimism about the future of our tourism economy and the ability to have a tourism economy that will continue to employ people on good rates and not to have a significant or detrimental impact on the community in which tourism takes place.

Thank you for the question. Our £136 million Transforming Towns programme focuses on the diversification and sustainable growth of our town and city centres. A number of the interventions include the reuse of derelict and empty buildings—we heard some of that in previous questions around Newport—increasing the variety of and access to leisure, services, and flexible working venues, mixed-use space and improved green infrastructure. 

Thank you, Minister, for the response. Llywydd, I welcome the recent figures provided by the Welsh Retail Consortium, which showed that the number of empty retail units in Wales has fallen 2.3 per cent over the past 12 months. This is the biggest fall in the UK, which is great. However, it's not all positive news. Despite the reduction, Wales has the second highest vacancy rate in the UK, and whilst the recovery hasn't been even, with some high streets faring better than others, there are further challenges, such as the cost-of-living pressures as well as the partial reintroduction of business rates. Minister, what further interventions is the Welsh Government considering to help attract businesses back into the high street? Is the Government considering boosting the financial support on offer to micro and small businesses in Wales provided by the Development Bank of Wales to encourage the creation of more local businesses, and particularly to those people wanting to start a business but who may find it difficult to access the finance provided by high-street banks? Finally, what consideration has there been of schemes to empower local councils to bring long-term and derelict empty properties back into use, which are a blight on many communities? Thank you.

Thank you. DBW will continue to make capital available for start-up businesses and microbusinesses, as the Member has indicated. He may also be aware that we provided specific funds to help start-ups in a range of sectors, not just in town centres but a range of others too. We're committed to continuing to do so. When it comes to the broader challenge of high streets and town and district centres—for those of us who have an interest in cities, there are many district centres that are in many ways equivalent to town centres in other parts of the country—the Deputy Minister for Climate Change has established a town centre delivery group and in a recent meeting we've made sure that we joined up the work that he is leading on in that area and his responsibilities for regeneration together with the coming launch of a retail strategy that brings together trade unions and, indeed, businesses themselves. So, retail is part of the answer but not the only answer for ensuring that we have vibrant town and district centres, and that's why a 'town centre first' principle is an important consideration within this. So, I do welcome this recognition that there is some good news in this space, but I think there's more to be done to ensure there really is a vibrant future for our towns and communities around them.

On 2 March, I set out this Government's approach to enterprise zones in Wales. Whilst we have no immediate plans to introduce a zone in rural mid Wales, our commitment to place-based economic development is clearly set out in the regional economic framework for mid Wales that was published in December. 

I'd like to thank the Minister for his answer. Many communities and towns right across rural mid Wales—that's in Brecon and Radnorshire, Montgomeryshire and in Ceredigion—would really benefit from an area of an enterprise zone so that they could have better growth opportunities for the businesses that live there, better planning decisions for the people who are there, a better business environment, and we could even look at having a tourism board to encourage people there. So, Minister, will you look again at this and please look to introduce an enterprise zone in mid Wales to benefit those businesses so that mid Wales is not left out yet again?

Well, I don't accept that mid Wales is left out. Actually, the regional economic framework developed by the two local authorities and endorsed not just by the Government is work that's been led by local authorities and those partners who understand their local communities. That goes alongside, of course, the mid Wales growth deal that both the UK Government and the Welsh Government have invested in. I think we can have a deal more optimism about the economic future within mid Wales. We'll continue to work alongside partners to ensure that we do deliver a better economic future for mid Wales. I'm not persuaded that providing an enterprise zone would provide all of the economic outcomes that the Member and I would want to see for mid Wales, but, of course, I'll be interested in what works, working alongside our partners, businesses and communities.  

Supporting and developing social enterprise and the social economy across Wales to develop and grow is key to contributing towards creating a stronger, fairer and greener Wales. The Welsh Government provides dedicated support for the sector and provides match funding towards a social business Wales service.

Thank you, Minister. Over the past year, it's been an honour to meet with many social enterprises across the region and to see the excellent work that they do in regenerating our communities and supporting people of all ages and developing the local economy. Can I ask you what discussions you have had with other Ministers to ensure that social enterprises and the social economy are things that are promoted across Government portfolios, such as through the new curriculum?

I have not just discussions on the education aspect but practical discussions, for example, with Julie James, the housing Minister, about the impact of housing associations as important economic actors within local areas, as well as the direct engagement I have with others. Given that Jane Hutt is next to me, I should, of course, mention her continued interest and advocacy of the third sector as economic actors as well. So, this is something where a range of Ministers have an interest, although I have lead responsibility, and we continue to invest in the sector and the bespoke business support that is available. I should, in answering this question, of course, draw the attention of those Members who are unaware of it to the revamp, change in name and mission, or the reinvigorated mission, of the Wales Co-operative Centre, which is now known as Cwmpas Cymru, and I look forward to working with them to continue to practically support the sector to grow and develop in the future as a mainstream part of what we expect the future of Wales to look like.

I thank the Minister and Deputy Minister.

The next item is item 4, today, the 90-second statements, and the first is from Sioned Williams.

Thank you, Llywydd. It gives me great pleasure to call on the Senedd to celebrate the Coleg Cymraeg Cenedlaethol's tenth anniversary, and I, as Plaid Cymru spokesperson on post-16 education, wish to congratulate them on their first decade of planning and developing Welsh-language and bilingual provision—provision that is providing valuable opportunities to so many students in our universities, further education colleges and in terms of apprenticeships.

All too recently—indeed, when I was a student—it was only by chance, if the lecturer in your particular field of study happened to be able to speak Welsh, that it was possible to study through the medium of Welsh. But, thanks to the One Wales Government's agreement between Plaid Cymru and the Labour Party, the work of forming the coleg ffederal, as the plan was called, began, which led to the establishment of the Coleg Cymraeg Cenedlaethol in 2011.

I was working at Swansea University at the time, and I remember clearly the excitement and delight as the work of planning and investing in Welsh-medium provision went ahead. There are now 4,700 students every year who study an element of their degree course through the medium of Welsh. And the coleg's recent work in further education colleges is just as important and exciting. And thanks to the Government's co-operation agreement with Plaid Cymru, the coleg will begin investing in apprenticeships too.

So, happy birthday to the Coleg Cymraeg Cenedlaethol, and all the best with the work that is so important to our nation's future.

I'd like to extend my best wishes to the ColegauCymru multi-sport duathlon event that is being held today in Pembrey Country Park, near Llanelli, following an absence of three years due to the pandemic. The event will see over 250 learners and further education staff from eight colleges across the whole of Wales coming together during this inclusive event, with participants attempting either a 6 km tri-duathlon or a full 27.5 km duathlon.

This event has been arranged by ColegauCymru, and has also received support from organisations such as the Welsh Government, Triathlon Wales, Cycling Wales, Coleg Sir Gâr and Carmarthenshire County Council. This event is funded by the Welsh Government to support the further education sector in order to promote physical, mental and emotional well-being amongst young people who have been detrimentally impacted as a direct result of the COVID-19 pandemic.

And it is, of course, currently Mental Health Awareness Week, so I'd like to extend my very best wishes to this event, as well as all of those participating in Pembrey today, and, on behalf of the Senedd as a whole, I'd like to recognise the role that events of this kind can play in promoting physical, mental and emotional well-being. Thank you.

Next, a motion to elect a member to a committee, and I call on a member of the Business Committee to formally move. Siân Gwenllian.

Formally move.

The proposal is to agree the motion. Does any Member object? No. The motion is therefore agreed, in accordance with Standing Order 12.36.

Item 5 today is a Member debate under Standing Order 11.21, the Holodomor. And I call on Alun Davies to move the motion.

I'm grateful to you, Deputy Presiding Officer. I'd like to start by saying how grateful I am to Jane Dodds and Sam Kurtz, who are co-submitting the motion today, and to Rhun ap Iorwerth, who will summate the debate we have this afternoon. I'm also grateful to Janet Finch-Saunders, to Jenny Rathbone, to Mark Isherwood, to Peter Fox and to Vikki Phillips—Vikki Howells—who also supported this motion.

It's important to discuss, and it's important to debate. It's important to remember, and it's important to educate and to learn. But it is also important not to repeat the mistakes of the past and to relive the horrors of the past. For many of us, and myself perhaps I'm speaking personally, being born 20 years after D-day, I grew up in the shadow of the second world war. I grew up in the shadow of listening to survivors speaking about the Holocaust. We learnt, at first-hand, what genocide means. I never thought that we would see genocide again, but we have. I bore witness to it in Rwanda and in the former Yugoslavia. We are seeing mass murder, industrial-scale murder, on our screens today, tonight, on a daily basis. It is not only unbelievable, but it is simply unacceptable that we continue to listen and to remember, but never to learn. What I hope we can do this afternoon is to learn about what happened in Ukraine 90 years ago, but also, in learning about what happened 90 years ago, the actions and consequences of what happened then echo down the years and resonate today. What happened 90 years ago is happening today.

At the end of this period, Stalin forced many Ukrainians, a million Ukrainian people, to leave their homes and their villages, and they were transported, forcibly removed, from Ukraine to Russia. That is happening today. It is happening again. And when we speak about genocide, and when we speak about human suffering, let us also remember that none of these things were an accident. They were the consequence of a deliberate choice. Stalin decided that he would commit genocide against the Ukrainian people. The harvest was good. There was no crisis in the harvest in those years, 90 years ago. There was no shortage of grain, shortage of seeds, shortage of supplies. They had enough food to feed themselves and to become known as the bread basket of Europe and of the world. The crisis happened and millions of people died because Stalin sought to eradicate the Ukrainian nation and the Ukrainian people, and we know that he was not alone in mass murder, because, several thousand kilometres away from where he was sitting, there was another dictator planning the same activity against Europeans, against the Jews of Europe. We have seen genocide in Europe, and we must learn, and not simply remember, and learn that it should never happen again.

When you look at the systematic way in which the Soviet Government worked to ensure that people starved—villages were blocked, villages were prevented, from accessing the food that was all around them. We saw that starvation was used as a deliberate act of a Government to terrorise a people, and then think about what is happening on the coast today, the southern coast of Ukraine today, where siege mentality and a siege is used against people today. Again, we hear the echoes down the years.

The goal was to crush the resistance of the Ukrainian people to both collectivisation, but also to total incorporation into the USSR—the extinction of the Ukrainian nation. And all those who opposed Stalin were liquidated, starved to death as a deliberate act of Government. And it is important that we bear witness to such genocide and to speak the truth about what happens. We remember that this week, here in our Parliament. The work of Gareth Jones in exposing what happened was central to teaching the world about what happened in those days, and I think we're all grateful to the national library and to Martin Shipton for writing and for ensuring that people hear the words of Gareth Jones again down the years. He saw at first-hand the famine. He saw people desperate with hunger, and he reported the full magnitude of human suffering.

'I walked along through villages and 12 collective farms. Everywhere was the cry, "There is no bread. We are dying"',

and those words spread across the world, not only across Europe, but across to the United States as well, so people were to know about what happened. [Interruption.] I will take an intervention. 

I'm very sad to say that I knew very little about this terrible famine that was imposed and caused by the Soviet regime in Ukraine until fairly recently, when I took the opportunity to watch the film, Mr Jones, which very well depicted the terrible situation that people endured, the death, the misery, but also the heroic efforts of a Welshman, from Barry, using his journalism to make sure that the message got out. Do you agree with me that one thing that we do need to ensure here in Wales for all future generations is to promote the work of decent journalists like Gareth Jones and to make sure that our children, our future generations, don't have the opportunity to miss the importance of these sorts of events in our history that we must make sure that we learn from? Because I certainly knew nothing about it. I went through the Welsh education system and heard nothing. We must not let that happen again.

Can I say I absolutely agree with the point that Darren Millar is making? And of course it's no accident, because what Stalin did, having committed genocide, was to ban information and to conceal his actions in Ukraine. And the ban on information that was instigated by the Soviet Government in 1933, I think it was, was in place until 1987. And it is little wonder, when people seek to commit these acts of terror against a population, that they then seek to conceal their actions and conceal their part in those actions. We saw the same thing happen across occupied Europe in 1944 and 1945. And it was important—[Interruption.]

I'd just like to say that the role of journalists in uncovering these dreadful acts of genocide is absolutely crucial. And would you agree also that the death of Shireen Abu Akleh in Palestine, apparently by Israeli forces, is another example of how journalists risk their lives to report what is going on? And obviously that is an everyday occurrence amongst journalists from across the world in Ukraine.

The right that we have today to discuss in safety and freedom these matters is a right that we should never take for granted. Our ability to have this debate is rooted in our knowledge and our information, and one of the great terrors that I feel today is that, whereas we've always disagreed sometimes across the Chamber in different parties and places about our interpretation of history and our knowledge of history, we've always agreed on where history starts and what history is. What we see today is a perversion of history in all sorts of different ways, and I hope that there will continue in this Chamber at least to be an agreement on the facts and to interpret those facts potentially in different ways. But the role of journalism down the years has always been central to our understanding of history and our understanding of what happens. And that is especially true, of course, in those parts of the world where there are dictatorships and where there are attacks on the civilian population.

I'll seek to bring my remarks to a close, Deputy Presiding Officer. In 2006, the Ukrainian Parliament declared this to be a genocide. This was a deliberate attempt to destroy a country and a nation. The famine was followed by the deportations, which was an attempt, again, to destroy the Ukrainian people. What I hope we will be able to do today is to remember those actions, to remember this suffering, and I hope that in doing so we will again seek to renew our commitment to the people of Ukraine. The Counsel General has spoken passionately and movingly about his family and their experience over the past few months. I know that he will continue to tell his family and others in Ukraine of our support for their struggle today. And I hope that what may be born from our conversation this afternoon and from our experience at this time is a renewed link between our peoples, and a renewed commitment to remember, but not only to remember, but to learn. Thank you.

I'm grateful to the Member for Blaenau Gwent for tabling this timely and important debate, as it comes in a week when Russia has celebrated victory day on 9 May, the day that the united Union of Soviet Socialist Republics, or USSR, achieved victory over Nazi Germany and the end of the second world war with fellow allied countries. This display of military might through parades acts as a muscle flex towards the North Atlantic Treaty Organization, and as a chest-beating exercise to reassure its own citizens that mother Russia is still able to act unchecked.

In Soviet times, victory day was used to mark both the defeat of fascism and the perceived strength and virtues of communism. Thankfully, before the end of the twentieth century, communism was found out as the dangerous ideology that many now see it as, an ideology that left millions of Soviets living under draconian rules, with their liberty lost and millions more dead, having been sent to gulags. Some of us in this Chamber are young enough not to have lived through eastern and western blocs of Europe—indeed, I was born some 12 days before the dissolution of the Soviet Union—but when, in the words of Churchill, 

'From Stettin in the Baltic to Trieste in the Adriatic, an iron curtain has descended across the continent',

we must remember this time.

However, the current events that are taking place in Ukraine, events that the west have long been warned about, are certainly making us realise the danger that a rogue state with an unpredictable leader pose to the peace that many of us have taken for granted for a generation, which the Member for Blaenau Gwent has referenced. Ninety years ago, the Holodomor showed the devastating impact that a power-hungry leader, desperate to cling on to power, can wield if his power goes unchecked. The Member for Blaenau Gwent has already spoken about the devastating impact that this famine had on the people living in Soviet Ukraine in the 1930s. 

If we fail to present a united front against Putin's current illegal war in the region, many in Ukraine and further afield will be at risk again. Of course, this Senedd has shown its clear commitment to stand with Ukraine. The UK Government has been one of the leading western nations in arming and supporting the Ukrainian military, and this Senedd rightly urged the UK Government to go further in supporting Ukrainian refugees. To see a British Prime Minister walk the streets of Kyiv alongside President Zelenskyy, and be the first western leader to address the Ukrainian Parliament, shows that the support our nation has provided Ukraine and its sovereign people has been gratefully received.

Like others in this Siambr and across Wales, I have relatives born outside of these islands, and I know from them first-hand the devastation that war can bring. This is why it is imperative that these same mistakes made during the first half of the twentieth century are not repeated less than 100 years on. And it is through the language we use that we can and must start to do better. Too often, the phrases 'far right' and 'far left' are used when referring to those with whom some may disagree. To use these descriptions in such a throwaway manner does a disservice to those who perished under the rule of real far right and far left authoritarian regimes and dictatorships. The far right is what we witnessed in Nazi Germany and Spain during the 1930s and 1940s. The far left is what we saw in the Soviet Union, where deliberate actions led to the horrific Holodomor or terror famine, leading to the death of some six million Ukrainian people. These regimes murdered many millions of their own people, people whose only crimes were not conforming to the warped ideologies of their leaders.

With the language used on social media still going unchecked and the spread of hatred and abuse becoming far too common, it is important that we as politicians step up and commit to becoming more aware of the language that we use. Some have taken to social media to question why the Senedd is debating this today. As a co-sponsor of this debate, I tell them here and now that it is incumbent on all of us to do better, to be better. By acknowledging the Holodomor and the appalling way the Soviet Union murdered their own people, we keep the crimes of yesteryear close to the forefront of our mind, as those who cannot remember the past are condemned to repeat it. Diolch.

I call on the Minister for Social Justice, Jane Hutt.

Diolch, Dirprwy Lywydd, and I'd like to thank Alun Davies for bringing this important debate to Senedd Cymru and to thank all Members who have contributed. We are all acutely aware of the current tragedy that is unfolding in Ukraine, and we have discussed this many times in recent weeks. However, it is also important for us to reflect on times in the past when actions have been pursued that have undermined our common humanity. 

We regularly commemorate experiences of genocide and atrocities in this Siambr and across Wales, but we've not devoted significant time in recent years to talk about Holodomor. But my colleague the Counsel General, Mick Antoniw, has of course regularly drawn our attention to the suffering visited upon the Ukrainian people during the Holodomor, and I do welcome today the strong cross-party submission of this motion and engagement in the debate.

The ninetieth anniversary of these atrocities and the current focus on Ukraine provides an important stimulus for us to shine a light on the injustices of the past and to seek to avoid history repeating itself—as Alun Davies has said, not just to listen and remember, but to learn.

One of the few western journalists who reported on the famine in Ukraine and its causes was the Welshman, Gareth Jones. He was from Barry and he is buried in the Merthyr Dyfan cemetery. He was honoured locally, led by Barry Town Council, and a plaque will be placed over his grave or in the vicinity. He is still considered a hero in Ukraine and we must start to raise awareness of his warnings from today.

Gareth Jones was an eyewitness to the suffering in Ukraine, and told the truth about the horror he found. Initially, his stories were widely published, but by all accounts he was quickly ostracised and moved into the journalistic wilderness, and there is much we will learn about that and the reasons why, I'm sure, at the event that is taking place here at the Senedd tomorrow, commemorating Gareth Jones, sponsored by Mick Antoniw, and of course this all-important digitalisation of the archives by the National Library of Wales. I do hope that many Members will attend, to learn more about one of our often overlooked Welsh heroes.

The international media has changed dramatically since Gareth Jones was a journalist, and it's much easier for us to see with our own eyes the barbaric actions that Putin has taken in Ukraine. However, it is still crucial that we bear witness to the hardship of the Ukrainian people, and do whatever we can to ensure their rights are upheld. The UK Government has done much to hold out the hand of friendship to the Ukrainian Government, and we support them wholeheartedly in this endeavour. And the Welsh Government has contributed £4 million to the Disasters Emergency Committee Ukraine appeal, submitted medical aid amongst other efforts in Ukraine and the region, and we are supporting Ukrainians themselves to come to safety in our nation of sanctuary.

I'm not going to rehearse our work to support Ukrainian visa holders, because this is about commemorating the past, but I will just say that we are thinking very carefully about how we can support Ukrainians arriving here to record what they've experienced as part of the war crimes investigations. We will not turn away from those who have suffered, as happened during Holodomor.

It's clear that the deliberate actions of the Soviet Union, in forced collectivisation of land and seizure of resources, played a critical role in causing the famine. As Gareth Jones coined at the time, and I quote:

'I would look upon the children with their distorted limbs and feel the tragedy of that man-made famine which had the country in its grip.'

The Welsh connection to the Ukrainian people goes back a long way. Well before Holodomor, John Hughes travelled to Donetsk to establish an ironworks and collieries, as part of what was then called Hughesovka. We now see that city of over 1 million inhabitants under bombardment, and our heartfelt sympathies are with its residents. Gareth Jones's family history is relevant here. His mother, Annie Gwen Jones, was actually a governess to John Hughes's children in Donetsk, and it was her stories of Ukraine that inspired Gareth Jones, her son, to visit when he was old enough. She was a graduate of Aberystwyth University like her son, was a magistrate and secretary of Cardiff and District Women's Suffrage Society, and is really well honoured, as her son is, in the town of Barry. Even in the establishment of this Siambr, there are connections with Ukraine in the Heart of Wales, which sits in the floor at the centre of our Parliament. It was created by Alexander Beleschenko, a Swansea-based artist born to Ukrainian parents. 

We've all been awed by the bravery of the Ukrainian people during the current conflict. During the Holodomor, the suffering must have been immense, but Gareth Jones reported on the fortitude of the people, who asked not to be pitied because people in other parts had things even worse. Ukrainians have demonstrated again and again that they have the right to determine their own future, and they will find solidarity here in Wales. 

Before this conflict, Wales was home to around 500 Ukrainians, but we shortly expect to be home to more than 10 times that number. We will welcome them and learn from their experiences to strengthen our communities. Whilst it is clear to the Welsh public that Putin has attacked a sovereign nation, the deeper historic injustices caused by Stalin, such as the Holodomor, are not as well understood. I'm happy to commit the Welsh Government to raise awareness and commemorate the tragedy that occurred in Ukraine 90 years ago. We will remember the victims and encourage greater solidarity with the Ukrainians who are now finding sanctuary in Wales. 

I call on Rhun ap Iorwerth to reply to the debate. 

Thank you, Dirprwy Lywydd, and to everyone who has made such thoughtful comments today, and thank you for that commitment by the Minister. I'm pleased that we as a Senedd can express in such a unified way our sympathy and our solidarity with the people of Ukraine, as we note 90 years since the Holodomor, which is called the 'great famine' very often, but, of course, the use of that word 'famine' suggests something natural, when we know, of course, that it was the result of a particular policy, a policy of collectivisation and political decisions made with regard to the Ukraine. 

Stalin said that his policy towards Ukraine was due to the fact that Ukraine opposed his policies. There was famine in huge areas of the Soviet Union as well, but it is Ukraine that saw the greatest numbers of deaths, as the Soviet state took millions of tonnes of grain away from them. We do not know exactly many people died during the Holodomor. As Khrushchev admitted in his biography, nobody was counting. But the historian Robert Conquest uses data from the Soviet census that estimates that around 5 million of the people of Ukraine died as a result. It's impossible to comprehend it. Whole villages were eradicated, as we've heard, cities and roads were littered with the bodies of those who had left their villages to seek food but who died on their journey. The rural areas of Ukraine, the land of the black soil, that was considered to be one of the most fruitful lands in the world, was turned into a silent desert. 

Victor Kravchenko was a Soviet official who was told to take part in the process. He had to flee to the west as a result of what he saw in the Donbas region in the Ukraine of his birth. This is how he described what he saw in Petrovo: 

'What I saw that morning...was inexpressibly horrible. On a battlefield men die quickly, they fight back, they are sustained by fellowship and a sense of duty. Here I saw people dying in solitude by slow degrees, dying hideously, without the excuse of sacrifice for a cause. They had been trapped and left to starve, each in his home, by a political decision made in a far-off capital around conference and banquet tables.'

But, of course, this wasn't a story that could be told publicly. The Soviet press, as we've heard, denied that any famine had taken place at all. Unfortunately, there were plenty in the western press who were willing to believe that.

There was one man, of course—we’ve heard his name time and time again today—who tried to draw attention to the genuine situation, and that was Gareth Jones, the journalist from Barry. He had an interest in Russia, as we’ve heard from the Minister, since hearing the stories of his mother when she lived in Hughesovka, now Donetsk. He visited Ukraine for the first time in 1930 and he returned several times afterwards, and decided to wander on his own, rather than be guided, as a number of other journalists were, on Potemkin trips by officials of the Soviet Union to see what they wanted them to see. And by travelling under his own steam, he experienced directly the impact of this famine on those people living there. He used his voice as a journalist, and, as a journalist myself, I’m so pleased and proud of what this Welshman did for Ukraine and for journalism.

He reported back about what he saw, through newspaper articles in the UK, America and Germany. He explained that he had to leave because of the suffering and that food wasn’t available. 'So many Russians are too weak to work', he said. He said that he saw people fighting over a piece of orange peel on the floor of a train. 'I didn’t visit one village where a number hadn’t died', he said. But by trying to reveal to the world the atrocities Stalin wrought on his own people, he drew the attention of the secret police. He was forbidden from travelling to the country again, and, more than likely, because of his journalism, he lost his life, ultimately.

Even amongst his contemporaries in the west, he was accused of telling untruths. One journalist with The New York Times, Walter Duranty, said that, because the Kremlin, the headquarters of the Soviet Government, denied it, Gareth Jones’s story wasn’t true. In his response to him, Gareth Jones said:

'May I...congratulate the Soviet Foreign Office on its skill in concealing the true situation in the USSR? Moscow is not Russia, and the sight of well-fed people there tends to hide the real Russia.'

The Soviet Government denied the existence of this famine until the end of the 1980s, but it’s been seared on the minds of the people of Ukraine for 90 years. It’s important that we remember too.

To conclude, the sadness beyond words is that this isn't something that has been laid to rest forever in history. Here we are in 2022. Last week, an official of the United Nations said that the forces of Russia are stealing grain from Ukraine that could lead to a shortage of food there now. And of course, thousands upon thousands are dying to this day, and millions are suffering at the hands of an oppressor. People have to learn about what happened, and, in so doing, let us be unambiguous that we stand shoulder to shoulder with the people of Ukraine today as they remember this terrible chapter in their past, as they experience again the suffering of 90 years ago, whilst they battle for their future.

The question is that the motion be agreed. Does any Member object? No. The motion is therefore agreed in accordance with Standing Order 12.36.

We move now to item 6, the Welsh Conservatives debate on NHS waiting lists. I call on Russell George to move the motion.

Diolch, Dirprwy Lywydd. Foolish—that is what the then health Minister said to having a plan to tackle the NHS backlogs in Wales before the pandemic is over. And what has that led to? As it stands now, Wales is experiencing its worst accident and emergency waits, longest waiting times for treatment, and second slowest ambulance response times on record. The number of people waiting over two years is now over 60,000, and one in four Welsh patients are waiting over a year for treatment. We, of course, as Welsh Conservatives, have long been raising the increasing NHS backlogs, and it is frustrating, when we voice concerns for the need for a recovery plan, to be told that's foolish. I of course fully accept that the pandemic has caused huge pressures on our Welsh NHS, but we can't get away from the fact that there were deep-rooted issues, including workforce gaps, bed shortages and a creaking NHS estate, and that happened well before the pandemic. Unfortunately, all this was happening well before the pandemic hit us. 

As it stands now, even before the pandemic struck, thousands were waiting over a year for treatment. In fact, that doubled in the year before the pandemic. A&E and ambulance services were already feeling the strain each winter, and the NHS workforce was already facing significant challenges and shortages. So, unfortunately, now, we've got the equivalent of one in five of the Welsh population on a waiting list. In emergency care, a record-breaking one in three patients are expected to wait more than four hours to be seen in A&E, and ambulance response time targets have not been met for nearly two years. These are, of course, harrowing statistics, but behind every stat are, of course, real people, who desperately need the Government's latest recovery plan to work, and I hope it does. It's important, as an opposition, that we highlight the Government's failures, but that we also come forward with solutions ourselves, and that's what I will do later in this debate today.

One of the big issues that urgently needs addressing is the issue around delayed transfers of care. No doubt, of course, this has all been exacerbated by the pandemic, but there were long-standing problems that existed well before that pandemic hit. Delayed transfers of care are not just again stats; behind every delayed transfer of care is a person who has not received the care and support they need to enable them to return home or to move into appropriate accommodation. Family members and unpaid carers are being put in the impossible position of leaving their loved ones in hospital longer than is necessary, or taking on further caring responsibilities that they may not necessarily be equipped to cope with, often at the detriment to their own health and well-being. For there to be 1,000 people in hospital beds, when they could have been discharged, is totally unacceptable.

Of course, it's well documented that remaining in hospital longer than is necessary is detrimental to the patient, particularly older patients, and being discharged without the appropriate support in place places unreasonable demands on families and presents risks to the safety of the individual, increasing the likelihood of readmission—so, not breaking that cycle. We've got unprecedented pressures, of course, on the health and social care workers, and unpaid carers as well, and I think, of course, they should be thanked for all that they have done and they continue to do. Another issue, though, here as well is the poor communication, the lack of integration and joined-up working, amongst some of the other issues that have to be tackled if we want to see improvements in patient flow through our hospitals in Wales. 

Shockingly, national performance against the 62-day cancer waiting times target remains significantly below where it should be, and, prior to the pandemic, Wales already had poor waiting times for routine treatments. It's worrying to know that cancer waiting times have not been met since 2008. Furthermore, waiting times for key cancer diagnosis targets are still substantially large, despite progress in recent months, and the Welsh Government targets that patients wait a maximum of eight weeks for diagnosis remain unmet. 

There are some areas that I do welcome some progress from the Government on. I welcome the fact that the Government has started on regional surgical hubs, something I've long called for, of course. I also welcome the fact that we had the recovery plan in April. But, so far—I hope the Minister can tell me I'm wrong on this—we've only seen details for those surgical hubs rolled out in south Wales. So, can I ask the Minister to give us a timetable on when we're going to see those surgical hubs rolled out across the rest of Wales? When are they going to be fully mobilised? It's really important, of course, for those suffering with other conditions and long COVID, and, of course, again, it will free up the pressure from hospitals.

I said I'd provide some solutions myself also. Certainly we need to improve access to primary care appointments and change current guidance on telephone triage. This will reduce the number of patients presenting themselves to A&E. We need to redouble efforts on rapid recruitment of paramedics. I appreciate the Welsh Government has announced 136 new recruits, and the Welsh Ambulance Services NHS Trust is committed to recruiting a further 127 this year. However, it's got to be key that the Welsh Government provides support for rapid recruitment to cover any potential gaps. Mobilise members of the public and former healthcare professionals to join their local NHS team as part-time reservists to support the NHS during periods of high demand. Establish routes of support for NHS staff and care workers and families who have experienced trauma through the pandemic. Set a plan and timetable to raise wages of care workers. This will provide, of course, care workers with the security they need, and will also potentially keep more workers within the sector to help with hospital discharge. That's a key element that needs to be addressed. Also, clear and regular communications with patients on waiting lists, as well as available mental health support and a public health campaign to ensure cancer diagnoses are caught earlier.

We can't just look to the short term. This is why I'd suggest plans for the long term, which would include focusing on the time for treatment, so ambulances and hospitals work closer to deliver timely care. I'd also suggest developing a clear, clinically led plan for Welsh NHS to clear the waiting list backlog, and utilising cross-border and independent facilities as well. And not forgetting COVID-19, we should aim to establish long-COVID clinics to support people experiencing the long-term effects of COVID-19. I also think we need to build upon the 10-year health and social care workforce plan by introducing a recruit, train and retain plan across the whole of the health and social care sector. We need to significantly increase the number of doctors and nurses and care workers, through, for example, a nursing apprenticeship scheme also. That's how we do that. 

But the Labour Government here needs to get a grip, I think, on the NHS, stop breaking all the wrong rules and the wrong records, and I would suggest that the Labour Government concentrate on making sure that the right records are not broken and get a grip, really, on the NHS, as we go forward. I'm hoping that we'll have some solutions from the Minister today, but I move the motion in the name of my colleague Darren Millar.

I have selected the amendment to the motion. I call on the Minister for Health and Social Services to formally move amendment 1, tabled in the name of Lesley Griffiths.

Formally.

There's quite a simple motion before us today. Myself and my colleagues on these benches agree that the Welsh Government doesn't have an adequate plan to tackle NHS waiting lists in Wales and the backlogs in Wales. We've seen the plan, over the last few weeks, and there are, of course, positive elements. One, that we have a plan at last, having waited far too long for it, and there are plans in place in certain areas that will assist, there's no doubt about that, and, importantly, we have targets that enable us to measure success or otherwise in terms of the Government's actions, although there are some gaps in those targets too, and we'll return to that in due time. 

For far too long, the NHS in Wales has been locked into some sort of vicious circle where it's creaking under the pressure from day to day, and Minister after Minister failing to ensure that the right steps are put in place to reduce those pressures, first of all through a number of preventative measures, and then, secondly, to ensure the sustainability of the service and how it works in terms of the workforce, more than anything else, perhaps. So, the pressures grow and the unsustainability increases.

If there's one point that is truly important and should be made at the beginning of my contribution, that point is that all of this was true before the pandemic struck, a little over two years ago. What the pandemic has done is to highlight more than ever before that lack of sustainability, and highlight in a more graphic way than ever the inequalities that drive these huge pressures on health services. The upshot, of course, is that waiting lists now are longer than they have ever been before. Almost 25 per cent of the population, nearly 700,000 people, are on waiting lists—60 per cent of those are waiting for their first appointment as an outpatient.

This delay at an early stage in the journey through the health system, the delays in diagnostic appointments and surgical appointments has had a catastrophic impact on so many of those who are waiting. We know how many more are discovering cancer later on now, and are being given a diagnosis having gone to A&E, rather than having been diagnosed as an early stage as part of the kind of cancer pathway that we need. The survival hopes are so reduced in finding that cancer late.

Back to that figure of 700,000 people on waiting lists—yes it's an increase of 50 per cent since pre the pandemic, because of the pandemic, but it was 450,000 before the pandemic, so we can't think of any Government strategy as something that will take us back to where we were two years ago. The Government says that its plan is ambitious, but I fear that there are many elements here that raise very serious questions as to how ambitious it is in reality. First of all, a plan would have to persuade me that the Government is going to transform its attitude towards the preventative agenda in order to take pressures off our hospitals.

Yes, the Government says it wants to push the preventative agenda, and I do believe that, but I don't see that in its plans. I need to be persuaded that there is a new attitude and a gear change like we've never seen before in terms of training—training and retaining health staff. But I don't see that gear shift, although I don't doubt that the Minister wants to see that, and I should say 'health and care' here, of course.

Neither do I see in the Government's plans that crucial commitment to make integrating health and care a central part of the solution to these backlogs. Yes, there is work happening at the moment in creating a national care service. I'm confident that the work that's happening in the light of the co-operation agreement will bear fruit ultimately, but a lack of adequate reference to care in the Government's plan that was recently published is something that concerns me greatly.

And in terms of the targets, well, time is against us. As I've said here recently, I am very concerned that these new targets are going to exempt some areas of specialism. Orthopaedics, as we know, is so problematic, as we know. What we also know is that the orthopaedic workforce in Wales has provided a plan for the Welsh Government, and that that plan isn't included in the plan published by the Government. Listen to those on the front line in health in Wales; then, perhaps, we will have plans that can ultimately bear fruit.

The COVID-19 pandemic has proved beyond doubt that good health is the cornerstone to our society. COVID has caused so much grief and loss and no aspect of our lives remain untouched. Like I’ve said before, the NHS is an organisation we can all be proud of. But the Welsh Government is failing to produce a plan that targets the ever growing waiting lists in Wales. The Welsh Government spends £2,402 per head, more than England and Scotland, but has the third worst performance figures. One in four patients are waiting over 52 weeks for treatment, and 64,000 have been waiting two years. Something must be seriously wrong. As a result of this, pressure is growing on NHS staff and patient care is suffering, and there is a sense the NHS is losing the battle to deliver the standard of care people deserve. 

Three weeks after I had my COVID vaccination in February 2021, I began suffering with severe anterior chest pain. After speaking to 999, I was advised to take four aspirin whilst waiting for the paramedics. After a period of time, my wife phoned, again, 999, and the paramedics arrived 40 minutes later. I was taken to the Heath hospital where I received excellent care for five days. After returning home for three weeks, I again began experiencing severe abdominal pain, which was when I was taken to the hospital, and I spent another 10 days in the intensive care units. I was fortunate enough to make a full recovery, and the kind of treatment and care I was fortunate enough to receive in the Princess of Wales Hospital and the Heath should be given to everybody. Unfortunately, this is not the case, and many others will have dire experiences.

After another recent stay in hospital, I, like many others, have experienced the challenge facing NHS Wales. The surgery I went through this time should have been performed in six months; instead, it took six more months after postponing four times, twice after admission and once on the day I was supposed to be going to the theatre—instead I was discharged home. These cancellations can and will have consequences for patients' well-being.

There is a sense that the NHS is fighting a losing battle to deliver the standard of care patients deserve. The widespread view is that the NHS is in a sorry state. However, this is not always based on personal experience, as I had. During my stay, I witnessed people on trolleys and chairs because of a lack of capacity in assessment wards, staff talking to patients with little regard or compassion and, all too often, patients had little idea who they were talking to. We obviously have a long way to go to achieve the high standards we strive to meet.

In A&E it is well documented that patient waiting times are extraordinary. Only 65 per cent of patients are seen within the target of four hours—the lowest on record. Due to a service that lacks the capacity to meet demand, some have waited days to receive treatment in a chair due to no beds being available. Some have experienced communication difficulties, with staff members who appear to ignore their concerns and medical history, which is vital to their treatment and prognosis. They all call themselves practitioners. In addition, some staff with dark blue uniform, and they look and act like a sheriff or a marshal, who remind people to behave, or else. These staff obviously forget their ethics and the patient's human rights. 

After a serious fall whilst exercising during the pandemic, a lady needed treatment at the Princess of Wales Hospital in Bridgend. She had broken several bones. In obvious pain, she waited six hours with limited pain relief, and was then sent home as there was no doctor available. We all know this is a difficult time for our NHS, but even before the pandemic, NHS Wales had been struggling. There has been little progress over 20 years, since the Welsh Government came into being. Change is long overdue and is vital to make NHS Wales fit for purpose. [Interruption.] I'm sorry. It will take me—. It's been 70 years; history can talk. Give me one or two minutes more, sir.

I'm sorry, you have your allocated time, and you know that. So, you will have to conclude now, please.

Let me finish, then. The current state of the NHS demands urgency for corrective measures. We are still unable to identify the basic problems in the NHS, and that is why our corrective measures never seem to bear fruit. Let me have the last word, sir. As the health and care system moves forward, and the focus shifts to re-establishing services and supporting the ongoing health and well-being of people, who have been waiting, and in isolation, there will be opportunities for further learning and innovations, and we must continue to rebuild our way back to health. Thank you.

The experience of Altaf Hussain is, I'm sure, repeated, and I know it's repeated, amongst many of my constituents, but that doesn't really get us very far, in the sense that we can acknowledge that the service is under huge strain at the moment, not least the pent-up demand from two years of lockdown, but also the reduced capacity of hospitals caused by the additional public health measures needed. It is no use operating on somebody for a particular complaint and then they get COVID during that intervention, because, obviously, the health outcomes from that are unlikely to be very good. And it's also the case that health staff catch COVID too, and we definitely don't want them coming into work when they've got COVID, and that reduces the capacity of professional staff. And these are not people we can just pick off the supermarket floor and get to come in and do the job in the hospital instead; these are trained people who need years of training in order to be able to do their jobs. 

So, I think we have to acknowledge the pain that everybody's going through, and the health Minister does that regularly, but we have to come up with solutions that are coherent and that are also doable. Because it is just two weeks and one day since the health Minister announced the recovery plan from COVID, and it's a little bit early at the moment to say, 'What's happening, and why isn't it working?' So, I think that we need to have a little bit more critical use of our faculties to work out what we need to be doing and how we're going to get there.

Certainly, we had a broken system before. If we've got somewhere between 20 per cent and 25 per cent of the population waiting for a hospital appointment—and it was a bit unclear from Russell's contribution which it is, but it doesn't really matter, let's just say it's one in five—that is just a staggering figure. And we just have to tackle the cause of the problem, as well as treat the symptoms, so we have to get on with the prevention agenda. And my colleague Lynne Neagle is sitting next to me; nobody could be a better Deputy Minister for public health than Lynne Neagle, and we are definitely getting on with the business of supporting people with their mental health, of tackling the obesity crisis that we have and also tackling smoking, which is obviously a major cause of cancer and many other problems, as well as obesity. These causes of ill health undoubtedly cause huge problems for the individual and for the health service system. And the best time to intervene on that, in terms of a response to Rhun ap Iorwerth, is at the beginning of the journey, which is when women are pregnant. That's when they want to change, that's when they'll give up smoking, that's when they'll change their diet. And we have to ensure that people are picking up the money that they can get when they're pregnant to ensure that they eat a healthy diet. So, there are many, many things that we need to do on that, but we can't not do it, because it's completely unsustainable to just go on the way that we are going at the moment.

One of the things we've got is—. It's no use asking for more beds—that's really not where it's at; if you've got beds, people will fill them. We need to do interventions differently, more effectively, with more skill, just like the north Wales orthopaedic surgeons who do day surgery of knee operations, enlisting the patient and their family in preparing for that operation to ensure its maximum outcome.

Thanks, Jenny. I agree with your comments in regards to prevention. I think we do need more beds, but I do agree with you on the general principle, though, because we've already got, as I said in my contribution, 1,000 beds with people who don't need to be in them. So, the big, big problem is the delayed transfer to care. If we can tackle that, that will answer a large part of the issues that we've got.

I agree. And that was on my little list. [Laughter.]

So, the Welsh Government is investing £43 million in social care, which is the main cause of delayed transfer of care, by offering the real living wage to make it more attractive to go into social care and also by having the wraparound care that's available through the neighbourhood nursing schemes. These are definitely things that need rolling out. But we also need to develop an equitable service and the Minister's plans to bring services closer to home. Because, remember, 90 per cent of the population don't go anywhere near a hospital; it's a much smaller number who actually need to be in hospital. But we also need to acknowledge that we have problems with staffing levels and that these are not going to be easily resolved. That's why we had the closure of two midwifery-led birthing units announced in Aneurin Bevan, which means that we're having to concentrate hospitals on a smaller number of units that are further away from where people are living, and that causes additional problems. But the problem is also exacerbated by Brexit. Those of you who think that Brexit was a good idea, let me just tell you that one health board—

The Member needs to conclude now, please.

—had a Greek ophthalmologist—. A Greek othalmologist was—. An appropriate person was offered the job by this health board, and, when the Home Office told them they couldn't allow their family to come with them, guess what? They decided they didn't want to take that job. So, that problem is exacerbated for all the other health professionals who we have, in the previous iteration, allowed to come from other European countries to come and support our services.

Jenny, you need to finish, please.

So, we absolutely have to change, and I think that the recovery plan is a coherent plan for change. But doing things the way they have always been done is definitely not an option.

Let's not beat about the bush: COVID-19 has not caused this waiting list crisis. Yes, it has exacerbated problems, but those were issues already present within the Welsh NHS under the remit of this Welsh Labour Government.

As of January 2020—2020—12,428 treatment pathways were waiting over 36 weeks for treatment in north Wales. That already horrific figure has now reached 58,988 in February 2022. It's the highest number on record and is 250 per cent higher than the low of 17 in May 2012. Clearly, the staggering worsening delays we are encountering in the Betsi Cadwaladr University Health Board form part of over a decade of decline and overcentralisation in three major hospitals—Ysbyty Maelor Wrecsam, Glan Clwyd and Gwynedd. Look at Llandudno hospital: prior to the pandemic, it already had empty wards, and then the management team at the board went and closed the ambulatory care unit—ACU—in 2021, a newly opened unit to actually reduce pressure on Ysbyty Glan Clwyd, Ysbyty Gwynedd and even Wrexham Maelor. Despite having an excellent minor injuries unit, which saw 98.4 per cent of patients spend less than the four-hour target time in the emergency department, its responsibilities now have decreased to around nine injury categories. And this—. We were told, once the A&E department went, that we would have an all-singing, all-dancing minor injuries unit, and, again, one that would take pressure off the three major hospitals. And yet, as we speak, the services there are being reduced. Consequently, even residents living in the town opt to go now straight to Glan Clwyd or Gwynedd out of fear that the MIU will simply refer them there. This is compounding the pressure in the worst-performing A&E in the nation. At Ysbyty Glan Clwyd, less than one in two patients are seen within four hours, and one in four patients wait over 12 hours.

Now, I've been leading my own campaign to try and reduce pressure on the three major hospitals. The health board is undertaking a six-month bridging service—and, Minister, this is where you've got people in beds in those three major hospitals who really should be in the social care system. So, you know, because I think you've welcomed it, this bridging service—. But the costs of it, it's only going to be open for six months. We need that to be a longer functioning service. These are people who are medically fit to be discharged and have a suitable care package in place, and these are being transferred to the specially configured Aberconwy ward in Llandudno. But no initiative can be judged on its merit on a six-month basis.

I hope you will agree that increasing the role of our smaller hospitals is a key lever at our disposal. And I will always continue to stand up and fight hard to see services integrated at Llandudno hospital, because you've promised me, as have previous chief executives of the health board, and previous Ministers, that Llandudno General Hospital does have an integral part to play. So, you know, actions speak better than words.

At present, the Welsh Government management of the Welsh NHS has caused a situation in which the Stroke Association are warning that delayed transfers of care are causing a number of problems in emergency care for stroke patients. Cancer Research UK has stated that the quality statement lacks detail and accountability. It does not set the vision needed to support services to recover from the impact of the pandemic whilst improving cancer survival. We certainly have a crisis with mental health services in north Wales. Despite the Deputy Minister claiming that mental health for children and young people would be a top priority, only 38.1 receive their local primary mental health support services assessment in north Wales within 28 days, and that was in December. Compare that to Cardiff, however, where the figure is 91.3.

And it gets worse. The Nant y Glyn community mental health team in Colwyn Bay is failing our residents. I have constituents who are in mental health crisis, and, when they reach out to this Nant y Glyn clinic, they can't get through to the centre on the phone, let alone access any specific support. I've asked Fleur Evans now to meet me with Mr Kenny Burns, the manager of that centre, because it is not good enough. People are coming into my office seeking urgent mental health support, people are also coming into my office threatening suicide because they cannot access this support. I've raised this year after year after year here, and you can turn around, Minister, with all due respect—and I do have a lot of respect for you; I just feel that we come here week after week, we raise the same concerns, you listen and you respond, but it's not words I want, it's action for my residents—

On that point, you have used your time.

Gosh, right. [Laughter.] We have at least 100 consultants across Wales—of shortages. There has been no increase to the advertised 309 medical school places at Cardiff University. I could go on—

No, you will not.

—but I'm not allowed, but this is a really serious subject, and I thank my own group and Darren Millar and Russell George for bringing this. We will bring these debates week after week, month after month—I hope not year after year. Please listen to us, Minister, but please improve the health service in Wales.

I too would like to thank Darren Millar for submitting today's vitally important debate and, of course, Russell George for opening today's debate on NHS waiting lists. I'd like to start today by firstly putting on record my gratitude and thanks to all those wonderful and dedicated people who work in our health service, who go above and beyond in the work that they carry out. As someone who has both a brother and a sister who are nurses in the NHS, I understand first-hand the work and dedication carried out by so many—[Interruption.] An important phone call, I'm sure.

Nevertheless, Deputy Presiding Officer, it's this Welsh Government who continues to fail our health service here in Wales, and, of course, this is an issue that was evident, as already described eloquently by so many, long before the COVID-19 pandemic started. This has been a responsibility for Government here in Wales for 23 years now, and, with all due respect to Jenny Rathbone's contribution, I hear what was said, but 23 years to fix many of the issues that have been raised here and I too will raise in a moment—.

We constantly see, of course, a significant portion of taxpayers' money in Wales, over half of Welsh Government's budget, being spent on health, and we have to ensure we see value for money.

Will you take an intervention?

Certainly.

Thank you. We've talked about—. Over the last 10 years, we've had cuts in public service funding, which has impacted on the money that's been available to social care through the councils. We've talked about not being able to move people on—[Interruption.] No, the UK Tory Government have cut public service funding under 10 years of austerity, which has impacted—

Can you let the Member make the intervention, please?

—which is what has impacted on not only social care services, but services that are able to be provided through local authorities, preventative services, all sorts of things and help to people. Do you not agree with that, Sam Rowlands?

Well, you make a point in terms of the budget allocation here in Wales, the responsibility of the Government of Wales, but you have to ask the question: pressures across the United Kingdom in terms of budgets and dealing with debts that Government has to deal with, but we still see the worst waiting times in Wales than anywhere else in the United Kingdom—. Darren Millar wants to intervene.

Yes, I'm grateful to you for taking the intervention. It's a matter of fact that no Conservative Prime Minister has ever cut an NHS budget. The only Government in the United Kingdom that's ever cut an NHS budget is the Welsh Labour Government. It's your party, Carolyn Thomas—it's your party, Carolyn—that have actually cut the budget. 

Can I remind the Member that an intervention is directed towards the speaker and not somebody else?

I appreciate the Member's intervention and I took that to come to me directly there. 

It was directly to you.

Thank you very much. So, in my contribution, if I may continue, Deputy Presiding Officer, I'd like to focus on emergency waiting times initially and how, quite frankly, we see this area continuing to fail. The statistics are shocking. As already outlined today, we see one in five on a waiting list; one in four in Wales waiting over 52 weeks for an appointment; and, in addition to this, since just August we've seen those waiting over two years more than treble across Wales.

Now, in looking at my region in north Wales, the health board in north Wales has more people on waiting lists than any other health board in Wales, and I'm afraid these statistics continue to get worse when looking at those in accident and emergency units. Within four hours, we see some of the worst waiting times in accident and emergency units—within four hours—in Wales than anywhere else across Britain. They are deeply concerning statistics. Again, coming back to my region in north Wales, for example in Ysbyty Glan Clwyd, one of the main hospitals in north Wales, one in four patients had to wait in accident and emergency for over 12 hours. Looking at ambulance response times, north Wales has one of the worst response times in Wales. I've stood up here before and talked about this north-south divide, and, again, in terms of health outcomes and health performances, we see a north-south divide. Health is not performing anywhere near as well in north Wales as it is across in other places in Wales. I come back to this point: 23 years to solve some of these issues. We do forget sometimes, sadly, that people are paying for this service. People are paying through their taxes to sit in accident and emergency for over 12 hours; people are paying to wait for hours and hours and hours for an ambulance to turn up to help them out. This really isn't acceptable.

The second area to focus on, I believe, is the cancer waiting times. Staggeringly, prior to the pandemic, the target for cancer waiting times had not been met since 2008. In addition to this, the Welsh cancer intelligence unit's data sadly shows that Wales has the lowest survival rates for six cancers and the second lowest for three cancers in all of the UK. Of course, deeply concerning for patients and families up and down Wales. It's clear to me that the plans that the Welsh Government have are not working.

When looking at some of the most up-to-date statistics, we can see that the Welsh Government is still failing on cancer targets. In February this year, just 59 per cent of patients newly diagnosed with cancer started their first definitive treatment within 62 days of first being suspected of cancer—well below the 75 per cent target. Again, it's worrying for patients and families across Wales that these targets are being missed. I mentioned it in my contribution earlier, Minister, in terms of the question. My worry for much of this—and we'll stand here and we'll highlight these issues—is the trust that this erodes in the health service and in the targets and the actions that the Government are looking to take to improve the health service. If that trust goes, then we're really, really struggling to bring our residents along with us. 

The Member needs to conclude now.

I will wrap up, Deputy Presiding Officer. Now, of course, is a time for Welsh Government to take these issues seriously. People's lives are on the line, which I know we're all aware of. I believe that Welsh Government needs to urgently rebuild the trust of residents across Wales by improving our health service, hitting the targets that it sets, and improving our health service for all. In light of this, I call on all Members to support our motion and reject the Welsh Government's amendment. Diolch yn fawr iawn.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. I'd like to start by, I hope, speaking on behalf of the whole Chamber, just to say that I'm glad to see Altaf Hussain back in his place. I'm really pleased that he's had good treatment from the NHS, along with 200,000 other Welsh people per month who are receiving treatments in the NHS. I think we've got to start with that. Can we please recognise that the NHS is not broken, that 200,000 people per month, despite the pandemic, are still being seen and are getting good treatment?

I want to thank you, Dirprwy Lywydd, for allowing me to respond to this debate. I published the report on planned care on 26 April. That, of course, was developed in collaboration with our clinicians, so this is not a civil-servant-created plan; this is one that's been developed with clinicians, with our NHS. And what we wanted to do was to make sure we had something that was both challenging and achievable. So, you can say, 'We're going to clear the whole backlog within a year', but it's unrealistic to think that's going to happen, and my predecessor was very clear that it's going to take the whole of this Senedd term to clear that backlog that has developed.

You know that we've promised to invest £1 billion in clearing the backlog. I'm glad to see the finance Minister's here to hear me saying that. And I guess, if we had more, we could do more, but, actually, we are restricted because of the money we get from Westminster. And let me tell you that if you put together health and care—and you've all talked about how important that relationship is today—then we're spending 4 per cent more than they are in England on health and care here in Wales. And I must say that, in terms of Plaid Cymru, this is one of our priorities, but this was not one of the priorities that you set out in the partnership agreement. So, we have to deal with the money that we have here.

Now, I know, through meeting our dedicated NHS staff, that despite what they've gone through over the past two years, they are up for the challenge. I've spoken to surgeons and anaesthetists who've told me of their frustrations in not being able to operate at the rates that they need to for their patients. And you're right, Rhun, you hear the Royal College of Surgeons saying, 'do this', but then you speak to the Royal College of Physicians, and they say something different. So, let's be clear that there is not a one view from the NHS in terms of how to tackle this backlog. And it is absolutely clear that the pandemic has had a massive impact on our health and care services. It's stretched the NHS to its limit and, prior to the pandemic, in 2019, we had no more than 9,000 people waiting for 36 weeks for treatment.

North Wales—lots of you talked about north Wales—it needs some attention, and I'm giving it lots of attention. I can assure you that I've been to the north Wales health board more than any other health board, but, actually, can we start to talk up what's good about north Wales as well? Cancer treatments are better than anywhere else in Wales. Now, we're not hitting the targets and we've got further to go, but let's give praise to all those NHS workers who are really working hard to clear that backlog. I think it's really important we're really careful about talking down Betsi all the time because, frankly, it's making it more difficult to attract and recruit people. So, can we please be sensitive in the way we talk about it? Of course you can hold me to account, of course we need to hold the health board to account, but just understand that there is a consequence to this constant criticism.

We're acutely aware, Minister, of the importance of praising the good, but shining a light on the bad. We have to have honest discussions, and that means calling out when the health board is failing. And certain aspects, unfortunately, of service in north Wales are failing, and that's what you've heard referred to today. We adore the hard-working staff in our NHS in north Wales. We're constantly praising them. As local Members of the Senedd, I know that we visit local surgeries and hospitals all of the time and have lots of interaction with our health board, but you can't expect us to have a gagging order from you about not calling out bad practice—

I'm not—. I was very careful in what I said then.

—because it's important that we do so that you can get to grips with it.

I can assure you there is no gagging order from me.

Thank you.

Can I just make it clear also that we heard loud and clear when the UK Government published their planned care plan that they didn't have a workforce plan alongside it? Well, we are very aware that we can't deliver this without a very active workforce, and we have recruited 8,000 more staff into the NHS than we had in September 2019. That's about a 54 per cent increase in staff to the NHS in the past 20 years. That is a significant increase. Not enough, there's still more to go. But we're not starting from scratch here. We will need more staff in clinical and administrative posts, we'll need to use the staff we have effectively, and we're going to make much broader and better use of the skills and expertise of our staff, including our nursing staff and our allied health professionals, to support people while they're waiting for their appointments. [Interruption.] If you don't mind—. Go on, Altaf.

I just want to speak about a very small thing. What you said about the clinical staff, nurses, everybody, is fantastic. But I have written this paragraph: managers have been appointed without a job description, or at best a job description of managerial description. They have become the embodiment of self-focus, self-development, self-progression, self-preservation, self-extension, self-propagation to the exclusion of the broader interests of the NHS. This tendency can fundamentally subordinate and undermine our NHS. That needs to be looked into, please.

Altaf, let me tell you what I do and what I don't do. What I don't do is I don't manage the NHS. That is not my job.

Someone needs to.

Wait a minute—that is not my job as a politician. That is not my job. That is the job of the NHS health boards, and it's my job to hold them to account, and it's my job to set them targets and to hold their feet to the fire for those targets and those outcomes, and that's what I'm doing. But I will not be getting involved in writing contracts for people, and I think it's really important that we understand where the lines are here.

Lots of people have pointed to the need to do something about the delayed transfers of care, and it is a really difficult situation we're in here. Let me tell you that, at this point in time, about 43 per cent of our care homes are closed in Wales as a result of COVID. This is not something we've created. These are the circumstances we're in at the moment. Now, I can't take full responsibility for that. One in 25 people in Wales have COVID at the moment, so these are pressures that we're having to deal with. We could have published our plan a year ago, but what would the point of that have been? Because there is no way you can respond if you know that, actually, you're going to have wave after wave of COVID, where you can't actually see the movement and progress that we want to see.

So, I think it's really important that we understand that COVID is still with us. There are 700,000 open pathways, and we're very aware of that, and I can tell you it keeps me awake every single night, but they're pathways—they're not all individual people. There are lots of people who have more than one pathway that they are on. I was clear that it would take the full Senedd term and a lot of hard work to recover from the impact of the pandemic, and I was interested—. Rhun and Jenny always talk about the importance of the prevention agenda. This was very much a planned care programme, and I can tell you that I am not taking my eyes off the planned care agenda, because, frankly, they will just keep coming into the system unless we do something on the prevention agenda. I've been meeting with the World Health Organization this morning, who are very interested in our prevention agenda, and it's really important that we don't take our foot off the pedal on that. If you were in the Chamber yesterday, you'll have heard about our outcomes framework, which is all really geared to the preventative agenda.

It is important now that we increase the capacity of the health service, that we prioritise diagnosis and treatment, that we transform the way that we provide elective care, and it's also important that we provide better information and support for people. We have allocated additional millions of pounds to ensure that we see theatres and additional resources for endoscopy, and that is already making a difference. So, our recovery plan does acknowledge that the whole system needs to work together to achieve the aims of this plan, from the primary care sector working very differently with the secondary care sector, services to support patients to manage their health in their own homes and we need to decrease the need for care in hospitals. It's important that the care sector and the social sector work together to ensure that patients are released from our hospitals safely. I'm sure that we're all going to work together to recover from the pandemic.

I call on James Evans to reply to the debate.

Diolch, Deputy Llywydd. I want to start this by thanking everybody in this Chamber who has contributed to this very important debate today. This debate is of vital importance to the people of Wales. I know personally about this waiting list, because my mother had been waiting four years for a hip operation, in excruciating pain, but I'm pleased to say that she has now been treated.

As my colleagues Russell George, Rhun ap Iorwerth, Janet Finch-Saunders and others have said, NHS waiting lists now are longer than ever before. One in five people are on a waiting list. This affects people of all ages and all backgrounds and they're all being hugely, negatively affected by these backlogs. As Rhun said, the NHS was creaking under pressure before the pandemic began. Early delays, which were mentioned, have caused problems in the wider NHS and it has made pre-existing health conditions an awful lot worse, especially around cancer diagnosis. 

I was very pleased to see more investment going into the NHS. However, we do need to be assured that that additional investment will be spent on the front-line NHS and not lost in bureaucracy. We don't need anymore managers; what we need is more doctors, nurses and front-line health professionals to deal with the problem. More money goes into the NHS in Wales than in England. So, it's not the money that's the problem, it's the way that the NHS is managed. It was great to hear Altaf Hussain's very powerful contribution to this debate. I'm sure that everybody in this Chamber knows of your experience, Altaf, and you're very well respected, not just here, but across the world for your experience in the NHS and what you have done.

In my own constituency, residents face lengthy delay times. They don't have access generally to a district general hospital. We are seeing community support being reduced. Knighton Hospital in my community has seen the services cut back. We're seeing local wards close. Janet Finch-Saunders made the point about local community health, and if we are to sort the delayed transfers of care out, we need to make sure there are beds in our community hospitals for people to be transferred into.

We have previously discussed the damning report 'Waiting well?', which stated the impact of the waiting times backlog. It called for robust plans to be put in place. Whilst the Minister has announced a series of measures to tackle this, and I and many others welcome that statement that there are commitments in place, it's vitally important that the Government and this Senedd and relevant committees can scrutinise health boards to make sure they are delivering on their targets and that people aren't let off the hook.

Jenny Rathbone did say that this plan has only been in place for two weeks. But, I would just like to remind you that this Government has been in place for over 20 years, and it was creaking before, so you cannot blame the pandemic for everything. Things were going backwards before, so I'd like to ask the Minister to reflect on that and not blame everything on the pandemic. Yes, Jenny, I'll take an intervention.

Yes, it has only been there for two weeks. What is it that's not adequate about this now? You said it's not an adequate plan, so what would make it adequate in your view?

What we want to see is timescales. We're not seeing adequate timescales for delivery on these things. We're seeing the surgical hubs some of us don't have; we're not seeing when surgical hubs are going to be delivered right the way across Wales. There's no time frame for that—it's in the plan. We're not seeing where all this money is actually going to be invested. We want to see that so that we can scrutinise it properly. 

Because we do welcome surgical hubs, Minister. That's something that you and I, and Russell George and my party, have been calling for for many years, because we want to see the number of people going into the NHS increasing. But when those people go in, we need to ensure there is adequate staff there to make sure that people are getting seen. I've said to you, and I'll say it again: I do think we need to have a radical look at how we get people into the NHS, whether that's through degree apprenticeships or having a radical overhaul of how people become nurses or doctors.

A lot of people have mentioned in this Chamber—[Interruption.] I'll make a bit of progress, Carolyn, and I will come back to you. Prevention is better than cure. Many people have said that. And I do respect the Deputy Minister's position here of trying to address that, but we need to push this faster, quicker, to make sure it's delivered. We don't want to see people who are suffering with obesity on waiting lists, because that puts pressure on the NHS in terms of delays in discharge. Public health needs to be prioritised and that means closer integration with our local authorities. 

I do want to talk about discharge. Social care and the health sector working together isn't working at the moment. We have seen too many people sat in hospitals bed blocking, and the link between the health boards and our councils needs to be more integrated. I know, Minister, you will say that we now have the regional partnership boards in place to help deliver that, but with 1,000 people still waiting in beds, as Russell George has said, I'm not sure if that integration is working. And something I'd like to push you on is to make sure the regional partnership boards are delivering that.

Minister, I don't want you to see this motion as an attack. I think emotions got very high earlier around this. Russell George, my colleague, put in some very good points on how we would like to see things improve across Wales, and that's what I want us to do here. The NHS isn't Labour's, it's not the Conservatives', it's not Plaid's, it's not the Liberal Democrats', it's the public's NHS. They pay their taxes, they expect a decent service, and that's why we as Welsh Conservatives will hold the Government to account on this. That is what we are here for, and that is why I urge all Members to support this motion in front of them today. 

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes. I will defer voting on the motion until voting time. 

Item 7 today is the Plaid Cymru debate on alcohol-related harm. I call on Peredur Owen Griffiths to move the motion. 

Diolch, Dirprwy Lywydd. Pubs have been part of the fabric of community life in Wales for centuries. The industrial revolution saw an increase in licensed premises, with many social clubs springing up in the new communities that were created to house the workers that were part of this population boom in Wales. These venues were a place where people could go after a gruelling shift to quench their thirst. They also provided a meeting place for the community to come together and organise. Since my election, I've been providing support to a community group within the region seeking to reopen a pub that has lain dormant for some time. I recognise the huge boost this would provide for this particular community. 

Before the industrial revolution, we know that alcohol was part of life for many centuries. It is true to say that most people who drink alcohol have no problem at all. They can enjoy a few pints or a glass of wine responsibly, they can stay within the recommended units of alcohol per week, they may even go weeks or even months without an alcoholic drink. This debate is not about condemning or discouraging moderate drinking, it's about ensuring that help is there for those who simply cannot take it or leave it. Most of us will know or have known someone with a drink problem, whether they are friends or family. 

The statistics at our disposal underline the pervasiveness of alcohol abuse in our country. In 2018, there were 54,900 alcohol-related hospital admissions and 14,600 alcohol-specific admissions in Wales. More than a quarter of adults who drink alcohol are drinking more often since lockdown. Perhaps most damaging of all is that, in 2020, despite various policies and actions from the Welsh Government, we reached the highest number of alcohol-related deaths in 20 years. These numbers are stark and they are horrific. We must never forget that behind these statistics are ruined lives and lives cut short, causing untold misery for the alcohol abuser, their family and their wider friends and community. 

Family members of alcoholics may experience mental health problems such as anxiety, depression and shame due to their loved one's addictions. There is also the risk that they may be the victim of drunken outbursts. For an estimated 200,000 adults in Wales, alcohol led to greater tension or conflict during lockdown, and more than one in 13 people said that their own or someone else's drinking had made the tension in their households worse since lockdown. This figure is even higher in households with children.

As well as a considerable human cost, there is also the financial cost that alcohol has on our local services, our NHS and the criminal justice system. It impacts on absolutely everyone. In 2015, it was thought that alcohol misuse was costing the NHS in Wales more than £109 million a year, a figure that is likely to have grown higher since. We acknowledge that the Welsh Government has a substance misuse delivery plan for 2019-22, but we believe that more must be done to effectively tackle the growing issue of alcohol misuse in Wales. This must be done in a progressive, not punitive, manner.

The picture has changed since this plan was drawn up. The Government has an opportunity to react to the increased threat that alcohol abuse is posing to our communities. We need enhanced resources and measurable targets to combat alcohol-related harms within the Government's substance misuse delivery plan from 2023. The status quo just isn't working. That much, I hope, everyone can agree. I move the motion. Diolch yn fawr. 

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call, therefore, on the Deputy Minister to formally move amendment 1, tabled in the name of Lesley Griffiths. 

Formally.

I now call on James Evans to move amendment 2, tabled in the name of Darren Millar. 

Diolch, Llywydd. I move the amendment tabled in the name of my colleague Darren Millar.

I'm extremely grateful for Plaid Cymru bringing forward this important debate on a pressing issue that we all face here in Wales. The last contribution was very powerful and I thank you for that contribution. This debate on alcohol-related deaths highlights the number of alcohol-related deaths in Wales. It is at its highest level for 20 years, with a 19 per cent increase from 2019 and the pandemic only made things worse. It is simply not good enough. Too many people are losing their lives unnecessarily due to alcohol abuse. 

Cases of alcohol dependency in Wales disproportionately affect those from poorer communities, and the Welsh Government, along with the UK Government, must do more to help those people in our poorer communities, and provide a stronger commitment, enhanced resources and measurable targets to combat alcohol-related harm here in Wales. I'm deeply concerned by the figures from the patient episode database from 2019-20, which showed that there were nearly 14,749 hospital admissions with an alcohol-specific condition. This is an absolutely staggering figure that should shock everybody in this Chamber, and it just shows how much alcohol abuse is putting pressure on our NHS at a time when it can take no more. 

Furthermore, it is estimated that alcohol is a factor in nearly 49 per cent of all violent crimes in Wales, compared with 39 per cent in England, and that 18 per cent of Welsh adults reported drinking over the weekly guidelines. Having a couple of glasses of wine may be okay, but for some people, it's not enough. Some people cannot handle their alcohol, and this feeds into domestic violence cases and extreme violence cases on our streets. If we can get underneath this, we can start to tackle the wider problems in our society.

When we're aware of an issue like this, and we have the tools and the means to address the challenges people face, we have a duty to act wherever possible, and we must work together. I am fully aware of the Welsh Government's substance misuse delivery plan. We've discussed this in this Chamber before, but we must go further on that to really help people who are dependent on alcohol.

I don't wish to add much more because I think the opener of this debate has made such a great contribution. We on the Welsh Conservative benches will be supporting the Plaid Cymru motion this afternoon, because I think a progressive, forward thinking, collaborative approach to addressing substance misuse is needed. People lose too many loved ones far too soon, and I would urge all colleagues right across this Chamber, even Government members, to support this motion today to make sure we don't lose anybody before their time. Diolch, Llywydd. 

The increasing incidence of alcohol abuse is very concerning, and it's something that each and every one of us should be concerned about. It's believed that high-risk drinkers have been driving the recent increase in alcohol consumption, and that has led to the highest level of alcohol abuse in 20 years. We know of the damaging impacts of alcohol abuse on our physical health, as well as our mental health. As we've heard already, we know that lockdown in particular had an impact on how much people drink, and that in turn has had a detrimental impact on health. The British Liver Trust told me at a Love Your Liver event outside the Senedd recently—and I know that many Members had visited them there—that there had been an increase of 20 per cent in liver-related deaths that were alcohol-related during the pandemic. So, the damage has been highlighted in the number of deaths in such a brief period of time, in just two years.

Drinking heavily in the long term can also cause changes to the brain, causing cognitive problems. It can also lead to very real damage to the brain—alcohol-related brain damage, ARBD. And it is a condition that can be prevented from deteriorating if the patient can stop drinking alcohol, and with the appropriate support at the right time, then most people can make a partial recovery. But despite that, the Royal College of Psychiatrists tells us that only around 16 per cent of those who are suffering are diagnosed, because of a lack of understanding, a lack of awareness of the condition, and an inconsistent approach to treatment, because of the absence of the kind of treatment model that would be sufficient to meet demand. They are very eager to see the Welsh Government investing in and introducing an ABRD awareness package—which has been developed by the University of South Wales—and they want to see that done urgently.

Now, the relationship between alcohol and mental health is one that's well known but it's also very complex. Alcohol, of course, is sometimes used by people to try and help the symptoms of anxiety—as they see it—or the symptoms of depression. But the reality is that drinking too much will probably exacerbate those symptoms, and depression and heavy drinking are closely related, and it's a self-fulfilling relationship, which means that if one shows signs of either depression or heavy drinking, then it's likely to increase the likelihood that the individual will experience the other side of the coin too. It's a worrying correlation, and managing drinking and getting the right support is crucial for good mental health.

Now, the clear link between the lockdown and the increase in alcohol abuse figures does demonstrate how isolation and loneliness and changes in daily routine can have a detrimental impact on individuals and their state of mind. And having learnt from that experience, I do think that we do have to seek to provide support for people. And we are talking here of providing support to people to prevent self-harm. That's why we wanted, as the minimum alcohol price Bill went through the Assembly, as it was at that time, to see something in legislation that would ensure that there is funding provided as a result of that legislation and that efforts are made through that legislation to tackle alcohol abuse too. This wasn't just setting a price for the sake of setting a price; we wanted legislation in place with the intention of changing people's relationship with alcohol, and it's extremely important that those steps are taken as a result of that legislation, in order to ensure that people do understand that support is available and that they experience that support that they haven't had from Welsh Governments in the past.

I'm really pleased to be speaking in this debate. It's a really important topic. It has a profound impact on so many people's lives. Alcohol harm in Wales, and indeed the UK, is a significant issue. When you take a step back and look at how frequently it's pushed on us at every given opportunity by advertising, it's extremely hard to ignore. If you were to believe advertising and the hype surrounding alcohol, you'd think that we can't possibly get through life without it. We are peddled the message that we need it at sporting events, a night out or in with friends, celebrations, sad events or even day-to-day parenting. With this incessant push, it's no wonder that alcohol harm is a growing problem, especially when you consider that alcohol is one of the most addictive substances legally and readily available. Recent years have seen the growth in the so-called mummy-wine culture. This includes memes on social media, placards to hang in the home and birthday cards telling mums they need wine or gin to cope with parenting. I recently saw one that said, 'I am the reason my mummy drinks'. Yes, I know they're supposed to be funny, but I don't think that's the overriding message. What sort of message is that giving to parents and their children? There are similar messages that are targeted at dads as well, but they're not on the same scale as they are for women.

Alcohol harm amongst women has seen an increase in recent years and yet, it's not talked about enough. I think that is incredibly worrying. I'm not attributing all of that increase on the mummy-wine culture alone; those reasons are multifaceted. The impact of this increased alcohol consumption in women is having devastating consequences on their health and their well-being. Research has shown that women start to have alcohol-related health problems sooner, at lower levels of consumption than men. That is mostly down to the biological differences. These include heart disease, liver disease, breast cancer and brain damage. With this in mind, I'm keen to know that the Welsh Government is doing something specifically to target alcohol harm in women. We know that alcohol use can cause a plethora of diseases in both men and women, but where do we see the warnings on the bottles or the cans that highlight that? What you usually see is a message that says, 'Drink responsibly', whatever that might mean, and a picture of a pregnant woman with a cross through it. I'd like to see a change to this, and I'm eager to know what discussions Welsh Government is having with the alcohol industry regarding their lack of health warnings on products.

There are also confusing messages about alcohol strengths and the units, neither of which is clearly and boldly displayed on the product, and I do check quite frequently—and as many of you know,  I'm a virtual teetotaller—the strength of alcohol on products. And sometimes, you'll be lucky if you manage to find it at all. It will be there, but if you can find it, you will have searched for some time. So, I think that we have to do two things: we have to display the warnings clearly, but we have to stop the advertising—and reduce its harm—saying that you have to have a drink to get through the day. I hope some of you when you go home and watch tv will take notice of the ads, whether you're having a meal or whatever it is you're doing in life, and the number of times that you will see alcohol in every single advert. And we have the same problem, of course, in gambling, if you watch sport.

So, I think those are the messages that we have to really, really tackle, and help people not to become addicted in the very first place. It is not all right to drink too much, it is harmful, and the harms are significant. Thank you.

What is most tragic about alcohol-specific deaths, alcohol-related hospital admissions and the consequences of alcohol dependency is they are completely preventable. What is unforgivable, perhaps, is that alcohol dependency disproportionately affects people who are socioeconomically deprived. On average, people on low incomes drink less than people on higher incomes. The minimum unit pricing measure introduced by the Government is attempting to respond to the fact that affordability is a key driver of consumption. However, the most vulnerable in our society are still at most risk from harms and ill health caused by alcohol. By failing to address the causes of poverty, and failing to better support the most vulnerable in our society, we are putting too many people at risk of the dangerous consequences of alcohol dependency. The figures speak for themselves. In Wales the rate of alcohol-specific hospital admissions is 3.3 times higher in the most deprived areas. Around 45 per cent of people seeking alcohol treatment live in the 30 per cent most deprived areas, and 10 per cent of people seeking alcohol treatment have housing problems. Nearly 30 per cent of people in the UK receiving alcohol treatment report having some kind of disability. The Welsh Government needs to act with urgency to prevent further increases in these shocking figures. These figures reflect, however, deeply entrenched health inequalities in our society, inequalities that were reflected in the high death rates due to COVID within deprived communities.

The future impact of the economic storm, the cost-of-living crisis that is hitting these communities the hardest, on addiction and mental health, makes targeted action now to address those inequalities all the more critical. We need to take a holistic approach to reduce alcohol-related harms by supporting people who are most vulnerable to those harms. Poverty impacts on health. Research shows that those in poverty are more likely not only to lead an unhealthy lifestyle, but they are also harmed as a result of poor housing and stress related to their material and social circumstances. We know that poverty reduces people's resilience to disease, which, in turn, of course, makes them more vulnerable to the greater health harms of alcohol. It has been shown by multiple studies that alcohol can thus amplify and worsen the harmful effects of poverty. When alcohol and poor diet are combined, for example, the risk of alcohol-related conditions increases significantly in poorer communities.

The Westminster Government showed again in the Queen's Speech whose interests are at its heart, and it was again clear that it was not those who live in need, who deal everyday with financial stress, poor living standards, disabilities and insufficient income. If we had full devolution of welfare and taxes, for example, we could fashion and implement a compassionate benefits system, finance targeted support, rather than shrug and accept that we are at the mercy of a callous and neglectful Tory Government in Westminster. We could provide people with appropriate disability support, for example, to raise people's standards of living and help them better weather this cost-of-living crisis.

Whether or not minimum unit pricing goes some way towards addressing consumption, the inequalities that will always make some of our citizens more open to the harms of alcohol remain and are deepening. Understanding the role of social inequalities in driving alcohol harms and addressing those inequalities to prevent alcohol-related harms is of critical importance. I urge Members to support the motion.

I want to make a declaration of interest as I am a trustee of Brynawel Rehab. I am grateful for the opportunity to contribute to this debate, and I thank colleagues in Plaid Cymru for bringing this important subject for debate on the floor of the Senedd.

There are many aspects of this debate with which we all agree. Alcohol-related harm, dependency and, regrettably, death are major challenges here in Wales, as they are across the United Kingdom. We are not alone in our concerns for the increasing use of alcohol as a means of coping with the challenges of everyday life. It is important to remember that alcohol-related death, and the pain this causes is, indeed, preventable, and with the increase in dependency, the effects of the COVID lockdown and the concerns over the mental well-being of the population, it is clear that we have to act with greater urgency, over the course of this Senedd term, to start to halt and reverse the trend that we have witnessed.

I am proud to be a trustee of Brynawel, a drug and alcohol rehabilitation service in south Wales working to support people who have become dependent. What we know is that there are many people throughout Wales who can live normal, functional lives, whilst at the same time maintaining a lifestyle that increasingly relies on alcohol as a key part of their social and family life. Many sustain this lifestyle before becoming physically unwell and requiring the support of acute NHS services. Many drift into dependency all too easily, and, from there, the shift ever downwards into consistent alcohol abuse becomes sadly normalised.

I would like to focus on the Welsh Government's delivery plan, as this is crucial to how this country responds to a growing challenge; at a time when we have seen a reduction in treatment numbers over the past five years, the number of alcohol-related deaths is the highest it has been for 20 years. I would like to set out a number of concerns that I have, which I hope the Government will address. 

Whilst we need to tackle the causes of the problem, and this is incredibly challenging, I want to pay tribute to all those professionals across the health and third sectors who play such an important role in supporting those with addiction. Lifestyle choices, how we live our lives, add hugely to the pressure on the NHS, whether it's drug and alcohol use, smoking or obesity. The NHS is therefore largely reactive to this increasing challenge, and I don't want to underestimate the impact on them and the services they provide. There are, of course, a range of options for us to pursue, and the NHS is not the only provider of services. 

Ensuring appropriate and efficient service provision is key, and, whilst I am encouraged to see a focus on partnerships and pathways for service users, this is not always played out in their experience of services. Partnerships between health, social care, mental health and third sector services are critical, as with other areas of our health and care system. It does not always work effectively. Pathways between specialist substance misuse and mental health services can be unclear, with many health boards unable to articulate how they provide seamless pathways for individuals with co-occurring mental health and substance misuse issues. Surely, there is a case to be made for mental health and addiction services adopting a 'no wrong door approach' to service provision.

It is also important that Wales establish a Wales-wide recovery plan for those who are now sat on lengthy waiting lists for community prescribing and in-patient detoxification. I appreciate that, as we emerge from the effects of the pandemic on the wider population, we know that services are struggling to step back up to get to where they were before March 2020. This has an impact on many people, but it is worrying that, unless we act quickly enough, the impact of our failure will fall disproportionately on those who are socioeconomically disadvantaged.

Many people who succumb to alcohol dependency will, if their condition worsens, need the help of family members, who often take on a caring responsibility. I would like to know how the provision of support for carers and family members will be evidenced by services, given the relatively low number of carer assessments offered by tier 2 and tier 3 substance misuse services. It might also be useful to conduct an awareness-raising campaign for this group of people. Many family members of people with substance misuse problems do not see themselves as carers in the same way, for example, as those caring for those with dementia. They are not aware of the benefits, practical help such as carer assessments, or their rights at work in terms of flexible leave and protection from discrimination.

I would like the Minister to set out how we will both tackle the causes of the problem, including the lack of appropriate mental health support, which could reduce the chance of alcohol dependency, and examine what capacity is needed to redouble our efforts to support those who have hit rock bottom. I'll take a minute. Time is of the essence, Minister, if we are to avert a major public health and service delivery crisis.

Lastly, although the Government has published the treatment framework for those with alcohol-related brain damage, there is limited progress among the health boards. Thank you very much.

The Deputy Minister now to contribute to the debate. Lynne Neagle.

Thank you, Llywydd, and thank you to Plaid Cymru for bringing forward this important topic for debate. The Plaid Cymru motion today calls for

'stronger commitment, enhanced resources and measurable targets.'

As our amendment acknowledges, we are not complacent, but we do have a long-standing commitment to preventing and tackling the harms associated with alcohol use and a robust record of delivery.

Unlike elsewhere in the UK, we have protected and ring-fenced our funding over many years. This is further recognised by our increased investment in preventing and treating substance misuse, rising from almost £55 million last year to almost £64 million in 2022-23. As part of the Welsh Government's allocation to area planning boards to support the commissioning and delivery of local substance misuse services, we've increased both the children and young people and residential rehabilitation ring-fenced allocations by £1 million in 2022-23 to £3.75 million and £2 million respectively. Recognising an increase in demand for support, there are also plans to increase the children and young people's ring-fenced allocation in the coming two years.

In terms of targets, we have targets in place to measure referrals, access and treatment outcomes. Our record on access and treatment is encouraging, with statistics remaining above 80 per cent. In March this year, this went to just over 90 per cent. Referrals are more of a concern, which we will address, but have certainly been impacted by the pandemic. Having meaningful targets for measuring alcohol consumption is much more difficult, particularly as the data is self-reported. Instead, we need our public health messaging to help people recognise if they have a problem with alcohol and access the help we have made available as soon as possible. We know that the pandemic has disproportionately affected those with the most complex needs and vulnerabilities. We have therefore also doubled to £2 million our funding for services for people with housing and complex needs. This funding will also increase over the coming two years to a total of £4.5 million in 2024-25.

Addressing alcohol-related harms is a key part of our substance misuse agenda. The overall aim of our substance delivery plan, which was updated in response to COVID-19, is to ensure that people in Wales are aware of the dangers and the impact of substance misuse and know where they can seek information, help and support. And while we remain focused on delivering the current 2019-22 plan, we intend to explore, with a range of stakeholders this year, the need to refresh and refocus the actions for any new delivery plan post 2022. However, our engagement with stakeholders to date suggests that many of the current priorities remain relevant.

The factors behind the increase in alcohol-specific deaths are complex, and numbers will fluctuate from year to year. Every one of these deaths is a tragedy, and we absolutely recognise there is more work to be done. Deprivation is recognised as an important factor, and data from Public Health Wales shows that people from the top 10 per cent deprived areas in Wales are almost three times more likely to be admitted to hospital for alcohol-specific conditions than those from the least deprived areas. Reducing health inequalities, particularly as we emerge from the pandemic, will be a priority area of our work going forward.

We also know that finding the right job is one of the most important factors in helping people recovering from substance misuse. Our European-funded out-of-work service, which ends in August 2022, has helped over 18,000 participants recovering from substance misuse and/or mental health issues since it began in August 2016; over 46 per cent of these are recovering from substance misuse alone, or from substance misuse combined with mental ill health. Despite repeated promises that Wales will not be a penny worse off after Brexit, this funding has not been replaced by the UK Government. But we know that being in work is so important for many people's general health and well-being, providing a purpose as well as an income and can play a part in preventing both physical and mental health problems. Therefore, supporting people who are struggling in work and to get back to work is crucial. That's why this Welsh Labour Government will continue to invest in employment support services, including extending the out-of-work support service until 2025.

We recognise the vital importance of education and prevention when it comes to reducing alcohol-related harms. We're working to promote the UK chief medical officers' low-risk drinking guidelines, which aim to support people to make informed decisions about their drinking. Public messaging around minimising the health risks from alcohol were also a key part of our Help Us Help You campaign and encouraged people to reduce both the amount of alcohol they drink and how often they drink it.

Prior to the pandemic, Public Health Wales convened a national alcohol prevention partnership to develop collective priorities for reducing alcohol-related harms across Wales. This work will recommence in 2022-23, beginning with a focus on reducing the number of young people in Wales of school age who regularly drink alcohol.

We're also proud of our implementation of minimum unit pricing, which will play a key role in reducing the harms of alcohol. This is an area where we have maximised our devolved powers to take action on the World Health Organization's advice that action to reduce alcohol-related harms includes looking at affordability, accessibility and availability. The legislation came into force on 2 March 2020, and our aim is that its introduction will make an important contribution in tackling the health risks associated with excessive alcohol consumption. The intended effect of this legislation is to tackle alcohol-related harms, including alcohol-attributable hospital admissions and alcohol-specific deaths in Wales, by reducing alcohol consumption in hazardous and harmful drinkers.

Finally, our alcohol-related brain damage treatment framework is a key development. The framework is designed for health and social care providers to give guidance on how they should respond to those affected by alcohol-related damage.

So, as I have highlighted, we have shown a continued commitment to this agenda for many years, both in terms of support and finance, evidenced by the recent increase in funding of £9 million this year. But, as I said, we are not complacent. We will continue to work with partners on the prevention agenda and through supporting services to tackle the harms associated with alcohol. Over the coming year, we will also be working on our delivery plan commitment to develop a substance misuse outcomes framework, including reviewing performance indicators. Although we must recognise there are many complex factors behind these tragedies, I hope that the additional resources and focus we have provided for our services will help reduce alcohol-specific deaths in the future. I urge you all to support our Government amendment. Diolch. 

I call on Peredur Owen Griffiths now to reply to the debate.

Thank you, Llywydd, and thank you very much to everyone who's participated in the debate this afternoon. It's been an interesting debate with interesting ideas raised with regard to the way forward. We heard from—.

James was talking about enhanced measures and targets, and we need those.

Rhun spoke about the numbers and the highest level in 20 years, but that alcohol and mental health go vice versa. It's a vicious circle in that regard.

Joyce talked about advertising and the prevalence of alcohol in every aspect of life and also the increased alcohol harm in women in particular; Sioned, the tragic and often—the health inequalities causing the issues. They are deeply entrenched in our society and the most socially deprived areas are being the most affected by these. And Altaf talking about functioning alcoholics becoming unfunctioning and then the pressure on the NHS, but also making a good point around the 'no wrong door' approach to accessing help.

Diolch to the Minister for her personal commitment to moving this forward and not being complacent and the long-standing commitment there. We're aware that the Government is—now, from yourself—exploring and refreshing the post-2022 plan and I'd be very happy to work with you on those things because it's so important to so many in our society. 

This debate has demonstrated, in my view, that to tackle the problems that we've heard about today the Welsh Government must become more radical in their solutions. We have a system in place for prevention and support that isn't having yet the desired effect. Without a change of tack and some more radical policies, I feel the figures will potentially continue to rise. The Government needs to acknowledge that the policies are not quite hitting the mark and making changes accordingly, and we've heard of the refresh going forward.

With the cost-of-living crisis harming so many families and due to get worse, there's a need to act with urgency on this matter. Without change, we'll lose more lives, and more individuals, more families and more communities will continue to suffer. More funding is required to fund more extensive preventative mental health treatment therapy, as well as the treatments needed when somebody is already in the midst of alcoholism. There's a need for enhanced preventative measures that could be applied within families at higher risk of developing alcoholism. This may take the form of keeping in touch with relatives of people with known alcohol misuse disorders or to prevent the genetic and hereditary alcoholism within families. In tandem with this is the need to provide support for those with potential adverse childhood experiences. Having met again today with the 70/30 Campaign, there are definite targets that could be set around that.

As highlighted within this debate, it's vital that greater support is brought to communities at socioeconomic disadvantage that are struggling, so that no-one is left to feel without opportunity and hope. When alcohol abuse has such a big impact on our communities, it is worthy of this Senedd to have this debate here in our national Parliament. I set up the cross-party group on substance misuse and addiction to encourage more dialogue around the experiences of people who have been battling against drug addiction and alcoholism. I hope that this can be a vehicle for sharing good practice and strengthening the services we provide for people attempting to get their lives back on track. I hope that everyone in this Chamber today can support our debate, which not only seeks to strengthen and support, but also provide the resources devoted to helping people escape the clutches of alcoholism. We need to give people with a drink problem, not to mention their families, friends and communities, a hope of a better tomorrow. Diolch yn fawr.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there is objection. Therefore, we will defer voting on that motion until voting time. 

The next motion is a motion to suspend Standing Orders. I call on Hefin David to move the motion formally to allow item 9 to be debated. Hefin David.

That was a nod. I think it was a—

Move.

Yes, it was a formal move of the motion.

I don't want to speak on it.

Excellent. The proposal is to suspend Standing Orders. Does any Member object to that? No. Therefore, the motion is agreed to suspend Standing Orders.

That allows us to move on now to voting time. We'll take a short break first of all, before we hold the vote, to make the technical arrangements. 

That brings us to voting time. The first vote this afternoon is on the Welsh Conservatives debate on NHS waiting lists, and I call for a vote on the motion, tabled in the name of Darren Millar. Open the vote. Close the vote. In favour 23, no abstentions, 26 against, and therefore the motion is not agreed.

The next vote is on amendment 1, tabled in the name of Lesley Griffiths. Open the vote. Close the vote. In favour 25, no abstentions, 24 against, and therefore amendment 1 is agreed.

The next vote is on the motion as amended. 

Open the vote. Close the vote. In favour 25, no abstentions, 24 against, and therefore the motion as amended is agreed.

The next votes are on the Plaid Cymru debate on alcohol-related harm, and I call for a vote on the motion, tabled in the name of Siân Gwenllian. Open the vote. Close the vote. In favour 24, no abstentions, 25 against, and therefore the motion is not agreed.

I should know by now. The next vote is on amendment 1, and if amendment 1 is agreed, amendment 2 will be deselected. I call for a vote on amendment 1, tabled in the name of Lesley Griffiths. Open the vote. Close the vote. In favour 25, no abstentions, 24 against, therefore amendment 1 is agreed and amendment 2 is deselected.

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

Open the vote. Close the vote. In favour 25, no abstentions, 24 against. Therefore, the motion as amended is agreed.

And that takes us to item 9, the short debate, and I call on Hefin David to speak to the topic that he has chosen. Hefin David.

Diolch, Llywydd.

I'm sure Members will be leaving quietly—

I'll wait patiently.

—if they have to leave. You don't need to clear the glasses, Joyce Watson.

That was 'cheers' from Joyce Watson there. Diolch, Llywydd. I will get started if you set my timer to now, please. I'm glad to give a minute of my time to Laura Anne Jones and to Mark Isherwood, at their request, so I think then that'll leave me with 12 or so minutes, so I'll assume that's correct. I can never remember the right time.

When we stand for election, we stand to support those people in our community and those causes that we strongly believe in, and when I stood for election, autism was one of those things that I wanted to stand up for, and I never dreamt that it would be directly affecting me and my family, because I was elected in 2016, and it wasn't until 2018 that my daughter was diagnosed with autistic spectrum disorder. And as a parent, it kind of creeps up on you—certainly as a parent of a first child, with no baseline to compare it with—and it was actually my parents who said to me, on holiday, 'I think Caitlin may be autistic', because of her significant speech and language delay. And sure enough, that was the diagnosis we had.

Therefore, I'm kind of living this pathway that parents in my constituency are living, too, and far from it being selfish for me to raise this debate, what I'm trying to do is raise it on behalf of those parents that I've worked with as a result of my work as a constituency Senedd Member, and I think having the insights myself has been very important in giving me that ability to represent them effectively, because I am on the same journey. Caitlin had to wait a year for a statement, which she should not have. She was a year in mainstream when she should have been in a resource base, so I've had this experience, this frustration that people have at the delays that happen because of the multidisciplinary nature of autism and the requirements of so many people in so many parts of the public sector to agree on what is needed.

So, there are huge challenges, huge challenges, although we do have fun as well. In my community, we've got many voluntary groups. Two in particular come to mind: the Valleys Daffodils, who meet in Gilfach YMCA, just underneath my office. They meet every Saturday morning and they do a wonderful job. We've been along there. And also the Sparrows ALN group, which is active across my constituency, run by Nana Deb. Nana Deb was going to be going to Buckingham Palace to see the Queen, but unfortunately she wasn't well enough to go, and I suspect that's why the Queen won't be attending the garden party this year. We attend Cefn Fforest swimming pool every Saturday. At first, Caitlin used to say to me, 'Bye-bye, swimming. Bye-bye, swimming.' And I'm glad to say now, every Saturday morning, she says, 'Hello swimming. Hello swimming', which means she wants to go. I couldn't live without some of that support that exists in the constituency. Meeting parents who have very similar problems to mine and hearing their stories is really, really important, and how similar—although the condition presents itself in different ways, how similar the problems that parents have on that route to finding support for autism.

We've also got Trinity Fields special school, of which I'm a governor, but I think we also need another special school in the borough, such is the demand. And I'll be pushing that to the new leadership of Caerphilly County Borough Council. We're also lucky enough to have the Autistic Minds hub, which is a charity organisation, and they allow me to hold surgeries there in Caerphilly town. Once every two months, I hold a surgery there and I meet parents and adults with autism and try to help them through some of these difficult times that you find when you have either a family member, or yourself, diagnosed with autism. 

One thing I wanted to mention was the impact of lockdown. I'm really glad Lynne Neagle is here today. She was Chair of the Children, Young People and Education Committee, of which I was a member, last term, and she'll recall that, during the first lockdown, we were at our wits' end, where the narrow definition of 'vulnerable children' was such that many children with autism and other ALN conditions were finding themselves at home when they should have been in hubs, because children who were being taken to hubs were vulnerable in the sense that they might be harmed at home, not children who were vulnerable with conditions like ASD. Lynne Neagle introduced me to the Together for Children and Young People partnership, and the chair, Carol Shillabeer. And we, as a group of parents from Caerphilly, met with Carol Shillabeer. In the second and third lockdown, those children in Caerphilly went to school and were seen in hubs and onsite. Thank you, Lynne Neagle, for making that happen, and thank you to Carol Shillabeer as well for listening and making sure the Welsh Government made sure that that definition was broader. It was really, really important for people in Caerphilly. And I noticed in our Facebook group, they were saying, 'To my surprise, my son or daughter had a place this time around.' And you can't get closer to democracy and making democracy work for you than that, I don't think. 

But there remain challenges, and ongoing diagnosis and support is one of them. The Royal College of Psychiatrists have been kind enough to supply me with a paper that briefs on some of the things that are needed, and they draw attention to the children's commissioner's 2022 report, 'Making Wales a No Wrong Door Nation—how are we doing?' They highlight a passage from it:

'Waiting times for an assessment for a neurodevelopmental condition (for children with suspected Autism, ADHD and other similar conditions) are extremely long, and in the meantime children and their families can receive very little if any support....When children may have both a neurodevelopmental condition and poor mental health they often receive a very disjointed service, despite this being very common.'

The reason for that is the number of professionals that are involved in the process. I have experienced that, going from the speech and language aspect to the child psychologist aspect, to the teachers, to inclusion in the local authority. There are so many different people involved that it is difficult for a parent to map your way through that process. That is why this idea of 'no wrong door' is a good one. And the variety of manifesting symptoms are always different. For Caitlin, she doesn't have huge meltdowns because of external stimuli; if anything, she's understimulated by her environment. For other children who I see at Sparrows, they are overstimulated, and that's why you might see children wearing ear muffs or earphones, to try to drown out the external noise—although Caitlin has started wearing them, but I think it's more of a fashion statement on her part, because she's seen everybody else doing it. [Laughter.]

There's also, according to the Royal College of Psychiatrists, a shortage of child and adolescent psychiatrists, which is a key problem when it comes to supporting children and adults with autism, because that is a key part of what is needed. I can see Paul Davies in the Chamber, and we had much dialogue when he introduced his autism Bill. We came to the point where we actually disagreed on that. I just took the liberty of digging out the aims of the Bill, and one of them was to introduce a strategy for meeting the needs of children and adults with autistic spectrum disorder conditions. Primarily, it was about ensuring a clear pathway to diagnosis of autism in local areas.

My issue, and the problem that I've seen so often, is that it is too much about seeking a diagnosis and then dealing with the symptoms, rather than the first bit, which is looking at what is presenting—what are the presenting behaviours, what are those behaviours we're seeing, how can we support and treat them. A diagnosis is almost—not quite, but almost—secondary to that. We shouldn't be rushing to diagnosis. In fact, in the cases of ADHD, some people with ADHD do not want an autism diagnosis, because they do not consider themselves to be autistic; they have ADHD. If we overdiagnose, they may seek an autism diagnosis in order to access services, and that wouldn't be right. So, with the greatest respect—and I've got no party political difference—I just didn't support the autism Bill for those reasons. I think the National Autistic Society got that wrong, to be honest with you. But, that said, I think that is now water under the bridge and we've moved on from there.

One thing I want to say about many of the cases that are coming across my desk and people I'm meeting at the surgeries, people I'm meeting at Sparrows, is schools, and how their children experience schools. Exclusion is a huge thing. I was sent by Steffan Davies, who's a PhD student at Swansea University, this report that many of you may have been sent, which is 'The Education of Autistic Pupils in Wales'. It's well worth a read because it's the preliminary findings of his PhD study, and in it there's a stark statistic that I think we need to be aware of, and that is that 76 per cent of autistic children and young people in the survey told them they'd been bullied in school. And not only that, 20 per cent of parents told the survey that their child had been temporarily externally excluded. And half of the parents of boys who had experienced fixed-term exclusions say that schools had given the reason that they were unable to manage their child's behaviours, with disruptive behaviour being the second most common reason.

This is one of the problems that children are facing with autism. They're being excluded from school because their behaviours are being addressed, and not their needs. It has to be the need. I've had the pleasure of working with Caerphilly's inclusion lead, Sarah Ellis—I met with her today, just this afternoon—and Claire Hudson, whose son Jack is in this position. She said that too often, what schools tend to do is look at disruptive behaviour and take action against the behaviour. Instead, there's always a reason for the behaviour. What is that reason? Those are the questions that need to be answered. Support the need, not the behaviour. 

That brings me to ADHD and Tourette's, two conditions that are associated with autism. My daughter uses verbal stimming. It sounds like verbal tics. Sometimes, you get that with autism. Sometimes, you don't have autism and you have Tourette's and you have ADHD entirely separately, and this is where people may fall through the gaps a little bit. I've spoken today to Helen Reeves-Graham, who has reported her own child with Tourette's, and she said that there do not seem to be pathways for those children who aren't presenting with ASD as a comorbidity. That is a real challenge, I think, for the sector to meet that, and there's a report on the BBC website about that. While I mention Tourette's, I also want to mention Lucy-Marie, who has written a book—she's 12 years old—for children with Tourette's explaining some of the challenges that she faces, for children to understand that. There's also a piece on the BBC website with a video of her talking. She's one of our Sparrows group children. We call them 'fledglings' and she's involved in that group.

So, what I am asking for? Well, there are some key recommendations that I'd like to see. First of all, a key point is addressing needs, not behaviours, and reducing the number of children affected by ASD, Tourette's and ADHD in school being excluded—reducing that number. Diagnosis needs to be multidisciplinary and not in isolation, therefore we need people working together cross-disciplinary, not just for autism, but for ADHD, and increasing understanding of Tourette's as well. And we need to increase understanding and awareness of the associated co-occurrence and risk between neurodevelopment conditions and mental health problems. That needs to transcend policy and practice. We know that issues waiting for CAMHS is part of that, and I know we've had conversations about that too. Remember the 'Mind over matter' report; it's all wrapped up in that—the work that Lynne Neagle did and Julie Morgan is doing.

At that point, I'm going to give time to Laura Anne Jones and Mark Isherwood, so I'm going to stop there at this point and say that this isn't the end of the debate. I think we're going to have a further debate on Tourette's that the Petitions Committee is bringing forward. I've only just had a chance to scratch the surface today, but I hope to bring more to that debate as well.

Autism is covered by the Equality Act 2010, requiring understanding of and adjustments for autistic service users, each of whom is a unique person with individual needs, just like everyone else. However, although autism spectrum conditions are not mental health conditions, I continue to hear daily from people with lifelong neurodevelopmental conditions, including autism, or their families, that public bodies have failed to understand individual needs and make adjustments accordingly, causing heightened anxiety and meltdown. For example, in Flintshire, children taken into care with the parents blamed had a specialist report observing that the children's behaviours were consistent with autism, but the council refuses to refer them for diagnosis. In Denbighshire, a mum wrote that her son had been waiting for an autism diagnostic test for 18 months, but as he has not been assessed, the school is unable to access support such as educational psychology and autism outreach. And a final example in Flintshire: a family whose son, who has an autism diagnosis, had a very serious meltdown, after which a council legal executive wrote, 'It would be inappropriate for the local authority to assume your son's mental health state without health diagnosis.' Until services are truly designed, delivered and monitored with neurodiverse people, their families and carers, lives will sadly continue to be damaged in this way.

I'd firstly like to thank Hefin David for bringing this important debate to our Chamber today. I very much hope that his personal experiences with his beautiful daughter, and knowledge that he now has, will be listened to. For most of what you've said, you've had that experience, unlike most of us here, and you know what is needed to right the wrongs of the system. The current state of affairs isn't good enough. Currently, we're seeing a two-year-plus waiting list for children to see an NDT specialist, which is storing up significant issues for the future and, in my opinion, putting children's learning and life chances at significant risk. Without the NDT appointments, we now have children not being clinically identified as autistic or having ADHD, resulting in poor levels of understanding and provision, thus creating a scenario where children are simply not being adequately supported to thrive. I have also been told of one case of a parent potentially having to go into debt to fund a private referral for their child. I've also been told that headteachers and teachers can put measures in place themselves to support literacy and numeracy—that's not the issue—but what they have stressed and what they do struggle with is that neither headteachers nor teachers have the training or capacity to provide vulnerable learners with what they need and that support, which often results in exclusions, as they can't deal with that behaviour. I would ask the Welsh Government now, as we have a new ALN system coming into play, that we have real and regular checks on it and safeguarding in place, to ensure that the scheme does alleviate all our concerns here today, and that we don't let any more children slip through the gaps. Thank you.

The Deputy Minister for Social Services to reply to the debate. Julie Morgan.

Diolch, Llywydd, for the opportunity to respond to this debate. Firstly, I'd like to thank my colleague Hefin for putting forward this really important topic. I know there is a lot of interest in the Chamber on this topic. Obviously this is so personal to him, and I'd like to thank him very much for sharing his personal experiences with all of us here today. Diolch, Hefin.

I do recognise the challenges faced by individuals living with autism and other neurodevelopmental conditions, and I've heard experiences first-hand from parents of children with autism and with ADHD. I also met with parents of children with tic disorders and Tourette's syndrome—a meeting where my colleague the Member for Caerphilly was able to join with me. I think having those meetings with some of the most powerful voices that stressed the need of what we have to do and these meetings where parents have told me about the struggles they're experiencing trying to access support are at the forefront of my mind as we strive to make positive changes.

So, firstly, let me restate my commitment to making sure that all neurodiverse children, young people and adults, along with their parents and carers, have access to the services and the care they need. There is a lot to do, I absolutely acknowledge that, but we have taken big strides in moving forward, and this includes the success of the integrated autism service that is providing assessment and support services for adults and help for families, and this is supported by £3 million of Welsh Government funding each year.

Our programme for government commitment to introduce a statutory code of practice on the delivery of autism services has also been achieved, with the code coming into effect on 1 September last year, and we are seeing a clear commitment from statutory organisations to embrace the code and proactively improve services and support. Our national autism team is working directly with regional partnership boards to help them develop an autism infrastructure and appoint an autism champion role in each area. The code has given us the foundation from which to make a real change in improving services for autism and other neurodevelopmental conditions.

During stakeholder engagement when developing the code, we listened when we were told that despite the progress made in autism services, many people with other neurodevelopmental conditions and their families and carers are still struggling to access the support they need, even though their needs were often similar or were co-occurring with autism. This situation was echoed in my meeting with parents of children with ADHD and Tourette's syndrome.

So, this is why we are widening our approach, from a focus on autism to seeking improvements across neurodevelopmental conditions, so we now have a dedicated policy team working across health and social care, linking closely with education colleagues. Our national autism team is also expanding its remit and expertise to provide advice across neurodevelopmental conditions, and we want to make sure that the progress that has been made with autism is extended to the other conditions and that they all work together, and I think that's a really important development. We know, and it's been mentioned in the debate by several Members today, that assessment services are experiencing increasing demand with long waiting times across children and adult services, and for some conditions, new service pathways are needed. So, to better understand this complex area and to identify options for improvement, we commissioned a demand and capacity review of neurodevelopmental services last year and the authors have now presented their findings to me. I'm currently considering the final report from the review, which has provided strong evidence for the need for a programme of improvement to put in place sustainable services that have clear and easy access. And I think Hefin mentioned the importance of the support that's needed while you wait for a diagnosis, and I feel that that is absolutely key.

I'll come back to colleagues shortly when we publish the review and I will be making an announcement about the immediate medium and long-term actions we'll be taking to support improvements. This will include urgent action to reduce the pressures on assessment services and to put in place early help and support for families who need help now.

It's important to acknowledge that neurodevelopmental services reform will build on the successes of the Together for Children and Young People programme and its neurodevelopmental work stream, which comes to a close at the end of September this year. I must thank those involved for all they've done. We're working to ensure there is a smooth transition from the programme to ensure that all of the good practice is captured and that the strong relationships built by the programme team are maintained and further strengthened.

Future policy and delivery will be co-designed with individuals and families with lived experience of neurodevelopmental conditions. We recently issued a survey through our networks and social media to gather current experiences of those who are seeking access to assessment and support on a waiting list or who have had contact with services. The survey was live for over eight weeks and we received over 370 responses. We are currently reviewing the feedback received, and an early theme identified reinforces the need for better pre and post-diagnosis support, something that is reflected in the findings from the demand and capacity review. 

Another key area of feedback from parents is support in schools, and that has been mentioned, and Hefin mentioned that very powerfully today. I was very struck by the figures: 76 per cent of autistic children bullied in school; 20 per cent exclusions. I really feel that we have to address this issue. The role of education in supporting neurodiverse children and young people is absolutely crucial. We're working closely with education colleagues, who are delivering improvements through the additional learning needs reform, to ensure the needs of neurodiverse children and young people are recognised, and that staff have knowledge and skills to support them. I was so struck by what the parents in the group I met with children who had ADHD said, and also talking about how crucial the way that the school responded to those children is, and the difference it made to their lives. 

I'm looking forward to next week, visiting two schools in the Carmarthenshire area who are working hard to support neurodiverse pupils to maximise their potential and widen the opportunities for them. One of the schools has recently received an award from the ADHD Foundation for its work, and we want to share the experience of that school, because I think there are many ways that schools could shift towards being ADHD-friendly; it would make such a huge difference. 

And I also want to recognise the role of the third sector, who've been instrumental in the progress we've made with the autism code of practice, and will have a pivotal role in our neurodevelopmental reform, particularly in providing both pre and post-diagnosis support services.

So, in conclusion, by the end of this Senedd term, we want to be successful in reducing the pressures impacting on neurodevelopmental services, and ensure families can access early help and support quickly, as well as timely assessments. So, we want neurodiverse children, young people and adults to feel supported and equipped to meet the challenges of daily life now and in future years to come. I'd like to end again by thanking Hefin for bringing this debate, and for Laura Anne and Mark's contributions. Thank you. Diolch.

Thank you very much. That brings our proceedings to a close.