National Assembly for Wales

Good afternoon and welcome to this Plenary session. The first item this afternoon will be questions to the Cabinet Secretary for Health and Social Care. The first question is from Gareth Davies.

Our vision in 'A Healthier Wales' is for people to have equity of access to an increasing range of community services to support them to stay well and live independently. Local partners are expected to collaborate to build community capacity and design and deliver more integrated and preventative services.

Thank you very much, Cabinet Secretary. The chronic lack of healthcare provision in Denbighshire is sadly getting worse week by week and can’t be ignored any longer. Residents across Denbighshire have had to put up with a hospital that has the worst-performing accident and emergency department, with the worst waiting times, in the worst-performing health board for far too long. Eleven years have passed since the commitment was made to build north Denbighshire community hospital in Rhyl in my constituency and people have lost hope that it’s ever going to happen. Ysbyty Glan Clwyd is quite literally at breaking point, yet there appears to be no urgency to do something about this. We’ve had 11 years of dithering and broken promises, with the First Minister saying in April that proposals are being drawn up for a facility that includes a minor injuries unit, intermediate care beds and integrated care, but that a strong business case must be presented to the Welsh Government. In other words, he has no intention of this ever happening and the suffering of people in my constituency is not a priority for this Government. So, an 80-year-old can wait over two years in agonising pain for a hip replacement because the Welsh Government would rather spend £120 million on more politicians in Cardiff Bay and 20 mph than spend money on community healthcare provision in north Wales. So, does the Cabinet Secretary share the regrets, which the former First Minister confessed, that the hospital was never built on his watch? And will the Welsh Government finally get the ball rolling on this vital and long-overdue service for the people of the Vale of Clwyd? Thank you.

Well, thanks very much, Gareth, for your question. I’ve got to tell you that the NHS in Betsi Cadwaladr is making more contacts than it's ever made before with the population there. Also, if you look at the number of GPs and the fact that they’ve all signed the new contract, it means that access to GPs is much better. I hope you have found in your postbag a significant reduction in the number of people complaining about getting access and in particular during the 8 a.m. bottleneck.

Let me turn now to the Royal Alexandra Hospital site, obviously when this was an initial proposal, the costs indicator was significantly less than the £100 million that it would now cost to build, and that’s because partly the Tory Government has allowed inflation to get absolutely out of control. So, it’s partly down to you. But let me tell you also that we are expecting the local health board to review its proposals for the Royal Alex Hospital. I’ve been to the Royal Alex Hospital; I’ve got a sense of what they’re looking to do and the approach—the new approach that you have outlined—was agreed at a board meeting on 28 March. We are now waiting for them to develop a full business case for the preferred new option, and the health board will be seeking approval from us for fees to develop the full business case. So, we’re waiting for that submission. That scheme is one that has been prioritised by the regional partnership board for submission to the health and social care integration and rebalancing capital fund for part funding to go towards the costs that it would require. So, it is very much still on the table, and I would be grateful if you could stop doing your scaremongering stories to the people, once again, in north Wales.

A comprehensive review of the all-Wales nutrition and catering standards for food and fluid provision for hospital in-patients is currently under way. This review will be informed by expert advice from the Scientific Advisory Committee on Nutrition, which will include emerging evidence on ultra-processed food.

Thank you for that reply, Cabinet Secretary. Sadly, we know only too well that budgetary constraints push NHS managers to secure food at the lowest possible price and, far too often, this means utilising ultra-processed food. Yesterday, you launched a consultation on a new Bill to tackle the promotion and sale of unhealthy foods, yet we are still allowing such foods to be provided to patients in our hospitals. Cabinet Secretary, what steps are you taking to ensure that all meals provided in the NHS are not only nutritious, but also use the best local produce and are reflective of individual dietary requirements?

Thank you very much, Altaf, and, as I say, we are looking at this. This review is being undertaken and I'm expecting that to report in August. And we have got a group of absolute experts who are looking in particular at the issue of ultra-processed foods within that. You are right—we've got to take this really seriously. We do have an obesity crisis in Wales. Sixty per cent of the population are overweight or obese. We do have to make certain interventions. We've got to make it easier for people to eat the right food. That's part of the reason why we've gone out to consultation this week on the new regulations, which are going to make it more difficult for supermarkets, for example, to put the kind of foods that we all feel tempted by right next to the cash desk, making sure, for example, that you can't just keep on going back for your full-fat coke refill time and time again—all of these things. We've got to make it easier for people, and that's part of the reason why we'll be introducing those regulations.

But you're quite right—we've got to take hospital food seriously. That's why this report was commissioned. And let's not forget that, actually, Audit Wales has also undertaken a number of reviews of hospital nutrition and catering, and the audit commission in Wales examined the topic in 2011 and 2016, and 10 of the recommendations in the Public Accounts Committee report were actually implemented by December 2019. So, we're making progress, but, then, the real issue is that the ultra-processed issue is becoming more acute.

The party spokespeople now to ask questions. Altaf Hussain once again.

Thank you very much, Presiding Officer. Cabinet Secretary, on Monday, the Royal College of Nursing in Wales revealed that less than a quarter of all shifts in Wales have sufficient registered nurses. The RCN's last shift survey, which asked nursing staff in Wales about their experiences on their most recent shift, uncovered alarming shortages that are impacting patient safety. Over three quarters of nurses in Wales who participated in the survey reported that the number of nursing staff was not sufficient to meet the needs of patients safely. Around eight in 10 respondents believe that the staffing level on their last shift of the day at work would have been made safer if there was a maximum patient-to-nurse ratio in their workplace. The RCN are calling for the 2016 Nurse Staffing Levels (Wales) Act to be amended to reduce the nurse-to-patient ratios in all settings, and to allow nurses time to care. Therefore, Cabinet Secretary, what steps are you taking to address these critical shortages, and to address the concerns of our nurses?

Well, thank you very much, Altaf Hussain, and you'll know that we are taking this very seriously. The fact is we are training more nurses than ever before. We've put more money into it. We've got international recruitment exercises, including with India, and specifically Kerala, to get more excellent nurses from abroad. Also, we are making sure that there is flexibility by default allowed. So, people want to have that flexibility. What that means is that we're more likely to get them as substantive posts rather than agency nurses. And if you look at what's happening in relation to agency nurses, the amount that we're spending on agency has come down significantly as a result of that shift. So, I'm pleased to see that that's happening.

Thank you, Cabinet Secretary. Of course, the main challenge is retaining nursing staff. There are currently around 2,700 registered nurse vacancies across NHS Wales. If we are to have any hope of filling those vacancies and retaining existing staff, then we have to, in the words of the executive director of the Royal College of Nursing Cymru, ensure

'that nurses are valued and rewarded if there is to be a sustained supply to meet those staffing levels.

'This means delivering every promise made to our members that ended our industrial action. The solution to this crisis starts with valuing nursing staff and giving them the time to care.'

Nurses have said they feel insulted by what was offered to them in comparison to NHS doctors. Sadly, this adds to the narrative that nurses are not valued. Cabinet Secretary, you made a number of commitments to nurses in order for them to abandon their industrial action. When will you deliver on those promises?

Thanks very much. Well, we're obviously waiting until the general election is over, and then we'll be waiting for the recommendations of the pay review board to be published, and then we will, obviously, need to enter a negotiation on where we settle in relation to salaries this year. I do think it's probably worth looking at the fact that, actually, we've just come out of a very difficult negotiation with the doctors, as you say. Some of those junior doctors were actually paid less than nurses, and I do think that we do have to recognise that junior doctors in particular needed a significant uplift, and that is certainly what we've given them.

Can I just also say that you're quite right about retaining the existing staff, which is why we've built this flexibility in, which is why we've got a workforce implementation plan? Much of that is already being delivered. But you're quite right—I think one of the issues we've got to consider also—. You talked about getting the right ratio of nurses and, of course, we do have the Nurse Staffing Levels (Wales) Act 2016, but it's interesting that the health committee of the Senedd has recently written a report on this and they did not follow the recommendations outlined by the RCN, which suggested that we should have that ratio outside of certain hospital settings. I think that we've got to take this team approach, which is so crucial in the NHS. Let's keep nurses working to the top of their licence, and if we can get other people to take the strain off them, at perhaps different grades, then why is that a bad thing?

Thank you again, Cabinet Secretary. Sadly, the direct consequences of the shortage of nurses is not only the impact on patient safety, but the number of people waiting in pain for treatment in our NHS. We have the longest waiting lists in the UK and over 21,000 people waiting longer than two years for treatment. This is shameful. Cabinet Secretary, Sir Keir Starmer is seeking to become the next occupant of No. 10. He has promised to treat 2 million more patients each year in order to tackle waiting lists in England. How are you planning to tackle Wales's ever-growing waiting lists? What is the Welsh Government plan?

Thanks very much. As you will know, Altaf, the longest waits have fallen 70 per cent since their peak in March 2022, and I'm not going to apologise for the fact that we treat the most urgent cases first. We, of course, also count waiting times very differently from England. We count, as you will know, diagnostics and therapies, and they don't do that in England, so I think we're more honest with the public. And I think it's probably worth emphasising as well that the average waiting time for treatment is 22 weeks. We're also, of course, living with a much older, sicker and poorer population than they do in England. Of course, if Labour is elected and that money goes into the NHS, then we will get a consequential from that and, obviously, it will be up to the Cabinet to determine how we spend that money. I will certainly be making the case, and I think I have managed to make the case, for a proportion of that, at least, if not all of it, to come to help us to tackle those waiting lists, which, of course, are the biggest headache, probably, for me at the moment.

Plaid Cymru spokesperson, Mabon ap Gwynfor.

Diolch, Llywydd. Well, an interesting response there by the Cabinet Secretary at the end. As we've long suspected, however, the incoming Labour Government's embrace of Tory designated fiscal rules and a refusal to countenance progressive tax-raising measures, such as aligning capital gains tax with income tax, only means one thing: more austerity. Last week the Wales Governance Centre calculated that UK Labour's spending plans will result in a shortfall for non-ring-fenced areas in the Welsh budget of £248 million in 2025-26, rising to £683 million by 2028-29. So, can the Cabinet Secretary, therefore, confirm how this will affect the social care budget in Wales next year, and where does she anticipate the resultant cuts will land?

Well, you'll be aware that it is for us to determine where the money goes in Wales, and the fact is that we determine differently and we probably will continue to determine differently, because we'll do what we think is right for the Welsh population. This year, for example, we have spent 4 per cent additional funding on the NHS, whereas it's only gone up 1 per cent in England. We'll wait until we see what the books look like, we'll wait until we see the additional money that comes in, and then, of course, we will have to determine how we spend that money, and there are lots of calls on that money, as you'll be aware. It is interesting, Plaid, of course, wants to tax and tax and tax; that is the story of Plaid—there's this magic money tree that just keeps on giving. That, I think, is something that I hope the public will have heard this afternoon, that Plaid are interested in taxing and taxing and taxing.

The Cabinet Secretary sounds like someone from the Conservative Government in London when she speaks here. Of course, the consequences of Starmer's vision for public services is that the incoming UK Labour Government will fall into the same trap this Government in Wales has been stuck in for years when it comes to funding health services—it's the false economy of throwing money to plug front-line gaps, while resourcing for social care and public health programmes is left to wither on the vine.

So, let's be honest with the public in a way that Labour has so far failed to be. Firstly, the Welsh Government's own tax conference concluded that the NHS will need additional spending of £1.5 billion over the next three years to simply meet the current demand. Secondly, UK Labour's funding over the same period for ring-fenced services will deliver consequentials for Wales that, even if they're allocated in full to health, are insufficient to cover this demand. So, does the Cabinet Secretary accept that, based on the fiscal outlook that I've just laid out, the incoming Labour Government's spending plans will leave the Welsh Government with no other option but to find substantial savings from elsewhere in the budget just to keep the Welsh NHS afloat?

Well, there's no question about it, we are living in challenging times. I don't think anybody understands that more than we do in the Cabinet. We had to go through some really, really difficult decisions last year, and you went through some difficult decisions when you were in a partnership agreement with us. We both agreed that social care was really important and social care was absolutely central to that, but it was also telling that you didn't put a penny towards the budget when it came to how we enact the difference in relation to social care. So, I think that, if you are going to make some suggestions in this space, it would have been good to have seen you put some money on the table in relation to the issues that you prioritise.

A surprising response again from the Cabinet Secretary. Might I remind her that we're not in Government and she is in Government and you're in charge of health here? The cuts will come with you having to carry them out. The most frustrating aspect of this bleak outlook is that there is an alternative, namely scrapping the outdated Barnett formula and replacing it with a funding model that fully reflects the health needs of our society. We've had sticking-plaster solutions compounded by years of austerity and a pandemic that has stretched our NHS to breaking point, yet the challenges keep on growing. Our population is ageing faster than the rest of the UK, and it'll take years to undo the damage of austerity in entrenching health inequalities that cost our NHS £322 million each year. So, when we hear the First Minister say that he's got everything he's asked for from a Labour manifesto that says absolutely nothing on fair funding for Wales, that tells us that the Labour Party have no intention of changing course from the unsustainable path our NHS is currently on. This isn't change, this is more of the managed decline that we've come so used to in Wales. We in Plaid Cymru firmly believe that the fight for economic fairness for Wales is an inextricable part of securing a sustainable future for our NHS. Why doesn't your Government? 

Well, I can tell you our Government has, actually, prioritised the NHS over everything else. We have seen a 4 per cent increase in relation to funding on the NHS, when they've only given a 1 per cent increase in England. So, that's not something for us to apologise for, it's something that is demonstrable in terms of where we set our priorities. And I think it is probably worth emphasising the fact—and I do lament the fact that we're no longer in a partnership agreement—it probably is worth emphasising that, you know, we're talking about a £22 billion budget. But within that budget there was a certain amount of money that Plaid Cymru wanted to ring-fence for the projects that they wanted, and there wasn't any money for health nor social care, and I do think you've got to take a certain amount of responsibility for that. You could have prioritised that. That was not a priority of yours. 

The Welsh Government has published a policy for cancer that focuses on ensuring people have access to high-quality diagnostic and treatment services for conditions such as lung cancer. Our approach is based on supporting NHS organisations to deliver care in line with clinical standards.

Thank you, Cabinet Secretary. Early diagnosis of lung cancer is critical. Six in 10 people survive their cancer for five years or more if it's been diagnosed at its earliest stage, compared to less than one in 10 at its latest. Lung health checks can be a real game changer, and a team from Cwm Taf Morgannwg University Health Board has recently won the early detection and diagnosis award for their transformational lung health check pilot programme at the Moondance Cancer Awards. It's an excellent pilot. So, Cabinet Secretary, I know that you'll join me in congratulating all the winners. But what plans are there to roll out this project across Wales, so we can detect lung cancer cases as early as possible? 

Thanks very much. And I've got to tell you that I was at those awards and it was one of the most uplifting things that I've been involved with this year. So, congratulations to everybody who were nominated, but in particular to those who won and in particular to that Cwm Taf pilot that you've mentioned. And I was, actually, thrilled to go and visit the pilot in Ysbyty Cwm Rhondda back in January, and it was fascinating just to see how they target people, how they're working with GPs and how they're catching that cancer early, as you said. So, it is a model that we are looking to develop. We funded Public Health Wales to undertake the scoping work for this, and we expect this to report by quarter 3 next year, and after that, of course, we will be looking to see how it may be possible to roll that out across the whole of Wales.

I just want to also mention, in relation to your constituency, Aberdare—I was just reading AberdareOnline, as I do on a Wednesday afternoon, and it was really great to see that Cwm Taf Morgannwg have a patient who has just been the first in Wales—or one of the first in Wales—to have robotic surgery for bowel cancer. So, you know, we are talking about cutting-edge technology happening in your neck of the woods, and you should be really proud.

Cabinet Secretary, as we've just heard, the operational pilot for lung health checks in Wales started in the South Wales Central region last year, and has how screened 500 people. However, in contrast, over 1 million people have been screened in England for lung health. Tenovus Cancer Care suggests that lung health checks could save in the region of 190 lives each year in Wales, because if lung cancer is detected in the early stages then it is treatable and survivable. Communities in the south Wales Valleys and areas with an industrial legacy have some of the highest rates of lung cancer, and therefore have the most to gain from lung health checks. I know that you agree with me that everyone at risk of lung cancer deserves a chance to survive. Therefore, what commitment will you make for targeted lung health checks to be rolled out to areas of greatest need first, and publicised in such a way that maximises uptake amongst those most at risk of developing lung cancer? Thank you. 

Thanks very much. Well, you've heard we've already started, and those targeted lung health checks have already been piloted, and I think we're working really successfully. We're assessing that now and analysing the data. What has happened is that Health Education and Improvement Wales have rolled out digital training to GPs to their computers to make sure that they know how to support better identification of symptoms and referral practice. We've now also got, of course, rapid diagnostic centres, so that speeds up the process. But the key thing is we've also got to get all of our systems across Wales to be following the same pathway, the absolutely optimum pathway, in order to deliver the best outcomes. That doesn't always happen, which is why you've got to do these pilots, just to check if that is how you get the maximum out of this kind of approach. As I say, that's being assessed.

I am very committed to seeing that we can roll this out, because lung cancer is very much a killer, especially, as you say, in some of those Valleys communities with those long industrial backgrounds where people have been suffering a huge amount. So, it's catching it early, but also GPs identifying smokers. Who are the people who've smoked? Call them in—ask them to come for a health check. If we catch them early, we can get their cancer early and their chances of survival are much, much greater. So, things are improving. It is absolutely something we're focused on.

Public Health Wales is delivering the all-Wales breastfeeding action plan, and the plan is reaching key targets, including a continued increase in breastfeeding rates. The strategic leads are working with other UK nations and health boards across Wales to share best practice and identify key data measurement points for future benchmarking.

Thank you for that response. Constituents in the Vale of Glamorgan who currently receive breastfeeding support services are very concerned to hear that the health board intends to close one breastfeeding support group and withdraw specialist health visitor support from another group, meaning that anyone who needs specialist breastfeeding support will need to ask for a referral to an appointment-only system, which will be available in Llanedeyrn, or through a home visit.

The expectation now is that mothers will have to travel from the Vale of Glamorgan to Cardiff with young babies, and perhaps older siblings too. This isn't practical for people who don't drive or who, of course, aren't allowed to drive having gone through an operation during childbirth. I have written to the health board and am awaiting their response. But I heard of one mother who had taken advantage of specialist support in a group environment, and she'd not only been supported with feeding, but also emotionally supported. Getting expert advice at home wouldn't lead to this kind of support.

You will know that Wales has one of the lowest breastfeeding rates in the UK, and the UK has one of the lowest breastfeeding rates in the world, so this kind of support is essential. Can the Minister address this issue with Cardiff and Vale health board and provide an assurance that parents everywhere in South Wales Central will be able to receive specialist help in a timely manner and in a supportive environment?

Diolch yn fawr. I am aware that there have been changes to the breastfeeding support group provision in Cardiff and Vale. Now, officials are assured that the alternative arrangements meet the needs of women and family. I'm really pleased to note the upward trend of babies in Wales being breastfed at 10 days and six weeks during 2022 and continuing through all the quarters of 2023. In fact, Cardiff has one of the highest rates of breastfeeding within Wales, but, obviously, we're very keen to increase that. At birth, the breastfeeding rate for Wales is 65 per cent. That's the second highest on record, and at 10 weeks, we can see that it was 56 per cent—sorry, 10 days, 56 per cent. That's the highest on record again. Just under a third of Welsh babies are breastfed at six months. I'm really keen for this to go up, to continue to go up and up and up, but we are absolutely on the right track in relation to breastfeeding.

There's some work to be done here. Sticking with Cardiff and the Vale, a woman who recently gave birth at the Heath hospital reports that her pre and postpartum care was fantastic, but there was a real lack of support for breastfeeding; she describes it as woeful. The staff simply plonked the baby on her chest without any support to get the baby to latch on, and it was only when they managed to track down the specialist Seren breastfeeding team that she got the support she needed, otherwise, she said, she would have simply resorted to the bottle. She said that the Seren team had been asked not to visit patients on the wards. This clearly is something that needs to be picked up with the health board, but it does raise concern about the implementation of our breastfeeding policy, because women need consistent and effective breastfeeding advice from the whole of the team offering maternity care, not just the infant feeding lead. Otherwise, I fear that many new and expectant mums who are keen to give their babies the best start in life are not getting that help that they need in establishing breastfeeding. So, what audit has been done of the consistency and effectiveness of breastfeeding support in hospital maternity units and in the community?

Thanks very much, Jenny. You'll know that we've got an all-Wales breastfeeding action plan. It's important that health boards stick to that action plan, and I will make some enquiries, following this question, just to make sure that there is consistency in terms of delivery—very disappointed to hear about the experiences of these new parents, and, if you can give me the details, I'll see if my officials can look into that. But I was very pleased, because I quizzed him this week, with the experience of Jack Sargeant and his family in terms of the care he had in the Heath and he said that it was absolutely exemplary. So, it is that inconsistency, you're quite right, that we need to make sure that we iron out.

Social care services are vital to the people of Wales. Annual data demonstrates that, at any one time, local government provides over 70,000 citizens with care and support. We continue to work across the health and social care system to ensure that people can achieve what matters to them and be supported to live well at home, or as close to home as possible.

Diolch. I want to stress the importance of social care, not just in facilitating speedy hospital discharge, but also in reducing the number of people needing to enter hospital and improving the life experiences of those who receive social care. Does the Cabinet Secretary agree that we need to promote equality with health in terms of status and esteem, that we need to recruit more people into the care sector, and that we need to learn from the reablement programme in Swansea and reduce the number of people leaving hospital needing to move into a care home?

Yes, can I thank Mike Hedges for that supplementary? I would absolutely agree with him in terms of the importance of social care, particularly in the two examples that you've just talked about—the delayed transfers of care. I'm working very closely with the Cabinet Secretary on how we work across health and social care to speed up that passage of patients through the system, and I think those two examples that you've highlighted, the building community resilience to prevent people going into hospital in the first place and the pathways to care, those two examples actually show why there is the need for that parity of esteem between health and social care.

I think it is fair to say that social care hasn't always enjoyed the same esteem as health, and that's been one of the challenges that has traditionally made it very difficult for us to be able to recruit into social care. But, because the delivery of health and social care is entirely dependent on our workforce, we did launch a health and social care workforce strategy, which gave us a 10-year plan of priorities. And we've recently just published a social care delivery plan, which is focusing specifically on the social care workforce and the recruitment, retention and resilience of that workforce. I think it's probably important to talk, as well, about the really good work that's going on in the social care fair work forum, with trade unions, with employers, Welsh Government, all continuing to work in social partnership on what steps we can take to improve terms and conditions for social care workers and make that a much more resilient workforce. We've now set up a sub-group of the forum to develop a draft pay and conditions progression framework, which is about having consistency across pay, terms and conditions of social care workers, not just in local authorities, where we do have that consistency, but out in the third sector and in private care provision as well. I think we're going to have to continue on that path, if we are to achieve the parity of esteem that you referred to, as far as the social care workforce is concerned.

Diolch. The local authorities have statutory responsibility for planning and putting in place care for their local citizens, which would include the provision of care homes. On an annual basis, local authorities set and agree their own commissioning fee rates for services, including care homes.

A number of care homes across north Wales have contacted me recently raising concerns about the state of the sector's funding. Care homes receive less funding from Betsi Cadwaladr for the provision of continuing healthcare than they receive from local authorities for caring for individuals who have less intensive care needs; in Conwy, for example, it's £6,000 per annum less for every resident. Now, the health board has made the funding decision for the current year without consulting with the sector, although now, by the way, as a result of the angry response from the sector and intervention from politicians, it has agreed to a meeting to find a way forward.

But can I ask whether you agree with me that not funding care homes properly is a false economy? That is to say that if these care homes refuse to take residents or close because of underfunding from the health board, then it's the health board itself that will then have to deal with the situation, with more hospital beds blocked, and it's they who will pay the price. So, what steps are the Government taking to resolve this unsustainable situation? What advice do you have for Betsi Cadwaladr in terms of paying fair fees to care homes to avoid a situation where the care system is deteriorating, which would cost far more to Betsi Cadwaladr in the long term?  

Diolch, Llyr, for that supplementary question. There are two things that you referred to there: there are the care home fees and there are the charges for continuing healthcare, and they are different things, and, actually, they sit in different ministerial portfolios as well, but I'll come to that in a moment. I think the starting point is, and you will understand and appreciate this, that we provide funding to local authorities that goes into their rates support grant, and they determine how that funding is then allocated to all of their services, including social care, and that includes the provision for care home provision. The statutory responsibility is theirs to make sure that they're meeting the care and support needs of their local citizens, and it's for the local authorities to set and agree their own fee rates for the provision of homecare placements on that annual basis and to publish these.

What I would say, however, is that local authorities are encouraged to work within the 'Let's agree to agree' framework, and I don't know if the local authorities that you're referring to are doing that. But they are encouraged to do that when setting care home fee rates, because that includes working in partnership with providers to understand costs, and then rates are then set using a fee methodology that is used either by the local authority at local authority or at regional level. So, that is the approach to setting care home fees and why there is, sometimes, inconsistent care home fee setting across each local authority, because each local authority will set their own.

However, you asked, then, the question about what we're doing to try to resolve that particular issue. What we can't do is we can't tell local authorities how to spend their money—that's in the rates support grant; they determine what that spend looks like. But what we have done is developed a new code of practice. So, we've got the national framework for commissioning care and support, which is currently laid before the Senedd, and it's intended that that will come into force in September. Now, the national framework is going to be setting the principles and the standards for commissioning practices aimed at both reducing complexity and facilitating national consistency of commissioning practices and rebalancing the commissioning focus on quality of outcomes. So, what I would like to see is that, when that national framework comes into place later in the year—we're hoping that that will come in in September time—that will give an impetus to having more consistency of approach, not only in practice, but in actual care home fee setting as well. I would like to see that being rolled out fairly quickly, and that local authorities engage with that, and that we see, as I say, the consistency of both practice and fee setting.

Mark Isherwood. You'll need to be unmuted before you start your question, Mark Isherwood. If you can start again. You're fine now.

Okay. During the business statement yesterday, I called for an urgent statement on care home fees after Betsi Cadwaladr University Health Board wrote to providers in north Wales setting out a care home fee uplift of just 3.71 per cent for 2024-25. As I stated, Gareth Davies and I met Care Forum Wales last Friday, and they told us that north Wales now has the lowest care home fees in Wales, putting pressure on providers to stop accepting new continuing healthcare patients and to give notice to their current continuing healthcare funded residents, a distressing outcome that nobody wants to see at the very time when need has never been greater and health boards so desperately need these care home beds. In her response, the Trefnydd stated

'that's something that the Cabinet Secretary for Health and Social Care is actively addressing'

on a cross-ministerial basis. How, therefore, do you respond to the call for urgent intervention with the health board to ensure both a sustainable settlement and a national approach to fee setting, to provide a baseline figure that's acceptable to the sector and delivers good value for the taxpayer?

I thank Mark Isherwood for that question. I refer you back to the answer I gave to Llyr Gruffydd, which was relating to the overall process for the setting of care home fees. You've come—. Sorry, Llyr, I didn't address the point you raised about continuing healthcare, which I will do now in response to Mark's question. Continuing healthcare and the setting of policy around that is a matter for the Cabinet Secretary for Health and Social Care, but what I would say is it is the responsibility of the health board to set the appropriate rates of fees for providers under the continuing healthcare. There isn't a national methodology for agreeing the CHC rate. That weekly rate is paid by the health board for CHC, and it might vary depending on the needs assessment for the individual that is in receipt of that care. So, the care that's required and the residential care fee rates are set in accordance with the particular needs.

I will speak further to the Cabinet Secretary for Health and Social Care about that, because, of course, there is an overlap. The CHC fund setting is not in my portfolio; care homes fee setting is. So, we'll have a conversation, and I'm sure we'll be able to get something together and submit it to the Senedd, or circulate it to Members, so that they have a better understanding of what's going on.

We've been open about the challenges emergency care services are under. These are not unique to Wales, and the Grange hospital is not an exception. The recent business continuity incident at the hospital reflects the level of pressure the system is under due to demand on services and issues with patient flow.

Diolch. Cabinet Secretary, the Aneurin Bevan University Health Board last week, as you've just outlined, at the Grange hospital, announced that it is under enormous pressure, urging people to only attend if they had serious injuries. I went to the accident and emergency department at the Grange two weeks ago, just the weekend before this concerning announcement was made, and I've never seen it so busy—around 20 ambulances outside, and people rammed in the not-fit-for-purpose waiting room and spilling out of the doors, literally. The infrastructure has never been fit for purpose. As you know, it was designed for another purpose originally.

But it's not just the poor infrastructure that's the problem; the systems weren't working either. And I know the enormous pressures, of course, on social care, which has an impact on A&E. I witnessed first-hand the 18-hour waits in A&E in the Grange last September, and it certainly didn't look like anything had been improved since then. In a country such as ours, this situation is not acceptable. Funding needs to be prioritised to do whatever is necessary to improve this urgent situation. So, can the Cabinet Secretary today reassure us that works to improve A&E in the Grange hospital, in infrastructure and management, is something that she is prioritising at the moment, working with the Aneurin Bevan health board, of course, to improve things urgently and drastically for our constituents? It's time this Labour Government stopped wasting money on its pet projects and put the money where it's desperately needed.

Well, I can reassure you, Laura, that I am very fixed on keeping an eye on what's happening in relation to the Grange. That's why, in relation to emergency care, they are in enhanced monitoring, which means that my officials are keeping a very beady eye on them. But also, it's probably worth underlining that we've provided an extra £14 million capital to support the expansion of the emergency department, and I'm expecting those improvements to be completed by the spring of 2025. That is going to double the waiting capacity from 38 to 75 seats. But, as you suggest, it's not just about the infrastructure, it's also about the flow, it's about getting all of those other things right. That's why Aneurin Bevan have also been provided with an additional £6 million from the six goals programme, and the emergency care department are going to receive a further £2.7 million from that. So, there's a huge amount of money going in. We are expecting to see improvements.

As you say, the demand just keeps on coming. The demand we see in emergency care is like nothing we've seen before. And that is really difficult for us to ramp up that quickly, which is why of all the massive, massive pressures that we have in terms of capital—and let's not forget that the Conservative Government only gave us an increase of £1 million in capital for the entire Welsh Government this year—for us to find £14 million capital, for us to spend it on the emergency department in Aneurin Bevan, I hope underlines the seriousness with which we take this issue.

Last year there were over 850,000 hospital attendances within Aneurin Bevan University Health Board, reflecting continued increases in demand and considerable pressures. But there are opportunities for improvement and we are working closely with the health board to improve access to safe and timely health and care services.

Thank you, Cabinet Secretary, and it gives me no pleasure to raise this question. It follows on, I think, from Laura Jones's, but I felt I had no choice but to raise again my grave concerns about capacity at the Grange hospital in particular.

Over the last two or three weeks I've received some urgent casework. One raised real concerns, where a very ill and distressed constituent rang me from his bed in the hospital. He was asked to vacate his room to the corridor to make space for another patient. This was dealt with quickly, and my thanks go to the hospital's patient liaison team, who engaged with the constituent immediately and reassured him that he would not need to be moved.

I also was urgently contacted by a concerned constituent who was extremely distressed about the lack of communication and engagement with them about a family member in the Grange, who was critically ill and sadly passed away just a few days later. And last week a social media post went out telling people not to go to the hospital unless they were in a life-threatening condition due to immense pressure on their services.

Cabinet Secretary, what can be done to alleviate the pressure at the Grange? Clearly, pressure is immense there at the moment and there has to be a solution there, and we must find something, even if it's in the short term, because for sick people to ring me from their bed in the hospital, that's just too much. Thank you.

I agree with you. I think the pressure is intense. I do very much feel not just for the patients, but also for the staff and the pressure that they're under, particularly if you look at the number of patients. So, the demand on the service is absolutely enormous. In May 2024, the emergency department saw nearly 8,000 patients—that's an enormous, enormous number of people. But, despite that, there was an 8 per cent reduction in the number of one-hour ambulance handovers, if you compare it with January 2024, and you can look at the fact that the median time, the average time from arrival until you're admitted, transferred or discharged, is two hours and 15 minutes. So, I think it's important to, of course, make sure we focus on those cases that take a long time, and that corridor care that is not acceptable, but let's not forget the fact that, actually, the vast majority of people are being seen within two hours and 15 minutes. So, I do think we need to keep some perspective, but there has been a huge amount of money gone in. There's a new same-day emergency care service that has taken a lot of pressure off; around 600 patients a month are now being treated in that same-day emergency care centre, and around 75 per cent of those are safely avoiding admission. So, we are putting measures in place, we are seeing improvements. It's not good enough, which is why we've got them in enhanced monitoring at the moment.  

I thank the Cabinet Secretary. 

Item 2 is next, questions to the Cabinet Secretary for Economy, Energy and Welsh Language. The first question is from Julie Morgan.  

The life sciences sector in Wales has a number of world-class capabilities, and we are supporting its growth in a number of ways, including through the financial support we provide to Life Sciences Hub Wales and the sponsorship of MediWales events such as BioWales and NHS Connects.

Thank you for the response. 

Last month, a new world-leading life sciences manufacturing facility opened in Cardiff North. I believe the Cabinet Secretary for health actually attended the opening. The Molecular Devices site will manufacture 3D models of human organ tissue, known as organoids, grown from human stem cells for research into diseases and for drug development. And the industrialisation of organoid research was first pioneered by Cardiff and Bath universities, through a start-up company that has now been acquired by Molecular Devices, and the workforce has doubled and further jobs will be created. Would the Cabinet Secretary agree that this is a prime example of what the Welsh Government intended to achieve with the manufacturing plan? And what more can be done to attract other world-leading life science companies into Wales?

I thank Julie Morgan for that further question. I think this is a really good example of genuinely world-leading innovation in Wales, drawing on a commitment from the Government, but also the underlying strengths in our economy and public service. And I think that it's a really good example of academic and industrial collaboration, with that aim of revolutionising healthcare and bringing economic benefits to Wales. This is something that the Cabinet Secretary for health and I have spoken about on a number of occasions. 

Julie Morgan was asking what this means from the perspective of our manufacturing action plan. We will be mapping out both current and potential supply chains for life sciences, and discussing with the NHS—continuing the discussions we've already started, in fact—how we can support it to source from Wales-based manufacturers, encouraging companies to invest in Wales and helping Wales-based manufacturers to diversify into these supply chains. I think it's a really good opportunity from an economic point of view, and I believe the Cabinet Secretary for health would agree that it's an important opportunity from a healthcare point of view as well. 

Thank you, Julie Morgan, for raising the question. Supporting our life sciences sector is incredibly important to promote a thriving economy, and there are huge opportunities, we know, here in Wales, but we need to generate an interest in life science careers at a young age. It's integral to ensure that the next generation of life scientists are intrigued, engaged and trained up, and that, of course, starts in our schools, but there is a problem.

The Labour Welsh Government have made the political decision, through the new curriculum, to reduce significantly the amount of science on offer at GCSE. Instead of offering young people the choice to study triple science, as it was previously called, the maximum on offer for pupils as part of the new curriculum is what was previously known as double science, so a third less. So, Cabinet Secretary, what representations have you made and will you make to the Cabinet Secretary for Education to revise this short-sighted decision to deprive young people of the level of rigour in science at GCSE level, which is clearly still on offer over the border?  

Well, I must be careful not to trespass into my previous Cabinet responsibilities in answering the question. But the Member will know, of course, that the decision that was taken by Qualifications Wales to reform those qualifications has met with the approval of the royal societies for chemistry, biology and physics. And the reason I believe that they have supported those decisions is because they know, based on evidence, that people progressing to A-level will do very well based on those qualifications—there is evidence of that happening—and based on discussions with universities. But I think it is important, the broader point that the Member makes is important, that we must do everything we can to encourage young people into sciences and into STEM subjects more broadly. That's why I'm really proud of the work the Welsh Government does to support schools in order to do that.

Cardiff Airport is an essential element of Wales’s economic and transport infrastructure. The Welsh Government is committed to maintaining an airport in Wales because of the benefits it brings to the Welsh economy and its regional supply chain.

Thank you for your answer, Cabinet Secretary. My views on Cardiff Airport aren't exactly a secret for anyone inside or outside of this Chamber; I strongly believe that the dead hand of the Government should be removed from the airport and a return to private ownership. However, despite repeated calls, it appears as though the Welsh Government won't be relinquishing the airport, which continues to swallow up millions of pounds of taxpayers' cash. So, with that in mind, Cabinet Secretary, as the airport now falls under your brief, what new ideas do you plan on bringing forward to turn the airport's fortunes around?

Also, Cabinet Secretary, a week or so ago, Manchester Airport was thrown into complete chaos after experiencing a power cut. Up to 90,000 passengers were affected, with flights cancelled and arriving planes diverted. Now, I appreciate, Minister, that Manchester isn't comparable with Cardiff Airport, but what contingency plans does the Welsh Government have, should a similar incident unfortunately unfold here in Wales? Thanks.

The Member will know, of course, that the operations of the airport are at arm's length from the Government, as she would expect and I expect would approve of. She is, I think, misguided in her view in relation to the Welsh Government support for the airport. It is a really, really important part of our economic infrastructure in Wales. The most recent economic analysis that we have suggests that the airport's direct economic footprint was around £87 million-worth of gross value added, based on around 2,000 employees employed in and around the site. And the indirect economic activity that the airport supports is estimated at a further around £159 million of GVA.

As the Welsh Government's existing plan draws to the close of its period, my focus, coming into this portfolio, has been to consider a longer term strategy for growing the business in a manner that would make the most of the airport's undoubted strengths. I want to maximise the airport's potential benefit for the regional economy, and to inform that thinking, we've commissioned consultants to provide updated estimates of the airport's both current and potential economic benefit, so that we have that long-term trajectory, which is really important, and I've got absolute confidence that we have the right team at the airport, making the right decisions. And she will know about the increase in passenger routes this summer, which I'm sure many thousands of people will take advantage of.

Cabinet Secretary, 96 per cent of airports in the world are in public ownership, and it always perplexes me that the Conservatives are keen to promote Teesside International Airport and its public ownership model, but yet are always keen to run down Cardiff Airport and its international importance for us and its economic significance as well. Bearing in mind the GVA figures that you have quoted there, and the fact that the airport facilitates 4,000 jobs related to aviation in the Vale of Glamorgan alone, would you agree with me that the Tories' constant sniping about Cardiff Airport represents a lack of ambition for Wales and, quite possibly, a lack of understanding of the economic modelling?

Well, I'm as tired as the Member is of hearing the Welsh Conservatives run down Wales. They have no—[Interruption.] They have no—[Interruption.] They have no confidence in our national institutions, and they do not see the approach that a positive Government engaged with the economy can bring, the benefits that can bring to Wales. I think it's about time that, rather than complaining about the approach that we take as a Government, she should recognise the commitment that we have made on behalf of people in Wales to the airport, which is such an important part of our economic infrastructure.

Questions now from the party spokespeople. The Conservative spokesperson, Joel James.

Thank you, Llywydd. Cabinet Secretary, major events in Wales are a vital source of revenue for many businesses. Not only do they bring visitors to Wales, who often stay for several days, but they provide vital jobs, especially for younger people who are looking for temporary work around studying. The Ironman Wales event, held in Tenby each September, is one of many such events across Wales. It attracts athletes from across the world, and it fits in with the ethos of encouraging sporting activities and challenging all of us to exercise more, which is probably something I could do a bit more, I suppose. However, as you are aware, Tenby north beach, where the athletes swim, has had yet another discharge of raw sewage, which has caused Natural Resources Wales to issue a pollution risk danger warning to not only this beach, but Tenby south beach, Castle beach and the nearby Penally beach as well. Constituents have raised with me how fed up they are of Welsh waters being polluted with sewage. If this discharge had happened in September, then the Ironman contest would probably have been cancelled, which would have seriously impacted tourism, the local economy and ultimately the reputation of holding such events in Wales.

The potential for encouraging major events in Welsh waters is massive. However, failure to hold to account Welsh Water for not doing enough to stop raw sewage from entering Welsh waterways is a primary factor for major open water swimming events to look elsewhere. Cabinet Secretary, major events such as Ironman Wales are good for the Welsh economy. However, having continuously polluted waters is seriously damaging our reputation and our potential for events. What conversations have you had with the Cabinet Secretary for Climate Change and Rural Affairs to apply pressure on water companies to do more to stop raw sewage from entering Welsh waterways? Thank you.

I do support the work that my Cabinet colleague is doing in relation to this and he is working very hard to make sure that he holds accountable those agencies responsible and those who cause the pollution into our rivers and our seas. On his broader point about major events, I do think he's right to say that major events can be very significant contributors to the Welsh economy. We have good examples of that right across Wales. And that’s why, actually, supporting major events is a really important part of what we try and do as a Government. I would just suggest to Natasha Asghar, though, as she reflects on the importance of the airport, that, actually, our ability to attract many major events is in no small part down to the fact that we have an airport, which people know they can use to reach those events very swiftly. So, that’s yet another reason why having that critical part of our infrastructure is so important.

Thank you, Cabinet Secretary. Turning to transport, the Taylor Swift Eras tour came to Cardiff on 18 June this year, and as you will be aware, broken-down engineering equipment blocked one of the main train lines into south Wales, causing widespread train disruption for several hours. Because of this, many more people chose to drive into Cardiff for the concert, creating extensive traffic and some very long tailbacks. Interestingly, when the Eras tour went to Liverpool and Edinburgh, no such issues were reported.

Two years ago, drivers experienced 19 miles of tailbacks on the M4 when Pink played at the Principality Stadium, and when Ed Sheeran played in Cardiff, many were caught in 15-mile queues on the M4 into south Wales, with people reporting that they actually missed the concert completely. Not only is this very annoying for those drivers stuck in queues, giving them a very bad experience, it is very frustrating for people who live in south Wales if they have to deal with the traffic chaos without even the enjoyment of attending the concert. And there's the obvious problem that having 19 miles of tailbacks causes a huge amount of pollution, which is more than likely to undo all the efforts to improve air quality in south Wales, which is only getting worse. 

Last year, you announced an end to the plan to build a major events stabling line, with Transport for Wales reporting a loss of £10.5 million on the project, which would have undoubtedly increased capacity to support major events, which shows that your heart really isn't in helping to develop a positive experience for those attending events in Wales. Cabinet Secretary, with this in mind, what conversations have you had with the Cabinet Secretary for North Wales and Transport to understand the impact of such poor and fragile transport links on encouraging major events in south Wales and what plans have you got to change this? Thank you.

I think I'll just draw attention to the stark contrast between the picture the Member describes and the experience that those people who went to see Taylor Swift and to other concerts have been able to share. My Cabinet colleague the Cabinet Secretary for transport is focusing laser-like on investment in our transport network in Wales. We've seen marked improvement over the last number of years because of additional investment going into both our rail and bus networks. I'm sure that he shares my ambition on behalf of the Welsh economy to make sure that our transport network is able to support the major events that we are keen to put on and that bring happiness, joy and entertainment to so many thousands of people.

Thank you. And finally, Cabinet Secretary, when places across Wales hold a major event, I believe there should be an overall net gain to the area accommodating it, not just in jobs and tourism, but also in terms of reputation and improvements to their amenities. In other words, areas shouldn't just be trashed, leaving tonnes of litter and various problems for the local council to sort out. I've advocated on many occasions that Welsh high streets are in desperate need of more public facilities, for example, and one way of investing in these is through major events investing in the amenities of the area, which has a double benefit of not only the local population feeling more enthusiastic about the events that come but also an improvement in the experience of those who visit, and giving a secondary economic boost to the area by providing amenities needed to support visitors all year round. With this in mind, what steps have you taken to encourage major event holders to invest in the towns and cities that they hold their events in? Thank you.

Many of the ways in which we support major events very much have in mind the impact that major events can have on the environment, and we work, often, with those organisations and companies who hold those events, and the venues that host them, in order to make sure that they have as little impact as possible on the environment. In particular, we've done some innovative work in relation to some net-zero solutions for those events being held. I think it's really important to have that holistic view, as the Member suggests—that we see the economic benefit, but also that we have an eye on the environmental impact. And we want to make sure, of course, that we support and work with our partners who provide those major events to ensure that that holistic approach is taken, both to the economy and to the environment.

Plaid Cymru spokesperson, Luke Fletcher. 

Diolch, Llywydd. Over the past two years, Citizens Advice Cymru has provided more assistance with energy debt and crisis support than at any other time in the past five years. Much has been made in recent weeks of Great British Energy, since it was announced by Keir Starmer. Pat McFadden, Labour's national campaign co-ordinator, recently confirmed in an interview that GB Energy will not be a company that generates energy, but it will essentially be a finance company designed to generate private sector investment, a de-risking vehicle subsidising private energy companies, who will, doubtlessly, end up owning what will be key renewables infrastructure in the years to come as a result. On the basis that he gets the result he wants tomorrow, how will GB Energy interact with Ynni Cymru? Have there been any discussions with UK counterparts outlining that relationship, and has any thought been given by the Welsh Government to how they would interact?

Let's hope that we do get the result tomorrow, which I very much hope for, and I hope the Member will encourage others to bring about that result as well, so that we can have that more collaborative approach, which I know that both he and I would support. We have had discussions in relation to the work that we're already doing in Wales through Trydan Gwyrdd Cymru, which is intended to make sure that there is a public voice in the development of renewable energy, and to make sure that that's innovative and is able to return value to the communities that host those developments, and, also, the work of Ynni Cymru in investing in community energy projects. 

So, there is a real opportunity, I think, to see the plans of, I hope, an incoming Labour Government dock very well with those plans that we already have at work here in Wales. I was able to have a very productive discussion, actually, last week, at the RenewableUK Global Offshore Wind conference, with Ed Miliband—who may be the incoming energy Minister in a new Labour Government—and I'm very confident there'll be a close and collaborative working relationship, which will mean that Wales is also able to take advantage of those UK-wide developments.

That model that was set out for GB Energy could be quite worrying in terms of its interaction with Ynni Cymru, because, in essence, what we could have here is a private finance initiative for the renewable sector. So, this is something that we need to keep a close eye on if it is to interact and work in unison with the Welsh Government's aims around Ynni Cymru.

We need the state to intervene at the generation end, the transmission end, and the retail end of the energy market, of course—there's no argument here from me. But the system currently isn't right. It's no secret at the moment that, at every level, profit is maximised and extracted from our communities. We had a debate on this very fact last week. We're talking here about a basic utility necessary for everyone in their everyday lives, and companies are simply making a mint on it.

One of the claims is that GB Energy will finance offshore wind, the dividends of which will presumably fill the UK coffers. Does the Cabinet Secretary agree that, actually, we should, in this instance, cut out the middle man here, that we should seek full powers over the Crown Estate, allowing us, then, to benefit directly here in Wales from offshore renewable development, ensuring that those dividends go straight into the Welsh Treasury?

I had a very good conversation—an informal conversation, I should say—at that same conference, in fact, with the Crown Estate. I'm hoping to meet with them very shortly to discuss our needs in Wales, and to make sure that, in future leasing rounds, we are able to maximise the clean energy opportunity for Wales, but also the economic opportunity to support communities that host energy generation projects, and Wales more broadly than that. It is our position as a Government that we would wish to see the devolution of powers over the Crown Estate. I think that could be a very significant contributor to our energy needs but also to our economic needs. But critically, what I think we can all agree on is that having a Government in Westminster that is committed to investing in renewables, in the renewable infrastructure of this country, in the national grid, will be a step change in our ability as a nation to capture that opportunity, both for Wales and the UK at large.

That's exactly the point, isn't it? The devolution of the Crown Estate allows us quick and easy access to those funds that we can then use to the benefit of our communities. What we want to see here is the setting up of, essentially, a sovereign wealth fund, using the profits taken from offshore windfarms to invest directly in communities across Wales. Estimates suggest that several new offshore windfarms planned in Welsh waters could generate £43 billion in rents, which would be a significant basis for such a fund. How is the Cabinet Secretary working with colleagues like the Cabinet Secretary for climate change and the Counsel General to secure those full powers over the Crown Estate as soon as possible? Is he able, then, at a future point, to give us a timeline on when we can expect those discussions to happen and progress? And what consideration has he given to the report of the energy sub-group of the independent commission on the future of Wales, which recommends an urgent review of the devolution settlement in relation to energy policy, Ofgem and the Crown Estate?

I think the Member makes interesting points in relation to the devolution settlement and our capacity to take more decisions on energy here in Wales, which I would support. On the model that he touches on, which I think he described as a sovereign wealth fund in the context of energy—and other countries have obviously done that in the context of oil, haven't they, in decades past—it's that principle, really, that underpins the establishment of Trydan Gwyrdd Cymru, which is obviously in the very early stages. But the principle there is that it's the Welsh public purse that essentially receives a profit from project development and, potentially, from construction or operation, depending on the delivery model and depending on access to capital. The critical point is that the return from that, then, can be deployed to support, as I say, those near the developments, but also to support wider Welsh Government priorities for the nation as a whole. I think that is an interesting model and I am very excited to see what more we can do in that space.

I have not had any discussions with individual developers regarding large-scale wind projects at specific locations in Wales. I continue to engage with the renewable industry, through round-table discussions and through RenewableUK Cymru, to understand the opportunities and challenges to scaling up renewables in Wales.

Thank you for your answer, Cabinet Secretary. With the Welsh Government aiming for 70 per cent renewable energy consumption by 2030, a lot of these windfarm developments are going to need compulsory purchase orders to get land. So, I'm interested to know whether the Welsh Government will be helping these companies with compulsory purchase orders for their large-scale developments. In addition to that, if some of these proposed windfarms become commercially non-viable in the future or some of the companies running them go bust, can you today, Cabinet Secretary, rule out the Welsh Government stepping in and taking forward any of these schemes as part of the Welsh Government's energy company?

I don't think there's been any suggestion of that. Our policy as a Government is to support the principle of developing renewable and low-carbon energy from a range of technologies. He will know that from the point of view of planning and consenting, the Infrastructure (Wales) Act 2024, which will be a step change, will bring forward new consenting processes, streamlining and unifying those consenting arrangements for renewables, as well as other large-scale devolved infrastructure projects in Wales. From a planning and consenting perspective, my interest as the energy Minister is making sure that there is sufficient capacity in that part of the system to enable projects to be taken forward in a way that complies with planning requirements and respects the needs of local communities. There have been a number of process improvements, which we've introduced already, as well as additional dedicated funding for Natural Resources Wales, and I'm hopeful that that will make a significant contribution.

We work in social partnership to promote fair work and encourage better working conditions. This includes formal and regular engagement with employers and trade unions at the social partnership council, the workforce partnership council and sector-specific arrangements such as the retail forum and, as was mentioned earlier by the Minister for Social Care, the social care fair work forum.

Well, as much as I'm glad to hear all of that, you might be aware that approximately 1,200 workers at Rowan Foods in Wrexham are facing an uncertain future due to plans by the owners, Oscar Mayer, to make workers redundant and change working conditions, and that includes an annual pay cut of £3,000. That's a policy of firing and rehiring on worse conditions, which, obviously, belongs to the Victorian age. I'm seeking a commitment now, as are the 1,200 workers and their union Unite, that this Government will do all it can to oppose such a regressive policy. So, do you agree that it's absolutely reprehensible that a company like this can on the one hand pay its chief executive £0.5 million a year and on the other hand treat its workers in this way? If you do, then what are you going to do to ensure that this firing and rehiring isn't allowed to happen?

Thank you very much. I will declare that I am a member of Unite the Union as I answer this question. Obviously, I'm not in favour of fire and rehire. It's not something that, as a Welsh Labour Government, we are in favour of either. I know that sometimes they try to call it something else as well. But, I myself have worked with trade unions over the years to very much push back on this, with the levers that we have at the moment in the Welsh Government. Obviously, where we're coming from and where I'm coming from as the Minister for Social Partnership is that we'd never want to get to a place where this is happening and is happening to workers in a way that surprises them, catches them off guard, and then leaves them high and dry but also without the support to maybe be upskilled and go on to other work. I would start by saying that is what we always endeavor to do. That is not what has been able to happen in this situation.

The only way that we're really going to be able to make any progress on this—and I don't want to get political about this, but I will because it is true—is the new deal for workers that is being promoted. We've done a lot of work with the trade unions in order to get it to where it is at the moment. It's hopefully going to be coming in and there is a commitment to be doing something on this very early on. It's one of the things that is at the top of the agenda when it comes to trade unions, because this fire and rehire, often deliberately to bring people in on less money, as you've mentioned, but also worse terms and conditions, takes back very hard won rights that we have for workers. It totally undermines fair work, which we are big promoters and supporters of in Wales. I'm doing a lot of work at the moment on the real living wage, for example, and trying to get even those big private companies, and particularly retailers, to actually commit to that. So, I am very saddened to hear this. It is under the Cabinet Secretary for the economy. We take every hit like this and feel it as well. Ultimately, we want to make sure that this doesn't happen again, going forward. But, let me say on record that, no, I do not agree with this approach, and I want to make sure that this cannot happen, going forward. Diolch.

The Welsh Government's guide to fair work provides a practical example of what fair work could look like in a working environment, delivering inclusive opportunities to obtain work, to acquire and develop skills and learning, and to progress in work. The last meeting of the cross-party autism group included access-to-employment perspectives of autistic people, with speakers from Denbighshire and Flintshire. As one told us, she's struggling to find a job—she's applying for entry-level positions and getting declined almost immediately, which she feels is due to her autism. She's also part of a wider social group in which her peers are facing similar problems. She told the meeting that people have different operating systems but are equal, and that she did not need help changing her CV as the issue was the attitudes of employers towards her community. After years of warm words, what practical, outcome-focused action will the Welsh Government now take to address this?

Thank you for the question, Mark Isherwood. I am dismayed to hear that that is the case and how people are being made to feel when they're trying to remain in and enter the workforce. You mentioned there fair work, and that is about having a fairer, safer and more secure workplace. But, as you said, it's about also getting access to be in that workplace, to join the workforce, to be respected, just like everybody else.

What I would say is that, obviously, at the moment I am overseeing and part of the set-up of the social partnership council that is chaired by the First Minister. It's very interesting that we're now very quickly starting to talk, for example, about the sub-groups and the pieces of work that will be done, because everybody who is involved in the social partnership council is just very, very keen to get on now and start producing that action, as you said. One of the ones that has come through, that people have recommended, is that they want more on inclusivity, on diversity and on equality. I will be more than happy to feed back what you've been saying, and if you would like to write to me as well, then I would like to hear more about this and the difficulties that people are facing.

This is exactly what fair work is about, honestly, Mark. This is about standing up for everybody, and everybody having an equal right to be in the workforce, and to be respected, be paid fairly, be able to progress and be part of the workforce in Wales. So, thank you very much for raising this. This is something that I will be able to report back to you on as we continue to do more work in this area. Diolch.

Part of Social Business Wales, Employee Ownership Wales, provides fully funded bespoke advice to support employee ownership of businesses. There are now 75 employee-owned businesses in Wales, an increase of 38 since the start of this Senedd term.

I was really pleased to see that you've reached your target, and I believe that that aim to reach 74 employee-owned businesses in Wales was to happen by 2026. So, that means that we are two years ahead of schedule. One such business in my area of Mid and West Wales that has benefited from this help is the Pembrokeshire-based woollen mill, Melin Tregwynt, and it became an employee-owned business in 2022. Cabinet Secretary, do you agree that offering this support for employees to own the companies they will work for will help these businesses thrive and, more importantly, help them to remain in Wales, as well as offering a huge advantage to those people wishing to remain and work in the place that they live?

I thank Joyce Watson for raising this as a question in the Senedd today. As a co-operator, and I know she shares this view as well, the ability to support employees to own the businesses in which they work is a really important part of that vision. And I pay tribute to my Cabinet colleague, the Cabinet Secretary for rural affairs, in his previous capacity as Chair of the co-operative group in the Senedd, for the work that he did around Marcora-inspired legislation and other means of increasing employee ownership. I do think it is really important that we continue to provide specialist advice so that we can support employee buy-outs not just for businesses when they're in difficulty, but also, in the context particularly of Melin Tregwynt, where that is part of a planned offer. I think, if I'm remembering correctly, it happened when the company was celebrating 110 years of its establishment, so it was part of a plan to hand over control to the employees, which I think is a fantastic way of doing it. The critical thing is, as is the case with Melin Tregwynt—and there are others, of course, in the Member's region—that these businesses are rooted in their local areas in the regions, and they are a really good means of securing good-quality jobs for the longer term. And we have good evidence that employee-owned businesses can have particularly high levels of productivity, which I think is quite an important aspect to bear in mind as well.

Business rates relief has a positive effect on the economy. Our package of support, worth £384 million this year, has reduced or eliminated non-domestic rates liability for more than 100,000 properties. Less than 20 per cent of properties will attract full rates, and the package recognises the pressures that ratepayers have faced over recent years, and is intended to support continued economic recovery.

Diolch, Cabinet Secretary. Last year, it was recorded that one in three shops on Newport high street lay empty, and there are many more empty shops across my region of South Wales East, with it now seemingly being the norm to see, which is a sad place to be in. At a time when businesses are still getting back on their feet after COVID, this Labour Government decides to lower the business rates relief from 75 per cent to 40 per cent, making Welsh businesses pay effectively double their English counterparts. I fail to understand why the Welsh Labour Government is now calling for the 12-month review into business rates relief, wasting public funds and time when we all know what a difference that extra help is giving businesses just across the border in England from the Conservative Government. We're at a time when the Government should be doing all they can to help businesses flourish, even survive, let alone attracting more businesses to open, as it's not just they who benefit, but all of us from that, of course, with the impact on the economy. So, Cabinet Secretary, will this Government finally do the right thing and reduce their cuts to business rates relief?

Well, the Member talks about the pressure in particular on the retail sector. We're investing an additional £78 million to provide a fifth successive year of non-domestic rates relief for retail, leisure and hospitality businesses, building on almost £1 billion of relief provided since 2020. Those who are eligible will receive a 40 per cent relief for the entirety of this financial year. This doesn't happen by default; it's a decision taken by the Welsh Government to support retail, leisure and hospitality businesses that we understand are facing very difficult times. The Member asks me to compare the position in Wales with that in England. The tax base in Wales differs very significantly from that in England. As it happens, our small business rates relief supports up to two properties per local authority for businesses in Wales, which is much more generous than in England, where businesses can only claim for one property. Small businesses account for a much higher proportion of the total rates revenue in Wales compared to England—more than double. The cost of the small business rates relief in Wales is fully funded by the Welsh Government. It makes up 10 per cent of total rates revenue compared to 4 per cent in England, and by capping the multiplier increase to 5 per cent this financial year, compared to 6.7 per cent in England, we have reduced the difference between the multiplier in Wales and in England. So, all of those measures tell you that we are absolutely committed to doing everything we can through our rates policy to support businesses and the economy in Wales, but it is inescapable that the financial settlement that she celebrates, that her colleagues in Westminster have foisted upon the Welsh Government, which does not recognise the increasing costs and that has failed to keep the promise of replacing the funding that we lost in leaving the European Union has caused incredible pressures on our budget. That is an inescapable fact of Conservative economic policy. But, in Wales, the Welsh Government will do all it can to support our businesses and support our economy.

Planning legislation, 'Future Wales: The National Plan' and 'Planning Policy Wales' provide a robust framework to ensure the impact of development on communities is considered fully in relation to decisions on applications for renewable energy.

Thank you, Cabinet Secretary. Sadly, many communities in my region are being used as guinea pigs when it comes to renewable technologies. The village of Bryn looks set to be dwarfed by 18 wind turbines, each bigger than the London Shard. I'm not asking you to comment on an individual planning application, but to address the principles. How can we deem such projects safe when we have nothing to draw upon? As your colleague said in response to a question, national planning policy does not specify the levels of shadow flicker or ice shedding deemed acceptable. So, here we have renewable schemes utilising turbines only previously installed offshore, and we have no national guidelines in place to protect communities. Cabinet Secretary, will you now urge a review of planning guidance to ensure that the vital step to decarbonising our energy grid does not impact the health and safety of Welsh residents?

I know this is a question that the Member has pursued on a number of previous occasions in the Chamber, so I recognise his interest in it, and he is right—obviously, I won't comment on any particular planning application for the obvious reasons. But all applications are, of course, subject to statutory requirements, both in relation to pre-application consultation, but also other opportunities throughout the process for communities to engage with developers and raise, as they should, concerns with the potential impact of schemes, when that arises. It's really important that communities do have that opportunity, but also take that opportunity to voice concerns. That is the best way to make sure that planning decisions take all relevant factors into account.

As a Government, we support the principle, as I mentioned to your colleague James Evans a little earlier, of developing renewable and low-carbon energy from all technologies and all scales in order to reach our energy needs. Some, I recognise, will be controversial, and we need to consider those carefully, but the truth is, in order to be able to make progress on our renewables objectives, a range of technologies, both onshore and offshore, will be required in order to do that, and our task, then, is to make sure that we take full account of the impact of that on communities and take full account of what we hear from communities.

Policy 18 of 'Future Wales' ensures that planning applications for developments of national significance do provide that opportunity, so that communities, designated areas, landscapes are all protected from unacceptable adverse impacts, and we are absolutely committed to making sure that communities are able to actively engage with those who are proposing new developments.

We've outlined our plan for improving the economy of Wales, and north Wales in particular in the context of this question, in our economic mission and regional economic framework. We are collaborating with our partners to showcase its unique advantages and to make sure that north Wales shares in the fair transition to a more resilient and sustainable economy.

[Inaudible.]—from the north Wales growth deal to generate total investment of over £1 billion for north Wales, to the £160 million purchase of the Wylfa nuclear site on Ynys Môn for new nuclear energy developments, from the decision to establish a free port in Holyhead, backed up by up to £26 million UK Government funding and expected to generate billions of public and private investment, to the decision to establish a new £160 million investment zone around Wrexham and Flintshire, the UK Conservative Government has taken the initiative and then worked in partnership with the Welsh Government to deliver these. All of these and more, including the commitment to invest £1 billion in the electrification of the north Wales railway line, are in the Welsh Conservative manifesto for tomorrow's general election. What plans do you therefore have in place to take these programmes forward with the next UK Government?

I thank Mark Isherwood for his ingenuity in converting a press release into a policy in that question. As he absolutely knows, there is no sign-off at all for the funding committed to the north Wales transport infrastructure, which I think we would all accept is needed.

He describes, I think, in his question ways of working between a Welsh Government and a UK Government. By the way, he doesn't list any of the investments that the Welsh Government has made into any of those projects, which I think probably reveals the motivation behind the question, if I may say, in the context of an election. The point is that there is much more scope for the Welsh Government and the UK Government to work together. There have been very good examples, actually—some of them he's listed in his question. I look forward to seeing a Welsh Labour Government here in Wales being able to work with a UK Labour Government in Westminster to build even more on that joint working so that we can deliver for all parts of Wales.

I thank the Cabinet Secretary.

The next item would have been the topical questions, but there are no topical questions.

Item 4, therefore, is the 90-second statements, and the first 90-second statement this afternoon is from Carolyn Thomas.

Diolch, Llywydd. National Meadows Day is usually the first Saturday in July each year. This year it takes place on Saturday, 6 July. It's an opportunity for us to celebrate our most species-rich habitats when they are at their absolute summer best, and perhaps visit one. They are great for connecting to nature and restore health and well-being.

Flower-rich grasslands and meadows can store 500 per cent more carbon in their soils than monoculture fields of pure grass. Soil carbon is a particularly valuable store. It is far more stable and long-lasting than the carbon in trees, which are vulnerable to forest fires, pests and diseases.

The role of fungi in carbon storage is huge, and Wales is home to some of the most valuable sites in the world for rare grassland fungi, like waxcaps and pinkgills. And orchids are symbiotic with fungi, and I am pleased to be the species champion for the rare and beautiful lesser and greater butterfly orchid. 

Meadows are also home to over 700 of the UK's plant species and around 1,400 invertebrate species. Species-rich grasslands and pastures are an agricultural habitat and can play an important role in farmland sustainability in the face of climate change. Species-rich pastures are far more resilient to drought or waterlogging than those containing only a handful of grass species, yet species-rich grasslands have declined by 97 per cent in the last century and now they only cover 1 per cent of the UK's land, which is why I'm so pleased to be working in partnership with Welsh Government and communities on a project called 'It's for them', where we've been managing grass verges and amenity grass for biodiversity. And as I wander around, I do little biodiversity audits, and I was really pleased to see that, by St David's, where grass has been left to grow, there are some lovely bee orchids. Thank you.

This year marks 150 years since the creation of the North Wales Quarrymen's Union, an event that was very significant in our history as a nation. It's also 150 years since the lockout at the Dinorwig quarry. The union was established in the Queen's Head pub in Caernarfon in response to the ongoing conflict between the workers and managers for fairness in terms of safety, salaries and working conditions. The union was also supportive of all of the quarrymen through the strikes and lockouts as they fought for their rights, such as the right to a day's holiday a month and the right to help in their community by gathering hay and much more. The union gave voice to the quarrymen, and it was a social school, providing education to the workforce, but also, according to Saunders Lewis, it was a foundation to the formation of the National Party of Wales, Plaid Genedlaethol Cymru, 50 years later.

The mountains of slate are an ongoing testament to the hard work of the men and their families, but amidst them there are the poncs and sinks that were created by them. The Welsh names for these features, such as Bonc Wyllt, Sinc Harriet and Ponc Allt Ddu are being lost and being renamed as Mordor, Never-never Land or Far Out Level. Protecting these names that belong to the history of the quarry would be a good way of remembering the sacrifice of our forebears. Thank you.

Eirlys Parri, or Eirlys Eckley, was a daughter of Morfa Nefyn, and the magic of the ocean stayed with her throughout the years. 'Cerrig Gleision' was the beautiful name of her home in Cardiff. Eirlys was very prominent in the early days of Welsh television and Welsh pop music. She won Cân i Gymru in 1986, and her voice and charming personality won the nation's hearts. I got to know Eirlys when I was in my early teens, when my mother started working with her as a Welsh language advisory teacher in Cardiff Council. She also worked diligently as a teacher in Pontypridd, seeking to reintroduce the Welsh language to the residents of that valley.

In recent years, Eirlys was in the same care home as my father, and as I arrived one day, some of the residents were doing karaoke, singing some of the popular second world war songs, with Union Jack bunting around the place. Naturally, Eirlys looked rather bored, and she was just sitting there in silence. I asked the carers to play the song 'Yfory'—'Tomorrow'. And as the opening bars echoed around the room, her eyes lit up, and we sang the song together. The carers asked us to sing 'Yfory' together several times afterwards. It’s not often that one can sing an iconic song with the singer who made that song so famous.

I remember Eirlys talking about how she should have died in 1974. She was supposed to be on a flight. Her ticket was booked. She was meant to be on flight from Paris to Heathrow, and that plane exploded and killed everyone on board. It was only because of the persuasion of members of the Paris Welsh Society that Eirlys stayed a few more days. Thank goodness for that, and Eirlys had the satisfaction of becoming a grandmother to four grandchildren.

Her influence remains in the hundreds of children whom she taught, and her beautiful voice will be heard forever. The day’s work is done and it’s our privilege to say, 'Thank you and goodbye, Eirlys.' Thank you.

Thank you for the three 90-second statements.

Item 5 is next, the debate on the Standards of Conduct Committee report, 'Thirteenth report to the Sixth Senedd under Standing Order 22.9'. And I call on the committee Chair to move the motion—Vikki Howells.

Diolch, Llywydd. As the Chair of the Standards of Conduct Committee, I formally move the motion. The committee considered a report from the commissioner for standards in relation to a complaint made against Mick Antoniw MS regarding an offensive tweet. The Standards of Conduct Committee gave the commissioner’s report careful consideration, and our report sets out the committee’s judgment as to the sanction that is appropriate in this case. The facts relating to the complaint and the committee’s reasons for its recommendation are set out in full in the committee’s report.

I would like to take this opportunity to highlight to all Members the importance of treating interactions on social media in accordance with the same principles that would be applied to face-to-face interaction.

This is the fourth substantive report in this Senedd relating to social media, and I’d like to remind Members that there is support available on this topic. It is possible to robustly challenge those with opposing views without being offensive, and by doing this, Members can set an example in keeping with the important principle of leadership. The motion tabled invites the Senedd to endorse the committee’s recommendation.

I have no further speakers on this item, and I—. Oh, I have a speaker. Mick Antoniw.

I don’t disagree with the report. I acknowledge the contents of it and it contains my apology, which I repeat today.

Diolch yn fawr. Vikki Howells, do you wish to respond?

I’d just like to close by thanking the Member for the positive and respectful way in which he has engaged with the committee and with the standards process.

The proposal is to agree the motion. Does any Member object? No, the motion is therefore agreed.

Item 6 is next, a Member debate under Standing Order 11.21(iv) on dentistry training. And I call on Siân Gwenllian to move the motion.

Thank you very much, Llywydd. The shortage of dental services through the NHS is a subject that’s regularly raised in this Chamber and it’s certainly an issue that worries my constituents in Arfon. Of the six NHS dentists in Arfon, when we phoned them in April, not one of them—not one—was taking new NHS patients, and the picture is similar across the country and there are a number of challenges that need to be overcome, including the nature of the contract. But this afternoon, I want to make an argument for increasing the number of university training places in Wales for dentists. I would argue that that has to happen along with other changes if we are to see ongoing and far-reaching improvements for my constituents in Arfon and across Wales.

The 'Dental Strategic Workforce Plan', which is newly published, shows that Wales is a net importer of dentists. It shows that Wales is reliant on dental schools outwith Wales in order to produce sufficient numbers of dentists to recruit to the workforce, and it shows that the UK has the lowest number of dentists per capita compared to other large members of the G7 in Europe, and we also know that more dentists from Wales leave Wales to study than remain here: 20 staying, 40 leaving. That kind of situation is not sustainable.

The shortage of dentists here without doubt contributes to and exacerbates the three-tier system that we are moving towards according to the Senedd's own health committee. And this system is one my constituents in Arfon are far too familiar with: a three-tier system where some are fortunate to access an NHS dentist, others can pay to go privately, and the third tier, unfortunately, are those who can't access NHS dentistry and can't afford to pay to go privately. I don't have to outline the problems that emerge for those in the third tier. Members are only too familiar with horrific stories about sepsis and do-it-yourself dentistry.

Now, one would imagine that it's a matter of common sense, therefore—quite fundamental common sense—to increase the number of university training spaces in Wales in order to nurture a workforce to provide this public dental service that is so badly needed. But, to the contrary, the Government sets a cap on the number of places that can be provided in our only school of dentistry in Cardiff, an annual cap of 74 places. Given this context, there was great expectation for the strategic dental workforce plan from the Government's workforce planning body that was published in the middle of May of this year. And it does provide an excellent description and analysis of the problem, but, unfortunately, it falls short as a strategic plan, mostly because it does not commit to any specific increase in educational and training provision for dentists.

We had a statement from the Cabinet Secretary about the Government's investment in education and training for healthcare professionals last week. And despite the warm welcome for the progress made in the teaching of doctors in Bangor, as the medical school there takes a significant step forward in September, there wasn't a word in this statement about an increase in university dental places. And the same was the case on Tuesday, as the First Minister answered a question on the health workforce—no mention of increasing the dental workforce or training places at our universities. 

Even the Conservatives in their dental recovery plan published earlier this year have made a commitment to increase the number of undergraduate training places for dentists in England by 24 per cent to 1,000 places by 2028-29. Unfortunately, the party of Aneurin Bevan hasn't shown the same ambition, and it is depressing and it's a stain on Wales that the ability of a number of our constituents to access dentistry is reliant on their ability to pay. The truth of the matter is that the Labour Party in Wales has had 25 years to plan, but it appears that we are no nearer getting a sustainable system in place where the ability to say with certainty how many dentists there are in Wales, where they live and work, how many more are required to meet the needs of our population and a practical plan to deliver that. That is staggering. In addition to that, the Cabinet Secretary has commissioned another 10-year plan to run alongside this from the chief dental officer. That doesn't make much sense to me, either. Until there is a real commitment in specific terms to increase training places, we can only gather that the support from the Labour Party for a public health service with dentistry as a key part of that, a service that is free of charge on the basis of need, is just warm words.

To turn to the only school of dentistry here in Wales, which is located at Cardiff University, there were 111 out of 1,442, or around 8 per cent, of the candidates for Cardiff school of dentistry for entry in 2023-24 who were from Wales. We know from the most recent data available that eight of the 111 students from Wales were successful in getting a place at Cardiff that year—eight of them were from Wales. Of all the students studying at the school of dentistry in Cardiff, half of those remain in Wales once they have qualified. Now, this is no criticism of the school of dentistry in Cardiff in any way, or of the staff working there, or of the students studying there. But it is now clear that the provision in Cardiff will never be sufficient to meet the needs of the whole nation. And it's also known that there is a link between where students undertake their fundamental core dental training and where they then work and lay down roots in their formative years.

So, what needs to be done? One new dental school has opened its doors in the UK in the last 40 years, and that's the Peninsula Dental School in Plymouth in 2006. A medical school was established there in the year 2000. In September of this year, up to 80 students will start their medical studies at Bangor—the first full cohort—adding to the work that's ongoing there in terms of health sciences and, to be fair, increasing the training of dental therapists and hygienists. You may see my direction of travel here. There are excellent facilities available in Bangor in the dental academy, although there are initial challenges there, and the Cabinet Secretary has accepted the recommendation of the health committee that a school of dentistry should be established anew in north Wales. And you've also committed to sharing with the committee the work that the health department has been doing, and to do so by the summer recess. Bangor, without doubt, would be an excellent location that invites itself for a school of dentistry, and the provision could be tailored to meet the needs of an area that combines the urban and the rural.

But that is a debate for another day. I will return to the issue. I've commissioned work to look at the case for a school of dentistry in Bangor and I look forward to sharing that with the Senedd in due course. I understand also that Aberystwyth University is interested in working with others to introduce dental training in rural areas. What we are asking the Senedd to do today is to direct the Welsh Government to set out a clear policy stance in favour of increasing the number of university training places for dentists, with a specific figure to drive progress, and to outline clear plans that can be scrutinised to deliver that. It is a debate for another day as to where that new provision should be located. Thank you.

Thank you to Siân Gwenllian for putting forward this important debate today. Right across the UK, people are struggling to access NHS dentists, with nine in 10 not accepting new patients. We saw earlier this year hundreds of people in Bristol queuing for hours to register with a newly opened surgery, which is a symptom of years of underinvestment from Westminster in public services, and we cannot allow a situation where only the fortunate can afford to access basic healthcare.

As the motion recognises, there are Wales-specific challenges when it comes to training, recruiting and retaining dentists. I want to see more people training in Welsh universities and deciding to work here in our NHS. I know that the Cabinet Secretary is working hard to address these challenges, and, in my region of north Wales, a number of innovative steps have been taken to try and improve the situation. Bangor dental academy is improving access to NHS dentistry in north Wales, providing care for 12,000 to 15,000 people every year when fully operational. The North Wales Dental Academy aims to provide both established and newly qualified dental professionals with an opportunity to train, work and upskill whilst living in our beautiful part of north Wales. It's so important to promote the benefits of living and working in Wales when encouraging people into the NHS in Wales.

In November 2023, we also saw a new community dental clinic officially opened at Bryn Beryl Hospital and it will provide a full range of community dental services to people who cannot be easily treated in general dental practice, including people who have certain health conditions, a learning disability or a mental health issue. It replaces a service that previously operated from a mobile unit at the site, which was not wheelchair accessible—a really important improvement. Another challenge being addressed is the dental health of young people, and a mobile dental unit at Ysgol y Moelwyn in Blaenau Ffestiniog provided dental care to all 11 and 12-year-olds with parental consent, the vast majority of whom had not seen a dentist since before the pandemic. The initial response to the evaluation is that this was an extremely positive intervention, and it was welcomed by parents and the wider community, which is great news. The mobile unit is scheduled to move to a second site at Ysgol Godre'r Berwyn in Bala, with a further three schools identified for the remainder of the academic year, and that's really welcome. 

At the UK level, the Labour Party has a fully costed, fully funded plan to rescue NHS dentistry, providing 700,000 urgent-access dental appointments per year, and to reform the NHS dental contract in the long term. This will mean much-needed consequential funding to Wales. There is still some way to go to get to where we need to be, in terms of the availability of NHS dental treatment, but I trust that we are on the right path to achieving that. If we do get the Labour Party in the UK Government, and that funding is made available and we get that consequential, that will be a big step in the right direction. Thank you.

I thank Siân Gwenllian for bringing forward this important and timely debate before the Senedd today. I do note, and it is interesting to note, that Keir Starmer has been campaigning quite a lot on dentistry, referring very often to a visit that he made to Alder Hey, and talking about the number of children who have to go there in order to have their teeth extracted. Of course, everyone's aware of the problem in England, but Welsh Labour are in control here in Wales and Welsh Labour have failed to deliver for the children and the people of Wales when it comes to dentistry here. 

In discussing dentistry, as in every other sector, it is first necessary to get to the root of the problem, namely a failure to retain dentists here and an even greater failure to train new dentists. As we've already heard from Siân Gwenllian, only Cardiff University offers a dentistry course in Wales at the moment, and, as she mentioned, only eight people from Wales were successful in gaining access to that course last year. Despite excellent efforts, such as the bursary, from this Government, only about half of the cohort of dental students choose to stay in Wales to work every year, and some of those are short-term arrangements more often than not.

This means that the scarce resources of the Welsh Government that are being used to fund these students are going to fund services that will go across the border or elsewhere. Those students are not staying in Wales, so we are missing out. Cardiff University is doing an excellent job in training the dentists here, and thank goodness for that, but it is clear that the university cannot meet the needs of the whole of Wales.

If we look at my constituency, Dwyfor Meirionnydd, there are no dentists taking on new patients through the health service at present. My office has contacted every dentist in the area and has seen that they're not doing that. I undertook a survey throughout the constituency and had 1,000 responses, with people saying that they were having difficulties accessing an NHS dentist, with the most extreme example being one of my constituents having to travel to Dunbarton in Scotland in order to see his dentist, and nearly all of them noting that they had to travel dozens of miles in order to see a dentist.

The number of dentists that we have in north Wales is contracting rapidly, and of those who are lucky enough to be on the books of an NHS dentist in north Wales, only a third have received treatment in the last two years. It is, therefore, a crisis. The figures that I've referred to in north Wales are quite a bit lower than the national figures, and there are many reasons for the regional disparities; one obvious one is that students from north Wales have to travel much further for their education, down to Cardiff, or over the border to universities in England, in order to specialise in this area.

Despite the Government's efforts to increase the number of Welsh students studying at the dental school in Cardiff, it is clear that this is not enough. There is a need to restructure the current bursary system, for example, in order to persuade people to stay in Wales after they have completed the required two years of work. In addition to this, we could offer better collaboration between the school in Cardiff and north Wales, whether that be by extending the period of student work placements in the north or by announcing collaboration with Bangor University as a starting point to develop efforts to ultimately open an independent school in Bangor in collaboration with Aberystwyth. Based on this information, could the Cabinet Secretary tell us what specific plans the Welsh Government has to ensure that dental students from Wales stay in Wales and have opportunities to expand their skills through specialisation and collaboration?

I thank Siân Gwenllian for bringing forward this debate. It is clear from the contributions that have been made already that this is a problem throughout Wales. This afternoon, Cabinet Secretary, I would like to raise one obvious deficiency and also mention an example from my casework.

In terms of the deficiency, I cannot understand at all why there is such a large gap in the data regarding dentistry in Wales. To me, it's astonishing that we can't say here and now in the Senedd how many people are waiting to see a dentist under the health service. We also don't have data regarding how many people are receiving private treatment from a private dentist within Wales.

I know that some health boards have tried to fill that gap by creating their own waiting lists, but there is nothing on an all-Wales basis—there is nothing central in order to plan. So, how is it possible to plan to improve dentistry in Wales if you don't know the answers to some very basic questions: how many people are waiting to see a dentist? How many people are receiving private treatment? And, thirdly, therefore, how many people are not having any treatment at all? How many people are falling between those cracks? How many people are going to end up having their teeth extracted, as Mabon mentioned in terms of children going to Alder Hey? I'm sure many of us remember relatives who had no teeth. My grandfather had no teeth. He lost all of his teeth when he was 19 years old, but that was the way things were at that time. Are we going to see this happening again in Wales in 2024?

In the absence of basic and fundamental data, I'll provide you with a personal story from my casework. A constituent got in touch this year with concerns, very similar to ones already raised in this debate, and this is a key reason why I'm talking this afternoon. My constituent is the mother of a teenage boy who, in 2021 at the age of 11, was referred by his dentist for orthodontic treatment. He wasn't placed on a waiting list in that year because he was only 11 and wasn't old enough for the treatment.

In 2022, he was told the treatment would be more extensive than at first imagined and was sent to Prince Charles Hospital for further exploratory work. The wait only got worse. Upon seeing the consultant, the family were told that it would take another six years for him to finally get the treatment. Having been first assessed at the age of 11, he is now being told that he'll have to wait until he's 20 to receive treatment. Throughout this, my constituent's son has experienced bullying, his confidence has been knocked and his self-esteem damaged.

I wrote to you about my constituent, to ask whether he will be entitled to treatment beyond his eighteenth birthday; if he moves away for university, whether he'll still be allowed treatment from an NHS Wales dentist, or whether the Welsh NHS would fund treatment for him elsewhere, if there wasn't capacity within the system. Whilst I appreciated the Cabinet Secretary's answer to me that she couldn't directly respond on any individual cases, it is clear to me from this example that the system isn't working, that we haven't got the correct data to make the system work. I appreciate that you have yourself acknowledged the data issue and that you have mentioned that there will be waiting list information by the end of this year. So, is that still on track, because clearly, at the moment, things aren't working for my constituent and, unfortunately, as we've heard this afternoon, he is far from being unique? Diolch yn fawr.

Can I also thank Siân Gwenllian for introducing this Member debate today? Also, can I apologise to the Member as I was hoping to be a co-submitter of the debate, but managed to miss the submission deadline by a few minutes, and I'm down as a supporter instead? But I was truly hoping to be a co-submitter with you on the debate here today.

We know that dentist provision is such an important part of the healthcare system and is a major part of the preventative agenda. I'm not sure that's been mentioned yet—the importance of the preventative agenda in healthcare, and, of course, dentistry is such an important part of that in reducing much bigger, more expensive issues further down the line. And we know this is especially important for children, who can and should then be building healthy teeth-cleaning habits into adulthood. And I'm particularly concerned about the issues that we're building up here in Wales for young people and adults down the line. And, sadly, for the people I represent here in north Wales—and others have spoken already—the provision simply isn't good enough, and we are left with what some describe as 'dental deserts' across the region. And this lack of consistency certainly exacerbates those problems down the line that I mentioned a moment ago, increasing major issues in the future, and, ultimately, costing taxpayers more as well. 

As the motion outlines in front of us today, dentistry is something that we all receive a lot of correspondence about, especially our constituents not having access to an NHS dentist. And this shouldn't be ignored or dismissed. And I do worry at times that, because of the number of times this issue gets raised, we just get used to it and kind of shrug our shoulders and say, 'Perhaps that's just the way it is.' But I think it's perfectly reasonable for people paying their taxes, or those who have done all their lives, to expect to have access to an NHS dentist. I don't think that's beyond what people should be expecting to receive as a basic part of their health needs. But, sadly, too many people are being let down with this most basic of expectations. 

And as the motion outlines—and colleagues have already shared—the process of providing that adequate dental provision starts with training and education and having the right number of people in place. And, Cabinet Secretary, you've recently confirmed the number of student places for undergraduate education in dentistry at Cardiff University is 74 a year, which, as it stands, is not enough to plug the gap. And, as colleagues have already mentioned, the health committee report on dentistry last year contained a number of useful recommendations, one of which was to look at a dental school in north Wales, in partnership with the university. A fully funded and fully functioning dental school in our area in north Wales would certainly go a long way to giving Wales and north Wales the dental workforce that it needs, for those patients that need that service.

It is necessary and fair, though, to recognise that an expansion of training places isn’t without cost, and we have to consider the cost of training, university clinical placement capacity, in addition to having quality academic staff who can design and deliver those courses. But, Cabinet Secretary, I would argue that there must be a strong spend-to-save business case to be made here, and I would urge you to pursue this in the strongest terms possible. And, as such, and in support of Siân Gwenllian’s proposals today, I would encourage you, Cabinet Secretary, to increase the number of dentists and support staff alongside traditional dentists. I would make increasing those numbers a central plank of this Government’s work, and getting a grip on a broad-ranging long-term plan would certainly go a long way to making this happen, so that our constituents can have access to the NHS dentists that they need. Diolch yn fawr iawn.

And I call on the Cabinet Secretary for Health and Social Care, Eluned Morgan. 

Diolch yn fawr. I'd like to, first of all, thank Siân Gwenllian for tabling this debate today. As Members will know, NHS dentistry has been a key priority of mine since taking up the portfolio, and I very much welcome the opportunity to provide Members with an update today.

The motion tabled today refers to the recommendations made by the Health and Social Care Committee, following their inquiry into dentistry. Now, one of the recommendations made was to establish an all-Wales central waiting list for people wanting to access routine NHS dental care. And I want to answer directly the question asked by Rhys ab Owen in terms of data. I am really pleased to confirm today that Digital Health and Care Wales have completed their initial design of a dental access portal, which will provide people across Wales with a single point of contact for them to register their interest in receiving NHS dental care. The first iteration of the system is currently being piloted in Powys Teaching Health Board—Powys is one of the health boards that was already operating a locally held waiting list—and work is under way to transfer their existing list into the new system before the patient-facing element goes live next week.

So, it's taken longer than I had hoped, but we're almost there. Once fully tested in Powys, we will be rolling this system out to all other health boards in the autumn. As I say, this is later than I had hoped, but I'm sure you'll agree that this is a major step forward in being able to quantify the unmet demand for NHS dental services, and I hope it will provide patients with a much fairer way to get access to NHS dental care. Now, once that unmet demand is properly identified, only then can we have an evidence-based conversation on the actual gap in the provision. I'm not sure if we'll be able to tell how many go privately, because we clearly don't have that data any more than I could tell you how many people go to Tesco on the weekend. That is not for Government to do. But we can, at least—. Where people want that NHS provision, we can at least quantify that.

I'd like to take a moment today to focus on the NHS dental treatment that actually is being delivered. The last official statistics showed that over 1 million people received NHS dental treatment in 2022-23, and management information indicates that this level of service has slightly increased for 2023-24. Members will know that one of my key aims of dental reform was to improve access for new patients—those people who have historically struggled to get access to NHS dental care. The most recent management report shows that nearly 380,000 new patients have received a full course of treatment and a further 114,000 have received urgent treatment since our reforms restarted in April 2022. These are not small numbers, and they mean that nearly 500,000 people who had not received NHS dental care for more than four years have now gained access. Now, of course I appreciate there's a lot more to do, but these numbers, I hope, show that we have delivered on our intent. It's interesting to note that an incoming Labour Government is also planning to deliver new NHS appointments, but proportionally we're streets ahead of where the UK Tory Government was in terms of NHS access by new patients.

Turning to the issue of increasing dental training places, we need to take a long-term evidence-based view on this. Healthcare Education and Improvement Wales recently published their dental workforce plan, as was suggested by Siân Gwenllian, and there are a number of commitments within it that will help us to identify the best way to develop the dental workforce needed in Wales. The first point I would make is that any increase in the commissioning of training places will be reliant upon robust workforce data and modelling, and there is a specific commitment in the workforce plan to develop needs-based dental workforce models and scenario planning to inform workforce shape, size, and the future commissioning of education and training, and that's going to inform the size and composition of the future workforce that we're going to need. So, we must recognise, I think, that the dental workforce is not only made up of dentists. I think this is really important, so let's be careful that we don't over-focus on dentists. The skill mix is a clear aspiration of ours in terms of dentistry.

We have already taken steps to increase the number of hygienists and dental therapists. This includes the establishment of a dental hygiene programme in Bangor and increasing the number of training places for dental therapy in Cardiff. However, I do want to go much further in terms of working on this team aspect. There are also clear steps in the dental workforce plan to increase the numbers that are being trained. This includes a new qualification that enables hygienists to study for an additional year in order to qualify as dental therapists. And, of course, we now have resolved the regulatory problem to allow these members of the team to open and close courses of treatment on the NHS and to play a full role.

I want to conclude by mentioning the establishment of a second facility for a graduate course in dentistry. At the moment, we fund around 74 places per annum at Cardiff University, and funding is available for the same number of foundation training places for postgraduate students. Members will be aware that we are seeking to encourage these by providing additional funds for them to undertake that training in rural areas.

A further increase would be difficult because of financial challenges and a lack of places in the dental school, so my focus at the moment is to ensure that more students from Wales do get places at Cardiff University. I met with the school of dentistry recently, and they talked about the initiatives that they have to support students to apply. They are also committed to increasing the numbers of students from Wales who are accepted to study there from 8 per cent to 40 per cent over the next two to three years.

I was delighted to participate in an event a fortnight ago that encouraged pupils from Welsh-medium schools in south Wales to apply and to follow courses in dentistry in Wales, and I want to thank the headteacher of Ysgol Glantaf, Matthew Evans, for arranging that event.

Certainly, the establishment of a second facility in Wales would be the best option, but that would mean a great deal of investment and financial pressures don't allow that at present. However, last week, I had a conversation with the new vice-chancellor at Aberystwyth University and he told me that he was working on a joint proposal with Bangor University. I have encouraged them to develop these proposals. I'm very aware that we can't delay as we wait for funding to become available, and we need a plan in place so that we are ready to implement.

I hope that this update will have been useful and has provided assurance to Members that many of the issues discussed this afternoon are on my agenda and that actions are being taken. Thank you.

I now call on Siân Gwenllian to reply to the debate.

Thank you very much. I thank Jane Dodds, who has been a joint submitter for the motion, but she has apologised for not having been present today. I also thank Sam Rowlands, who is a joint proposer in principle, if not technically. I thank Carolyn for her contribution, and she agreed that we need more people from Wales to be trained here in Wales. She mentioned pupils in Blaenau Ffestiniog who haven't seen a dentist since the lockdown—that does show the scale of the challenge—but outlined the work that's being done there to address that.

Mabon mentioned the failure to retain dentists and retain dentists here in Wales, and that Wales is missing out because of that. He also mentioned the work that has been done by his office in Dwyfor Meirionnydd, the questionnaire and so forth, and the problem facing one constituent who had to go up to Scotland to get treatment. That's just not good enough, is it?

I also thank Rhys ab Owen for talking about the data and the incredible gap in the data, where we can't tell how many dentists are being trained here, how many stay here, and we don't know how many people are receiving private treatment. It's difficult to plan in that kind of situation. And his terrible story about the constituent with the orthodontic service—I could have presented another debate on orthodontic problems, to tell you the truth. The same problems are facing constituents in the Betsi Cadwaladr area, there's no doubt about that. 

I was pleased to see, on the data aspect, that there is at least some movement on having one point of contact for people to register. But if the service is not there after you register—. Those two things both have to happen. But I am pleased to see that there is some movement there.

Sam Rowlands mentioned his specific concern about young people, and the fact that we're creating problems and storing them up for the future in life. And he also talked about the dental deserts that we're very familiar with. And I'm very pleased to have Sam Rowlands's support for the establishment of a dental school in Bangor, and the need for a long-term plan. 

Turning to the comments made by the Cabinet Secretary, I am pleased that you're going to be able to gather some data regarding the new patients who need the service, and, in the wake of that, that we're going to be able to plan. But it's very late in the day, isn't it? A long time has passed when these kinds of things should have happened, so that we're not in the kind of crisis that we're in at present.

You talked about the need to have that skills mix: the hygienists and the dental therapists. I do agree entirely with you, but that shouldn't happen instead of training dentists. It has to be part of the wider package that happens, particularly in the hospitals. A lot of the work happening in the hospitals is done by dentists—the oral surgery and so forth. But I do recognise that there is scope for hygienists and therapists, although there is a problem in the dental academy in Bangor. I'd like you to look into that, in terms of the fact that the therapists are not there. They still haven't come to an understanding about that aspect of the academy in Bangor. 

I am disappointed that you haven't been able to give a clear commitment to develop more training places in universities in Wales this afternoon. You have mentioned the work that you're going to do with Cardiff University, in order to ensure that more people from Wales can have places in Welsh universities, and that's to be welcomed. And you've also talked about a second facility as being the solution to the problem. I am pleased to hear that—that is, not just expanding the number of places in Cardiff, but creating another facility.

I am pleased to hear that you're encouraging more discussions between Aberystwyth and Bangor, and that there is some desire to see that happen from that direction, and that there is some joint planning going on. It's important. And I have commissioned a piece of work, as I said, about Bangor University and the possibilities in that area, and I'll be coming back to the Senedd with the results of that work very soon, hopefully. Thank you very much. 

The proposal is to agree the motion. Does any Member object? [Objection.] There is objection. I will, therefore, defer voting under this item until voting time. 

Item 7 this afternoon is the debate on the Climate Change, Environment and Infrastructure Committee report, 'Report on rail services and Transport for Wales’ performance 2023-24'. I call on the Chair of the committee to move the motion—Llyr Gruffydd. 

Thank you very much, Dirprwy Lywydd. This is the second report on Transport for Wales and rail services that the committee has published during this Senedd term. Before addressing the specific issues raised in the report, it is important to acknowledge that 2023 was a very challenging year for TfW, with problems with the fleet, reliability issues and rising costs all playing a part. The recommendations in our report focus on three key areas where improvements are necessary, in our view: first of all, TfW's corporate governance; secondly, the delivery of rail services; and, thirdly, TfW's role in terms of modal shift. And I want to thank TfW and the Welsh Government for responding positively to our recommendations in our report. 

First, I will mention the issue of corporate governance. TfW is an arm's-length company with a budget of around £0.5 billion of public money. Aas such, it is essential that it operates in a way that is transparent, so that it can be held to account. Our report contains several recommendations on that issue. During 2023, TfW faced a £100 million shortfall due to lower-than-expected revenue growth from rail services. The Welsh Government took decisive steps to address this shortfall by providing TfW with the funding to plug that gap.

However, as a committee, we remain concerned about its future financial stability. Running a rail network is not a cheap thing to do, obviously, and TfW cannot be given a blank cheque because of the huge pressure on public services. In response, TfW and the Welsh Government have said that they have plans in place to manage potential revenue shortfalls and maximise commercial opportunities. We as a committee will keep the effectiveness of these plans under review, particularly when we scrutinise the draft budget.

As Members will see in the report, one of our primary concerns has been the transparency of the budget-setting process. We have recommended that TfW should publish its business and financial plans before each financial year, and this will facilitate better scrutiny. We have also recommended that TfW's full budget should be available at the same time as the the Welsh Government's draft budget to ensure comprehensive scrutiny, and I am pleased that the Welsh Government and TfW have accepted our recommendations.

Performance monitoring and transparency are vital in terms of holding TfW to account. The committee has called for TfW to publish and update its key performance indicators regularly. Again, I am pleased that TfW has accepted our recommendation, and that it will be publishing its most recent KPIs after the UK general election later on this week.

Moving on, therefore, to the second key theme of the report, which is the way in which rail services are delivered. Passengers must be at the heart of any successful rail service. Unfortunately, there were high service cancellation rates and, indeed, low passenger satisfaction scores for TfW in 2023. It must be said, however, that 2024 has started more positively, and that performance has improved significantly with the introduction of new trains. TfW says in its response to the report that over 85 per cent of trains were arriving on time as of March 2024, and that cancellations across the network had stayed below the annual average target of 5 per cent. Personally, I have experienced a much better service on my journeys between north and south Wales. That's not to say that there are no exceptions, but we must give credit where it's due. The improvement has been significant, and we should commend the staff at TfW for this progress.

Running a rail network, of course, is not easy, and things will inevitably go wrong now and again. When this does happen, of course, prompt and accurate information is needed by passengers, and no-one should be stranded without alternative transport options. We made several recommendations to address this, including providing funds to passengers so that they can arrange alternative transport if rail replacement services are unavailable, and TfW has accepted, in principle, that there is a need to improve processes where services are terminated early. Again, therefore, we will keep this under review as a committee, and we hope to see improvements by next year.

Rail services for major events was an issue raised with the committee, but, again, we must give TfW credit here. A series of concerts in Cardiff have attracted enormous crowds, and, on the whole, services have improved significantly. In its response, TfW recognises the considerable effort made by its operational staff to keep the network moving when these events do occur, and I also want to place on record, if I may, Dirprwy Lywydd, how much I and the committee appreciate the efforts of those staff. Of course, it is not only Cardiff that hosts major events. The under-19 Euros tournament, which is expected to come to north Wales in 2026, will definitely attract large crowds to north Wales. As you can imagine, this will present new challenges for TfW, and we as a committee are eager to see how it rises to those. 

Looking forward, TfW faces the ambitious target of ensuring that 95 per cent of rail journeys are undertaken on new trains by the end of 2024—this year. We understand that TfW has now received around 70 per cent of the new fleet, with more trains being delivered all the time. Some, as we've already seen, I'm sure, are already in daily service, and some are being used also for driver training. Now, this is a big step forward and we will continue to keep this under review.

The final issue that I want to refer to, the third issue, is modal shift. Now, TfW is evolving to be much more than just a rail service provider. The ambition is for TfW to be responsible for public transport systems that are truly multimodal. It will play a leading role in the proposed bus franchising system. This in itself is a huge challenge and we have sought assurances that TfW is preparing for this new role, and that it has sufficient capacity and expertise to respond to that challenge effectively.

TfW also has a key role to play in advancing active travel by developing the national delivery plan and managing the Welsh Government's active travel fund. Joint working with the corporate joint committees on the development of regional transport plans will be vital in increasing active travel rates, and the committee will continue to review progress in this area as well.

In conclusion, therefore, Dirprwy Lywydd, 2023 was clearly a challenging year for TfW but the early signs are that 2024 will be more positive, with more rolling stock coming online, significant progress on the south Wales metro and performance improvements. However, if we're going to see continued progress, TfW and the Welsh Government must address the issues raised by the committee. We will continue to monitor progress over the next year. I hope that when we debate our next report as a committee, the story continues to be one of improvement. Thank you.

Thank you to the committee clerks for putting together this report. I'd like to begin by noting that the customer satisfaction data included in the report dates back from last year, and there have been improvements over the last few months as Transport for Wales have transferred to a new rolling stock and more carriages have been rolled out. Transport for Wales ordered 71 new trains of two and three cars, and I know that, by May, 46 had been delivered. Some were to go on the Aberystwyth line and others have been used to increase capacity at hotspots and long routes. I have noticed the difference as well on the service from north to south Wales, as well as Llyr Gruffydd. I was waiting on the platform last week and there were a huge number of passengers, hundreds waiting on the platform, and I was so relieved to see extra carriages, and everybody managed to get a seat, thank goodness. So, it does appear that more people are actually choosing to travel by rail as well.

I understand that issues were resolved with driver capacity a year ago as well, unlike services across the border, and Transport for Wales were not on strike, which was such a big relief, and we're not looking at reducing ticket offices in Wales, or removing staff on trains, which is really appreciated. Platform staff are invaluable, as are the new companions who are wearing blue tabards. I often see people being helped on and off trains along my journey. Staff phone ahead to ensure there are staff available to help at the other end too. A train I was recently on was delayed by 10 minutes as there was a tree on the line, and it got really busy as it gathered up those that were delayed and not able to use the earlier service. But transport staff on the train worked with platform staff, organising taxis to connect destinations for those inconvenienced.

I was told after the report was published in May that for the last two games, Transport for Wales put on late-night capacity, and it went into extra time and penalties, but they held trains back until the end of the match, which was really appreciated. Regarding events at Principality Stadium, many improvements have now been made this year with transport following the late concerts, and I believe that Transport for Wales works with the organisation, with the Principality Stadium, and they're able to give breakdowns of postcodes of people attending, so if many concert-goers are returning to London, Transport for Wales will talk to Great Western Railway and organise with them as well, which is appreciated.

Some train companies operate reservations, so can't oversell, but Transport for Wales don't have reservations. However, I'm told the new trains have cameras on them, so they can count passengers on and off and can increase capacity at some stations, for example at Chester.

Sunday morning to Bangor is an issue, so Transport for Wales have strengthened trains on a Sunday. It's because Avanti have removed the train from a timetable and so they've had to increase capacity. But I have noticed people sharing crowded journeys on social media again recently, where there have just been two carriages on the north Wales line, and I just hope that that will improve as more carriages are rolled out. There is a perception that rail travel is poor because people often share negative images on social media, and I'm hoping that we can promote that it is actually really good to travel on our rail services, and that they are really improving. We need to share positive journeys as well. 

We need a programme of investment in maintenance from the UK Government to Network Rail. The £1 billion investment in electrification of the north Wales coast line printed on campaigning material for the UK elections was not signed off by the UK Government; it still sits in somebody's in-tray. The north Wales coast line is vital and at risk of flooding, so we need to increase capacity at Chester railway station. We need investment in maintenance and improvement to crossings.

And regarding the roll-out of public transport franchising and any highway safety schemes, we do need to work in partnership with local authorities, operators and residents. Reliability and clear information are really important when it comes to growing passengers using bus transport, just as it is with rail, and we really need to engage. I'm not quite sure whether corporate joint committees are the right place still for doing this, because transport is really complicated, especially public bus transport, and I'm not sure whether CJCs will be able to be the right place.

Active travel funding has trebled over the last few years to a disproportionately large amount, while the highway maintenance grant was discontinued. There are not many areas where you can have designated cycle routes in my area of north Wales, and people need to travel on two wheels on highways and walk on pavements. They need to be sound and we need to invest in them. It would be good to use the active travel funding for permissive off-road routes, such as old railway lines and green ways, such as the Lôn Las Môn project on Anglesey, which I'm sure Llyr is aware of as well, rather than for schemes that are little more than widening of pavements, or taking up already crowded road space and then not being used. We need to ensure that any transport plans also include safe walking. Thank you. 

I'd like to start by thanking the Climate Change, Environment and Infrastructure Committee for their work in bringing forward this important debate, and I'm grateful to be able to contribute today. As the Chair said in opening, this report covers both Transport for Wales and Transport for Wales Group as a corporate entity, and therefore it not only looks at the function and efficiency of the rail network itself, but also the corporate structure and management within the organisation. 

I wanted to start off by looking at the corporate findings in the report, as I was shocked and appalled to discover that in this day and age, a Government-run organisation still has such a vast gender pay gap. The report notes that the gap reduced significantly to 14 per cent in 2023-24, down from 33.2 per cent during 2022-23. It also notes James Price's recognition of historic challenges faced by female employees in the transport sector. In my view, if we wish to truly eradicate these challenges by removing any traces of gender advantage or discriminatory workplace cultures, delivering on equal pay would be a great way to start, as we will surely attract more women into the industry with meritocracy at the forefront of the recruitment process, and create a rightly equal environment for everyone. I would therefore like to know how exactly this Welsh Government plans to lead Transport for Wales in reducing this figure from 14 per cent to nil within the next financial year. As I'm sure you'll agree, this is a situation that needs urgent rectifying.  

Secondly, I must note the report's finding that unveiled that TfW had failed to meet their own commitment to publish key performance indicators in a clearer format, which would have allowed the organisation's performance to be comparable with clear benchmarks. I believe that this type of benchmark comparison is crucial in identifying issues within the organisation to then be able to rectify them going forward. This commitment to publish these new KPIs was made in a 2022 scrutiny session by James Price, yet at the time of the following annual scrutiny session none had indeed been published due to an apparent, and I quote, 'loss of momentum'. Cabinet Secretary, clearly enhanced guidance and support is needed to ensure targets that are set are, in fact, met. A large-scale organisation such as TfW must be publishing targets to track progress and identify areas for improvement and focus, as without comparable benchmarks there is significant risk of stagnation or, indeed, decline.

Alongside this, Cabinet Secretary, the report has indicated that TfW has little to no financial plan if the farebox revenue fails to hit expected levels. I must reiterate it is important to note that post-pandemic recovery rates have, understandably, been difficult to predict. Yet, we are faced with a situation where it appears as though pre-pandemic forecasted growth rates are being used to predict profits, and therefore money reinvested into the organisation. These figures, naturally, have not matched expectations of pre-pandemic forecasts and have resulted in shortfalls in profit. Therefore, a big in-year top-up was needed to keep TfW's finances afloat.

With KPIs and financial returns intrinsically linked, Cabinet Secretary, it's therefore more crucial than ever that we have a plan in place as to how you'll attempt to boost growth and public transport take-up across Wales. With other public services in such dire need of more funding, I'm sure you can agree that we cannot afford to see more of these large mid-financial-year injections handed over to TfW to the tune of £125 million, such as the one that was made in 2023. So, with these increasingly concerning findings unveiled within the report, I hope that today the Cabinet Secretary will set out his plan and clear vision to start to get TfW back on track in due course.

Whilst there are more corporate findings I wanted to cover, I am aware of time, and want to shift our focus on to the efficiency and operation of the rail network itself. Despite the First Minister's continuous claim that TfW is the best-performing operator in Wales when it comes to punctuality, it may be worth noting that TfW proudly operate the large majority of routes and are one of only four operators here in Wales. Alongside this, all three other operators are in control of routes in and out of Wales and England, and when you look at the UK-wide basis, TfW has ranked last for punctuality.

The report also highlighted TfW's ranking as worst in the UK for customer satisfaction, in September last year, and just to briefly summarise some of the other operation-related findings: during 2023 to 2024, TfW failed to meet 95 per cent of all services on new train targets; instead, they were operating on 29 per cent. In July they announced that they would not be able to meet their commitment of timetable additions, and their passenger time loss was worse than the previous year. Between January and June 2023, their stations across Wales had the highest rate of cancelled trains in Britain, and to top it off, they scored bottom in a UK-wide rail user survey for punctuality and reliability, frequency of services, cleanliness and satisfaction with information provided during the journey. So, if that is the First Minister's idea of success, it's no wonder his lack of judgment led to him to accept certain things that he really shouldn't have in the past.

So, Cabinet Secretary, for me, this report is indeed genuinely concerning. One aspect that concerns me the most is the increasing number of staff in TfW corporate roles. Whilst the day-to-day on-the-ground services are not where they should be, I have no dispute about members of staff that are required to do their jobs, and I understand the importance of the correct management that needs to be in place to run an organisation like TfW. It's no shame, and it's actually a fact that TfW's workforce increased by 30 per cent between 2023 and 2024, yet as you can see from my previous statements that I've made my contribution, the organisation has scored bottom on almost every category—

And you need to conclude now, please.

—for a rail survey. So, if the opinion of the people right across Wales is that Transport for Wales does not provide adequate services anyway, then how are we supposed to incentivise them into using these services in the first place? So, transport Secretary, I hope that we're able to gain a clearer understanding of how you aim to unleash the potential of our public transport sector, through Transport for Wales, and give the organisation the reforms that it so desperately needs. Thank you.

Thank you very much to the committee for this report, which should be an urgent incentive for Government on the issue of the management of train services.

Prolonged delays, frequent cancellations, persistent overcrowding and inadequate service provision during major events have become regrettably familiar experiences for TfW passengers. It's not surprising, in this respect, that TfW was ranked last out of all major UK rail operators for overall customer satisfaction, in the latest Transport Focus survey. As the report rightly concludes, this is simply not good enough. Despite these chronic failings, TfW passengers have had to contend with yet another sizeable hike in rail fares of 4.9 per cent this year.

I'm particularly troubled, therefore, that TfW is open to the suggestion of scrapping its compensation scheme for delays of between 15 and 30 minutes. Rather than tackling the problem of delays head-on, and ensuring that passengers are given value for money, it looks like a rail operator moving the goalposts on how they are held to account. A 15-minute delay is not inconsequential; it can make all the difference between catching a connecting train, as planned, or getting stranded at a railway station for hours on end. Given the disconnected state of our rail network, this is an issue for many Welsh passengers. I'd be very grateful if the Government could confirm its position on this matter. If a decision to end the 15-minute delay repay scheme is made, what other recourse will be available to consumers to hold TfW to account for performance issues?

The report also reflects on the precarious financial position facing TfW, which recently required a cash injection of £230 million. This came as a result of the hastily convened in-year rebudgeting exercise in October last year. I fully acknowledge the impact of the pandemic on passenger numbers was both severe and entirely unexpected, but over two years on since the lifting of the final set of COVID restrictions in Wales, and almost four years on since restrictions on public transport use in Wales were lifted, TfW is still playing catch-up compared to other operators in Scotland and England. Many of TfW's counterparts have already exceeded their pre-pandemic passenger numbers.

The concerns raised in this report in relation to funding issues at TfW are merely the tip of the iceberg. The likes of the Institute for Fiscal Studies have rightly called out the conspiracy of silence from both Westminster parties with respect to the state of UK public finances. Last week, the Wales Governance Centre assessed the implications of their respective spending plans for Wales, which, as we have long suspected, will mean yet more austerity. In real terms, the expected shortfall for non-ring-fenced policy areas, which includes rail services, is estimated to be £248 million in 2025-26, rising to £683 million by 2028-29. Combined with the equally damaging conspiracy of silence of the Labour and Tory parties when it comes to HS2 consequentials for Wales, the detrimental consequences of Westminster's underinvestment in our rail network have never been more stark. Cabinet Secretary, do you accept that, without a radical change of direction on the part of Keir Starmer's approach to public spending, which should include providing Wales with its fair share of HS2, the incoming Labour Government is condemning our rail service to a highly uncertain future?

Finally, I'd like to remind you of something that you said in Plenary on 7 February 2018. You told the Plenary session:

'Welsh Government is not the cause of the problems on the Welsh network at the moment, but Welsh Government will be the cure.'

Are you any closer to finding that cure?

I call on the Cabinet Secretary for North Wales and Transport, Ken Skates.

Well, thank you, Dirprwy Lywydd. Firstly, I'd like to say thanks to members of the committee for their valuable and, I think, for their fair and balanced and objective and encouraging contributions today. The report is an excellent report, which reflects the situation that Transport for Wales was in in 2023, and I welcome the committee's assessment of the performance of Transport for Wales, and I'm pleased to accept all of the recommendations for both the Welsh Government and those on operational matters on behalf of Transport for Wales.

I was struck by something that Carolyn Thomas raised. Carolyn raised the value of companion services on the rail network, and I think this demonstrates how public transport is viewed by this Welsh Government as the third public service and a driver for social justice. Now, significant changes have taken place since TfW was established back in 2015. As a result of the need to bring rail operations in-house, because of the pandemic, as well as the transfer of active travel and other grant programmes, and the significant growth in the scope and scale of the bus remit to support the forthcoming bus Bill, Transport for Wales has naturally had to grow and expand and support Welsh Government and support the public.

Due to these additional responsibilities, we've also had to enhance the governance approaches and also the oversight arrangements, including greater financial security and new performance indicators, and also the inclusion of observers on Transport for Wales's board. The coming years are likely to see further growth in the scope and scale of the organisation as a result of changes in its bus and regional transport planning remits. These changes and recent budget challenges amplify the requirement to continually and to regularly review governance and funding arrangements, and the committee has an important role in this very process. So, to support both our own and the Senedd's scrutiny of their performance, Transport for Wales will publish their new multimodal and corporate performance indicators this very month. These will improve transparency, they'll improve supporting scrutiny, and allow us all to monitor their performance.

I do welcome the progress that the organisation has made in areas such as closing the gender pay gap by increasing the representation of women among senior leaders and train drivers, and through reducing barriers to employment and through improving the retention of women, but I do entirely agree with Natasha Asghar that we cannot be satisfied until there is no gender pay gap.

Now, the Welsh Government works closely with Transport for Wales to ensure the business and financial plans are published at the beginning of the new financial year, as has been the case in recent years, and planning has already begun for the next business plan to ensure that priorities are understood from the outset and to inform funding decisions that will need to be made. And a timeline for agreeing Transport for Wales’s next budget is being developed to align with the Welsh Government's own budget-setting process to allow scrutiny of both the Welsh Government and Transport for Wales at the same time; as the chair of the committee highlighted, it is so important.

Now, I recognise that Transport for Wales's performance in 2023 was not good enough. We set them a huge challenge, to be fair, when we established them. They inherited one of the oldest train fleets in Britain, and, at the same time, they were tasked with upgrading the core Valleys lines infrastructure, and I'm pleased to see the investment now paying off. All of the major infrastructure works between Cardiff and Treherbert, Aberdare and Merthyr are now complete, and this has allowed us to run extra services and introduce some metro-style, 'turn up and go' services in the core Valleys lines area. And outside the CVL, 70 per cent of services across Wales and the borders area are now operated on brand-new fleet, with more coming into service every week. And by the end of the programme, as the Chair identified, 95 per cent of all journeys with TfW will be taken on brand-new trains. We've also delivered the biggest improvement in punctuality across Great Britain this year. This is something to be applauded and, Dirprwy Lywydd, I think it's fair to say that Transport for Wales is stepping up. They have turned the corner. This year they've increased capacity, they've provided additional services, improved punctuality, improved reliability, driven up revenue. I am confident, as a consequence of this, that passenger satisfaction will improve as well, and it must improve.

In addition, though, to operating rail services, TfW are taking on additional responsibilities, as Members have highlighted. The bus Bill, for example, will require TfW to lead planning and engagement to deliver bus franchising in Wales, and Transport for Wales will also strengthen their support for local authorities to develop and deliver effective travel schemes.

But, as Peredur has identified, it is important that the Welsh Government and Transport for Wales offer the solution to the public transport woes that people have faced for many, many years. We are doing this by introducing what will be one of Britain’s newest fleet of trains, with £800 million being spent on the train fleet. We'll do it by working in partnership with the incoming UK Government to ensure that the infrastructure, which is so creaking across Wales, gets the investment that it needs.

And I do welcome the Chair’s positive recognition of the progress that is being made across all modes, and we've made that since the establishment of Transport for Wales back in 2015. The real change that passengers are now experiencing is tangible, and there are exciting further plans for integration through one network, one timetable, one ticket and one team. In the meantime, I am very pleased indeed to accept the recommendations of an excellent committee report. Diolch yn fawr iawn.

I call on Llyr Gruffydd to reply to the debate.

Thank you very much, Dirprwy Lywydd, and may I thank everyone who's contributed to this debate?

Carolyn mentioned customer satisfaction data. There are different interpretations of maybe what certain organisations and the work that has happened are telling us, but we all want to see more people choosing to use the trains, don't we, and, in order for that to happen, they have to be reliable and it has to be a pleasant experience. And if we don't get those right, then we can discuss this for as long as we want to. But we also, at the same time, have to expect that there will be delays, there will be glitches now and again, and it's all about minimising those and dealing with those situations, when they arise, as effectively as possible. And I think the reference to the football—you know, despite there being extra time, despite there being penalties, the train was held back, and that's what public service is all about. It isn't that the public have to fit into what the system says; it's about building the system around what the people need. And as somebody who raised concerns from previous experiences of using trains for football matches in Cardiff, they are to be commended for responding positively to that. 

Natasha's absolutely right about the gender pay gap, and we know that Transport for Wales have committed to responding, or giving us an update, in November. I can give you an assurance that, as a committee, if we're not happy that sufficient progress is being made, we will go hard on Transport for Wales, because I absolutely agree that the gender pay gap shouldn't be closed, it should be disposed of totally. And in relation to the KPIs, of course, they have committed to publishing those as soon as the election is over; because of purdah and everything, it's maybe not possible for them to do that. 

Now, we are in the foothills of recovery here, I think. There's a long, long way to go. You referenced being last for punctuality; I think Peredur mentioned last for overall customer satisfaction. A hike in rail fares is an issue. It needs to be affordable. When the prices are going up, as they are every year, that is very challenging. And with reference to the delay repay scheme, it was in fairness something that the committee has raised and felt maybe should be under review—not scrapped, but whether Transport for Wales feel that the right balance is being struck at the moment, because revenue, as we all agree, is an issue, and there was a question as to whether the delay repay scheme was a little bit too generous and that it kicks in maybe too early, accepting that you will have certain delays. But that's open for discussion. I'm not saying we had a particular view on it as a committee; we just thought that maybe that is something that Transport for Wales should keep in mind. But, when it does come to money, of course HS2 consequentials are an issue, which again highlights more generally, I think, the need for greater investment in rail infrastructure, which brings us back to Network Rail and some of the points that were made by other Members. 

Now the Cabinet Secretary—and thank you for your response—spoke about transport as the third public service and a driver for social justice. Absolutely. But, getting it wrong, of course, could lead to it being a driver of social injustice. And we did see, didn't we, in relation to bus services during COVID, that the poorer communities lost a disproportionate level of bus services in that period. So, there's a way back before maybe we can move forward from where we were. And the delay in bringing forward the bus legislation to introduce bus franchising means that maybe that will be on a different trajectory, but very much one that the committee will be interested in pursuing when the Bill is tabled. 

Aligning budget scrutiny with information about Transport for Wales's budget is critical, and we do welcome enthusiastically the positive response from both Government and Transport for Wales on that. 

I think that the Cabinet Secretary said that we've turned the corner. Well, the committee will be the judge of that, as far as we're concerned. Certainly, I would concede that the early signs—. Well, I say 'early signs', we've been talking about this for a long time, but the signs now are positive, but there is a long, long way to go. And when you have an organisation that's being asked to do more and more and more in terms of its additional responsibilities, not just trains but buses, active travel, I think taxis and cab hire as well in future, it's critical that they are given the resource and the capacity to be able to fulfil those functions effectively.

So, appropriately, I think that we can say that Transport for Wales is on a journey; whether it gets there on time is another matter. But, certainly, we think that things are looking better now than they were the last time we were considering our annual scrutiny. Diolch.

The proposal is to note the committee's report. Does any Member object? No. The motion is therefore agreed in accordance with Standing Order 12.36.

Item 8 this afternoon is the Welsh Conservatives debate on NHS waiting lists. I call on Sam Rowlands to move the motion. 

Thank you, Deputy Presiding Officer. I'm very pleased to be able to open today's debate on NHS waiting lists in Wales and to move the motion in front of us in the name of my colleague Darren Millar. This is, of course, a really important debate on an issue that touches every corner of Wales and affects all of our constituents, whom we are elected to represent. And I want to recognise first and foremost the incredible efforts of those working in our national health service in Wales and thank them for their commitment to public service and improving the health and well-being of people right across the country. We cannot though ignore the fact that the Welsh NHS is not in a good place after a quarter of a century of Labour mismanagement, and it is waiting lists that are the evidence of this mismanagement.

It must be acknowledged that there are more than 21,000 people waiting more than two years for treatment and let’s compare that to just a couple of hundred people in England, with a relatively much larger population as well. We know that the median waits for treatment are at 22 weeks, compared to just under 14 weeks in England. We have the highest patient pathway figures on record, with one in four people in Wales waiting on a patient pathway, putting even more strain on those working so hard on the front line. All of this is thanks to chronic underfunding and the ineffective running of our health service by a Labour Welsh Government in Cardiff.

Patients in my constituency and Members’ constituencies are languishing on those lengthy waiting lists that I’ve just outlined and they can’t always access GPs in the way that works best for them, or as we heard a few moments ago in a debate here in the Chamber, they can’t get much-needed NHS dental provision. People are genuinely suffering. And just imagine being on a waiting list for two years, perhaps in severe pain and in desperate need of surgery: it’s a traumatic experience and it’s unacceptable. For that to be more than 21,000 people in a country the size of Wales is frankly shameful.

I don’t like to make comparisons across borders, but I think we need to be careful to not allow ourselves to get used to this level of service and these waiting lists and just accept that this is just the way that it is. It’s been this way for too long in Wales, but it does not have to continue and does not have to be this way forever. We must again recognise that it must be at times an incredibly difficult work environment for NHS staff to be in, whether it’s doctors, nurses, healthcare support workers or allied health professionals, and many others who are working hard and doing their best under incredible strain, thanks to the lack of investment and strategic thinking from Cardiff Labour.

There are some solutions to this Labour-made crisis, and I’m pleased that we’ve been able to outline those in our motion here today. First and foremost, fundamental to all this, is that the Welsh Government must ensure that the full Barnett consequentials, the money that comes from the UK Government, that money is made available for the health service in Wales. Let’s not forget, Welsh Government, you receive £1.20 for every £1 spent on public services in England. Yet the same Welsh Government chooses to not spend that full amount on our stretched NHS. Investing in these services properly would, for example, enable the NHS to invest in new technology, in new, more efficient ways of delivering services, and accelerate the phasing out of outdated technology, such as fax machines, which surely have no place in a modern health service.

Welsh Government Ministers should also bring forward a substantial workforce plan, so that we can have a health service fit for the modern age and, importantly, include a tuition fee refund for healthcare workers that stay in Wales for five years after their studies. This would be a great incentive to make sure we retain that skill and talent here in Wales. That workforce plan should have an emphasis on training and retaining quality healthcare professionals. As it stands, as we heard in the debate just last week, the Welsh Government are cutting the number of health training positions, and have not even been able to fill the reduced number of places that are on offer.

So, in summary, we cannot avoid the fact that the NHS in Wales has been run separately from other parts of the UK since 1999, when devolution began. Labour have run the Welsh Government for all that time, and things seem to be getting worse than ever. This simply is not good enough for people in Wales, and for those working so hard in our health service. They all deserve better and, Government, your politicians in this place must deliver on this. I’d encourage all Senedd Members to back the Welsh Conservative motion and back a national health service that is truly fit for 2024 and beyond. Diolch yn fawr iawn.

I have selected two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on Mabon ap Gwynfor to move amendment 1, tabled in the name of Heledd Fychan.

Thank you very much, Dirprwy Lwydd. Earlier this year, of course, we marked 75 years since the establishment of our national health service, the greatest sociopolitical success of the twentieth century and one that is rooted here in Wales. But following 25 years of mismanagement by the Labour Party and 14 years of Tory austerity, the NHS is facing a crisis, and without urgent treatment, it's difficult to see how the NHS can survive for another 75 years. Constituents are crying out for politicians to deal with this with the gravity, honesty and urgency that it deserves, but unfortunately the London-based parties aren't offering them this. The idea that the Conservative UK Government has been a paragon of good practice in managing the NHS, as is suggested in the original motion, is as risible as it is insulting.

With their disastrous hard Brexit that sent drug prices soaring, a cruel migration policy that's compounded workforce pressures, squandering billions on defective, crony-supplied PPE, a prolonged real-terms erosion in NHS pay and 14 years of austerity that has created health inequalities that cost the Welsh NHS £322 million each year, surely the Conservatives can't be trusted with the NHS.

But the UK Labour Party that is coasting to victory by default is not only utterly bereft of a progressive vision for renewing the NHS, it's pursuing an agenda that will rub yet more salt into the wounds. By embracing Tory-designed fiscal rules, they are setting a course for yet more painful cuts in public spending, which the Wales Governance Centre has estimated will hit Wales to the tune of £248 million through the next financial year, and £683 million by 2028-29. They also clearly have no qualms about opening the door for private providers to profit from our health system. It is a changed party indeed, one that has sadly turned its back for good on the proud legacy of Nye Bevan.

And here in Wales, we have known for some time that Labour does not have the answers to the NHS's woes. Upon taking office, the First Minister made it his top priority to reduce waiting lists, but with one in five of the Welsh population now on waiting lists—a record high—he has failed at the first time of asking. In so doing, rather than turning the page on over a quarter of a century of failing standards under his party's watch, he is simply following Labour's well-trodden path of managed decline.

We'd be far more sympathetic to the Labour Party in Wales if it wasn't for their chronic aversion to being held accountable for responsibilities they have held over health since the dawn of devolution. We've seen the very worst excesses of this trait throughout this election campaign. The fact that reducing NHS waiting times is one of Labour's six general election pledges for Wales is a damning indictment of a party whose wilful myopia on their record in Government borders on electoral gaslighting. We've also seen an abundance of campaign material claiming that Welsh Labour will drive forward digitalisation in our NHS, when we know that hospitals across Wales remain lumbered with outdated technologies such as fax machines. They also continue to resist the resounding case for holding a fully independent COVID inquiry for Wales.

While the Westminster parties peddle quick-fixes and duck responsibility, therefore, Plaid Cymru is the only party that has the serious solutions to restore the NHS to where it should be. Firstly, this means scrapping the unfair Barnett formula that is unsuited to our needs. The formula was designed as a stopgap solution 40 years ago, an outdated sticking plaster that is stretched to breaking point after austerity and the pandemic. The fight for economic fairness that is the centrepiece of our election campaign is essential to securing a sustainable future for the NHS. This includes rebuilding the shattered bonds of community-based healthcare by recruiting an additional 500 GPs; uplifting the real living wage by £1 an hour for social care workers in Wales, taking us a step closer to a fully aligned workforce. We can also create a new cancer contract for Wales to guarantee timely provision of care at all times. Most importantly of all, we can ensure that the NHS is protected for future generations as it was always meant to be: a public institution that is free at the point of need and is never threatened by the spectre of privatisation. In this UK general election, voters deserve a party that unashamedly champions the NHS in all its glory. In Wales, Plaid Cymru is that party.

It's a pleasure to take part in this debate this afternoon, although the subject is less than pleasurable, namely the Welsh Government's abject failure to address waiting times in the Welsh NHS.

When I retired as an orthopaedic consultant, I had not had much of a waiting list. In fact, I demanded that the hospital managers allowed me to see elderly patients privately, free of charge, to ensure that they were not forced to suffer in pain. So, it saddens me to see just how bad things have become. We have the worst waiting times in the UK; tens of thousands of people are forced to wait years for treatment. Even if we were to ignore the humanity of it all, ignore the fact that we're forcing people to live with debilitating pain, forcing them to suffer, it makes no sense from a purely economic point of view: the loss of productivity and impact on our GDP is astronomical. It is little wonder that Wales, in addition to having the worst waiting times, also is the worst performing economy in the UK. But we can't ignore the suffering. At least, I can't.

It sickens me that the NHS, which I spent my career working in, has deteriorated to such a degree, despite the herculean efforts of our dedicated front-line staff. Thanks to the leadership of the NHS from Welsh Government Ministers to local health board managers, our health services, they all have failed their populations. Nearly one in four of the Welsh population is on a waiting list. We are failing on every conceivable metric, from cancer survival rates to emergency care and everything in between, all because the Welsh Labour-run Government has failed to plan for the past quarter of a century.

They cut tens of thousands of beds, closed hospitals and failed to train, recruit or retain staff across a whole range of disciplines. We don't have enough nurses to provide safe care for patients. We don't have enough GPs to ensure that patients are not waiting months for an appointment and we don't have a suitable infrastructure to meet the demands placed upon a modern healthcare system.

We have surgeons and consultants unable to treat patients because we don't have the theatre capacity. This is one of the most acute symptoms of the rot that the lack of leadership has allowed to set in. We have recruited more specialist consultants and surgeons without a thought given to where these people will actually treat the patients. We did not increase surgical capacity, beds or recruit additional nurses. No, the Government patted itself on the back and told the public, 'Look, we recruited more doctors in our NHS.' It is the disjointed thinking that has brought our NHS to its knees, demoralised its staff and left patients to go blind, lose their hearing and even lose their lives, because they were not treated in time.

It is the twenty-first century; we live in an age of robots and artificial intelligence, yet, as said earlier, our NHS is still using fax machines. Our NHS is being failed by its leaders and I urge the Government to bring forward a detailed integrated plan to tackle waiting times in the short, medium and long term. I hope Members support our motion today. Diolch yn fawr.

The national health service is fantastic; we are so fortunate and we must not lose it. Our NHS actually offers incredible value for money, if you look at other healthcare systems across the world. However, our ability to properly invest in the NHS has been severely affected by 14 years of Tory misrule, including the devastating impact of a decade of Tory austerity and massive inflationary pressures impacting all public services. I remember NHS Wales being faced with a £20 million extra heating bill when energy prices increased, and that money had to be found within the service area.

Prior to 2010, under UK Labour, funding for the NHS rose in line with need with a 5.4 per cent uplift, and you could see the benefit. But in the decade up to the 2020 pandemic, under the Conservatives, this dropped significantly and included four years in which spending per head actually fell, causing stagnation. You could really see the impact starting to hit in 2013 and 2014, and life expectancy for women has started to reduce—it's started to decline. I recently saw a chart where the average height of children aged five years has actually started to reduce, which is really frightening.

You can't keep blaming the Ukraine war and COVID for the state of the economy. I remember, in 2010, George Osborne wanting to shrink public funding and Philip Hammond saying in 2017 that the belt had to be tightened further, although there were no holes left in the imaginary belt. I was a councillor wondering where on earth the next cut could come from, and for many years public services only had a 1 per cent uplift on annual pay rises, since 2013.

Across the UK, there needs to be a big uplift in NHS spending to increase productivity and reduce waiting lists. Capital funding to Wales has been restricted and so has borrowing, and this needs to change. Over the past decade, the UK had a lower level of capital investment in healthcare compared with the EU14 countries. If it had matched them, the UK would have invested £33 billion more between 2010 and 2019, around 55 per cent higher than actual investment during that period. Despite these financial challenges, Wales invests 15 per cent more in health and social care than England. Earlier, it was mentioned that more funding is received in Wales, but more funding is actually spent on the NHS and social care; you can't separate them. Free prescriptions and free parking help many in Wales, including staff.

Social care services play a crucial role in care pathways, keeping people well for longer outside of hospital and enabling faster, safer discharges home. The sector plays a critical part in protecting NHS capacity and its ability to deliver high-quality, safe care. In 2024-25, Wales will increase funding for the NHS by more than 4 per cent, compared to less than 1 per cent in England. Unlike in England, the health budget is spent on health in Wales. There's no expensive internal market, no purchaser-provider split and no alphabet soup of organisations and bureaucrats diverting funding from front-line care.

Health boards are responsible for every aspect of people's care, from primary and community care to hospital and mental health care. It's neither fair nor accurate to compare waiting times between England and Wales in the way that this motion does. Data is collected, coded and reported differently between the two nations, meaning performance is not directly comparable. This motion also fails to take demographics into account. Wales generally has an older, more rural and less wealthy population. This impacts health outcomes and should be understood and accounted for.

NHS recruitment and retention is a priority, and I welcome that the Minister recently made a statement about offering flexibility to the workforce. When talking to nurses on the picket line, this was a huge issue. Job sharing, having childcare-friendly hours and set shifts were all raised as helpful possibilities. Investment in extra training places for recruitment is now being provided across north Wales at Wrexham University, Bangor—the north Wales medical school—and through Coleg Llandrillo.

The NHS is its workforce, and you cannot continuously criticise the NHS without harming and demoralising the workforce. I would like to pay tribute to all of those who work in it, thanking them for their hard work and dedication, and thank the NHS for being there for my family and friends, free at the point of use. Thank you.

I'm pleased to be participating in this debate today on a subject that impacts everyone in Wales, and that also is important to me personally, having worked in our NHS for 11 years—before being elected to the Senedd—within Betsi Cadwaladr University Health Board. I know first-hand the incredible work and dedication that staff in our NHS display every day, and I'm sure everyone in this Senedd is grateful for the work that they do. But they have been badly let down, as have the patients. And I must say that I was rather surprised to see the Welsh Labour Party advertising during the election campaign that the Welsh Government spends more per capita on health than in England—spending more for diminishing returns. I'm not sure that's something to boast about to potential voters. Please permit me to delve into these diminishing returns, if I may.

Every health board in Wales is in some form of enhanced monitoring or special measures. The target for cancer patients to start treatment has never been met, which means that, out of 33 similarly wealthy nations, Wales ranks thirty-second for survival rates from stomach cancer, and thirty-first for pancreatic and lung cancer. The 95 per cent target for patients waiting fewer than 26 weeks in Wales hasn't been met in a decade. The four-hour A&E wait target has never been met. Over 21,000 people are waiting more than two years for treatment, compared to 275 in England. It's a health service with the technology of a hermit kingdom, and we can't expect to run a twenty-first century health service on Windows XP and fax machines.

We hear the same excuses in the Chamber every week, pinning the blame for these failings on the UK Government, with the same tiresome clichéd soundbites that read like placards from a protest scene in a Ken Loach film. People want to hear something of substance, not soundbites or whataboutery. Stubborn refusals to follow the example of the UK Government have led to Welsh people losing out. And as NHS England rolls out surgical hubs and diagnostic centres to ensure that backlogs don't accrue, the Welsh Government has refused to do the same here, which means we now have over 100,000 people waiting for trauma and orthopaedic treatment—over 60 per cent higher than pre-COVID levels.

Going back to funding, which I mentioned at the start of my contribution, Welsh Labour, the once party of Nye Bevan, are the only party in the UK to cut the budget of the NHS, and have done so several times. The cash-terms spending increase for health in Wales is close to 10 per cent less than the cash-terms increase in spending that the Conservative Party has invested in the NHS in England in 2010. On just about every metric, the Welsh NHS is underperforming. And this isn't about doing down Wales or blaming the hard-working individuals who work in our NHS; it's about holding the Welsh Government to account for this underperformance that they are responsible for.

Surveys show that Welsh people tend to agree. The British social attitudes survey this year found that only 21 per cent of people are satisfied with the NHS in Wales—the lowest in the UK. People deserve better than this. They shouldn't have to wait two years to start treatment. They should be able to call the emergency services and have an ambulance arrive within eight minutes. And perhaps the most shameful of all, they should not have to see the life expectancy of their fellow countrymen or women going down as it is. No amount of tinkering with buy-one-get-one-free offers, meal deals or any other absurd nanny statist overreach by the Welsh Government will reverse this. We need a health service that is properly resourced. That is what the Welsh Conservatives are calling for, and have consistently called for.

The figure that I'm sure everyone knows at this point is that, for every £1 spent on health in England, Wales receives £1.20 for health and social services. But the Welsh Government does not spend all this money on health. The Welsh Government can't find the funding for a new hospital in Denbighshire, but it can find £120 million for 36 new politicians in the Senedd and 20 mph.

In closing, the Welsh Conservatives have a clear plan for reversing the 25 years of managed decline of the NHS in Wales. We have consistently called for a commitment to spending the full Barnett consequentials for health on health. The Welsh Conservatives would also bring technology up to date, co-operate with the UK Government to pool best practice and services to bring down waiting lists UK-wide, and for social care to get the support it needs, so that those medically fit for discharge do not cause bottlenecks on hospital wards and take up valuable bed space. We'd also replicate the successful roll-out of surgical hubs and diagnostic centres, which have been successful at bringing waiting times down in England. Thank you very much.

We talk a lot in this Chamber about NHS waiting times, and how they're the worst of all the UK nations. I feel, however, that the waiting times are just the tip of the iceberg, and are actually the manifestation of many endemic faults in the Welsh NHS. I believe that, ultimately, most of the problems in the NHS in Wales are the result of the failure of Welsh Labour policy in other areas, in particular education, and the fact that, despite what Labour Cabinet Secretaries keep saying, policy and policy directions are not working in synergy.

Since being elected I've spoken with many NHS departments, cancer trusts, charities, hospices, and there's one prevailing issue: the lack of qualified staff in areas of diagnostics. As the Cabinet Secretary will know, there's a record shortage of physicists, who are needed in radiation oncology, which has a massive impact on the speed of diagnosis, and there are also record shortages of workers in clinical engineering, who use medical technology to optimise healthcare delivery design and develop and maintain medical equipment used to diagnose illness and to treat patients.

Yet how does the Welsh Government respond to this? They get rid of the triple science award, which is only going to intensify shortages in these areas for years to come. Getting rid of the triple science award is an absolutely ludicrous idea that has been condemned by so many scientific bodies, and it is the Welsh NHS who are going to feel the brunt of this. That is so frustrating, Dirprwy Lywydd.

Joel, will you take the intervention?

I did the equivalent of triple science, which was GCE chemistry, physics and biology. Did you?

Can you repeat that, sorry? I only heard you when the mike came on.

I did the triple science, as it was then, which was GCE chemistry, physics and biology. Did you?

Actually, I was advised against doing physics because my maths is terrible. I did the others, though. Thank you.

It is the Welsh NHS who will feel the brunt of this. What is so frustrating, Dirprwy Lywydd, is that Welsh Labour are either completely ignorant on this point or, much worse, they're deliberately doing it. It is truly bewildering that they cannot see this link. Like many other Members in this Chamber, I'm continually contacted by organisations who are appealing for national screening—liver screening, audiology screening, lung screening, as we've heard today, to name but a few. But why don't we have this screening in place in the first place? It's because you need to have clinical nurse specialists in place to do it who have had a proper science-backed education. Having these national screening programmes would save so much work for the NHS because it enables issues to be picked up early on, saving valuable resources by treating conditions in the primary stages, rather than trying to deal with more complex issues at a later stage.

What Welsh Labour also cannot understand is that education policy is very likely deterring people from coming to Wales who could do these jobs. The poor PISA results in Wales do not just mean that Welsh children are being measured as having poorer education outcomes; it also means that people who live elsewhere are probably not going to want to send their children to Welsh schools. Wales relies far too heavily on attracting an NHS workforce from elsewhere outside the country, and not having sufficient home-educated people to fill these roles is where a good deal of this problem lies.

We also have to recognise that people in Wales are not looking after their health as well as they should be, and this is also a result of our poor education. Schools are just not being given the ability to encourage sports and activity because they're either having to deal with excess workloads, a lack of facilities or, more worryingly, a lack of money. I admit that this is not going to be for all schools, but I will argue a lot of schools meet this criteria. Imagine what could have happened had this Welsh Labour Government accepted and backed my colleague Sam Rowlands's outdoor education Bill. A lot of these issues could have been addressed.

The health of the nation is also the result of poor policy in looking after our environment, with the loss of our much-loved urban environment, the loss of our much-loved green spaces, and, as I've mentioned, the continued pollution of our much-loved waterways and coastlines. 

Finally, we also have to acknowledge that the high waiting lists are an indirect consequence of overworked NHS staff. We've had COVID, and NHS staff have performed valiantly and gone above and beyond. However, there doesn't seem to be a let-up in the amount of work that needs to be done to recover the situation, and the Welsh Government are stubborn in their approach in helping. I've mentioned several times in this Chamber about how private audiology can be used to reduce waiting times for hearing. This is done in England, Scotland and in Northern Ireland. We do this for general practitioners, dentists and pharmacists in Wales, yet the Welsh Government are refusing to allow this for audiology, which is a bizarre state of affairs as it would dramatically improve outcomes for so many people and it would not cost the Welsh NHS any money whatsoever. High waiting times in NHS Wales may be NHS Wales's problem, but it is far from their fault. It is the fault and failure of so many Welsh Labour Government policies. Thank you.   

I call on the Cabinet Secretary for Health and Social Care, Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. We've heard an attempt at political point-scoring from the Chamber this afternoon in what I think has become a traditional eve-of-election debate about the NHS in Wales. Now, there's obviously quite a lot that we don't agree on, but there is one thing I hope we can unite on. As Carolyn mentioned, that's the wonderful staff who are the beating heart of the NHS. Every day they provide life-changing and life-saving care. They're by our sides at some of the most challenging and traumatic times of our lives, and that's one of the reasons why I'm so delighted that we've been able to secure a deal with the British Medical Association that means that, unlike in England, we've come to an agreement on pay for last year, stopping the junior doctors, stopping the consultants and stopping the specialist and specialty doctors from striking, meaning patient care will no longer be interrupted as it is in England under the Tories. 

It's important we acknowledge what they continue to achieve, often in really demanding circumstances in the face of huge public and political expectation. And those demands are significant here and across the rest of the UK. The NHS, we all know, is an incredibly trusted and well-used service. Every month it deals with 2 million contacts from the public across Wales, a phenomenal amount for a population of just over 3 million people. Now, I've spent the past few weeks knocking doors up and down Wales, and I've heard so many stories of incredible care and support and love for this amazing service. Yes, they've heard the noise around challenges, but when you ask about their personal experience, the answer is almost always positive. 

It's always worth reminding people on the doorsteps of the difference that Labour makes. In Wales you get free prescriptions. In Wales you get free car parking in hospitals. In Wales you get free school breakfasts, helping children to have the best start in terms of healthy eating. In Wales we pay the real living wage to our care workers. As Members will know, the majority of support is carried out in primary care in our local communities, and thanks to our new GP contract we've almost eliminated the 8 a.m. bottleneck and improved access. And it's good to see that a future Labour Government will be looking at how they ensure better access to primary care in England for patients there. It's interesting to note, isn't it, that 60 per cent more English people are registered with Welsh GPs on the border than the other way around. I think that says it all, so let's hope for the sake of the people in England that there will be a Labour Government in the next couple of days. 

We know that here there are thousands of people who seek emergency care. The massive increase in demand in this area means that there are thousands of ambulances who respond to medical emergencies and accidents on top of the tens of thousands of planned treatments, and hundreds of thousands of out-patient appointments that take place every single month. Now, these are challenges, of course, in our emergency departments, but let's not forget that performance against the four-hour target in our major emergency departments has been better than in England in 15 out of the last 21 months. Of course, we ask an enormous amount from our NHS, and it continues to deliver day in, day out.  

Since we launched our recovery plan in April 2022, the NHS has reduced long waits by 70 per cent. More than 2.5 million pathways have been closed at an average rate of 102,000 per month. And it pains me to correct you, Altaf, because I think you're a lovely man, but, actually, we are not the worst-performing part of the UK, and you and the BBC need to do a little fact-check on that. And also you suggested that we have fewer doctors and nurses; in fact, we've gone up by 17 per cent from 2019. We have a higher ratio of GPs than they have in England. We have more beds per head of population than they have in England. And if you just look at the increase in demand—look at cancer: 50 per cent additional referrals for suspected cancer, just in the last three years. So, with the best will in the world, it's very difficult to plan for that kind of massive increase, but that's precisely what we're trying to do. And it's very difficult to respond to it, if a Tory Government only gives us an additional £1 million of capital for the whole of what we need to do in Welsh Government.

We've heard today assertions about how the NHS in Wales measures up to the NHS elsewhere in the United Kingdom, and the Office for National Statistics confirmed, just a couple of weeks ago, that our statistics capture and report more elements of people's waits than they do in England. In England they don't count waits for diagnostics. They don't count waits for therapies. We report on the whole pathway, not just parts of the pathway, as in Scotland and in Northern Ireland. The fact is, we are more honest with the public in Wales.

We also need to understand demand. The needs of the Welsh population are different. People in Wales tend to be older and sicker. Our population needs have a direct impact on the size of our waiting lists and waiting times. But all the UK nations have the same goal, to reduce the backlog caused by the pandemic, and it's clear that we all have more work to do, including the NHS in England—

Will you take an intervention from Gareth Davies?

No, I'm not taking interventions, thank you. Currently, if you look at the waiting list in England, 7.57 million—I'm not sure if I'd be wanting to go into an election with those kinds of waiting lists.

At a time of significant financial challenge, we've made really difficult decisions to prioritise health and social care. We've spent 15 per cent more per person on health and social care than they do in England, and this year we're investing more than 4 per cent extra in the NHS, compared to the 1 per cent increase in England. Of course we want to transform our services and we want to focus on prevention. We want to be more productive and efficient, and we're trying to prioritise investments in new medicines, treatments and technology. But we could do more to modernise the NHS if we had more money from Westminster, which is what will happen if Labour is elected tomorrow.

The journey that a new Labour Government in Westminster will—[Interruption.] No, I'm not taking any interventions. No. I need to get out and campaign. The journey that a new Labour Government in Westminster will be embarking upon, if they're elected this week, is to shift support into the community, and that's one of the things we're already delivering on here in Wales. In the UK Labour wants to change the law, so high-street optometrists can carry out work previously undertaken in hospitals. We've already done that in Wales. They want pharmacists to be able to prescribe more; we are miles ahead on this, with one in four of our pharmacies already prescribing directly. Our local pharmacies offer free treatment for 27 different minor illnesses. In England, they can only support seven conditions. When Labour comes into power, they will introduce a teeth-cleaning programme; we've already done that in Wales, and we've delivered almost 400,000 new NHS dental appointments. We already have a ring-fence for mental health services, we have mental health support in every school, we have the '111 press 2' services—all of these things they don't have in England, and that's the difference that Labour, I hope, will make in the next few days. And if we use the UK Tory Government's definition of a new hospital, which is quite a wide definition, we're on course to build six times more hospitals than the Tories were in England—another broken Tory promise.

In Wales the NHS is much respected, it's much trusted, but it's also much in demand. Aneurin Bevan said, as he set up the NHS—

Cabinet Secretary, you do need to conclude now.

—76 years ago to this Friday, that

'the NHS will last as long as there are folk left with the faith to fight for it.'

The best gift we could give to the NHS this Friday is a Labour Government, not just here in Wales, but also in Westminster. Two Labour Governments working together, who are both committed to fighting for the NHS, just as Nye would've wanted.

I call on Peter Fox to reply to the debate.

Diolch, Dirprwy Lywydd. Thank you, Members, for your contributions today to this very important Conservative debate. I don't think there is anything that is a bigger issue for the people of Wales—not much bigger than this; this is affecting everybody day in and day out. Could I agree with everybody who has recognised the sheer hard work of the workforce in our NHS? Nobody has ever, ever dissented from that sentiment, because they work day in, day out for us, but they are being let down—we have to recognise that.

So, first of all, can I thank Sam Rowlands for opening the debate today? He shared that this issue touches every corner of Wales, and he again thanked our NHS staff because he recognises, as we all do, what they do, but we can't ignore that the NHS is not in a good place at the moment. It's pointless us trying to find a way to cover that up, because it's not in a good place, and we can't ignore that, and it's down to 25 years, he says, of Labour mismanagement here. He gave us the very real statistics that underpin that. He very clearly pointed out how Labour have short-changed our NHS staff, and the people are genuinely suffering, and this is shameful, and it's a Labour-made crisis, he says, and I think a lot of us can agree with that. Our NHS staff and our citizens deserve better.

Mabon talked about the 75 years of our NHS and the 25 years of mismanagement, and recognised again how the Welsh NHS is facing a crisis and it needs urgent solutions. But he diverted to the NHS in England, distancing himself from the Welsh NHS that Plaid Cymru have helped to run and support and allowed budgets to go through over many, many times, over many, many years, trying to hoodwink us into believing that Plaid Cymru had nothing to do with the decline of the NHS in Wales, but clearly they have.

Altaf Hussain pointed out the Welsh Government's abject failure, and spoke of his past professional service, a man who has been on the chalkface: he knows what it was like when it was good and how we're now forcing people to suffer, and the impact is profound on our productivity and our GDP, and the situation sickens him as he spent so many years trying to help people who were in pain, and this is terrible when we're now failing in so many areas. He pointed out how we fail to train enough nurses and GPs, and there are deficits in our infrastructure. Disjointed thinking has brought our NHS to its knees, and we need an urgent, integrated plan. 

Carolyn Thomas, we agree with you. Again, I agree: our staff are fantastic, but you went on to blame the UK Government again, and you forget—you forget—that Labour has control of the budgets in Wales. The Welsh Government have choices, and they've chosen to fund things in different ways. That's their prerogative: they're a Government, and they can choose to underfund health to put more money into different projects over the years. We've seen poor choices made, I think, over several years, where we haven't seen enough investment into the likes of social care—[Interruption.] Of course you can, Mike.

We've had this discussion in private, let's have it in public: will you be bringing the Conservative budget forward when the budget debate takes place?

When we take control in 2026, that's when we will do it. So, Carolyn, you've just got to focus and look at your own choices. There's nothing wrong with admitting that the Government has made the wrong choices here. Let's start working together to put it back together. 

Gareth Davies worked in the NHS for over 11 years, and again commended our workforce, but they have been let down, he pointed out, and that's demonstrated by the fact that all of our health boards are all in some sort of special measures, and pointed out previous cuts to the NHS in Wales by Welsh Government over many years.

And Joel pointed out that waiting times are the tip of the iceberg. He believes that there is something deeper here, a misalignment of policy that has led to the diminishing, the decline in our NHS, and highlighted the absence of the triple science award, which is going to undermine those people who are coming through the system that could help our NHS recover.

Cabinet Secretary, yes, political point scoring is something we will do, as you have done, and we will try and do, but we can't get away from the facts though—this is a real, serious, real problem here. We can massage the figures to justify why it might look better somewhere else than it does here, but it's indefensible, the situation we have.

Now, you've talked about the wonderful stories you've heard on the doors of recent—. Well, you need to come and talk to some of the people on our doors, because I very rarely hear anybody speak of a positive first-face interaction on the doors. I hear, when people are in the system and they're getting the treatment they want, that it's great. But first entry to the system—huge problems, massive problems, as we raised earlier in the Chamber today.

And GP practices—I've raised in this Chamber a few times how GPs are unhappy with the contracts, how they're leaving the system, how they're struggling to provide many of the things that they used to be able to provide free of charge, but they can't cover those now, because the contracts don't allow them to do it.

And we're seeing issues with other areas of primary care—dental systems. There are so many things that are being undermined. You talked about the additional moneys you've put into social care. Well, that may be the case, but what we're not actually seeing is the real benefits of enough money going into social care. In fact, I challenge that there has been. We saw lots of money going into health last year—some probably £800 million, £900 million—but we've seen a reduction, a real-terms cut, to social care through local government. So, how are we joining up the circle to make sure we can unblock this problem?

In closing, Presiding Officer, it's simply not right that two-year waits for treatment stand at over 21,000 in Labour-run Wales, compared to just 275 in Conservative-run England. We cannot justify the figures, and they are indefensible. It's simply not right that media wait for NHS treatment—. I don't know why I said 'media' there. Waits for NHS treatment are 22 weeks in Wales, compared to 14 weeks in England. And finally, it's not right that the number of patient pathways in Wales has increased again to over 775,000 people, the highest figure on record, all whilst waiting lists in England have fallen over the last six months. We need to see the Welsh Labour Government take proactive measures in cutting NHS waiting lists, which have been outlined in our Welsh Conservative debate today, and I call on Members from across the Chamber to support our Welsh Conservative motion unamended. No-one should defend these huge Welsh waiting lists. Diolch.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections. I will therefore defer voting under this item until voting time. 

And that brings us to voting time and, unless three Members wish for the bell to be rung, I will move immediately to voting time.

The first vote this afternoon is on item 6, a Member debate under Standing Order 11.21, and I call for a vote on the motion tabled in the name of Siân Gwenllian. Open the vote. Close the vote. In favour 29, there were 15 abstentions and none against. Therefore, the motion is agreed. 

The next vote is on item 8, the Welsh Conservatives debate. I call for a vote on the motion without amendment, tabled in the name of Darren Millar. If the proposal is not agreed, we will vote on the amendments tabled to the motion. Open the vote. Close the vote. In favour 12, no abstentions, 32 against. Therefore, the motion is not agreed. 

I now call for a vote on amendment 1, tabled in the name of Heledd Fychan. If amendment 1 is agreed, amendment 2 will be deselected. Open the vote. Close the vote. In favour nine, no abstentions, 35 against. Therefore, amendment 1 is not agreed.

I now call for a vote on amendment 2, tabled in the name of Jane Hutt. Open the vote. Close the vote. In favour 23, no abstentions, 21 against. Therefore, amendment 2 is agreed. 

I now call for a vote on the motion as amended by amendment 2.

Open the vote. Close the vote. In favour 23, no abstentions, 21 against. Therefore, the motion as amended is agreed.

That concludes voting for this afternoon. 

There is one remaining item, which is the short debate, and I call on Sioned Williams to speak to the topic that she has chosen.

Diolch, Dirprwy Lywydd. My debate will be on safer skin, the importance of education in preventing skin cancer. 

And I will be giving a minute of my time to Mabon ap Gwynfor and Siân Gwenllian. 

The warmer weather is finally here—well, I think so, anyway—so more people will have put away their heavy clothes and will be spending more time outdoors, whether relaxing in the garden or having fun on the beach or in the park. Summer gives us all the opportunity to enjoy more of what Wales has to offer in terms of our beautiful outdoor spaces. 

When I was a child, my mother always made sure that I had sunscreen on, and when my children were younger I would annoy them consistently by reminding them to use sunscreen and to wear a hat. When I had sunburn—yes, we've all been there, and I'm sure many of us have burned a bit while we've been out canvassing on the streets of Wales for hours over the last few weeks—I would, like many people I'm sure, dismiss it as just a little annoyance or irritation and just a little warning to be more careful in the sun next time. But, in truth, skin damage from the sun isn't just an annoyance.

Exposure to UV from the sun as well as the use of sunbeds is the primary cause of skin cancer. In 2019, skin cancers accounted for almost half of all cancers in Wales—half. And it is by far the most common cancer affecting Welsh people and, sadly, rates are increasing. Between 2016 and 2019, rates of skin cancer increased by 8 per cent, and the condition now makes up an increasing proportion of the workload of dermatologists. This, of course, not only comes at a considerable cost for our NHS, but has a knock-on on the care for other skin conditions. 

Out of the four UK nations, Wales has the highest rates of skin cancer and we now—all of us—have a one in five chance of developing it during our lives. Common symptoms include a sore or area of skin that doesn't heal within four weeks, looks unusual, hurts, is itchy, bleeds, crusts or scabs for more than four weeks, and anyone displaying these symptoms should go to their GP as a precaution.

Although skin cancer is treatable and the survival rate is very high and improving, over 2,000 people will still die each year across the UK; that’s more than six people every day. It’s essential, therefore, that people try to reduce their risk in the first place, and that is why the Welsh Government really need to have a focus on that preventive approach. As with many health issues we discuss in the Siambr, I would argue that we need a better focus on prevention. Because exposure to the sun is the primary cause, most skin cancers are completely preventable through small behavioural changes and protective measures. Just by spending some time in the shade, especially when the sun is at its highest and hottest, wearing light, baggy clothing, wide brimmed hats, UV-protection sunglasses, as well of course as generously and regularly applying at least SPF 30 sun cream with a four-star or above UVA protection rating, we could significantly reduce the incidence of skin cancer.

And I believe our schools can play a vital role in promoting greater awareness of the dangers of sun exposure and the simple measures like these that can be taken to reduce risk. The World Health Organization recommends sun safety in schools, calling it a cornerstone of skin cancer protection. In England, schools are required to ensure that pupils can, by their final year of primary school, know about safe and unsafe sun exposure, and how to reduce the risk of sun damage. The charity Skcin—which is spelt S-K-C-I-N—offers an accreditation programme that provides primary schools free resources to assist them in their duty of care to safeguard children against UV and prevent skin cancer. There has been limited roll-out in Wales, but the schools that have made use of these resources have praised them for the way they've helped increase awareness amongst pupils and staff.

In terms of what we are doing here, sun safety is recommended as part of Public Health Wales's network for healthy schools scheme, although this is not enforced. ‘A Cancer Improvement Plan for NHS Wales 2023-2026’ states that between 30 per cent to 50 per cent of cancers occur as a result of exposure to avoidable risks, and then prevention will be a key area of focus.

Twelve years ago, following a petition by Tenovus for all children under the age of 11 to be provided with free sunscreen, the Children, Young People and Education Committee of the Senedd conducted an inquiry into school sun protection policy. At the end of the inquiry, they made several recommendations, including that schools should be required to have a document setting out the school's approach to a range of environmental factors that might affect children during the school day, such as including sun protection and shade requirements; consideration should be given to the equipment provided to, and the school requirements for, children in the foundation phase to ensure that they are suitably protected to be outside in a range of weather conditions; the Welsh Government, Welsh Local Government Association, schools and third sector organizations should continue to work together to deliver sun protection education to children.

Sadly, despite 12 years passing since the committee reported back, and an initially encouraging response from the Welsh Government, a research project at Swansea University has found that several recommendations have not been upheld. That research project, Sunproofed, led by Dr Julie Peconi of the School of Medicine at Swansea University, funded by Health and Care Research Wales, found that only 39 per cent of schools that responded to their survey had a sun safety policy, and that not all schools with policies actually enforced them. Schools with higher percentages of children entitled to free school meals and with lower attendance were less likely to have a policy. Only 29 per cent of schools teach sun safety as a part of the curriculum in every year group. Only 5 per cent of schools had sufficient shade for most active outdoor pursuits. Only 8 per cent of schools include sun-protective hats as part of the school uniform. Welsh-medium schools and schools in north Wales were more likely to have a policy, which I believe demonstrates the fact that sun safety is not being taught in a consistent way across the Welsh education sector and local authority areas.

Schools that did have a formal sun safety policy or procedure were over six times more likely to liaise with school governors regarding sun safety; over five times more likely to include sun awareness guidance in their staff manual; over three times more likely to send out communications to parents regarding sun safety; and over twice more likely to include sun protection as part of the curriculum in every year group than to include it in some year groups only and discuss in an assembly as the need arose only. And also, they were more likely to encourage staff to model sun safe behaviours for students, to have spare hats that pupils could borrow and were more likely to schedule outdoor activities to minimise time outdoors between 10 a.m. and 3 p.m. in the summer term or when the UV index was above 3.

This extremely revealing and important research also included sun safety quizzes with pupils in years 3 to 6 in five primary schools in south Wales. It found that only 5.7 per cent of those pupils were aware that sun protection is needed when the UV index reaches 3, and only 36 per cent knew they could get sunburnt on cloudy days.

I understand that the Cabinet Secretaries for education, climate change, and health, as well as the Chair of the current Children, Young People and Education Committee have received a letter from Dr Peconi regarding the findings of her research. In light of the previous inquiry and this more recent research, I would therefore be keen to learn what steps the Welsh Government are taking to advance sun safety education in our schools.

Education will go a long way towards reducing skin cancer rates, but awareness and understanding are not the only challenges we face, of course. The cost-of-living crisis pushed up the prices of all household essentials, including sun protection. A recent analysis of ONS data has shown that in the last two years, the cost of sunscreen has increased by almost 30 per cent, while recent sales figures suggest that there may be some impact on the number of sun care products purchased.

Dr Bav Shergill of the British Association of Dermatologists said that:

'As sunscreen prices go up there's a distinct possibility that people will use it less, which could put them at great risk of cancer.'

This point is reinforced by a survey from last year, undertaken by Melanoma Focus, which found that nearly half of respondents thought sunscreen was too expensive, and Tenovus Cancer Care raised concerns that sun protection would be left off the list of household priorities. Most worryingly, 10 per cent of respondents said they never wear sunscreen.

Even with those who do purchase sunscreen, concerns over costs may be encouraging them to use less therefore than they should. We know that prior to the cost-of-living crisis most were not applying enough sunscreen, and this situation is unlikely to have got better, of course, as the price has gone up. As a guide, adults should be aiming to apply around two teaspoons of sunscreen if you're just covering your head, arms and neck, or two tablespoons if you're covering your entire body while wearing, for instance, a swimming costume, because if applied too thinly, the amount of protection provided is greatly reduced. And, of course, it should be re-applied every two hours.

Despite its essential role in protecting our health, sunscreen is currently classed as a cosmetic product and subject to the full rate of VAT. Amy Callaghan, who until recently was an MP for East Dunbartonshire, launched a campaign to have VAT removed from sunscreen as it is in many other countries. This campaign is supported by a number of charities and has also received cross-party support in the House of Commons. I know, of course, we don't have the power to vary VAT, but I would be keen to know whether the removal of VAT on sunscreen is something this Government would support and will take up with the next UK Government.

Some foodbanks have even started to include sunscreen as an item that they provide, but only a small number of foodbanks do this at the moment. The Government has, quite rightly, invested in improving access to menstrual products in schools, so I'd like to know whether the Government has considered investigating the feasibility of providing high-quality, effective sunscreen to schools. Also, in terms of the cost element, outdoor activities that can expose children to direct sunlight for long periods, such as going to the beach and parks and so forth, tend to be free and therefore more attractive to those on tighter budgets.

During the pandemic, Governments around the world took unprecedented measures to protect public health. We are currently facing increasing rates of skin cancer, more people being diagnosed with cancer and receiving treatment, as well as those costs, the increasing costs to the NHS. We saw during the pandemic how hand sanitiser, for example, became regularly and freely available to the public. I wonder whether sunscreen could be made available in similar dispensers in public sector workplaces, schools and hospitals. Most skin cancers are preventable, but they can be deadly. So, what are we going to do to ensure that they are prevented effectively?

This is a matter of the utmost importance. We know that climate change is affecting skin cancer rates, and will continue to have an effect as temperatures continue to rise. By implementing sound public health policies now, we can mitigate this growing health crisis, which will be exacerbated by climate change. We must see this through the lens of the well-being of future generations, and we must give this issue the serious attention it deserves. I look forward to hearing how the Government intends to act to ensure this. Thank you.

Cancer does or has touched almost every family in Wales. Twenty five years ago, my husband, Dafydd, died having been diagnosed with skin cancer, melanoma. He was 47 years old and he was the father of four young children, with the youngest just three years old. At that time, there wasn't must talk of melanoma or much discussion of it, but, now, it's well known that skin cancer is one of the most common cancers in Wales, and cases are increasing. But there still isn't enough discussion of the issue and the practical steps that everyone can take aren't given enough coverage either—practical steps to protect the skin from the dangerous rays of the sun. And I agree, therefore, that we need a focus on educating children and adults on the practical preventive steps they can take to mitigate risks.

Melanoma does steal loved ones away from us, but there are ways of helping, there are ways of mitigating the risks, and we must draw the attention of the people of Wales to those, and I think that the state here in Wales is duty bound to lead on that work.

Thank you very much, Sioned, for bringing this debate forward. It was very interesting to hear the recommendations on how much sunscreen to apply. My children will be very pleased to hear that, because we tend to lather them with too much and they look like zombies by the time we've finished. [Laughter.]

But it is important when you consider that cases of skin cancer in Wales are increasing, as you've said, and that we have more cases here in Wales than in any other nation of the UK. And it can happen so easily without us even knowing, which is why Sioned's debate is so important, and she's right, therefore, in calling for education for children about the condition within our schools and at a young age. And in understanding that only one in three children in Wales are educated does show that deficiency in the system.

Given, therefore, that cases are increasing, this does show the need for us to develop a comprehensive cancer plan in Wales, such as the cancer plan that Plaid Cymru is putting forward, which will lead to identifying patients earlier and better diagnostics for other cancers too. So, I look forward to hearing the Minister's response and, specifically, how the Minister believes that we can tackle that issue of how we educate children and young people on the dangers of skin cancer. Thank you very much, Sioned.

I call on the Cabinet Secretary for Education to reply to the debate. Lynne Neagle.

Thank you, Dirprwy Lywydd. And can I thank Sioned for bringing forward this debate, which has been really informative and very thought provoking? As Sioned highlighted, skin cancer is by far the most common cancer in Wales. There were around 15,000 recorded cases of non-melanoma skin cancer and 1,000 cases of melanoma in 2019. And, as Sioned highlighted, the cases are rising. Siân, I wasn't aware that your husband had died of melanoma, I'm really sorry to hear that, and thank you for sharing that experience with us today.

We remain, as a Government, committed to improving the quality of life for everyone in Wales, and this, of course, includes a focus on cancer prevention and education that supports health and well-being more broadly. Sun safety is a key part of skin cancer prevention, and education in this area is key. This is currently, as Sioned highlighted, supported by the Welsh network of health and well-being promoting schools, supported by Public Health Wales. The network is responsible for maintaining and promoting the well-being of all learners. Local co-ordinators signpost and share information and resources with schools to support sun safety across Wales.

Public Health Wales also provides a range of workforce development opportunities for local health and well-being promoting schools co-ordinators to remain up to date with current issues relating to sun safety, which they can share directly with schools, so they address issues with learners and parents. The network's proposed minimum standards describe the core components of a whole-school approach, and while these are not topic specific, a number of these standards support the development of appropriate policies and practices around sun safety, including learning through the curriculum.

I am aware of the Swansea University-led project, which is currently working with schools to help explore the current perceptions of tanning in children, parents, carers and educators, and the results of this project will support the development of new educational resources aligned to the Curriculum for Wales. I haven't received—at least, I haven't seen—a letter yet from the researcher, but I will make sure that I follow that up and ask for a copy of her research. Public Health Wales has arranged for the academic leading on this project to present at its Welsh network of health and well-being promoting schools meetings, which are taking place this week in north and south Wales.

In addition to this vital public health work, the Welsh Government provides advice and guidance for all schools and settings to support them to keep children and young people safe on extremely hot days. This, of course, includes practical advice on the importance of maximising shade, restricting time in the sun during outdoor activities and the use of sun covers. Within the guidance, there are different risk assessments that schools can draw upon to implement additional safety measures for their children and young people as necessary.

Education, of course, is crucial to support learners to develop health-promoting behaviours, and at the heart of the Curriculum for Wales framework are four purposes that are central to every decision made about the new curriculum. One of those four purposes is to support children and young people to become healthy, confident individuals. The Curriculum for Wales makes health and well-being a mandatory area of learning and experience for the first time, underlining our commitment to the health and well-being of learners. For the first time, health and well-being have equal status in law to other important areas of the school curriculum, and schools are expected to deliver teaching as part of their curriculum from early years through to 16. Since the roll-out of the Curriculum for Wales, we've worked closely with our partners, including Public Health Wales, to support teachers to deliver this.

This area of the curriculum provides a holistic structure for understanding health and well-being. The mandatory statements of 'what matters' code specifies that developing physical health and well-being has lifelong benefits. This aims to help learners to understand the factors that affect physical health and well-being, including health conditions, physical activity, nutrition and the importance of a balanced diet. As learners progress, other statements of 'what matters' that are relevant to this topic consider the assessment of risk, the importance of good decision making and the role of social influencers in their lives. This new focus will help children and young people to foster healthier and safer lifestyle choices throughout their lives and support them to understand the risks and dangers on a range of challenges and issues. Exposure to the sun or sunbed use, which is banned for under-18s in Wales, are obvious examples where learning in the Curriculum for Wales can support learners to make healthier choices informed by the evidence.

Innovative work and learning on cancer awareness and prevention is happening in schools in Wales. A project co-ordinated by several secondary schools across Rhondda Cynon Taf developed a learning programme aiming to raise awareness of bowel cancer. This was implemented through Pontypridd High School's work with the Moondance Cancer Initiative. Through a partnership approach, which included the council and Cwm Taf Morgannwg University Health Board, the programme produced learning resources and experiences for their learners. This includes understanding cancer screening, how to use a test kit, and developing materials to engage parents, carers and the wider community, which promoted key messages around prevention, screening and early symptoms. The programme helped improve the learners' understanding of cancer, and, in particular, bowel cancer, from causes to screening and recovery rates. The importance of screening as a part of this learning was crucial, because early diagnosis and treatment brings much higher survival rates. This was an effective programme that innovatively and creatively tackled a sensitive yet important topic. This is a great example of how schools have collaborated with learners and their families, with an aim to improve outcomes for their community, with the Curriculum for Wales values at its heart.

Although the focus of the project was bowel cancer in particular, a similar approach could be taken to support to skin cancer prevention and other conditions. These are the sorts of opportunities that the Curriculum for Wales provides for schools, and I am keen to see more of these types of innovative learning experiences that are so relevant to learners and their communities. That is the role that schools can play in issues like this, providing learning that helps learners understand health-related issues, builds their confidence in grappling with these topics and to make informed decisions that support their own health and well-being. But we also cannot forget that cancer prevention is an issue for the whole of society, not something that we can place entirely on the shoulders of schools. 

Can I just conclude by thanking Sioned Williams for bringing forward that debate? Eluned Morgan has also heard the debate today. I give her my assurance that I will look at the research and also the links with the previous recommendations of the Children, Young People and Education Committee, which, for some reason I can't understand, I don't think I was part of. I will make sure that I see what has happened with those recommendations. Diolch.

Thank you, all. That brings today's proceedings to a close.