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2. Questions to the Cabinet Secretary for Health, Well-being and Sport

July 19, 2017

65 speeches by…

  • Elin Jones
  • Rhun ap Iowerth
  • Vaughan Gething
  • Janet Finch-Saunders
  • Leanne Wood
  • Russell George
  • Michelle Brown
  • Angela Burns
  • Caroline Jones
  • Julie Morgan
  • Mohammad Asghar
  • Dawn Bowden
  • Jayne Bryant
  • Nick Ramsay
  • Dai Lloyd
  • Neil Hamilton
  • David Melding
  • Sian Gwenllian
…and 8 more speakers

Elin Jones

The next item, therefore, is questions to the Cabinet Secretary for Health, Well-being and Sport, and the first question is from Rhun ap Iorwerth.

Rhun ap Iowerth

1. Will the Cabinet Secretary make a statement on the number of patients referred for orthopaedic treatment in north Wales? OAQ(5)0201(HWS)[W]

Vaughan Gething

Thank you for the question. There has been a significant increase in orthopaedic referrals in Betsi Cadwaladr over the last four years and capacity has not met demand. The local health board is taking a range of measures to deal with the increase, including the use of various triage services such as physiotherapists in general practitioner practices and lifestyle and weight management clinics, in line with recommendations of the planned care programme.

Rhun ap Iowerth

More than 1,200 patients are waiting longer than a year for treatment in north Wales and that is unacceptable. I hope that you would agree with that. A recent paper from the board on developing orthopaedic services emphasises the need for more training places in order to provide the necessary workforce to create a sustainable service that can meet reasonable targets. Isn’t the statement that you made yesterday that there is no case for establishing a medical school in north Wales entirely contrary to the spirit of that paper and runs contrary to what was said in the recent health committee report? Of course a medical school cannot be established overnight, but your pledge to have more students spending more time in the north, as if it were some far-flung country, clearly isn’t enough. So, when are you going to show some ambition on this issue and set a target so that we can start to move towards it?

Vaughan Gething

Thank you for the follow-up questions. I do agree that long waits are unacceptable. There’s a real challenge for Betsi Cadwaladr in actually delivering property capacity and demand within its services. We know that there’s likely to be more demand as we move forward and that’s why they have to take a range of measures. The initial orthopaedic plan they had at board wasn’t endorsed because there’s still further work to do on it. There’s a challenge here about a range of our services, not just specialist services but elective services as well, in understanding how we use properly the capacity we have and in reconfiguring that capacity to make better use of it. I think the link that you attempt to draw between a decision over a medical school and the ability to recruit enough staff to work within a different model—I don’t accept that there is a direct link in the way in which you try to present it. The decision that I announced yesterday was meeting the commitment that I gave to the Assembly to give that indication before recess, and it was deliberately done before questions today to make sure there are opportunities to have this debate within the Chamber. But the health committee report did not say that there should be a medical school in north Wales. It made a number of points that I do take seriously about the case being made to make sure that training across the country takes place, and where those medical education places are actually provided. That includes a proper conversation with the two medical schools about where their students are housed and where they undertake their medical education, and, as I indicated in my statement yesterday, I do think there is a proper case to take forward to ensure that more people undertake medical education within north Wales. So, there has to be a proper partnership carried forward between Bangor, Cardiff and Swansea universities and the national health service to make sure we do deliver more places for medical education to take place. That must take place regardless of any expansion in numbers, because if I were to try and tell you and other people this will only take place if there is an expansion in numbers in medical education, it would be the wrong signal to give. I think it’s important with our current cohort we think about how we provide the opportunity for more of those people to undertake their education in different settings. That does tie in with work already in place, and I’m committed to doing that and to having and open and a sensible conversation with stakeholders, not just across the national health service but in this Chamber and beyond to deliver on that ambition, because I do think there will then be a greater prospect of people either staying in north Wales or returning to north Wales to undertake further periods of medical education and actually staying to work within the national health service thereafter.

Janet Finch-Saunders

Thank you to the Member from Ynys Môn for raising this once again in this Chamber. Now, according to the latest Welsh Government figures, the number of patients left waiting over 36 weeks, which is twice as long as long as in England, for trauma and orthopaedic treatment in north Wales now stands at 3,336. This is the highest it has ever been. Anecdotally, an 84-year-old female constituent of mine waited 103 weeks—84 years old—that’s over 720 days, almost two years, for their surgery. And a male constituent waited three years for hip operations. In response to my correspondence, you state that you expect all patients to be seen at the earliest opportunity. That is a laugh. What are you going to do about your failure to deliver for these 3,500 patients in north Wales? It’s your Government—you hold the brief and portfolio for health. And I have raised this question time and time again, and we get very, very waffly answers. Tell the people in north Wales—the 3,336 who have been waiting over 36 weeks, twice as long as in England—tell them when are they going to have their operations.

Vaughan Gething

I can assure the Member this is not a laughing matter and it’s certainly not something that I find amusing at all. The challenge always is, whether in relation to an issue where we understand there is more than one reason for a rise in demand, and the inability of the health service to meet that demand—. The demand for a simple answer, to flick a switch and deal with it—that’s unlikely to be the case. And I would much rather be honest and deal with Janet Finch-Saunders saying that I’m waffling by explaining honestly and clearly the challenges we face and what is being done about them, rather than pretend that there is a magic lever within Government to make all of this go away. I think that is absolutely the wrong thing to do. But I am clear—I do expect people to be seen at the earliest opportunity. And that is why I’m very clear, not just to her, but to other Members in the Chamber, across other parties too, that I do think that waiting times within north Wales are unacceptable. That’s why I expect the health board to improve. That’s why I expect to see a real plan for orthopaedic services in north Wales to make a real difference, not just at a long point within the future, but progressively over the rest of this term as well.

Leanne Wood

2. What efforts are being made by the Welsh Government to retain existing staff in the health service in Wales? OAQ(5)0196(HWS)

Vaughan Gething

There are a range of measures in place. The Welsh Government remains committed to supporting and retaining the existing NHS workforce. We have an open and constructive dialogue with trade unions and other staff representatives and we’re determined to create a supportive learning environment for our staff to work in and deliver high-quality care with and for the people of Wales.

Leanne Wood

There’s a link between waiting times and the number of staff that you’ve got working in the service. Recent figures have shown that the number of nurses and midwives in the UK leaving the profession has risen by 51 per cent in four years. Within these figures, released by the Nursing and Midwifery Council, home-grown nurses have been found to be leaving in the largest numbers. Now, the Royal College of Nursing and the Royal College of Midwives have both called for the pay cap to be scrapped to prevent this situation from getting worse. Do you not agree that it is time for you to fulfil the Welsh Labour manifesto pledge to scrap the cap, to ensure that nurses remain in post in Wales? Secondly, by ensuring that you stick to your manifesto commitment, you will help to prevent further damage to people’s trust in politics.

Vaughan Gething

There is a real issue about staff within the service, and the pay cap is not just about people’s financial means—there are real issues about value. And that was set out very clearly in the last NHS pay review body report. It was set out again, not just within the health service but across the public sector, in a report from the senior salaries review body, issued this week and in the armed forces’ pay review body as well. There is a real issue about the continuing pay cap, and the effective approximately 14 per cent drop in real-terms income. This Government wants to see the pay cap removed. We’ve been very clear about that. I’ve discussed that with both the RCN and other trade unions as well. And trade unions themselves understand very well that this requires the UK Government to shift its position. The remit that is given to pay review bodies essentially comes in the financial envelope from the resources available. And that means that if the UK Government do not shift their position and provide resources to deliver a real-terms pay increase, what we could do is give them a remit to give a bigger increase to staff, and we’d then have to fund that increase for national health service workers on the back of redundancies in other parts of the public service. That is the reality of where we are. And it’s no use the leader of Plaid Cymru saying that isn’t true—we need to deal in reality, because people in our public services are facing the reality of a pay cap. They face the reality of the Tories continuing that pay cap. You may think the right way to approach this is to give the Tories a free pass on the issue. I think all of us who want to see a real-terms pay rise for public service workers need to identify the real cause of the problem, and make sure the Tories do not get away scot-free—that we do make sure that the UK Government deliver on the signals they give and actually make sure that the pay cap is ended. That is what trade unions want; that is what our staff want; that is what this Government wants.

Russell George

The concern raised with me in mid Wales is not so much about retention, but about the recruitment of health professionals in the first place. There are concerns raised with me on a regular basis about the severe shortage of the recruitment of dentists in mid Wales. So, can I ask: what is the Welsh Government doing to incentivise the recruitment of dentists, GPs and other medical professionals to take up positions in mid Wales in particular?

Vaughan Gething

In terms of reviewing and understanding the recruitment across mid Wales and, in fact, every other part of Wales, health boards themselves, within their integrated medium-term plans, are supposed to be able to plan for the workforce. We are taking forward measures to more properly understand the needs of the workforce and our training and education requirements. That’ll get taken forward with the introduction of Health Education and Improvement Wales—that’s part of the picture. But the general picture of recruitment is also affected by the issue that we’ve just discussed with the leader of Plaid Cymru, about the continuing pay cap—that is a real issue about how people are valued. The way in which our services work is also a particular challenge for us. To try to pretend that there is one single issue to resolve all of these just means that a politician may have an easy answer to give, but will not deal with the issues that public servants face or that our communities face. The other aspect in the recruitment that none of us should forget is the onrushing juggernaut of Brexit. If we don’t have a proper deal about what this will look like, those European Union staff who have already left all parts of the service that you refer to, and those who are already considering leaving as well—that will make it worse, not better. If we can’t understand that all of those issues have an impact in every single part of Wales, then we will fail to not just understand the challenge, but to actually have a proper answer to make sure that we have a well-funded and well-resourced public health service, including, of course, the staff to actually undertake the work.

Michelle Brown

As has been pointed out in this Chamber on numerous occasions, there’s a nurse shortage in the NHS. This shortage has been getting progressively worse for years, and that’s basically because both UK and Welsh Governments have failed to ensure that there are sufficient nurse training places being funded to provide care for an ever-increasing population. What measures are you taking to increase the number of nurse training places in Wales?

Vaughan Gething

I’m happy to confirm that this Government has progressively increased the number of nurse training places within Wales. I announced in February this year another significant increase on the back of increases in the previous two years. If you went and spoke to the Royal College of Nursing, or to Unison, as the trade union representing the largest number of nurses in Wales, they would recognise that this Government is increasing training places, in addition to the ‘Train. Work. Live.’ campaign that we’ve introduced, working alongside stakeholders within the service, and in addition to keeping the NHS bursary that we are proud to have kept, unlike the decision made across our border. This is a Government that is serious about workforce planning, serious about working alongside staff representatives and serious about having the staff to undertake the job to do. But that does require a different conversation about resources, and Members from any party cannot simply point the finger to this Government and say, ‘Make more resources available to the national health service’ without then setting out which other parts of public service spending in Wales will have further cuts imposed upon them to do that. We already make incredibly painful choices to put extra resources into the national health service. I think that our staff and our public deserve honesty in this debate and that is what this Government will do.

Elin Jones

Questions now from the party spokespeople. Welsh Conservative spokesperson, Angela Burns.

Angela Burns

Diolch, Llywydd. Cabinet Secretary, the interim parliamentary review on health and social care has highlighted that there remain significant barriers for good ideas and policies to translate fully throughout the whole of the NHS due to cultural resistance and a fear of failure. There’s a recognition, evidence based, that a significant proportion of the public sector are often doing things without understanding what really works, and it stresses the need not to be afraid of failure, but to learn from it, because this approach will allow for a far more innovative and open approach to change that can only have positive outcomes. Cabinet Secretary, I’m sure you’re aware that the Behavioural Insights Team, which works very closely with the Westminster Government, sets out to encourage the public sector to address change in a more similar way to the private sector. I was wondering, and what I would like to know is: have you engaged with or considered engaging with organisations such as the Behavioural Insights Team so that we can fully engineer effective and sustainable change throughout the Welsh NHS?

Vaughan Gething

There is a serious point in the question that the Member asks about our ability to change and reform public services by choice, and understanding the choice we’ll be making in delivering a different service. There are arguments that we want the service to be broken before we fix it. And I accept that there are significant cultural challenges within every public service, including the health service. So, part of our challenge is, as you correctly identified, looking at where that experience exists. We have work ongoing, and I am certainly prepared to listen to and for the service and to engage with a range of different people, because, actually, delivering significant change in a large private sector employer isn’t easy, necessarily, and so there are insights to be gained in the private and the public sectors too. That does not mean we surrender the values and the ethos of the service, but we do need to understand how we deliver the change that is plainly required.

Angela Burns

Business process re-engineering is never easy to deliver, but the tactics of nudge and leading and culture change are very well evidenced and have been used successfully in the private and public sectors. And I would urge the Cabinet Secretary to engage with organisations like that, because we can all learn, and there are good practices to learn from these kinds of organisations. Whilst the parliamentary review team are also going to be working, over the next few months, to develop more of a detailed map to aid the identified direction of travel for the NHS and social care sectors, do you think that these sectors should continue with current plans for structural reform? If you do, is there any Government-led work to ensure that any divergence is minimised between proposed structural reform now and what the parliamentary review may say in the longer term?

Vaughan Gething

This goes back to the conundrum that we discussed in actually setting up and agreeing the terms of reference for the parliamentary review. Not just yourselves, but the spokesperson for Plaid Cymru also raised the point about, ‘Will the review mean that you will stop doing things you need to do now and kick things into the long grass?’ You have to look at the balance, in saying, ‘Do we want to put something off until the review comes up with their recommendations?’ There’s a balance to be struck, but I still think that where there is a clear case for services needing to change, and there is a clear case for different parts of the service needing to work more closely together, then that should happen. So, for example, on elective care, Hywel Dda health board and Abertawe Bro Morgannwg have had a joint planning meeting. I expect those to be a regular occurrence. The health boards in south-east Wales—Cwm Taf, Aneurin Bevan and Cardiff and Vale—are having joint planning meetings as well. So, there has to be an understanding of what needs to take place now under that, and not simply waiting and putting everything off for the parliamentary review to report. Because the challenge you raised in your first question about the cultural challenges—they exist among clinicians, they exist among the public and, indeed, politicians in our ability and our willingness to support and get behind change. So, I don’t think there is a need to put off the drivers to try and discuss and talk about change, but there is a need to properly understand what the parliamentary review will come forward with in a number of months—and I think they will go quite quickly—and then to understand how we do what they suggest and understand what we think works and then to do so rapidly and at scale across the national health service.

Angela Burns

I think that the parliamentary review interim report is very clear on the direction of travel, and my understanding is it has buy-in from not just the health and social care sectors, but also political buy-in in terms of that direction of travel. The question I actually asked you was: is there some kind of oversight going on to ensure that any structural reforms that are currently being undertaken or currently being proposed by health boards have got some kind of backstop review to ensure that they are going in approximately the right direction of travel? Because, like you, I do not think we can just stop everything until we have a nice fat report in our hands that we can all study. And, of course, one of the areas that has been highly identified by all of us here, by the health boards, by the parliamentary review, is that mental health services in Wales need, to be frank, to be totally overhauled for both adults and children. I do appreciate that there is work ongoing, and, indeed, I was pleased to sponsor and chair a session arranged by the NHS Confederation in which initiatives were outlined as to what we’re going to be doing to—or what they intend to do to improve and deliver transformative change within adult and child mental health services. And it is obvious that some areas in Wales have made outstanding progress. So, again, I ask you: whilst we’re not going to wait for this report to deliver all, what will you be doing to drive and to identify those initiatives that have delivered some outstanding changes, transformative changes, to child and adult mental health care? What will you be doing to identify those and to try to ensure that they are consistently and quickly applied throughout the rest of Wales? Because this is one area where we as a nation are not doing so very well.

Vaughan Gething

I thank the Member for the question. In the general sense, about the backstop and the ability to think about whether we’re delivering change and making sure it’s going in broadly the right direction, that’s why there’s an NHS collaborative, bringing chief execs together to discuss and review evidence for changes that are proposed. That’s why we have integrated medium-term plans to try and set up the direction of travel for each health board—to have a plan, moving forward, about the changes that are being contemplated and delivered. It’s why health boards themselves [Inaudible.] they have processes that return a capital investment as well. There has to be a business case, and then there’s an investment board that looks at all-Wales capital bids, so, where capital is being used to try and re-engineer a service. There are different layers of oversight about some of the plans and challenges over service reformation. In the particular area you raise about children and young people, I would not be quite so pessimistic about the need for a total overhaul. There are challenges in different parts of the country, of differing scale, but that’s part of the reason why, in recognising, if you like, the short-term, significant build-up of pressure that came in, we made the choices to start the Together for Children and Young People exercise with the NHS, working with the third sector, working with statutory partners, and, indeed, with young people themselves having an engagement in it, and it’s then about delivering a service model they recommend. That’s also why we invested the additional sums of money. We are seeing waiting times come down in this particular service area, and we are seeing faster access to therapies, backed up, of course, by tougher standards on waiting times in this area. But this is not a position where any of us should say we now have the perfect solution and the answer. The progress we’ve made is real. The reality is that it’s also real that there are still too many children and young people and their families who wait too long, and it’s a constant process of reviewing where we are and what we need to do next, and that is already delivering transformative change within our service. But it isn’t just the specialist end; it is about the wider, broader services that wrap around families, and you’re right that it is about the consistency of the ability to do that. That’s why being reflective, having a national mechanism as well as a local mechanism to do so, really matters, and it’s also why we take the third sector and the voices of children and young people themselves seriously in designing and delivering our services.

Rhun ap Iowerth

Diolch yn fawr. On Monday, the auditor general released a critical report about the behaviour of Cardiff and Vale regarding procurement and recruitment. Now, I understand that. In response, NHS Wales’s chief executive has written to LHBs to seek assurances about their processes. What’s your hunch? Do you think that this was a one-off?

Vaughan Gething

I think it is likely to have been a one-off, but part of the point about the chief executive writing to all health boards is to ensure that it has been a one-off. If there are other issues, then we want those to be uncovered and dealt with, because the Wales Audit Office investigation revealed a picture that is simply not acceptable and not in line with the established processes and recommendations, and, again, the chief executive’s letter to every chief executive in NHS Wales makes very clear that we expect those standards to be strictly adhered to.

Rhun ap Iowerth

The report itself highlighted what I think we’re justified in calling ‘nepotism’ when it came to procurement and recruitment. The auditor general also noted it proved extremely difficult to obtain a clear position of the facts relating to the matters subject to audit. UHB officers and former officers provided conflicting and inconsistent accounts. There was a tendency for them to blame each other for the failings identified in the report. I could go on. Cabinet Secretary, we have some excellent—many excellent—managers and officers in the NHS in Wales, but I’m sure you’d agree that, in this case, behaviour has been unacceptable. We have a GMC for doctors, an NMC for nurses and midwives, so where is the body for regulation of NHS managers? Of course, managers can do just as much damage to patients from poor decision making. Is this something that you would consider?

Vaughan Gething

I’m always open to considering whether our accountability framework is in place as it should be, but this should work by the proper challenge of the board itself—those independent members, the non-exec members. And that’s part of the challenge here in understanding what information was provided, how information was not provided to the board, and I think the honest truth is that the people responsible for the choices in this particular report, as has been revealed by the Wales Audit Office’s report, which is an unusual step—. It is unusual for a report to be provide all of that and I do not think the auditor general has provided a report like this before about NHS Wales. It’s a bit more common in England, where procurement is a different beast. The challenge here is to make sure that we are clear about our expectations, clear about the accountability that must flow where people do get this wrong, and that that is proper accountability. I think, actually, the health board now—and I was encouraged by the response from the new chief executive, who, again, made clear that what had happened was not acceptable and won’t be defended, and it’s important that there is confidence amongst the staff and the public about the processes in place today, and the expectation of behaviour today as well.

Rhun ap Iowerth

You mentioned their accountability within the NHS and how the NHS itself seeks to better itself through its own governance. You have recently published a White Paper on reforming NHS governance, and real concerns, actually, have been brought to my attention about some of the suggestions that have been made, certainly in relation to the replacement of community health councils with new arrangements and, in particular, the potential erosion of local knowledge, and also a lack of assurance that there will be a continued, real, strong patient voice in any new proposals. But, would you accept that a better way forward perhaps, rather than reforming NHS governance now, would be initially to have an independent review of management across NHS Wales, highlighting and seeking to promote the undoubted good practice that we have, whilst at the same time trying to root out the bad and using that as a basis for new legislation?

Vaughan Gething

Well, the White Paper is a genuine consultation. So, it really is only for people to express their views and, if they don’t support the proposals, to think about alternatives to improve the quality and governance and direction of the national health service. So, this is not the Government saying, ‘We’re asking you, but we’ve already made our minds up’. It is a genuine consultation. On the point about whether there is now a case for an independent review of managers and management within the health service, I would need to be persuaded that that’s the right thing to do, but if you think there is a compelling case to make, I’d be happy to consider representations that you provide on how that can add value over and above what we already have in place, and over and above the professional expectations we could and should properly have of NHS senior managers and the operation of boards within the national health service.

Caroline Jones

Diolch, Llywydd. Cabinet Secretary, the second Wales cancer patient experience survey has, once again, highlighted the fact that many cancer patients still do not have a key worker. While we have made progress, 14 per cent of patients still don’t have a key worker, and more than a quarter of patients said it was often difficult to contact the key worker. The survey also highlighted the benefits patients found in having a clinical nurse specialist, with the majority of the 81 per cent of patients who had one stating that their treatment was greatly improved due to this. As a result, Macmillan Wales is calling for every person with cancer in Wales to have access to a clinical nurse specialist. Cabinet Secretary, do you support this view and do you agree that the clinical nurse specialist should act as a key worker for Welsh cancer patients?

Vaughan Gething

We certainly want every patient, where a clinical nurse specialist is appropriate to provide care, to have one. The challenge about whether the clinical nurse specialist is the key worker, I think, is different, because, for some people, it need not be the clinical nurse specialist who acts as the key worker, although, in practice, in the great majority of cases, it is the clinical nurse specialist who undertakes that role. There’s been a significant improvement on people knowing who their key worker is. In the previous cancer patient survey, in 2013, 66 per cent of people knew who their allocated key worker was. In this survey, that’s gone up to 86 per cent. Again, this is a significant undertaking. Over 6,700 staff have given up their time to provide their view on a wide range of their own experience of cancer care, and it’s as a result of this wide-ranging survey that we’re able to understand the state of our current services, the areas where we’ve improved, and, equally, those areas where we still need to improve further in the future.

Caroline Jones

Thank you for that answer, Cabinet Secretary. Staying with the Wales cancer patient experience survey, nearly a quarter of patients said that the GP didn’t take their symptoms seriously before their diagnosis. In fact, 6 per cent of patients stated they had to see their GP at least five times before being referred to hospital. As stated in the cancer delivery plan, detecting cancer earlier makes it more likely that treatment can be curative, less intensive and less expensive. It is therefore vital that, when someone presents with symptoms that could be caused by cancer, they are taken seriously. Unfortunately, we seem to operate in a model where we rule conditions in rather than out. We work up to the most serious rather than working back. So, Cabinet Secretary, what more can be done to improve early cancer diagnosis in primary care?

Vaughan Gething

I don’t think the way in which you’ve characterised the way that general practitioners approach their job is particularly fair. I do think there is a serious case, though, about improving the number and the quality of referrals. This is a really big challenge for the health service, because the overwhelming majority of people referred in with suspected cancer are actually given the all clear. So, we already have a significant undertaking where we’re looking for the minority of people who are referred in and who are then told that there is a form of cancer to be treated. It is also the case that cancer referrals have gone up significantly in this last year. They’re up 12 per cent within this year alone, and it is about how we continue to improve the rate of referral, but also what the conversion rate is as well, because, within health boards, there are different referral rates, but also different conversion rates. So, for those who aren’t aware, the conversion rate is the number of people who are referred in and then go on to be told that they have a particular cancer. That may be about the communities themselves. It may also be about the numbers of people and how and why they are being referred in. it’s really important again that we have a properly reflective approach where general practitioners are able to talk to each other, and other actors within the service, to understand what is happening and the outcomes they’re delivering for their patients. I think there’s got to be a properly reflective and supportive approach as opposed to looking to say that there will be blame apportioned to GPs, who are being told that they are doing their job in their wrong way. I think that’s unlikely to see the sort of reflective and positive approach that people want to take. Let’s not forget that people make a choice to go into medicine to care for people and to help improve lives, and we need to help them to do their job as well as being properly reflective of where that improvement is required.

Caroline Jones

Thank you, Cabinet Secretary. Finally, less than half of cancer patients have the opportunity to discuss their needs, and only 18 per cent of patients were offered a written care plan. Care plans are not only focused on healthcare needs, but they also pick up on emotional, financial and practical support. Less than half of Welsh patients were given information on financial support and benefits or had the impact their cancer would have on their day-to-day life discussed with them. We need to improve the way we deal with the impact cancer has on the patient, not just on their physical health, but the broader aspects. So, what is your Government doing, Cabinet Secretary, to ensure that all patients are offered a written care plan that incorporates a holistic needs assessment?

Vaughan Gething

We’ve set out clearly our expectations for improvement in the cancer delivery plan. There’s no dispute within the wide range of healthcare professionals in tertiary, secondary and primary care services of the need for improvement, or in the real value of having written care plans. It is indeed because people see the whole person, so not just the particular direct impact of cancer in treatment terms, but what that means for that person—their ability to work, their ability to live their life, to make different choices and, actually their prospects for the future. So, it is really important to have that wider discussion and to understand that it will be at different points in time for different people. Some people, at the point of diagnosis, may want to know everything. Other people may want to get out of the room as soon as possible. It’s understandable why that happens, and that’s why a service cannot have a one-size-fits-all approach; it’s about being more agile and for it to be wrapped around that person. It also reiterates the need to have not just primary care and hospital-based care in a proper and constructive relationship with each other, but actually the real value of people in the third sector being able to support people in a different way, in a non-medicalised setting. But I do think that it’s important not to lose sight of the fact that more people are being referred for cancer, more people are being treated for cancer, more people are treated in time for cancer, and more people have better outcomes. More people survive now than ever before, and, actually, on the experience of care, 93 per cent of people have a good experience of cancer care here in Wales. So, more improvement required, I accept that completely, but let’s not try and say that everything is bad here. We have many things to be very proud of.

Julie Morgan

3. Will the Cabinet Secretary provide an update on the extent of injuries caused by dog bites treated in Welsh hospitals? OAQ(5)0210(HWS)

Vaughan Gething

The latest published information for 2015-16 shows 525 hospital admissions across Wales for patients bitten or struck by a dog.

Julie Morgan

I thank the Cabinet Secretary for that information. I understand from the Communication Workers Union that there’ve been 1,750 days lost by Royal Mail staff across the UK during the last year due to dog attacks. There’ve been some terrible injuries to postal staff including fractures, tendon damage, and even amputations. So, I’m grateful that we have those Wales-wide figures, because would he agree that having the figures from the health service will be a help in contributing to assessing the overall picture and informing the view of what actions need to be taken in order to address this growing problem?

Vaughan Gething

Yes, I do agree, and I want to pay tribute to both Julie Morgan and her constituent Councillor Dilwar Ali, for the approach they’ve taken, not just for the individual that’s affected and his family, but actually in seeing a wider issue to campaign on and improve, both for members of the wider public as well as, in particular, postal staff who are largely members of the CWU. This is not, if you like, a laughing matter, where the postie gets a nip and that’s just part of the job; actually this is a real and serious issue. People have real harm caused to them, and not just physical harm, but actually it affects someone’s willingness and ability to do their job. I know that the postal service spend a significant amount of time in trying to identify where there are likely to be dogs that are not controlled and the ability to provide mail to that house and to make sure that workers are properly protected. So, I’m happy that the health service has provided information to help understand the scale and the nature of the problem, the cost to the public purse, the cost to the individual, and the improvement that all of us need to be a part of making. I know that politicians who wander around the country in elections have a small example of what postal workers undertake and the difficulties they face on a regular basis.

Angela Burns

Indeed, Cabinet Secretary, you’re talking to one of the politicians who suffered so only last May. I had a very bad bite on my hand, thanks to a random dog, and had outstanding service at Withybush hospital A&E, who performed a lengthy but significant operation to repair my hand. But above all, I was able to return home and, for the rest of the week, I received treatment three times a day from the acute response team. Indeed, many of my constituents have had the acute response teams respond to them. This is a time-limited, acute nursing intervention for patients within the community to prevent them from having to stay in hospital. One of my constituents had septicaemia and had the acute response team come out to him and look after him, I think, four times a day actually. Cabinet Secretary, could you just give us an overview about the acute response teams and what we might be able to do to promote their use throughout Wales? Because they are a very good way of ensuring that people are not having to stay in beds, freeing up beds for other people, and giving them community treatment in their homes, where they want to be, and they wouldn’t be able to stay there without such a great initiative as an acute response team, such as the one in Hywel Dda.

Vaughan Gething

Well, it’s a good example of the fact that within each of our health boards there are examples of real excellence, and the drive is to have more care delivered closer to home, which means people don’t need to stay unnecessarily within a hospital setting. Again, the point is that significant areas of activity that would previously have been undertaken by doctors are now undertaken by different staff. Having a nurse-led intervention is a good example of, and another example of, the sort of reform we want to see in our service, delivered progressively, that isn’t about bricks and mortar, but is about how we make better use of our staff in different settings. I think it’s what we need to do, and there is an expectation within the public, and I think there’s a real desire amongst the staff themselves to design new models of care to do just that.

Mohammad Asghar

4. What action will the Cabinet Secretary take to improve services for cancer patients in Wales in 2017? OAQ(5)0197(HWS)

Vaughan Gething

Thank you for the question. The Welsh Government’s intentions were set out in November last year in the updated ‘Cancer Delivery Plan for Wales’. Through the national implementation group, there will be a focus on early diagnosis and health boards will continue to prioritise cancer waiting times.

Mohammad Asghar

Thank you very much for the reply, Cabinet Secretary. During the general election in 2010, Labour promised to provide every cancer patient in Wales with a key worker by 2011. However, the recent Wales cancer patient experience survey found that 14 per cent of respondents still do not have a key worker. Also, it is not mandatory for Public Health Wales to collect data on key workers. What action will the Cabinet Secretary take to ensure that these vital data are collected and when does he expect that cancer patients in Wales will receive the level of care promised back in 2010? I think six to seven years is much longer than our term and the promise should be fulfilled. Thank you.

Vaughan Gething

Well, in answer to the question from the UKIP spokesperson, I again indicated that, from 2013, 66 per cent of cancer patients had a key worker, and, okay, that’s risen to 86 per cent in the most recent survey. So, significant progress and yet more to do, as I previously indicated. Currently, the key worker information’s held within the cancer information system, otherwise known as Canisc. And we do know that needs to be replaced, and so it should then make it easier to understand a range of these areas. Rather than asking health boards to do it manually or to invent a different system to collect the information on key workers, I’m interested in getting a proper approach to collect and allow us to interrogate those data in a meaningful way, not just about key workers, but on a number of other areas. So, that work is being undertaken by the Wales cancer network and by officials across the Government. So, this is an area where I think we can be proud of the progress we’ve made, but as I say, and I regularly say, we still recognise there is more for us to do.

Dawn Bowden

Cabinet Secretary, the cross-party group on asbestos received a presentation at its meeting in May on immunotherapy as a potential treatment in mesothelioma, including the SKOPOS trial at Velindre, looking at how a vaccine called TroVax may work alongside chemotherapy for those who suffer from pleural mesothelioma. Funding for this research runs out in August of this year and there’s concern that the immunotherapy research being carried out in Leicester university, which is heavily dependent on the trial work carried out by the Cardiff research group, could be compromised. Do you agree with me, Cabinet Secretary, this is pioneering work being carried out in Velindre, and is key to identifying new ways of treating mesothelioma? And can you assure me that you’ll look at what funding can be provided to ensure that this work can continue beyond August?

Vaughan Gething

I thank the Member for raising the issue. Mesothelioma is something that I’m particularly interested in. Without wishing to go over my previous role, somebody else in the Chamber and I were lawyers before coming to this place and we actually dealt with and worked on a number of mesothelioma cases. Meeting members of the family and having to witness appeals was particularly striking at times—a very difficult experience to go through, because mesothelioma is, to date, always fatal. The path to the end is a quick and a distressing one. So, I’m particularly interested in research to potentially not just extend life, but save life as well. I’d be grateful, actually, if the Member would write to me. I’d be happy to discuss the matter with her in more detail—I understand you are the chair of the cross-party group—to understand where we are now and the approach that we’ll take with other parts of the UK in helping to improve outcomes in the future.

Jayne Bryant

5. Will the Cabinet Secretary provide an update on the progress of clinical research and innovation in the Welsh NHS? OAQ(5)0199(HWS)

Vaughan Gething

Thank you for the question. Research and innovation are key criteria for university health board designations in Wales and form part of the NHS Wales planning framework. As a Government, we have committed over £29 million in this financial year to continue our investment in high-quality research and technology-focused innovation within the NHS.

Jayne Bryant

Thank you, Cabinet Secretary. The clinical research innovation centre at St Woolos Hospital is an excellent example of investment by Aneurin Bevan health board that allows researchers and staff to participate in groundbreaking research in areas including dementia, diabetes and cancer. Last year, over 17,000 participants participated in nearly 480 clinical research studies, which helps researchers develop new treatments and ensures that patients have access to those closer to home. What plans does the Cabinet Secretary have to work with the centre, health boards and others to ensure that support and encouragement of patients, carers and staff fully embrace research and make it a core activity within the NHS in Wales?

Vaughan Gething

I thank the Member for the question. I enjoyed our visits—well, my visits—to your constituency to meet staff within the Aneurin Bevan university health board. I was struck by the range of activity that was being undertaken. That’s part of the £21 million that we fund through Health and Care Research Wales. The additional £8 million, when I refer to the £29 million, comes from the Efficiency Through Technology fund. There’s a range of different routes to getting there. But, actually, this is really important for not just having staff who are committed and who want to understand what more they can do, but actually to improve outcomes and the quality of care that is delivered. As I said, it is a key part of university health board designation and status. It also forms part of the criteria for approving or not approving an integrated medium-term plan. So, this is embedded within our planning framework, and I expect to see it in our regular meetings with chairs, in their appraisals, to make sure that research and innovation are a key part of what the health boards are actually undertaking today, to ensure that we improve healthcare for tomorrow.

Nick Ramsay

Cabinet Secretary, it was a pleasure accompanying you to the turf-cutting ceremony at the new critical care centre, now known as the Grange university hospital, on Monday in Cwmbran. I did tweet a nice picture of us, with you with a shovel digging the foundations. This new hospital has been a long time in the pipeline, as we know, and you have the virtue of being the Minister who actually got to cut the turf—many of your predecessors didn’t get around to doing that. But, would you agree with me that it’s more than just about the building? We want to see that the new hospital develops into a world-class centre of excellence and innovation. I know it was once considered as a possible centre for neuroscience, but I think that fell by the wayside. So, what work are you doing, and is the Welsh Government doing, to ensure that when the new hospital does finally open—hopefully in a few years’ time—that it really will be a hospital that will be world class, that will be something that the people of south Wales can be really proud of, and that will attract the brightest and best medical staff?

Vaughan Gething

I think it should make a real and significant difference in remodelling healthcare right across the Gwent area and beyond. It’s due to open, as you know, in spring 2021, when the Grange university hospital should be open for business. It’s important, in terms of the question that Jayne Bryant asked and the point that you make, to understand that the way in which we deliver services isn’t simply about delivering excellent healthcare—research and innovation have to take place alongside and through that as well. So, I do expect there to be a keen focus on research and innovation when that hospital opens, not just at the point of opening but throughout the period of time, because that is part of attracting and retaining staff there. So, for example, the moves that have already been made to have a hyperacute stroke unit, currently based in the Royal Gwent—a lot of that is actually about having a different service model that has allowed it to attract, recruit and retain high-quality staff who would not otherwise have come into an old model of care. The research that is already ongoing there should be carried forward within a new model of delivering healthcare as well. So, for me, it’s a key part of what we’re investing in for the future, not just the bricks and the mortar.

Dai Lloyd

Cabinet Secretary, what are you doing to promote clinical research in rural health here in Wales?

Vaughan Gething

Interestingly, I’ve had a range of conversations with people in the mid Wales collaborative, with Aberystwyth University and with Bronglais hospital, but also I attended last week the research and innovation day at Trinity college Carmarthen, which looked at a range of research and innovation activities right across the Hywel Dda health board area. There’s a very clear signal from this Government that we expect that work to continue, because there are a number of people who want to undertake activities in areas where they know they’ll have to work, effectively, in an urban area or in a city-based service, but there are lots of other people who specifically want to work in rural medicine. We need to make sure that our service doesn’t just provide the services people who live in rural communities want to undertake, but that we understand the best-quality evidence that is available about how to deliver that service safely and securely in a way that values the choices people make to live in rural communities so that they receive high-quality healthcare too.

Neil Hamilton

6. Will the Cabinet Secretary make a statement on the current provision of general practices in Wales? OAQ(5)0202(HWS)

Vaughan Gething

Thank you. We are committed to high-quality general practice as a core part of a modern primary care service. Investment in general medical services will increase by £27 million in this financial year. This, together with £40 million for primary care estates and our £43 million primary care fund, supports the ongoing provision of sustainable and high-quality general practice.

Neil Hamilton

I’m grateful for that reply, but the Cabinet Secretary will know that the national survey for Wales found that 39 per cent of respondents find it difficult to make a convenient appointment to see a GP, and 62 per cent overall were not satisfied with the service provided by the NHS in Wales. Since 2004, as a proportion of NHS funding, general practice has declined from 10 per cent of the total to 8 per cent—admittedly, that’s gone up recently—but the British Medical Association say that in order to get to a satisfactory position, this should be 12 per cent of what we currently spend on the NHS. Can the Cabinet Secretary give us an idea of what response he would make to the BMA about that figure?

Vaughan Gething

To be fair, this is the general practice committee of the BMA. I’m robustly confident that clinicians in secondary care would not wish to see a significant resource transfer between secondary and primary care. That is an honest part of our challenge: as we increase the money going into the health service—as I said earlier, at a painful and significant cost to other parts of public spending activity here in Wales—when you think about how and where we’ll invest that money, the honest truth is that delivering services in secondary care is more expensive than delivering services in primary care. So, even as we invest in trying to deliver more care closer to home—the example that Angela Burns gave earlier—that doesn’t always have the same cost attached, for example, as the significant capital you need to invest in a new generation of radiologists. So, there are honest choices to make here. What I’m determined to do is, as services move and are reconfigured, that funding is provided to make sure that that service is properly and adequately resourced. I don’t think it’s helpful to try and stick to a percentage figure within the NHS budget as the aim and the objective. The aim and the objective must be to deliver the right care at the right time in the right place, and with the right resources to allow people to do so.

David Melding

Cabinet Secretary, when it comes to mental health services, there is evidence that good counselling services can prevent repeat GP attendances, and they have a proven track record of helping and managing and even alleviating mild to moderate symptoms. I do think this sort of innovation is something we need to see more of in the NHS, particularly if we want to retain more GPs, perhaps some of the older ones who are thinking about retirement, of which there are quite a large number in Wales. This is just an example of how we can help balance the workload and use GPs at their best for the actual sharp end of the service that’s required.

Vaughan Gething

I agree that we need to consider how we make best use of professionals within the service, and outside the service as well. It’s a significant part of a GP’s caseload, actually, those sort of moderate to lower level mental health challenges that bring people through their doors. And it’s part of the reason why lots of primary care clusters are investing in counselling services with the resources that we’ve made available to them. Mental health and therapy services are some of the more significant and consistent areas, together with pharmacy, for that cluster investment. And it is about that general sense of well-being and how we actually address that as well. Sometimes, that is not a medical intervention. So, for example, when we think about social prescribing, much of that is actually about improving mental health and well-being as an alternative to, if you like, a formal talking therapy or, indeed, medication. That’s also why this Government has recommitted in our programme for government to undertaking a significant social prescribing pilot that we think will provide us with significant information on how to develop a service for the future that should make a real difference to mental health and well-being. And, obviously, we’ll look again, in a year or so, at the practice of Valleys Steps, which we think has made a real difference in this area already.

Sian Gwenllian

The Dolwenith surgery in Penygroes is closing at the end of the month and nobody will replace the GP who’s retiring. He was the only one providing Welsh-medium services in an area of 5,000 people where three quarters are Welsh speakers. The valley will have fewer doctors per head than the Welsh average and yesterday, in a very poor statement, you said that you wouldn’t be establishing a medical school in Bangor. How many other surgeries have to close? How many other locums will you have to pay a great deal for before you realise that a medical school is the only sustainable way of resolving the health crisis that faces us in north Wales?

Vaughan Gething

Well, I don’t share the points that you make, and I think we could either have a conversation where we’ll continue to talk about how we deliver more medical education and training, and more healthcare professionals in every part of the country that needs them—north Wales, mid and west Wales and south Wales, too—or we could go through a rather formulaic, ‘You are responsible, it’s all your fault and I’m disappointed’. I don’t think that gets us very far. I’m happy to have a row if there’s a need to have a row, but I don’t think this is the area to do that. I actually think that the decision that we made yesterday was based on a proper evidence base about the right thing to do. I am concerned about our ability to recruit, retain, and attract people to work within the health service in Wales. That’s why the incentives, for example, on GP training in north-west and north-east Wales—we’ve filled those areas that were hard to recruit to previously. So, I do take seriously the whole model of care that we provide, but I don’t share the tone or the content of the remarks you make. I’m committed to delivering a proper health—[Interruption.]—a proper health service for communities right across Wales, including north Wales, and I resent the implication and accusation that I do not care about one part of Wales.