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8. Plaid Cymru Debate: NHS Workforce

October 04, 2017

35 speeches by…

  • Elin Jones
  • Rhun ap Iowerth
  • Vaughan Gething
  • Mark Reckless
  • Dai Lloyd
  • Rhiannon Passmore
  • Sian Gwenllian
  • Caroline Jones
  • Llyr Huws Gruffydd

Elin Jones

That brings us to the Plaid Cymru debate on the NHS workforce. I call on Rhun ap Iorwerth to move the motion.

Rhun ap Iowerth

Thank you very much, Llywydd. One of our most valuable treasures, which is appreciated over and above every other public service in Wales, I’m sure I’m right in saying, is the health service, the NHS, and the most valuable resource of the NHS is its workforce—those people who, through a combination of their skills and their commitment, ensure that each and every one of us can get the best possible care when we need it most. One of the greatest duties that the Welsh Government has is to ensure that that workforce gets the support necessary, is planned properly so that we have the right people in the right places with the right skills in order to care for patients, and so there are sufficient numbers of people encouraged to come into the health service, and that they are getting the best possible training to make it a sustainable service for the future. Unfortunately, we do know that there are major weaknesses in the workforce planning at present, which creates real problems and threatens the ability of the NHS to make provision for the people of Wales. Some of you will have seen news reports this week, following Plaid Cymru research into risk registers of the Welsh health boards, where each and every one of them identifies workforce shortages—shortages of doctors, shortages of nurses—as real risks at the highest level. The risk reports of the health boards are sobering, talking about the inability to provide services or patients facing a risk of avoidable harm. Now, this afternoon, we will pursue some of the different elements of workforce planning that we believe need to be prioritised far more than we are currently seeing from the Labour Government. Welsh patients, NHS staff, now and in the future, deserve better. I will first of all try and paint a picture of where we are at present, and some of my fellow Members will expand on many aspects of workforce planning and the impact of having the unsustainable workforce that we currently have. Wales has one of the lowest levels in Europe of doctors per capita. A shortage in a number of areas of expertise, including in paediatrics and obstetrics, has led to a loss of some of these services in certain areas, with services being centralised in others and turning to nurse-led provision in other circumstances. The outcomes include longer waiting times, cancelled treatments and a lack of Welsh-speaking staff, having a very real impact on patients and outcomes for patients who want to have a Welsh-language service. In questions to the Cabinet Secretary earlier, I highlighted specifically the fact that thrombectomy had been withdrawn in Cardiff just nine months after it had been introduced, because staff had been lost and there were no replacements for them. Primary care is facing grave challenges—recruitment problems, retention of staff leading to longer waiting times for appointments, and unacceptable pressure being put on those GPs that we have, and that is a reducing number of GPs. The number of GPs has declined in absolute terms from 2,026 to 2,009 over the last three years. Now, that’s only a decline of 25, but when you consider that more and more people are choosing to work part-time, then the full-time equivalent number of GPs is likely to have declined at a far greater rate, and that full-time equivalent figure isn’t published any longer, since 2013, because of concern about the quality of data. But we need that data to know exactly where we stand. Consider then that a quarter of all our GPs are within a decade of retirement age, and the scale of the problem facing us comes into clearer focus. Dr Eamonn Jessup, the chair of the local medical committee for north Wales, said recently that he was concerned about the sustainability of one in three GP practices in north Wales. Full-time staff shortages are leading to huge costs, too—the costs of locums and agency workers is now around £150 million per annum and is increasing; it’s £44 million per annum in the Betsi Cadwaladr health board alone, up from £31 million in just a matter of three years. So, we need more doctors. But at the same time, we have seen a reduction of 13 per cent last year in the number of students from Wales who applied to study medicine. There was a 1 per cent decline across Britain. Only some 30 per cent of medical students in Wales come from Wales compared with 85 per cent of medical students in Northern Ireland coming from Northern Ireland, a figure of 80 per cent in England and 55 per cent in Scotland. Now, I’ve reiterated these figures time and time again, but it does show a dreadful situation. We desperately need more doctors, but can’t encourage our young people to consider medicine as a career, or not enough of them, and then we can’t find placements for them to study here in Wales. Sian will expand upon that, including our call for the development of undergraduate medical education in Bangor. Are we training more GPs given that we are desperate for more of them? Although the pressure on primary care has increased significantly over the past decade, the target for the number that we want to train has remained static—136. In England, the target has increased 30 per cent because they realise the scale of the problem. We too need to set higher targets. I will turn to nursing. On ITV news yesterday, in response to the Plaid Cymru research that I mentioned earlier on risk registers, Tina Donnelly from the Royal College of Nursing said, ‘If you're saying that an extreme risk is that you have got a shortage of nursing staff, then the responsibility would be to close beds because you should not be operating at that level where you are knowingly staffing your wards with insufficient staffing levels because that will compromise patient safety. And that is unacceptable.’ This is what Hywel Dda’s risk register says: ‘There is a risk of: Avoidable harm to patients, avoidable detriment to the quality of patient care and delays in A&E pathway. This is caused by: Lack of Registered Nurses leading to unsafe staffing levels in Emergency Departments.’ and ‘Baseline staffing levels not meeting NICE guidelines. Vacancies within registered nurse establishments.’ A study of UK wards by Professor Anne Marie Rafferty found that mortality increased by 26 per cent on wards with lower nurse staffing levels. In California, where a safe staffing law was introduced, mortality rates for 30 days fell by 10 to 13 per cent. A 2011 review of RCN members showed that 25 per cent of RCN members were not receiving continuous professional development, and in 2013, that rose to 43 per cent. Many LHBs have placed a moratorium on nursing staff being allowed to undertake any training. Welsh nurses are less likely to have received so-called mandatory training—we’re talking about equipment training, moving and handling, infection control—than in any other UK country. And 9.7 per cent in 2013 had received no such training at all—almost double the figure for the UK as a whole. This paints a really bleak picture of an NHS where nursing staff aren’t being given the supports that they need, and that is bad for patients. The chief nursing officer’s guidance recommends a ratio of one registered nurse to seven patients cared for on medical and surgical wards—1:11 at nights. The responses to a recent Royal College of Midwives survey of members indicates that, on average, 9.7 patients to one registered nurse on day shifts in Wales. Eighty-five per cent of the respondents reported more than seven patients to one registered nurse. That’s not good enough. Other survey findings: only 55 per cent of nurses felt satisfied with the care they could give; 32 per cent felt they had enough time to care for patients. I could go on. We already have accepted the principle, through legislation here, of the need to ensure safe staffing levels. We cannot let slip the need to get the right number of nurses with the right training, the right support, in order to give patients the care that they need. I’ll leave it there for now. We’ll have more from my Plaid Cymru colleagues here. In 2014, we launched a detailed policy paper on how we would train and recruit 1,000 extra doctors. A 10-year plan, with marginal gains, involving a range of policies: financial incentives; making the NHS more attractive for doctors to work; investments in medical education and training, including the development of medical training in the north. In 2016, we added the training and recruitment of 5,000 nurses and midwives over a 10-year period. We know this can’t be done overnight, but we need to be setting a trajectory. Now, this is a challenge, and these are challenges for Government. I’m looking forward to the debate this afternoon, looking forward to the response from the Cabinet Secretary, because I can tell you, lots of people working hard in the NHS in Wales are looking for far better from the Government and workforce planning than what they currently see.

Elin Jones

I have selected the two amendments to the motion. I call on the Cabinet Secretary for health to move formally amendment 1, tabled in the name of Jane Hutt.

Elin Jones

I call on Mark Reckless to move amendment 2, tabled in the name of Paul Davies. Mark Reckless.

Mark Reckless

I move the amendment in the name of Paul Davies. When I raised NHS work planning two weeks ago at First Minister’s questions, I questioned why, after 20 years of Labour running Wales, there are still Welsh Government reports that say substantial work is needed for medical recruitment and retention to be fit for purpose. The First Minister didn’t answer me then, and the Cabinet Secretary can say he’s only been in post a year, but Labour can’t say that they haven’t had time to implement a plan. They’ve been in charge of Wales for 20 years. Powers were devolved by Labour to Labour. It is Labour in Wales that decided to prioritise their friends in local government instead of the NHS, and there’s therefore no-one to blame for gaps in the Welsh NHS except for Labour. Despite that, they’ll no doubt try and blame the Conservatives at Westminster, yet the youngest Welsh-trained doctor or nurse, for whose training the Conservative Party would be responsible, is now 38 years old. It’s Welsh Government who must answer for why 187 more doctors and 287 more nurses have left the Welsh NHS in the last 10 months than have joined it. It’s not enough for the Government just to note, in its amendment, shortage of health professionals. They need to accept they are responsible. For the first four years of the Assembly, the Welsh Government was directly responsible for NHS workforce planning. Since then, they’ve tried a variety of approaches and structures with an alphabet soup of different bodies that have been involved. I really hope that the approach now proposed by the health Cabinet Secretary of a special health authority for workforce planning is more successful than what went before. I’ve three questions I specifically want to put to him if he is able to address at the end of the debate about those plans. The first: when push comes to shove, will the special health authority really be independent or will it do what it’s told by the Cabinet Secretary? The second: how will the Cabinet Secretary ensure that the special health authority has the confidence of those who work in the NHS? Why is it, given the Mel Evans and Professor Williams reports, that there is such concern? I accept what he said earlier—that it will not be a representative body—but does he understand the extent of the concern, not least from Royal College of Nursing, about this, which is referred to in our amendment? And what will he do to meet those concerns? Finally, how will we know, at the end of the Assembly term, whether NHS workforce planning is working? And will he accept responsibility if it’s not?

Dai Lloyd

Again, it’s a pleasure to take part in this debate about NHS workforce issues, and, obviously, I’ll concentrate on doctors and nurses, the parts that I know most about. Obviously, we’re all very well aware of GP shortages. The Royal College of General Practitioners’s figures show about 400 vacant GP post in Wales today. Whenever practices advertise for a new GP, sometimes they get no applications whatsoever. It’s very difficult to have fill posts nowadays. Now, it wasn’t always like this. I’m significantly older than the medical student age quoted by Mark Reckless, and, back in the day, being a general practitioner was a chosen occupation. In other words, there was a queue of people, and you had to really fight hard to get a GP post, back in the early 1980s. So, it wasn’t always like this, but lots of things have changed. One of the things that changed, obviously, was that the Conservatives in 1990 brought in the internal market and completely wrecked the workforce planning we had in the NHS for the 1960s, the 1970s and the 1980s. We still haven’t fully recovered the ground. Now, general practice itself has changed, obviously. It is now relentless and unremitting. Again, back in the 1980s and 1990s—

Mark Reckless

Is he really saying that the entire problem we have with workforce planning and shortages in the NHS, including GPs in Wales, is due to a period of seven years from 1990 to 1997?

Dai Lloyd

It’s my second language, but I did not say that, all right. [Laughter.] But the rot set in in 1990, because we had national workforce planning up to that point, and it was destroyed by the competition of the internal market. We’re regaining things now, slowly, but we still haven’t regained the lost ground. So, now, general practice is relentless, unremitting, with complicated cases that need sorting out every 10 minutes throughout the working day—50 or 60 patients, each with complicated problems—because the simpler issues have been triaged out to be seen by fellow health professionals. So, how does this affect patients who have great difficulty getting to see a GP, then? Increasingly long waits for routine appointments, no guarantee of seeing your GP, who you’ve been seeing for years, and there’s not always a practice nurse available, because there’s a nursing shortage as well. That means, at the end of the day, increasing A&E attendances as well. A lack of district nurses means, usually, as a patient, you get to see several different nurses now, and not just the one or two familiar faces that used to be when each GP practice had a guaranteed district nurse attached. That is no longer the case, because we haven’t got enough district nurses. Now, our patients are very well aware of this overstretched situation. It transmits to our patients, and some of them don’t call us when they should, and that is to their detriment as well. So, what needs to happen? Well, it is about, as alluded to by Rhun, recruitment and retention. If I go on, the retention of nurses and doctors is about those terms and conditions. It is about removing the pay cap for NHS workers, especially nurses. It’s about recognising the commitment, altruism and hard work, going the extra mile, of nurses, doctors, porters, physiotherapists, OTs and all the rest—being appreciated and valued by human resources management in our hospitals, which is now not always the case, so that staff don’t feel exploited, overworked, pressurised into working extra shifts to plug rota gaps, always having to fight for time off to study, to sit exams or to do research. Doctors have lost their doctors’ mess, where they used to talk with colleagues about issues, on call. They’re no longer in fixed teams, the old firm has gone—they’re always on call with different doctors. There are never enough beds. All of that sort of stuff builds intolerable pressure when you’re making life-and-death decisions that you’ve got no time to revisit. With a duty of candour—excellent—to always tell the truth—fantastic—how does that square with the treatment of whistleblowers, as whistleblowing, despite all the warm words, can still turn out to be career ending? That’s one of the issues that also our juniors are telling us and our nurses are telling us. But even if we stemmed all that haemorrhage of highly qualified nurses and doctors leaving the NHS now, and had full retention—even if we did all that, we just don’t train enough doctors and nurses in the first place. Even if every doctor graduating from Cardiff and Swansea stayed in Wales, stayed in the NHS, we haven’t got enough junior doctors and GPs now. We need to train more in the first place. As well as sorting out the retention issues, we need to train more in the first place. That’s why we need a new medical school in Bangor. That’s why we could double the medical students graduating from Swansea—you know, spread the load around. We need to train more doctors, especially for rural areas, for Welsh-speaking areas, to augment the already excellent training at Swansea and Cardiff now. Diolch yn fawr.

Rhiannon Passmore

I rise to support the amendments to the motion that have been tabled by the leader of the house, the Member for the Vale of Glamorgan. The national health service is one of the greatest creations of any democratically elected Government in the history of humanity. It is globally recognised as the optimum model of care. We, on these Welsh Labour benches, laud the achievements of the 1945 Labour Government in creating the national health service for succeeding generations to enjoy. I remember the story of my grandfather, a miner in the Valleys, who told me that when he went to the financial assistance board to beg for funding for his pregnant wife, he was refused and he went home, and she died. And this was the days before the national health service. In the two decades since the Welsh people voted for devolution, the Welsh Labour Government has taken it as a solemn obligation to the people of Wales to ensure that the Welsh national health service stays true to the principles of Nye Bevan and those Labour visionaries who created it. We have put our money where our mouth is. Moreover we also, though, fully recognise, as has the Cabinet Secretary today, that there are shortages in particular fields in a number of areas, reflecting the pattern across the United Kingdom’s national health service. It was once said that true perfection is imperfect, and those sages from Manchester, the Gallagher brothers of Oasis fame, were right—the NHS epitomises this—it is perfect because it is imperfect. The NHS serves human beings who all share one common feature, and that is their mortality. Sickness, illness and eventual death will be the fate of everybody in this Chamber. Even the very strong and stable Theresa May today, at the end of the Tory conference, betrayed her humanity with an inept defence of capitalism that could just be deciphered through her repeated hacking and coughing, and I wish her a speedy recovery—although you’ll forgive me if I hope that she really does get a P45 as soon as possible, for the health and well-being of the people of Wales. Thanks to investment by the Welsh Labour Government, there are now more doctors and nurses in Wales than ever before. Between the establishment of the National Assembly in 1999 and 2016, we have seen a 44 per cent increase in the number of nurses, an 88 per cent increase in the number of consultants, and a 12 per cent increase in the number of GPs in Wales. Thanks to Welsh Labour, more is now being invested in healthcare than ever before. Wales spends £160 more per person on health and social services combined than in England. And this investment has led to the NHS in Wales treating more than ever before, faster than ever before, as more GPs and other healthcare professionals fill roles across Wales. Claims about staffing issues in Wales are also very rich coming from the Tory UK Government, which has slashed the Welsh Labour Government's overall budget by £1.2 billion compared to 2010-11, and has cut social care spending in England by £4.6 billion. Let us think about that cut to the Welsh Government’s budget over the last seven years of Tory failed austerity Government: £1.2 billion to date, with more to come. It’s a bit rich, isn’t it? When needed, the Tory Chancellor, ‘Spreadsheet Phil’, can suddenly discover a magic money tree and shake it for £1 billion to give to the DUP, to keep a tired and failed Government in office on borrowed time. And I know it’s an inconvenient truth for some Members here, but every time the Welsh people are asked who they want to govern them, the Welsh people speak clearly and they vote Welsh Labour, and it’s a trust that we do not take for granted. That is why I know the Cabinet Secretary for health, who is a very talented Welsh Labour colleague, the Member for Cardiff South and Penarth, devotes his energy daily to ensure that the Welsh national health service is agile to meet the ever-increasing demands of an aging population. I am proud that Welsh Labour have invested in the nurse training bursary when England has cut this route to a very, very ancient and valued profession. I want to conclude by thanking the dedicated men and women of the national health service—the doctors, the nurses, the paramedics—who commit themselves to one of the greatest endeavours any Government has undertaken: safeguarding the health and well-being of our people, and we in Welsh Labour will support them. Diolch.

Sian Gwenllian

We do face a crisis in Wales in terms of the number of doctors. That’s very clear, and the crisis does exist in the wake of the failure of the Government to plan the workforce and to train new doctors, as well as recruiting from other countries. Plaid Cymru is a party that is striving to offer solutions to the problems that we face here in Wales, and this crisis is at its worst in north Wales. In May 2017, 141 jobs in Betsi Cadwaladr University Local Health Board were vacant, which represents 37 per cent of all the vacant posts in NHS Wales. Therefore, the solution is obvious: establishing a new medical school in north Wales in order to train a new generation of doctors for the benefit of the sustainability of the health service in the long term. But, unfortunately, the Labour Party is still stubbornly rejecting this idea, despite all the evidence and the opinions of experts, as we’ve outlined in our report, ‘Tackling the Crisis’. There’s been talk about the cost, and I’ve dealt with the cost previously in this Chamber, so I’m not going to expand on that but just remind you of this: over the last three years, Betsi Cadwaladr spent more than £80 million on locum doctors. Then, last week, the First Minister said this, in this place, ‘We know it would be difficult’— That is, difficult to set up a medical centre in Bangor— ‘because big medical schools are in big cities with big hospitals, which have a far greater spread of specialities.’ More excuses. The problem is that the Government is missing the point entirely here, because the three hospitals across north Wales would train students on work placements, and they would receive training in the community as well. The University Hospital of Wales in Cardiff has only 800 beds, but the university has 1,500 medical students. The university uses other hospitals across the region, just as a medical school in Bangor would use all the facilities available across north Wales. Ireland has seven medical schools, and there are five in Scotland, which suggests that one medical school per 1 million of the population is practical. A third medical school in Wales would correspond to the structures in Ireland and Scotland. Betsi Cadwaladr health board has the largest population of all of Wales’s health boards, with almost 700,000 people. Add the population of other rural counties of Wales, and you will reach a figure of 1 million people. The First Minister has also claimed that a lack of diversity and expertise in north Wales exists. Apart from extremely specialist work, like cardiothoracic and neurosurgery, then we have everything else required in north Wales, and it would be easy to actually teach those two areas of expertise with some vision. Labour’s support—or the lack of Labour’s support—is starting to become a joke, and the excuses are very poor indeed. Many universities in England and across the world have small hospitals nearby, for example, Lancaster and Keele. In a small town called Salina, some three hours from Kansas City in the United States, there is a medical school that has been established with the intention of ensuring that the graduates serve in rural areas once they’ve graduated. The reality of the situation is that none of the Government’s claims stack up. With ambition and strong leadership, this Government could tackle the crisis in north Wales—the crisis that exists because of a shortage of doctors and medical staff. The Government has to be willing to be innovative, to listen to evidence and to put parochialism aside.

Caroline Jones

I’d like to thank Plaid Cymru for bringing about this debate and the opportunity to speak in it. I agree with the sentiment behind this motion. Staff shortages within the NHS are detrimental to patient care. Not a day goes by when we aren’t confronted by news articles outlining the impact that staff shortages are having on NHS Wales. We have seen a 400 per cent increase in the number of patients waiting more than a year for surgery, and 39 per cent of Welsh people find it difficult to make a GP appointment. It’s not just the impact that staff shortages have on the patient, we have to consider the impact this has on NHS employees. Staff shortages put additional pressure on existing staff. In my experience, throughout the recess period, as I highlighted, there was a hospital within my region where staff were extremely short on the cardiac unit—so much so that they were asking a member of staff to double back and do a double shift. So, in order to meet this demand, our hardworking and dedicated NHS staff are forced to work longer and spend less time with patients. This is affecting staff morale and more and more staff are leaving the NHS, exacerbating the situation. Over 5 per cent of hospital staff are on sick leave and health boards are forced to rely on expensive agency staff to make up the shortfall. As a result, spending on agency nurses and locum doctors has skyrocketed and has forced many health boards to overspend. Lack of proper workforce planning over the last few decades has left us in a perilous situation. We have recruitment shortages in all specialties, and yet demand for services is rising. We are not yet in a situation where patient safety is routinely put at risk, but unless we can plug the gap then that will become the case. According to the Royal College of GPs, almost a quarter of the GP workforce could retire in the next 10 years. They are calling for an increase in the number of GP training places, to rise to 200 per year. When you consider we had only 127 training places this year, this shows you the scale of the problem facing us. Yesterday, we heard the news that stroke patients in south Wales, as has been highlighted by Rhun, are being denied the best available treatment because of the three radiologists able to perform a thrombectomy: one has retired, one is on sick leave, and the third has accepted a job elsewhere. A shortage of radiologists means that we have more and more people waiting longer and longer for diagnostic tests. We also have to ensure that any changes we introduce to health and social care do not place extra burdens upon existing staff. The Welsh Government’s proposals for phase 2 implementation of the Regulation and Inspection of Social Care (Wales) Act 2016 will see the removal of the requirement to have a minimum number of nurses in care homes that provide nursing care. This will have a detrimental impact on other services such as district nursing, which are already struggling to meet demand that massively outstrips capacity. We are approaching a crisis point and I look forward to hearing how the Welsh Government plan to approach workforce planning in the future. We need a medical recruitment campaign that prioritises domestic students and encourages young people in Wales to become radiologists, psychologists, physiotherapists, and the whole raft of healthcare professionals, not just nurses and doctors. We need to plan for an ageing population and an ageing workforce. And, above all, we need to plan for a workforce that can meet future demand and deliver patient care that is safe, effective and affordable. The growing reliance on expensive agency staff and locum doctors—

Caroline Jones

I will in a minute—is unsustainable and I urge the Welsh Government to plan for greater use of staff banks. With these points in mind, UKIP will be supporting the motion as well as the Welsh Conservative amendment. We will be abstaining on the Welsh Government’s amendment as it does recognise the impact shortages have on our dedicated NHS staff, but fails to address the issue. I’d also like to ask you a question, if I may, Rhianon. Am I allowed to?

Llyr Huws Gruffydd

Thank you, Llywydd. I just want to spend a few moments talking about one important aspect of this debate, one that Rhun made reference to earlier: the availability of services through the medium of Welsh, because if we think there is a problem—and there is a problem in terms of the numbers of doctors and nurses and other healthcare professionals—then you can just imagine how much greater the problem is in terms of the availability of those health professionals who can provide services through the medium of Welsh. I’m sure that many of us will have dealt with casework— regularly in my case, and I’m sure this is the case for others too—where parents are trying to access healthcare services for their children, and can’t get hold of the practitioners who can provide those services through the medium of Welsh. As it happens, this very morning, the Children, Young People and Education Committee were dealing with Stage 2 amendments on the additional learning needs Bill, and during the course of developing recommendations at Stage 1 proceedings, we had broad-ranging evidence on the lack of availability of Welsh language services in that particular area. That is a very clear signal to us that the workforce planning, as it has been taking place over the past few years, has been a failure. We, as a committee, are now finding ourselves in a position where we are proposing amendments to put on the face of the legislation some expectations in terms of workforce planning and the availability of Welsh-medium practitioners. Now, that isn’t the way to plan the workforce, but we find ourselves, to all intents and purposes, having to do that through the back door in order to meet the demand that’s out there, and demand that this Welsh Government and previous Governments have failed to address. There are, of course, cases that have been raised recently and have been given some coverage in the press where there is a shortage of GPs. There is the Dolwenith surgery in Penygroes, and we all heard the story of its closure: the only doctor who was a Welsh speaker in the area was leaving and there was no Welsh-medium provision available as a result. I want to mention rural areas too, because in rural Wales, GPs, on average, are older, are closer to retirement age, and recruitment levels are also lower, so the problem is exacerbated. I was looking at some of the statistics, and they tell their own story: a total of 54 per cent of core medical training places were unfilled in hospitals in Betsi Cadwaladr and Hywel Dda health boards, compared to just around half that level, 23.6 per cent, in other Welsh health boards. Sian Gwenllian, earlier in this debate, referred to vacancy levels: 37 per cent of all the vacancies listed were in Betsi Cadwaladr, despite Betsi, of course, only serving around 22 per cent of the population of Wales. As an Assembly Member representing the North Wales region, then I am particularly concerned about the situation there. And the largest hospital in north Wales, of course, Wrexham Maelor Hospital—this is something I raised with the First Minister earlier this week—currently, there are 92 vacancies for nurses in that hospital and, as a result, we’re now seeing some specialist nurses having to work on general wards. The Royal College of Nursing are concerned that wards might have to close. A growing number of those nurses who are working there are approaching retirement age, and just as we’ve seen with GPs in Wrexham and other places actually, many are opting to retire early after many years of service. Betsi Cadwaladr board have engaged a private agency to recruit abroad in Barcelona and in India in recent years, and many nurses recruited in Barcelona were unable to work for some time due to their language limitations, and they’ve largely now returned home. Only four nurses from India have passed the language test. All of this feels more like a short-term panic measure and not the long-term, thought-out strategy that we should have in place for north Wales and other parts of the country. You know, Betsi Cadwaladr has been for the past two and a half years in special measures, so the Government has to accept responsibility for failing to adequately plan to ensure enough nurses are trained and recruited here in north Wales. And we also need, of course, to focus more on retention and returnees, as well as ensuring that new recruits come through. To make things worse, I have to say, Glyndŵr University, less than half a mile from the Maelor—practically across the road—has now started to train nurses on a new course, a full slate, 35 trainee nurses have enrolled this year, which is great news, but none of these trainees will go on placements within Betsi Cadwaladr hospitals. Instead, they’ll be going to placements in Telford, in Chester, and some private healthcare providers locally. This is because the Welsh Government is refusing to recognise the course because the nurses are not eligible for the bursary. So, trainee nurses are not getting the practical training in their local hospital and therefore are more likely to settle into work across the border as a result. It’s a sad loss of talent for north Wales, but it does reflect the state of workforce planning in our health service in Wales today.

Vaughan Gething

Thank you, Presiding Officer. I’m grateful for the opportunity to take part in this debate, and the opportunity to highlight the significant amount of work already being undertaken by this Government and the national health service. I am sorry, though, that there won’t be more time to answer and debate all of the points made in this debate, and I’m genuinely happy to continue a conversation with Members who are interested in doing so about what we are doing outside of the formal business in the Chamber today. Again, I set out, as I have done in this room, in committee rooms, and in other settings, that this Government recognises the very real recruitment challenges in a range of our professions and specialities, and recognises that they are more acute in some parts of Wales than others. I understand very well that these challenges can have an impact on the delivery of services. It is, of course, true that this is not a unique challenge that Wales faces, but these are challenges that we need to tackle. We have taken a significant step forward both in ‘Taking Wales Forward’ and our ‘Prosperity for All’ commitments to attract and train more GPs. That’s why we developed the ‘Train. Work. Live’ campaign, working with people across the service and within the profession. That has been a successful campaign, resulting in an increase in our GP fill rate to 91 per cent, a significant step forward. But we will relaunch that campaign later this month in time for the British Medical Journal careers fair, learning from what worked last year and also learning from what didn’t work as well as we wanted to last year as well, and they’re just part of the range of measures that we wish to take. We’ll also be widening that campaign to take in other medical specialities where there are specific and acute recruitment challenges. We continue to invest in our future medical workforce with our commitment to increase undergraduate medical education in north Wales. We will stick to the collaborative approach between Bangor, Cardiff and Swansea universities, consistent with both my written statement in July, but also the budget agreement agreed with Plaid Cymru on taking this matter forward in practical terms. That will also be part of—

Vaughan Gething

[Continues.]—our commitment not just to medical education and training in north Wales, but to seeing a curriculum developed that encourages people and empowers people to go and spend more of their time in rural medicine, which won’t just be an issue for the north.

Rhun ap Iowerth

Thank you for taking an intervention. Perhaps now is a good time to say that you will look at developing, using the new funding that we agreed pre-budget, and exploring year 1 to year 5 undergraduate, in partnership with Cardiff, Swansea, anybody else, in Bangor, not just the additional placements for students from elsewhere in the north.

Vaughan Gething

We’ll be looking at the whole remit to understand where we get the greatest value to train the greatest number of people. And, of course, we want to make sure that that investment will lead to more people staying in Wales to serve here, because that’s the point and the purpose. We’re investing more money to try and get more doctors to stay in Wales as well. And, as part of the deal, the quid pro quo, we need with the university sector—there are challenges in what we can and we can’t mandate them to do—there will have to be some understanding about the mission that I and the Cabinet Secretary for Education are on in taking precious resources at a time of a falling budget to put into this area. Now, in addition to ‘Train. Work. Live.’ for doctors, we also launched a ‘Train. Work. Live.’ campaign for nurses. I was delighted to launch this campaign in spring this year, and it was very well received both at the launch and at the Royal College of Nursing congress in Liverpool. English nurses were delighted to see a Government genuinely on their side and trying to recruit nurses to be proud of who they are as well. That campaign, again, is being successful, but we know that recruitment alone isn’t the answer. We are, of course, implementing the Nurse Staffing Levels (Wales) Act 2016 in Wales—a first in the United Kingdom, a first in Europe. We are also training more nurses here in Wales. Two years ago, we invested in nurse training to increase the numbers by 22 per cent. Last year, we increased nurse training numbers by 10 per cent; this year, an increase of 13 per cent. We are actively looking to train more nurses here in Wales. It is the biggest investment in education and training for nurses since devolution. In addition, we’ve also increased midwife training by 40 per cent this last year as well. And, as Rhianon Passmore reminded us, we have maintained the student bursary here in Wales, directly different to the path taken by the Tories in England. That isn’t just important for nurses, but it’s also important for other allied health professionals in training. But, of course, our investment in education and training includes those allied health professionals, and the £95 million package I announced earlier this year has resulted in 3,000 new students joining those already studying healthcare education programmes across Wales. We are committed to extending the ‘Train. Work. Live.’ campaign to pharmacists and other healthcare professionals. Specifically on radiologists, who’ve been mentioned more than once, not just in the debate today but in the Chamber, we expect the £3.4 million investment that I announced in an imaging academy in Pencoed to make a real difference to recruiting and retaining radiologists here in Wales. Again, it’s a signal that we’re investing in and valuing all the varied and different parts of our workforce. Because we do know that we need to increase the skill mix of the staff we already have and the different range of staff we have within the service, as they will increasingly work in multidisciplinary teams. So, that £95 million package I referred to included an extra £0.5 million to support local healthcare, to develop advanced practice, education, and extended skills within our primary care clusters. So, we’ll also support new and emerging roles, including the pilots for physician associates programmes in Swansea and Bangor, and social care roles with a specific focus on those which alleviate existing pressures and contribute to better integration and outcomes for individuals. In terms of the planning of the workforce, regulation plays a key role as well, so I’m pleased that the UK Government have listened to voices in Wales and other parts of the UK to regulate physician associates. That is a good, positive move forward to allow us to plan for their role in the future workforce. I am, however, deeply sceptical about the UK Government plans to regulate nurse associates. That appears to me to be a cost-driven role substitution rather than the quality-driven, prudent-healthcare approach that we wish to take here in Wales. In addition, we will continue to develop the healthcare support workforce, who make a valued and increasingly varied contribution to service delivery in both clinical and non-clinical services. Again, that is something where we agreed in partnership with the trade union representatives and the staff in the health services about how to develop that role to use it to its fullest potential. We also continue to invest in the NHS workforce year on year. It’s worth making this point, bearing in mind the comments made in the debate. From 2015-16, the last year we have complete figures, the NHS full-time equivalent workforce rose by 3.2 per cent, and that is in the face of year upon year upon year of Tory austerity. That’s a simple fact. We come to this place and we debate the difficult choices we have to make and what it means to continue putting more money into the national health service—what that means for other public services who are shedding staff and deciding what they can no longer do. In that context, to continue putting more money into the NHS, to continue to see the staff headcount go up, is a real and significant achievement that we should all take note of, and it does not come easily. That is the context in which we have this debate about the demands for more staff in more specialities. It does not mean we are not planning to increase staff where we need to have them, but let us not pretend it is an easy thing to do. So, we remain committed to the development of a 10-year workforce plan, with the principle of that already having been developed. But we cannot and shouldn’t avoid the fact that all parties in the Chamber agreed to a parliamentary review for health and social care. It would not make sense to publish a detailed workforce plan in advance of the publication of the final report of the review. That review will, undoubtedly, as it properly should, affect our thinking and our planning of the services for the future and the workforce to deliver those services with the public. That does not mean the NHS here in Wales is standing still. Workforce planning is undertaken at all levels in our organisation, working collaboratively with partners to ensure the right workforce, with the right skills, both now and in the future. It is an essential part of the integrated medium-term planning process. So, we continue to press ahead with a number of strategic actions for the NHS workforce. That includes the establishment of Health Education and Improvement Wales from April next year, and that will, of course, maintain its independent approach. Now, crucially, Health Education and Improvement Wales will be expected to work with other bodies, such as Social Care Wales, to provide a comprehensive understanding of the present and future needs of the workforce. I can see time is against me, Llywydd, so I’ll finish now. I’ll make it clear that we will support amendment 2, but, in setting out our future direction, restate that we value the resourcefulness and the commitment of our NHS workforce to deliver high-quality care. There are recruitment challenges that we recognise. We’re committed to work with our partners, with the service, to address those and make sure we have the service that everyone here would want and that the public and the people of Wales deserve.

Rhun ap Iowerth

Thank you, Llywydd, and I thank everybody who’s taken part in the debate today. We all bring experience, don’t we, to a discussion like this. Some of us, like Dr Dai Lloyd, bring professional experience, medical experience. The majority of us bring experience of speaking to health professionals within the NHS, and the pressure that they tell us often is on them, and all of us, no doubt, speak to patients about the impact of weaknesses in workforce planning on their treatment within the NHS. I am grateful to everybody for their contributions. I’m grateful to the Cabinet Secretary—I’m certainly grateful for the confirmation that full training for undergraduates, from the first year to the fifth year, will be looked at as part of the study for developing medical education in north Wales, and I’m looking forward to seeing that process continuing in accordance with the agreement before the budget. What we’ve had, in all seriousness, is a repeat of what we hear from the Government time after time generally about what is already being done. We get this reiteration from the Cabinet Secretary of what the Government is already doing. You can’t continue to keep on doing the same thing time and time again and expect to get different outcomes. I understand that the Cabinet Secretary is trying to manage the NHS within very difficult constraints, not least because of policies of Tory austerity. I absolutely recognise that, but it’s not a management that we need because of the deep problems that we have within the NHS in Wales, but a real vision about a way forward. I’m afraid that the Member for Islwyn epitomises much of the problem that we have in that, yes, she paints a rosy picture of what Labour has done for the NHS that she dearly loves, and we all dearly love, but, when you have a party that has been running the NHS in Wales for 18 years, the failure to be able to admit the depth of the problems shows that—. [Interruption.] That is because to admit to those would mean they are your problems and problems that you have created. Unless we recognise the depth of the problems, we cannot move forward with visionary changes that can lead to a more sustainable NHS for the future. And, yes, you praise the Cabinet Secretary, and I don’t doubt for a second that he is a very, very hard-working Cabinet Secretary. But you know what? I’m not interested in how many hours he puts in in his work. He may be here first thing in the morning before anybody else. He may be the last one out of the Government offices at the end of the day. I’m interested in how high he sets the bar, how ambitious he’s willing to be, how innovative he’s willing to be for the NHS and for patients in Wales. I want to see that; the NHS needs to see that.

Elin Jones

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