73 speeches by……and 11 more speakers
The first item on our agenda this afternoon is questions to the First Minister. The first question [OAQ51256] is withdrawn. Therefore, question 2, Janet Finch-Saunders.
2. How does the Welsh Government ensure patient safety in Wales? (OAQ51245)
We hold all NHS organisations to account on a wide range of patient safety indicators and we encourage an open reporting culture of serious incidents to enable full investigation of every case.
Thank you, First Minister. In north Wales, however, we were shocked last week to learn that, of the 77 unintended or unexpected incidents resulting in patient deaths registered across Wales in the past 12 months, more than half of these fell within the Betsi Cadwaladr University Local Health Board. Every single one of these cases will have been simply devastating to the family and loved ones of these patients. First Minister, questions will be asked as to how the special measures and, indeed, your Government’s intervention in realising any improvement is, in fact, actually now to the contrary. I am asking you now: will you please commit to an inquiry as to why the safety of patients under this board and your Government’s responsibility appears to be increasingly compromised?
The Member doesn’t fully understand these way the statistics are compiled. First of all, we encourage honesty and openness, and that means we encourage people to report serious incidents. Now, that means, just like the crime statistics, for example, that when more people report serious incidents, then more are recorded. It doesn’t mean that there are actually more serious incidents. That said, of course, we want to make sure those incidents are reported. Nothing should be said or done that will discourage reporting in the future, because we want to make sure that incidents are reported and are out in the open. I can say to the Member that, in 2016-17, the crude hospital mortality rate for BCU hospitals was 1.79 per cent, which is less than the Welsh average of 1.81 per cent. So, yes, it is important that every case is investigated, but it is important that people come forward, that there is an open culture dealing with complaints. And that I believe is what we’re seeing here—more complaints coming forward rather than more cases coming forward.
3. What work is the Welsh Government undertaking to tackle fuel poverty in the Cynon Valley? (OAQ51248)
Our key programme for tackling fuel poverty is Welsh Government Warm Homes. Since 2011, we have invested over £240 million to improve the energy efficiency of over 45,000 homes. Since 2012, Nest has spent over £9 million in the Rhondda Cynon Taf area installing energy efficiency measures to low-income households.
First Minister, despite the progress being made in reducing fuel poverty in the Cynon Valley and across Wales through the Welsh Government’s suite of practical actions, it seems unlikely that fuel poverty will be eliminated by the previous stated target of 2018. Does the Welsh Government plan to review the fuel poverty strategy in light of that, and, if so, what lessons will be drawn from the successful and not so successful elements of the current plan?
The Welsh housing condition survey is now under way. That will provide important data to help to inform delivery of ‘Prosperity for All’. It will provide us with a range of information, including updated national fuel poverty estimates and data to help with the targeting of delivery measures. It will also help us to inform discussions with stakeholders, and that will mean, of course, that we can draw on the data that the survey provides in order to help to strengthen the strategy in the future.
First Minister, I agree with what you said about energy efficiency, but it’s also quite a startling fact that, according to Citizens Advice Cymru, only 12 per cent of those on lowest incomes are on the lowest available tariffs, and I do think there’s a job to be done here to inform people of the tariffs that are available and the lowest ones. Welsh Government, local authorities and housing associations, perhaps when they’re doing the various schemes that you’ve been referring to, can remind people how important it is to seek out the lowest tariff.
I’m sympathetic to that. People tend to stick with the same provider on the same tariff through convenience, and then, of course, they fail to get the best deal. What will help is to see—as the UK Government has adopted a Labour Party policy—caps on variable energy tariffs. That will help many people who have not taken the opportunity to change their tariffs, or find they are not able to do so, to benefit from lower prices.
Questions now from the party leaders, and, first of all, the Plaid Cymru leader, Leanne Wood.
Diolch, Llywydd. First Minister, later today, your Government is making a statement on minimum alcohol pricing. Now, I’m aware of the public health arguments and the need to reduce deaths from cancer in particular. But public health policy should be looking at all problematic substance use. What assessment has your Government made of the impact of minimum alcohol pricing on the use of other substances, like illegal drugs?
Well, we know that there will be some people, of course, who have an addiction. It may be that there are some who then look at illegal drugs. But, for the vast majority of people, this will have two outcomes. Firstly, it will help to reduce the health issues that surround over-drinking. And, secondly, actually, it will help pubs, because it’s the pubs that suffer the most as a result of supermarket selling that undercuts pubs, which we know are important for our communities. So, there is actually a commercial aspect to this as well. But we make no apologies for wanting to ensure that we get rid of scenarios where very cheap alcohol is available to people, in a way that causes them to drink too much and therefore affects their health.
I have some sympathy with the arguments that you’ve just outlined. But from your answer it doesn’t appear as though any assessment has been made between that link, which I hope very much is an oversight, First Minister. We need to reduce drug-related deaths as well as alcohol-related deaths. Now, drug-related deaths have reached a record high in Wales and England. According to latest figures, drug-related deaths are up 44 per cent compared to 2012. For Wales-only figures, in the latest year on record, there was also an increase on the previous year—168 people lost their lives in 2015. Hospital admissions are also up, which means an increased cost to public services and to the NHS. And, anecdotally, we all know that some people are openly using drugs in public places, on our streets, in town centres, where it’s less safe both for them and for others. First Minister, can you explain how your substance misuse strategy is using devolved powers to reduce drug-related hospital admissions and drug-related deaths?
One of the problems that is faced at the moment is that the Misuse of Drugs Act 1971 has always found it difficult to keep up with new drugs as they appear onto the market Drugs like Spice—fairly new, causes people to become extremely violent. And the leader of Plaid Cymru is absolutely right—there is too much open use of drugs, and dealers who seem not to be too concerned about being caught. The first thing to do is to target the dealers. They need to be convicted and jailed—that’s where they belong, off the streets. Yes, it’s true to say that others may come forward, but it’s important to send that message. Now, that’s not enough in itself; I understand that. How do we deal with people who misuse drugs? Well the substance misuse strategy is there to help to do that. It is a combination, to my mind, of medical intervention, but also being strong in terms of clamping down on people who supply the drugs.
Well, locking up the dealers hasn’t worked so far, and those powers are outwith your control. What you do have control over is health. Now, a harm-reduction approach has proven to be the most effective at reducing drug-related deaths. And, in your substance misuse strategy, you claim to be committed to a harm-reduction approach. We won’t know whether the actions that you’ve taken are sufficient until the new Welsh statistics come out this winter. But, of course, the Wales-and-England statistics that we’ve already seen don’t bode well. If you were serious about reducing drug-related deaths, as well as reducing the wider social problems, you would be open to the solutions proposed by Plaid Cymru police and crime commissioner, Arfon Jones. Will you agree to meet Arfon Jones and provide the police and others with the support that they need to enable a suitably located pilot safe injecting facility, which would reduce harm to the public, as well as help to reduce unnecessary deaths from harmful drugs?
Well, there are already regular meetings that take place between the police and crime commissioners and Ministers in any event. It is absolutely right to say that there is very little point, nor would it be right, to see substance misuse as something that is a crime. There are people who have medical issues; the suppliers are different. But those people, of course, who are in a position where they misuse substances, the intervention for them has to be medical. And that means working with the police—that’s true; it’s what the substance misuse strategy is designed to do. She herself said we’re waiting for the Welsh figures, and we want to make sure those Welsh figures show that we are seeing a positive effect on substance misuse. But the challenge is always there: how do you deal with new drugs that appear, all the time, synthesised originally from drugs that didn’t exist in 1971? She’s right to mention heroin—right to mention heroin. But it’s hugely important that we work with the police and crime commissioners, as we do, and that we develop and give our substance misuse strategy the time to develop, and in that way I believe we will help more and more people to get off the substances they become addicted to.
The leader of the opposition, Andrew R.T. Davies.
Thank you, Presiding Officer. First Minister, there are pressures across the United Kingdom when it comes to the health service. In June 2015, your Government took in to special measures the north Wales health board, Betsi Cadwaladr, and, in March this year, you said that actually where deficits run out of control and problems exist in other health boards across Wales, you might well have to consider intervening in those health boards. What we’ve learnt in recent months is that the deficit has doubled in the north Wales health board, waiting times have gone up by 79 per cent—from 4,858 to 8,700—and the deficit is projected at the end of this year to be £100 million cumulatively over the three years: £50 million for this one financial year, and the previous two were £25 million. How can people have confidence that your Government is putting Betsi on the road to recovery and, importantly, that the concerns that are raised by the Member from Aberconwy are being addressed, when the statistics show that, on waiting times, on recruitment and deficit control and reduction you are missing all your own targets?
Well, this is simply wrong. First of all, to clarify his suggestion that there will be £100 million deficit, we do not expect any of the health boards to come in with a deficit by the end of this financial year, and that is a message that we make very plain to them.
Well, First Minister, with the greatest respect, in their own board papers, which I presume you have sight of and, obviously, help put together because it’s under your control, this health board, they are projecting a deficit in this financial year of £50 million. It’s not my calculation; it’s their calculation, and they say that unless there are mitigating measures and actions implemented to bring that deficit down, that deficit will exist. Here in Cardiff, you are saying that isn’t the case. Your own managers and directors in north Wales who are responsible for the day-to-day delivery of service are saying that there is this deficit. You can’t have the two working there. Perhaps it’s a cause for concern that you’re so disconnected from what is actually happening on the ground. I ask you again, First Minister, with waiting times going through the roof, with the deficit not in control and, above all, the inability to recruit and retain staff, either at GP level or within the hospitals, how, after nearly three years under your direct supervision and control, can the residents of north Wales have confidence that their health board is on the road to recovery?
They can have every confidence. As I’ve said, we do not expect the health board to be in deficit by the end of the financial year. If they identify an issue now, they must deal with it. That is their responsibility. He talks about waiting lists going through the roof and offers no evidence for that. He also says that there are problems with recruitment and retention. I can say to him that ‘Train. Work. Live.’ has been hugely successful in filling training places, particularly in terms of nursing applications as well. And, do you know, what GPs say to us—and I’ve had this from one consultant who said this to me a month ago—‘The reason why I wanted to come to Wales was I liked the recruitment campaign’, and two other words: Jeremy Hunt.
Why are waiting times that much better in the UK as opposed to what’s happening here in Wales?
I used figures to—. Well, you say they’re not, First Minister. A&E—the 12-hour wait in England—there are 78 people waiting out of a population of 55 million people 12 hours or more in A&E. In Wales, the figure was 2,438 out of a population of 3 million. They’re not my figures; they’re your figures. What I’m just trying to seek from you, First Minister, is some ability to have confidence. I used the waiting times that your Government published last week that said that waiting times had doubled from 4,858 to 8,708. I used the deficit figures that the health board themselves have published in their board report. I’ve used the example that the health board say themselves that this deficit will exist at the end of the financial year unless mitigating actions are taken. So, everything I have quoted to you has come either from the health board or are statistics that have come from your own Government. I merely seek assurances from you, First Minister, after nearly two-and-a-half years of your Government being in direct control of the north Wales health board, that the health board is progressing to a situation where waiting times will come down, doctor vacancies will be filled and, above all, the deficit will come under control. On two occasions you have failed to give any assurances to date. I think that tells you more about your grip on reality than it does about anything else.
Well, all I can say to him is there’s been a complete abdication of responsibility towards the NHS in England. Every time a health board underperforms it’s never the fault of Jeremy Hunt, is it? Never the fault of the Conservative Government or Jeremy Hunt. Let me give him a figure that is correct so that he can mull over it: in England, the total waiting list is now the highest on record—the highest on record. That’s Tory stewardship of the NHS. There were 409,342 patients over the English target—that’s more than doubled over the last three years. More than doubled over the last three years. We know, in Wales, we’ve gone in the other direction. And he sits there and acquiesces a bung to Northern Ireland of £1.67 billion—some of it on health—and he did nothing to represent his country. [Interruption.] He did nothing to represent his country. What representations did he make to the UK Government and his colleagues to demand that Wales should get a Barnett equivalent of that money? Nothing; he’s too scared of them.
Leader of the UKIP group, Neil Hamilton.
Diolch yn fawr iawn, Llywydd. Returning to the theme mentioned by the leader of Plaid Cymru earlier on today—the Public Health (Minimum Price for Alcohol) (Wales) Bill—how can the First Minister possibly support a measure that is so regressive in the way it works? This is a measure that is explicitly designed, disproportionately, to target those drinks that are consumed in disproportionate measures by people on low incomes. It’s well known that low-income households buy fewer units of alcohol overall, but more of what they buy is priced at less than 40p per unit. Where’s the equity in a measure that leaves the champagne socialists of the posher suburbs of Cardiff unaffected, but target-bombs the beer drinkers of Blaenau Gwent?
Is he seriously saying that people on low incomes are proportionately bigger drinkers? That’s snobbery of an extent that I’ve never quite seen before, I have to say. And the consequence of his argument is that, in that case, we should reduce the tax on tobacco, because that’s disproportionately regressive as well, so let’s reduce the tax on tobacco as well. It’s exactly the same argument. What we want to do is make sure that alcohol does not get cheaper and cheaper, as it has done, so that people drink more and more, because they see it as cheap. As I said earlier on, there’s also an issue here for the pubs. Pubs are being hammered year after year after year after year by cheap supermarket alcohol, and pubs are responsible places where people drink—they look after and don’t serve people who are drunk—and pubs are being lost at a rate of knots in our communities. You speak to any publican and they will say to you that part of the reason is that people are buying cheap supermarket alcohol, sold at below-cost price, quite often. Now, those people deserve fairness as well. So, yes, of course there’s a health aspect to this, but also, of course, as a side issue, we know that one of the consequences is that it will provide a far better level playing field for pubs as well.
I didn’t say that people on low incomes buy more alcohol; I said the opposite actually—that people on low incomes buy less alcohol overall than people on higher incomes, but more of the alcohol that they do drink is cheaper brands, not more expensive brands, so it’s going to have a disproportionately tough effect upon people on low incomes. The Centre for Economics and Business Research said in 2009 that there’s substantial evidence, overall, that heavier drinkers are least responsive to price changes. So, the problem alcohol drinkers are the ones who’re least likely to respond to the measures that are now being proposed. What’s going to happen here is that the real problem drinkers will carry on drinking, and perhaps they’ll have less money to spend on things like food. So, in other dietary respects, their health is going to suffer. This will have no positive impact whatsoever. The only people who are really going to benefit from this are the supermarkets, because this is not a tax that is being imposed—it will just raise the price of a cheap product, and that will produce extra profits for the supermarkets. It certainly won’t produce extra profits for pubs.
Well, again, the same argument could be used for cigarettes. If he’s saying that the tax on cigarettes should be reduced because it’s regressive, let’s hear him say that. As far as alcohol is concerned, we know that alcohol has got proportionately cheaper, we know that it has encouraged people to drink more—there’s no question about that; if it’s cheaper it will do that. This is a way of ensuring that the balance is right between the price of alcohol and people’s health. I see nothing wrong with that, and it’s hugely important that we have a responsible attitude to alcohol, rather than one that says, ‘Buy one, get one free’, ‘Buy two, get one free’—and they’re not always on the cheapest brands; they’re quite often on brands that are proportionately quite expensive. That’s the way that people are encouraged to buy more and drink more. Surely, that’s not something that we want to encourage.
There is a problem with a relatively small number of people who overindulge. And, of course, we do want to target those. The problem with a measure of this kind is that it’s so scattergun in its approach that it actually penalises the many who are moderate drinkers whilst not actually having any measurable effect upon those whom we do want to help.
I don’t follow that logic. The same logic applies to cigarettes. He could stand up and he could say, ‘Well, it penalises the occasional smoker, and so the duty on tobacco should be reduced.’ The two things have the same kind of effect. Look, for me, it’s hugely important that, as a society, we don’t have alcohol being sold below cost price—and it happens in some of the offers we see in supermarkets—and we don’t have people being encouraged to buy more alcohol than they otherwise would want to buy. That encourages people who would otherwise be quite moderate drinkers to drink more than is good for them, and that is something that we’re keen to avoid. As it happens, as a side effect, it also enables pubs to be able to compete on a level playing field with the supermarkets that have driven so many pubs out of business. Don’t talk to me, talk to publicans and they will tell you this. The difference in price, proportionally, between supermarket alcohol now and alcohol in pubs is far, far greater than ever it was before. We need to make sure that people have a place to go in villages where they live, through pubs, for example. This is not what the intention of the legislation is—the intention is that it’s legislation that deals with health. But there are, of course, wider effects that are identified.
4. How is the Welsh Government using public procurement to drive up horticulture production in Wales? (OAQ51250)
The National Procurement Service develops collaborative approaches that aim to grow the amount of Welsh produce supplied to the public sector.
Thank you. I’ve just come from the vegetable summit being held in the Pierhead at the same time as in London and Edinburgh, and we heard really important pledges from a wide variety of producers and promoters of, for example, children’s rights. The children’s commissioner highlighted the fact that nearly 80 per cent of children aged five to 10 are not eating enough vegetables, and 95 per cent of 11 to 16-year-olds are not eating enough vegetables to be able to learn and play effectively, and that this is a children’s rights issue. We heard important pledges from the largest supermarket in the UK, Tesco, who have agreed to buy seasonable veg from UK growers, as well as putting more vegetables in their meal deals. Castell Howell, Brains, Cardiff University, Cardiff Metropolitan University, Cardiff and Vale University Local Health Board, Cardiff council all pledging to serve and promote more vegetables in their pubs, canteens and dining rooms. What can we do to ensure that that increased purchase of vegetables comes from Welsh producers, rather than from other UK outlets or, indeed, from abroad?
Can I welcome the fact that the vegetable summit is taking place at the Pierhead building as we speak? It brings together farmers, retailers, processors and Government, looking at the supply chain and how we can raise vegetable production. We are committed, through the food and drink action plan, which we share with our publicly appointed industry board, to not only grow the Welsh food and drinks sector, but to do so sustainably and to tackle the deep-rooted challenges of diet. The National Procurement Service has set up buying arrangements that allow Welsh public bodies to access a wide range of vegetable products to support healthier meal planning.
Following on from Jenny Rathbone’s question, can you tell us what discussions the Welsh Government has had with local authorities on food procurement in the public sector to ensure that more local producers are used by local authorities? Also, can you tell us one thing that your Government has done over the past 12 months to make a difference and to ensure that more and more local producers are being used in the public sector?
Well, a co-operative group has been established, and that includes some from the public sector in Wales, and the aim of that group is to ensure that we get a good deal on procurement. That is in collaboration with local bodies and the producers in order to progress this project. So, things are being done in working with the industry to ensure that more Welsh-produced food and drink is used in Wales. One of the problems, of course, which has changed over the years is that, at one time, one of the problems with the big contracts, such as those with the health service, was that there wasn’t a business or an organisation large enough to ensure that they could get into that market and that there was that sustainability of supply, day after day, month after month. But things have improved now, and that is, of course, as a result of the work that we’ve done as a Government in supporting the work to look at this in a different way.
I see, First Minister, that Denbigh plums are to be served as a dessert tomorrow, so everyone is welcome to contribute by eating those wonderful plums. But as we leave the common agricultural policy, which has never given any support to horticulture in Wales, what steps will you take as a Government to ensure that there is support to develop the infrastructure to ensure that farmers can now invest in horticulture for these new markets?
Well, this is something that is under consideration with the industry at the moment. The first thing I’d like to emphasise is that the same amount of money should be available in future as is currently available. What we’ve told the UK Government is that the funding should be ring-fenced and that nothing should affect that without an agreement between all the Governments. Having said that, there is now an opportunity to consider in which way we can use that funding for the benefit of Welsh farmers—to look at alternate ways of working, perhaps—and that is one thing that we can consider. I remember, 17 years ago, when I was a member of the Assembly’s agriculture committee, a review was undertaken at that time on diversification, and what came right at the top of the list, as regards the greatest strength in the sector ultimately was the cultivation of organic vegetables. So, this is something that has been around for some time, but, of course, the subsidy payment scheme wasn’t flexible enough in order to ensure that we could use that funding in the way in which we would wish to use it. There is an opportunity, in the future, to ensure that that happens.
5. Will the First Minister make a statement on patterns of self-employment in Wales? (OAQ51252)[R]
Self-employment remains a cornerstone of the Welsh economy and is central to the national strategy. We continue to support businesses to start and grow, to invest and, of course, to improve their contribution to the economy of Wales.
This afternoon, I chaired the cross-party group on small and medium-sized enterprises, and it was our pleasure to welcome the Federation of Small Businesses to launch their report, ‘Going Solo: Understanding Self-employment in Wales’, written by Professor Andrew Henley and Dr Mark Lang. There are a number of recommendations for Government there, but one of the stark issues in the report is that the largest levels of self-employment are in Powys, at 23 per cent, and the lowest levels are in the northern Valleys that I represent, and others, at 8.7 per cent. What specifically can the Welsh Government do to incentivise and increase self-employment in those Valleys communities, and particularly among under-represented groups and women?
What’s interesting about the report is that there’s been an assumption that the reason why more people are self-employed is because economic circumstances have dictated that—they lost their jobs. But, in fact, it seems to indicate that it’s an entrepreneurial pull. It’s actually a desire to be more entrepreneurial, which is something we have sought to encourage for many, many years in Wales. As somebody who was self-employed, mainly, before I came to this place, I understand some of the challenges that that can cause. How do we take it forward in the Valleys? The Valleys taskforce. That’s done a lot of work to see how we can encourage more self-employment. I don’t believe that people lack entrepreneurial flair in the Valleys; I think it’s encouragement. It’s being able to say to people, ‘You can do this. There’s no reason why you can’t be successful.’ And people need that encouragement. And that’s exactly one of the things that the Valleys taskforce is looking to move forward with in the future.
First Minister, I also attended the event, which Hefin chaired earlier on, and we heard how rural Wales is heavily reliant on the contribution of self-employment to the economy. Hefin’s pointed out that 23 per cent of those in Powys are self-employed, and that compares to the Welsh average of 13 per cent. Now, the FSB Wales report has found that those who are self-employed tend to be older, and young people are not following in their footsteps. Can I ask what consideration has the Welsh Government given to understanding the barriers to young people becoming self-employed, in rural Wales in particular? What potential could a mid Wales growth deal play to ensure that there are local solutions that meet the demands of self-employment in Wales, as opposed to a pan-Wales solution, which might not always be appropriate?
I think regional solutions are important. The Member is right to say that it can’t be one-size-fits-all across Wales. When it comes to younger people, much of it starts in schools, to my mind. I know that work has been done in schools with encouraging entrepreneurial projects, and, of course, the young entrepreneurs scheme, which we have, and also, of course, providing that kind of financial support to youngsters that they need. Older people often have access to capital in a way that younger people don’t, and they can use that capital to set up in business. How do we support people that come into business? Business Wales is one area where that’s done, of course. The development bank will be able to assist people to come into business as well. Improving small and medium-sized enterprises’ ability to access finance—that’s the biggie. We know that the banks in the UK have historically been resistant to providing capital for start-up enterprises, which is why we fell behind for many, many years, which is one of the reasons why the development bank will be there. You can encourage people, but they need to access capital to start up their business. Unless they’ve got family capital behind them, there’s got to be another way of doing it, and that is where Business Wales and where the Development Bank of Wales comes in.
One of the most striking things in the report is this fact: namely, that 38 per cent of the total jobs growth in Wales over the past 10 years can be attributed to the self-employed. Over the same period, there’s been no net increase in the inward investment sector. And again, and I quote from the report: ‘the language of economic policy-making is massively skewed toward the importance of securing foreign-owned inward investment.’ Does the First Minister accept the figures provided by the FSB, and if so, does he accept the need to change emphasis now to indigenous businesses and the self-employed?
I don’t think that we need to choose. I agree. At one time, in the days of the WDA, the emphasis was completely was on inward investment. They didn’t care, really, about small businesses. I remember talking to employees of the WDA. At that time, the focus was on securing inward investment, and after LG, nothing else big came in anyway. So, it is extremely important that we build a foundation of self-employment in the economy. I understand that. But, I don’t think that we can do that by avoiding giving any support to businesses that employ thousands of people in Wales, such as Tata, GE, Airbus, EADS, and so on, who employ thousands of people in Wales. So, we must maintain an emphasis on attracting foreign investment. But, it shouldn’t be solely our strategy, and I would argue that we have now struck the right balance, and we want to ensure that more and more businesses aren’t only established in Wales, but grow in Wales. One of the problems we’ve always faced is that businesses grow up to a particular level and then the owners sell them. So, we must ensure that more is done to ensure that people feel that they can grow those businesses so that they become larger. That, to me, is the greatest challenge in the economy: telling people, ‘Don’t sell out; stay and we’ll assist you to grow.’
6. How is the Welsh Government supporting the palliative care sector in Wales? (OAQ51226)
The updated end-of-life care delivery plan, published in March, sets out the extensive range of actions we are taking to deliver a collaborative approach to improving end-of-life care throughout Wales. That includes £6.4 million to provide specialist palliative care services.
Thanks for your answer. As you are probably aware, the majority of end-of-life care in Wales is provided by Wales’s 13 adult and two children’s hospices. You indicate a figure of roughly £6.4 million—that’s what I think you said—but they spend £32.5 million a year to deliver those services in people’s homes, and also day care and respite. So, they are having to raise over £2 million a month, and they’re keen to help you, the Welsh Government, and their local health boards do very much more. How can you, or will you, engage with them and ask them how they can help you achieve more? Perhaps a little bit more funding from the health boards and the Government would save massively more for health boards and liberate services to help tackle some of the other problems we’ve heard referred to today in different contexts.
Well, if we look at the recent report by Hospice UK into hospice care in Wales, that is something that we welcome—what the report said. It recognises the positive steps outlined in the palliative and end-of-life care delivery plan. It does highlight the need for assurances about long-term funding. As part of the budget agreement with Plaid Cymru, we did make £1 million extra available in 2017 to further enhance end-of-life care provision. That is recurrent funding as well. But, of course, in terms of engagement with the sector, it is the care boards that provide that level of engagement, and that’s why, of course, we work with them in order to identify the resources that are needed.
The cross-party group on hospices and palliative care here in the Assembly is looking at the possibility of holding an inquiry into how to deal with inequalities in terms of access to hospice care in Wales. You referred to the funding secured in agreement between us and the Government. But, isn’t the truth of the matter that a series of Labour Governments has failed to tackle that fundamental element, that there is inequality in terms of access to this crucial care across Wales?
No, I don’t accept that. We have ensured that there is investment available to the health boards. It’s a matter for them, of course, to ensure that the service is available. It’s something that we worked with them on to ensure that that is implemented. We know that the hospices themselves have taken a greater role over the past five years than previously, not just on the care side, but in giving people advice as well. And now, of course, we wish to work with the boards to ensure that we know what next needs to be done, in order to ensure that there is a uniform service available throughout Wales.
7. What assessment has the First Minister made of the impact that any changes to immigration controls following Brexit will have on the NHS in Wales? (OAQ51229)
Yes, it’s bad.
Well, I thank the First Minister for his observation, but the latest figures show that immigrant workers from the EU amount to just 1.55 per cent of employees in NHS Wales, and, given that the Welsh population of immigrants from the EU amounts to 3.3 per cent, it would seem that controls on immigration may well have a positive effect on our health service. But, I have previously brought to the attention of this Chamber the fact that each year, 80,000 applicants to work in the UK NHS are turned down due to a lack of training places. Surely, First Minister, it is time that we in Wales expanded training facilities, reconsidered the practice of sending every nurse to university, and explored the possibility of reintroducing the distinction between SEN and SRN nurses and on-the-ward training, particularly for SEN staff. Incidentally, Mark Drakeford said in 2015 that, ‘Discussions about the long-term future of the Welsh NHS should sit outside the knockabout of day-to-day party politics.’ Perhaps, First Minister, we should once again examine that excellent suggestion.
Could I say to the Member that I could not care less where doctors come from when they work in the Welsh NHS, as long as they deliver an excellent service to our patients? There are many doctors who come from the EU, and beyond—India, of course; we know that many doctors have come from India. Frankly, they are great additions to our NHS. The market for doctors and for nurses is worldwide. It’s worldwide. People will go—it’s a portable qualification—to where they think they will get the best deal for them as an individual and for their families. We know, for example, it’s true to say that EU nurses make up a fairly small percentage of the NHS workforce in Wales, but can we really afford to lose 360 nurses? Is that what he’s saying? Because what he seems to be saying is that that’s fine, as long as we train people to a lower standard in the future, and that will be fine as far as the future is concerned. Is he really saying, for example, that we don’t want doctors from the EU? Well, I have to say that I want to make sure that doctors and nurses come to work in Wales, regardless of their nationality, because they will add a lot more to the NHS than they take out. The myth that is peddled by his party is that, somehow, immigration puts a strain on the NHS. Most of the people who come to Wales are young. They pay taxes, and they pay far more in than they take out via the NHS. And we know that we pay tribute to those doctors from the EU and beyond who come to work in the Welsh NHS, who contribute to treating our people, who save lives. For me, that’s far more important than checking their passports.
The external affairs committee recently reported on the implication of Brexit for Welsh ports, of course, and there is criticism there that the economy Secretary hadn’t at that stage had direct conversations with his counterpart in Ireland, but I think that that may have happened now. Do you know whether there were any discussions about whether existing technology could be rolled out to help maintain the invisible border between Northern Ireland and the Republic, but also to reduce the delays in the transit of people between Wales and the Republic of Ireland itself?
Well, firstly, the reason why the committee mentioned it is that I mentioned it to the committee. I was the one who first raised it, this issue of the ports. I discussed it months ago with Leo Varadkar, when he became Taoiseach, and made it clear that we could not support a scenario where there was a more seamless border between Northern Ireland and the Republic than between Wales and the Republic while 70 per cent of trade between GB and Ireland goes through Welsh ports. If there is any incentive to go through the Scottish ports instead, through Northern Ireland, obviously it’s bad and the committee identified that—it’s bad for Wales. So, there have been discussions with the Irish Government on this. Frankly—I know the Member’s views on Brexit, and I appreciate them—I have now seen many documents from the UK Government that say that the issue of border control will be taken forward by way of innovative technology. It doesn’t exist. This technology doesn’t exist. If it existed we’d have sight of it by now. It talks about having innovative solutions, exploring solutions. That is code for, ‘We have no idea how to deal with this.’ It’s one thing, of course, to have passport-free travel between Wales and Ireland. Customs-free travel is a different thing. There were always random checks in those ports in years gone by, but not every vehicle was checked. There’s a greater problem in Dover, because the UK doesn’t have the capacity at the moment to put in place border controls in Dover without enormous delays, and the same, I suspect, applies on the French side as well, if I’m honest, in Calais. I do not believe that there is a technological solution to this. If there was one, then by now we’d know from the UK Government what that solution is. One of the solutions that was put to me was that there would be cameras on the border between north and south in Ireland. You put cameras in Northern Ireland and we could open a book as to how long they’d stay there, because they would not. They just wouldn’t stay there. It’s a physical manifestation of the border. People would see them as a breach of the peace agreement. So it’s an intractable problem. It can be resolved. The resolution is that the UK stays in the customs union. Then there’s no problem. There’s no problem. The UK leaves the customs union and you have to have the same kind of border as exists, for example, between Gibraltar and Spain, because Gibraltar is outside the customs union. That is an extremely hard border. You cannot have a scenario where goods go to two different markets in two different customs unions without any kind of physical checks on crossing a land border. This has always been the problem, to my mind. In the Brexit referendum, nobody thought about Ireland and nobody thought about that border, and it’s still an intractable problem. The solution? Stay in the customs union.
Of course, one of the greatest threats to staffing long term in the Welsh NHS would be for us to have a one-size-fits-all UK immigration policy after separation with the European Union. The University of Edinburgh have published a paper by Professor Christina Boswell, ‘Scottish Immigration Policy After Brexit: Evaluating Options for a Differentiated Approach’. It looks at a number of regional and national approaches to migration post Brexit, knowing the intentions of the UK Government in terms of their aspirations. The options include looking at human capital, a points-based system, post-study work schemes, employer-led schemes, occupational shortage lists, which I would suggest are of particular importance here in Wales, and in this paper they are proposing imaginative ways in order to have minimal administration costs and burdens. Would the First Minister agree that this is now worth exploring and taking forward seriously, and that we need Wales to have its say on a regional or national post-Brexit migration policy for the UK? Because at the moment, this is the only constituent part of the UK that has said very little about that prospect. Otherwise, we face having the UK net migration target being the big policy objective of the UK, which, as we know, will be detrimental to Welsh public services and the Welsh economy.
Let me just remind him what I have said publicly to set his fears at rest. First of all, I don’t agree with an artificial cap. I don’t see what sense that has. Surely an economy needs to recruit according to its needs, not have an artificial cap. If there were to be an artificial cap, then there are serious issues that arise as to whether there’d be sectoral caps. I have no doubt that the thinking in the UK Government will be to do as much as possible for the City of London—and the financial services sector’s important to us, but it’s hugely important to the City of London—and we will end up with a higher sectoral cap proportionally for the City than we do for the NHS. Clearly, that would not be in Wales’s interests. He didn’t say it specifically, but I know he is intimating the idea of regional quotas, and that’s an interesting idea. It is done in Canada, it is done in Australia. All right, they’re far bigger, but it’s not impossible to do this. Personally, I prefer there not to be a cap, but if there is to be a cap, I think then there is a case for looking carefully at whether regional quotas would work, and particularly at whether they’d work for Wales.
8. Will the First Minister make a statement on the Welsh Government's location strategy? (OAQ51234)[W]
The location strategy will deliver an economically and environmentally sustainable estate that is aligned with this Government’s future needs. The strategy maintains our commitment to being located across Wales and ensures that we are optimising the efficiency of our estate and reducing our operating costs.
Well, it’s entirely apparent that the jobs location strategy isn’t working if the intention was to spread Government jobs to all parts of Wales, retaining those that already existed. People in my constituency feel that we’re being left behind, a feeling that is backed up by facts. Fact 1: your Government intends to close and sell a building in Caernarfon without any intention to erect a new building in its place, creating great uncertainty. Fact 2: the number of Government jobs that are located in Caernarfon has reduced by 35 per cent over the past seven years. The intention of the strategy is clear, but, once again, you have failed when it comes to the matter of delivering those objectives. So, will you reconsider and look at the strategy again in order to set new criteria and specific targets in order to deliver growth and quality jobs in all parts of Wales?
May I say to the Member that the Caernarfon office won’t be quitting the town, it’s just moving buildings? It’s true to say that they are actually moving from the building where they are at present, on the top, and are looking at more modern office space in order to stay in the town. So, there’s no problem about jobs remaining in Caernarfon. Is it true that some jobs have been lost? It’s true for the whole of Wales. We have lost over 1,000 civil service jobs over the years—some seven years. So, it’s true to say that jobs have been lost in every part of Wales. Having said that, of course, if we look at north Wales, we have the Llandudno Junction office and the development bank headquarters will be in Wrexham, and so we have committed to moving jobs out of Cardiff. At the inception of the Assembly, there was an office in Caernarfon, but nothing in Merthyr, nothing in Llandudno Junction, and not very much in Aberystwyth—the Forestry Commission was there, but nothing else. We have demonstrated our commitment to moving jobs out of Cardiff, and there’s no problem whatsoever with regard to the Caernarfon office. We know how important Caernarfon is in supporting and assisting farmers, and also securing employment in the town.
9. What guarantees has the First Minister obtained from the UK Government during Brexit discussions in relation to securing human rights? (OAQ51249)
The UK Government has said it won’t repeal or replace the Human Rights Act 1998 while the process of leaving the EU is under way. We also support efforts to amend the EU (Withdrawal) Bill—whenever it’s introduced—to ensure the UK continues to respect the EU’s Charter of Fundamental Rights after we leave the EU.
When Britain does leave the EU, the Charter of Fundamental Rights will no longer have any effect in UK law. That means that those rights not covered by the human rights Act—for example, the rights of the child, workers’ rights and discrimination—could be scrapped. The great repeal Bill White Paper does promise, however, to protect existing rights. I don’t know about you, First Minister, but I am hugely sceptical about the Conservative Party that opposed many of those rights in the first place—in terms of trusting them to defend rights post Brexit. We only have to look very quickly across at the way that they have been willing so far to gamble with EU citizens’ residency rights. But, on another tangent, First Minister, will you reassure Welsh universities over their rights to academic freedom from Government meddling? I’m sure that you would have read today, as I have, the reports on the frankly sinister letter sent by the Tory MP Chris Heaton-Harris to all vice-chancellors asking for the names of anyone teaching European affairs or Brexit.
First of all, the EU Charter of Fundamental Rights contains rights and freedoms under six titles: dignity, freedoms, equality, solidarity, citizens’ rights, and justice. Surely, there is nobody who would argue that none of those things should apply when we leave, which is why it makes sense for that charter to remain. There are some—not all, in fairness, but there are some—within the Conservative Party who would love to get rid of so many of the protections that have been built up over many, many years. They are the hard right of the Conservative Party and I’m sure that they would delight in removing as many rights and protections as possible. I hope the sensible people within that party actually win out. Of not sensible, I understand that a letter was sent by an MP I’ve not heard of, Chris Heaton-Harris, who sent a letter to all academics, all academics—it’s not something I’ve heard of before—demanding to know who teaches courses on Brexit and the content of those syllabuses. The content of those syllabuses. That is as authoritarian a request as could possibly be made. Now, I don’t say that the entire Conservative party would agree with his actions, but, if that is the case, it’s incumbent on Government Ministers to slap him down, metaphorically, because it’s absolutely outrageous that somebody should look to create, in effect, a list of people who are there to be criticized because they do not follow the party line. I suspect this gentleman would have a lot to teach Stalin.
Thank you, First Minister.