Plenary

The next questions will be questions to the Minister for Health and Social Services, and the first question is from Sam Rowlands.

Welsh public sector contracting authorities, including NHS Wales, are expected to have regard to the principles set out in our Wales procurement policy statement. This approach seeks to ensure that public procurement in Wales maximises social and economic value outcomes when delivering goods and services for the people of Wales.

Thank you for your response, Minister. You will accept, as you've outlined there, that value for money is something that should be running through every Government department, and should be an absolute priority for every Minister and official in Welsh Government, and, of course, this applies to health services in Wales too. You’ll be aware that earlier this year the UK Conservative Government, on behalf of all parts of the UK, and the pharmaceutical industry entered a new voluntary scheme for branded medicines pricing, access and growth—the VPAG. This deal, brokered by the UK Government, means that the very latest innovative medicines are available to the NHS in Wales and can be used with patients, ensuring best value for money.

Now, historically these schemes have enabled hundreds of millions of pounds to come to the Welsh Government, and usually targeted at the health department. So, could you confirm today that this money will continue to be retained within health, and where you expect these additional funds to be targeted?

Thank you very much. The Member is correct, in January a new voluntary scheme, the voluntary pricing, access and growth scheme, came into effect. What this does is to set an annual cap on the value of total sales of branded medicines across the NHS, and what happens then is, if sales go above the cap, then there’s a rebate. Each rebate is apportioned between the four nations of the UK, and that’s based on the medicines expenditure in each nation. So, what it does is it doesn’t actually provide new money. Any funding derived from the voluntary pricing, access and growth scheme has already been factored into budget planning to deliver for the NHS and the people of Wales.

One way of ensuring value for money is to do very detailed research, to discuss with clinicians who will be using new equipment, and ensuring that the best products are procured. And that's exactly what was done by trying to select the electronic patient record system for ophthalmology services. Millions were invested in that work, and the conclusion was that the OpenEyes system should be procured—a system used very broadly already, including in leading eye centres such as Moorfields. It has been introduced in Scotland too.

But, five years later, nothing has happened. I met ophthalmologists at Singleton Hospital last week. There was representation from across south Wales there. Llyr Gruffydd, yesterday, raised this on behalf of ophthalmologists in north Wales. They are urging the Minister to please press the button to procure this system. It would transform their work, and would lead to better eye care. So, is the Minister willing to take that decision as a matter of urgency, given that the work has already been done?

Diolch yn fawr. I have been looking into the issues in relation to the digital eye care programme, because it’s also been brought to my attention. What happened was that there was an initial funding allocation that was granted, and Cardiff and Vale University Health Board were responsible for hosting and delivering that. And the idea was to digitise the referral process from primary care to secondary care as well as to introduce an electronic patient record. The programme didn’t progress as planned as far as I understand. And so there were some concerns reported in initial technology deployment, and clinical safety issues were raised by the health board.

So, what’s happened is that that was then transitioned to Digital Health and Care Wales, and I’ve asked for a meeting with Digital Health and Care Wales to progress this, because it is frustrating, I know. So, I have asked for a meeting, not just with Digital Health and Care Wales, but also with the ophthalmologists to make sure that I hear every side of the argument in relation to this.

As part of the special measures escalation, a comprehensive programme of work has been agreed to ensure that the health board is able to make the sustained progress required in mental health services.

Thank you for that answer. Deputy Minister, you'll be aware that, yesterday, I raised concerns with the First Minister about the poor experience of patients at the Nant y Glyn community mental health centre in Colwyn Bay. Patients are simply not getting the service that they need, and that is resulting in some of them having much worse mental health than would have been the case otherwise. I know that Healthcare Inspectorate Wales has previously raised concerns about access for patients to services provided by Nant y Glyn and that an announced inspection took place recently.

However, I am concerned that the inspection regime is insufficient. It does not always include patient experiences or reaching out to patients who have made their experiences known to elected representatives like me. I would therefore urge the Welsh Government to encourage HIW to look at its inspection framework to ensure that engagement with elected representatives and patients is paramount in terms of one of the pillars of their inspection regime in the future, including on the Nant y Glyn experiences that my constituents have been experiencing.

Can I thank you, Darren, for that supplementary question? And I listened carefully to your exchange with the First Minister yesterday, and I know that he gave you assurances, and I would like to repeat those assurances. We're waiting for the HIW report to come through and I'll certainly be looking very carefully at that.

As you're aware, HIW is independent of Welsh Government as an inspectorate, and I'm also conscious that they do attempt, as I understand it, to take account of service-user feedback as part of the work that they do. But, in relation to community mental health teams, I will make enquiries as to whether there was feedback sought from service users. And just to repeat the First Minister's assurance that I will get the report, I will look at it and we will make sure that everything that needs to be followed up is followed up.

Questions now from party spokespeople. Conservative spokesperson, Russell George.

Diolch, Llywydd. Llywydd, rural mid and north Wales needs a strong ambulance service, particularly in emergencies. With the lack of a district general hospital in these areas, it makes the need for an air ambulance service all the more vital. Now, Minister, you will be aware, of course, that the final engagement process has now begun. The review is being led by a service within the Welsh NHS, but, of course, you are the heath Minister and you are responsible for ensuring appropriate policy is in place, and ensuring that patients are transferred to appropriate medical facilities rapidly. And I know, Minister, that you've been involved in this process as well. So, you have the ability to intervene, to influence and to decide what happens. So are you, Minister, prepared to take on board the significant concerns that have come across from communities in north and mid Wales, to ensure that both sites in Welshpool and Caernarfon remain open, so that we have an ambulance service that reaches all parts of Wales and takes into account the very specific nature of some of the most rural parts of Wales?

Thanks very much. Well, the Wales Air Ambulance Charity, of course, is an independent charity—it's independent of Government. But you're quite right to point out that there is obviously a relationship with the Welsh Government, in the sense that there's a link with the emergency aspect of it and the Emergency Ambulance Services Committee, and the chair of EASC has been absolutely instrumental in terms of ensuring that the public has had its voice heard in relation to any proposed changes. So, as you say, there has been significant feedback already to inform the review during the last phase. What's happened now I think as a result of that is that two options have been put forward, and that's what's now going out to the public. I did ask the chair of EASC specifically to make sure that he'd listened in to the conversations that took place within this Chamber, just to get a real sense of what were the concerns of people in this Chamber.

Thank you, Minister. First of all, the Wales Air Ambulance Charity, as you say, is a charity, but they are commissioned by the Welsh NHS. And they've also accepted the result of this process, and they will follow the result of this process, and of course the NHS pays for the paramedics and the equipment on those air ambulance vehicles. So, it's important, Minister, that this is ultimately a decision for the Welsh Government and the Welsh NHS.

I was a little bit concerned when you said that there are two options that have now come forward, because the commissioner has told me, and it says so in the documentation, that there are six options that have come forward, and two are preferred. Of those two preferred options, both mean the closure of Caernarfon and Welshpool bases, which is entirely unacceptable. And I think, Minister, that what is frustrating here is that, whilst you've pointed out that there's been an engagement process that has taken place—yes, that is right, a significant one; thousands of people have attended meetings or responded to consultations—this is the issue: have they been listened to? Because that doesn't come through when you see two preferred options that close these two bases. And to go from four bases to three bases across Wales just isn't appropriate, Minister. I'm disappointed that we've got to this position, and I think now is the time that you, Minister, certainly need to intervene.

And it's not only the public that have got concerns; it's clinicians as well. They're saying that they fear lives will be put at risk should these two bases close. They're also saying that many of them will actually leave the service—these experienced people in Welshpool, in Caernarfon, will leave the service. Now, I and the public have repeatedly been told that this is never about saving money. Is that still the case? And if a case was made for an expansion of the air ambulance service, are you still committed to considering such proposals and financing such proposals?

Thanks very much. Well, you're right, it's not about saving money, but it is about maximising efficiency, and I think that is something that is a responsibility of Government to do. So, you'll know that there were some principles that were set out: if people get the service now, they will continue to get it, and more people will get the service. So, those are the two things that were absolutely key in terms of driving any proposed changes. I think one of the things that has been suggested is that there could be more cars at strategic points. This is something that I heard very clearly in the debates that we've had in the past in this Chamber. So, if, for example, you have somebody at the far end of Pen Llŷn, and there's fog and the helicopter can't make it, actually, the issue is not the helicopter; it's about the strategic positioning of the vehicles. And I think that's something that has very much come across and has been understood, which is why I think that has become, certainly, part of the options that have been put forward.

Well, thank you for your answer, Minister. Certainly, you're right in one sense—at the beginning of this process, we were told that 500 more people would be able to be reached under the original proposal. That, as I now certainly understand it, is something that has been dismissed, but the First Minister mentioned it again last week. So, I do hope, Minister, that you and the First Minister can intervene in this process and take a lead on this process, because it's important that you know the feelings on the ground, what the feelings are in mid and north Wales and in these communities.

You also mentioned the issue of fog. Well, we've got a weather warning coming in for mid and north Wales tomorrow, which is significant. At the moment, we've got two bases—Welshpool and Caernarfon—covering mid and north Wales. If proposals come forward to have one centralised base, then that base—. If that closes due to adverse weather, there is then no cover in the mid and north Wales area from a mid and north Wales base. So, there's greater flexibility by having those two bases, and that makes and answers the point that you made about fog. Fog, adverse weather—this is exactly why we need to retain both bases in Welshpool and Caernarfon.

So, can I ask you, Minister—? Given the fact that the First Minister I think perhaps made some statements that I'm not sure are entirely accurate last week, can I ask that you and the First Minister actively get involved in this process, intervene, and, ultimately, you, as the Minister, make the final decision in terms of what happens to the current bases in Welshpool and Caernarfon, because moving from four to three bases is entirely unacceptable for the population of mid and north Wales?

Well, I think it is important that local populations, once again, become involved in this consultation. There has been an incredible response to the consultation so far. We know how much this service is loved by the populations, in particular, of mid and north Wales. So, I would encourage them to feed into that response, and, obviously, a decision will be made after we've had the final recommendation.

Plaid Cymru spokesperson, Mabon ap Gwynfor.

Thank you, Llywydd. The Minister in her response to Russell George said that she wanted to know what the views of Members in this Chamber are on the air ambulance. So, I echo everything that Russell George said, and I hope that you will follow up on some of those questions and will take responsibility for this.

At the end of this month, the UK COVID inquiry hearings for module 2B will be heard here in Cardiff. The Welsh Government has, of course, so far resisted establishing a full inquiry into its own handling of the pandemic, in stark contrast with the Scottish Government. According to the First Minister, this is because the UK inquiry represents the best option for scrutinising the decisions that were made here in Wales. Almost eight months since the UK inquiry formally commenced its proceedings therefore, it's worth reflecting on the credibility of this assessment.

Firstly, we heard Baroness Hallett herself acknowledge that the scope of the UK inquiry would not be able to cover every issue relating to Wales. Then, we had both the First Minister and the former health Minister provide their testimonies for module 1 over a single day in July last year, at which the former admitted that Wales was not as prepared as it could have been for the pandemic. We've also discovered that organisations such as the Children's Commissioner for Wales, the Older People's Commissioner for Wales and Cardiff and Vale University Health Board have been denied core participant status, with the latter being told they would not receive the degree of focus that they initially believed. And though this Government has belatedly set up a special purpose committee to cover gaps in the UK inquiry, to date, it's only met four times, always behind closed doors, with the COVID-19 Bereaved Families for Justice Cymru group justifiably concerned about the ability of the committee to go beyond merely duplicating existing work.

So, Minister, do you still believe that a full Wales inquiry into the pandemic is unnecessary, and, if so, why?

Well, I do think it's unnecessary, for the reasons that have been said over and over again in this Chamber. What we have seen in the inquiry is plenty of evidence to suggest that, actually, in the link between the decision making in London and the decision making here, we were restricted by certain issues in relation to our ability to put in, for example, some supportive funding if we wanted to lock down for longer. So, there were some areas where it was almost impossible for us to take different actions. Another example, of course, is our ability to close the borders—very difficult for us to, for example, stop people coming in from countries where there was a high prevalence of COVID occurring. So, that link between them, I think, means it does make sense that we wait for the inquiry to report. Now, having said that, I know and, I think, the two Chairs—the Co-chairs, who are sitting in the Chamber today, and they will have heard what you said; I'm sure they won't agree with what you said—that, clearly, we haven't really started on the interrogation of module 2B yet, and I think there will be an opportunity after that for the committee to undertake more scrutiny, because then the gaps will become a bit more obvious.

It is disappointing to hear the Minister blame London for everything. While Boris Johnson and London were certainly to blame for a number of things, here in Wales the Government decided to introduce mask wearing at a later date than in England, for instance, and it was the Welsh Government that decided to release or allow elderly people to go back to care homes. So, those are entirely Welsh Government decisions. We also have best practice in Wales. Look at the test and trace in Ceredigion, which then rolled out to other parts of the UK. So, we've got things that we need to learn, and lessons to learn, here in Wales.

A creation of a Welsh-specific inquiry would not only give the thousands of bereaved individuals across Wales the answers and the closure they richly deserve, it would also ensure that the experiences of the pandemic can effectively inform future preparedness and resilience measures, so that we're never again in a position where we're not as prepared as we could be. And since the impact of climate change is increasing the likelihood and frequency of future pandemic outbreaks, this process of a constructive retrospection has never been more important.

One of the key issues to have emerged since the last set of legal restrictions were lifted is mask wearing by healthcare workers in Wales. Following the spread of a new sub-variant of the Omicron strand of the virus in December, the World Health Organization recommended the reintroduction of mask wearing in health and social care settings. While the risk posed by this new variant was ultimately deemed low, it, nevertheless, highlighted the need for vigilance and caution in how we manage the post-pandemic approach to COVID.

I have been very generous with timing for your preambles and your very short questions at the end—

I appreciate—.

—so, if you can get to your very short question at the end, then I'd appreciate it.

The very short question at the end, appreciating the patience shown, is: will the Minister commit to aligning with World Health Organization health guidelines by recommending universal FFP2 and FFP3 mask wearing for health and social care workers in Wales?

Well, I won't agree to that unless it's appropriate to do so. And, obviously, we take our lead from Public Health Wales, who scrutinise the evidence. They've looked at what the World Health Organization has recommended, and the World Health Organization, as you yourself have suggested, actually suggests that there's low incidence and there's low protection when there is low incidence. So, this is something that I've pushed, discussed with, and I've questioned Public Health Wales on, and, when it's appropriate, I'm sure that they will know when to recommend health boards should be reintroducing that. But that is not the situation at the moment, and, actually, the incidence is relatively low at the moment.

Retaining staff is equally as important as recruiting new staff. Our national workforce implementation plan sets out a number of actions to improve retention. The number of doctors, including consultants, directly employed by NHS Wales organisations has increased every year for the last nine years.

Thank you for that, Minister. The pay of junior doctors in Wales has been cut by almost a third in real terms since 2008-09. By now, as you'll know, there is real danger that successive pay cuts will drive even more doctors away from the profession at a time when patients need them most. Junior doctors are not asking for a pay rise; they're asking for pay restoration. I'm aware of how difficult the financial settlement that we have is, however, doctors' salaries must be fair and competitive with those in other healthcare systems around the world, otherwise we will lose them. So, will you, Minister, return to the negotiating table with the junior doctors in an effort to avoid more strikes, because they don't want to be on strike either; they want to be in the hospitals helping patients?

Diolch yn fawr. Well, we certainly recognise the strength of feeling amongst junior doctors, and, whilst we certainly are very keen to address their pay restoration ambitions, I'm afraid that the 5 per cent that has been put into their pay packages is at the limits of the finances available to us this year, and, obviously, it's the same thing as has been offered to other health unions this year.

We know, and you heard, in terms of the debate yesterday, the strength of feeling amongst other areas of Government and all the demands that were being asked of us as a Government yesterday. We took money from other parts of Government to shore up the health service, to enable us to pay for that 5 per cent. So, already it's been very difficult for us to make that. I think it's probably worth noting also that, when we can offer more, we do. So, last year, we offered 4.5 per cent, plus 1.5 per cent consolidated, plus 1.5 per cent non-consolidated, while in England they only offered 2 per cent. So, I do think it's important to take a longer term view of this as well.

Retaining doctors, including GPs, is absolutely fundamental to a sustainable health service. I recently visited a GP practice in my constituency. The current contract burdens them with bureaucratic paperwork, a lack of compensatory element and decreasing funding in the wake of increasing staffing costs, leading to redundancies, thus longer waiting times, and, indeed, driving some GPs to consider their and their practice's future.

Another practice in my constituency has now ceased to provide five key services, despite spending money on the equipment and training, because the contract funding simply does not cover the costs of providing the services. Simply put, the retention crisis cannot be addressed without revisiting GP contracts. Minister, are you in conversation with health boards to consider contractual issues that are threatening GPs, their practices and local primary care?

Thanks very much. I'm very pleased to say that, actually, today, we have announced that we have actually come to a conclusion with the general medical services in terms of conclusion with them. They have been offered 5 per cent as well, but that, obviously, is aligned to certain commitments that we're expecting of them. But it's not just for them; it's also for their staff. And I think it's really important that we remember that this is not just about people; it's the team around the doctor that we have to consider as well. So, I'm very pleased that we have come to a conclusion on that issue.

When GP partners take on responsibility for running doctors' surgeries, I think it is a sign of confidence in the sustainability of that local service in the community. And that's why the news that Aneurin Bevan University Health Board is handing back the management of Bryntirion surgey in Bargoed to new GP partners is welcome, although I have to say to the Minister that we would have preferred that to have been run directly from Bargoed, rather than at arm's length from a private company in England, although it will see contracted GPs at the surgery.

With Welsh Government support, the health board facilitated the construction in my constituency of a new centre for health in Llanbradach, which opened in August 2021, and there is the prospect of other new sites of primary care provision opening in my constituency in the future. Does the Minister agree, therefore, that we need to look at these good examples and that we need to be looking at where things are positive and turning around in order to recognise that the Welsh Government and the health boards are doing things to take pressure off our hospitals?

Thanks very much, Hefin. I had a meeting just this morning with the chief executive of Aneurin Bevan, who was positively buzzing about the fact that, actually, every single GP in her health board will be an independent contractor in future. Obviously, that actually represents quite good value for money for the health board. So, whilst we're very happy to have them directed by the health boards and run by the health boards directly, if people are happy to come in and run it for themselves independently, then that's also something to be celebrated. So, it's not just your area, Hefin. There are lots of other areas in Aneurin Bevan that have been super successful recently at recruiting new GPs and, hopefully, giving confidence to the communities.

Good afternoon, Minister. I'd just like, also, to follow up on the issue of GPs, particularly in rural areas where they face particularly severe challenges with recruitment and retention, but also escalating costs, a paucity of social care options, and difficulties in arranging home visits across such a wide area. They have a unique economic disadvantage, which does jeopardise their sustainability. I've been talking with GPs across Powys recently, and it is evident that the current arrangements don't meet their costs or meet their challenges. They need mechanisms and money, in essence, to offset these higher delivery costs. One idea could be a rural GP premium that enables rural communities to meet those primary care needs of their rural populations. Would you, Minister, perhaps give consideration to a rural GP premium? Diolch yn fawr iawn.

Well, you'll be pleased to hear we already have it, Jane. We already have a system. It's a targeted incentive system, which provides £20,000 to GP trainees who take up training posts in particular parts of Wales where we are challenged, and that includes north Wales—there are three training schemes in Bangor, Dyffryn Clwyd and Wrexham—and Ceredigion, Pembrokeshire and Powys. So, it is, I think, probably worth recognising that that scheme is already in place and is making a huge difference in terms of recruitment.

We do see the problems arising as a result of recruitment and retention problems, particularly amongst GPs in the crisis in the Cybi health hub at the moment. The Minister is aware of the situation, and I know that doctors have written to her, and to me, raising concerns about the sluggishness of the health board in appointing GPs in light of the fact that four are leaving on maternity leave at the same time, and that one GP is leaving the service. And it may be a temporary crisis, but it's still a crisis.

The health board tells me that they're confident that everything will be fine, but there's no solution to date. I would appeal to the Minister to help to push for staffing assurances in the short term in the Cybi health hub, because it's a population that's been through a period of inadequate primary care for reasons that the Minister will be aware of. But does the Minister also agree that this is a clear sign of how vulnerable and unsustainable the situation is in terms of GPs at the moment?

I think that people can prepare. I think health boards can prepare, but I don't think that it's fair to ask them to prepare for four people going off on maternity leave at the same time. I think there is a limit to how much preparation they can do. And that's why I am pleased that the health board has taken this seriously. I know that they have met you already to discuss this and, certainly, I know that they are taking this seriously and are putting measures in place.

We are committed to reducing the harm caused by substance misuse in Wales. We currently invest over £67 million in our substance misuse agenda, of which over £39 million goes to our area planning boards to commission local services in response to need.

Thank you. A constituent has contacted me saying that, since he was prescribed Buvidal, it has allowed him to stop using heroin, which has made a huge difference to his life. My constituent received the drug because he was in a special programme for offenders. Apparently, the waiting list for this treatment is long, and my constituent is aware of people who commit offences deliberately so that they can get access to Buvidal sooner. He is concerned that the treatment is not available to more people who could benefit from receiving it in the same way as he has.

Professor Bewley-Taylor of the Global Drug Policy Observatory at Swansea University has noted that there is a growing evidence base to suggest that Buvidal is effective in treating problematic opioid use, particularly among those whose circumstances render traditional forms of opioid replacement unsuitable. The social and individual harms caused by drug use are complex and widespread, and the Government should be doing all that it can, says Professor Bewley-Taylor, to help those looking for support.

Given that Buvidal has proven to be effective, and more effective than other courses of treatment, will you explain why it is not available to all opioid users who are eager to recover from their drug addiction? I understand that there are cost implications to this sort of treatment, but isn't there an argument for expanding its availability as effective preventative healthcare, considering the additional costs to the public purse of not ensuring that?

Can I thank Sioned Williams for that question? As I said, we have prioritised substance misuse services in Wales. We have protected funding for those services, and even for the next coming year, when, as you know, the budget has been so very difficult, we are increasing our allocation to area planning boards by a further £2 million, from £39 million to £41 million. We've been using Buvidal in Wales since the pandemic—it was rolled out in the pandemic—and we're currently investing £3 million per year in Buvidal. We've got more than 1,600 people who are on Buvidal, so we are very much leading the UK in terms of Buvidal treatment.

I share the Member's enthusiasm for Buvidal. We've commissioned a full evaluation of it, but the anecdotal evidence we've received—and you can see that through the word of mouth, that people are telling other people that Buvidal is a good thing to take—is that this is a really beneficial treatment. What we know is that it enables people to get on with their lives; they don't have to go back and forth to the pharmacy, they can hold down jobs and, also, it seems to bring with it a clarity of mind that enables people to tackle some of the problems underpinning their heroin use.

We have, to some extent, been a victim of our own success in relation to Buvidal, and, currently, demand for this treatment does exceed what we can financially support. In some, but not all, areas, there are waiting lists for Buvidal, but it is important to note that those people can still access standard opioid substitution therapy treatment. We've also got these pressures in relation to people entering treatment through the criminal justice setting in the community, and although we don't commission criminal justice substance misuse services, we have funded Buvidal in these settings as well.

So, we are very much leading the way on Buvidal. We will have the evaluation to look at the outcomes from it. I've also asked officials to look at the waiting lists in different parts of Wales, and we will do what we can within the financial envelope that we've got to ensure that as many people who could benefit from it will do.

I would like to declare an interest as a patron of Brynawel Rehab, and I'm thankful to Sioned for raising this important issue. Minister, residential rehab remains one of the best available treatments for those suffering from drug and alcohol misuse. However, this type of treatment is vastly underutilised. I remain concerned that tier 4 funding under the substance misuse programme is regularly underspent by local authorities. So, what discussions have you had with colleagues in local government and on programme boards about the importance of referring these patients to residential rehab?

Thank you very much, Altaf. I know how committed you are to Brynawel, and I've been very pleased to visit there on two occasions myself. You'll be aware that we've provided investment to Brynawel ourselves, including a very significant capital investment to enable them to develop some detox beds. In terms of rehabilitation, clearly that's a really important area of work, and that's why, in Wales, we've established Rehab Cymru, which is our framework for enabling people to access rehabilitation services. That's been underpinned with ring-fenced funding that area planning boards can access to enable people to access the services that they need. We're very committed to doing what we can to build on those rehabilitation services, and I'm very much looking forward to Brynawel being in a position to open their detox beds.

Thank you. We are working with the other UK nations to take collective action on smoking and youth vaping and intend to legislate to create a smoke-free generation. This will make it an offence for anyone born on or after 1 January 2009 to be sold tobacco products, thereby protecting future generations.

Thank you, Deputy Minister. I welcomed your written statement of 29 January, covering actions that will be taken on disposable vapes, and to deal with some of the aspects of vaping that are, perhaps, aimed at under-aged users. From discussions with schools in my constituency, I know that this is one of their priorities too. Public Health Wales has produced guidance aimed at secondary schools and other settings, and is working to develop materials to support its implementation. So, can I ask when you expect that these will be available, and also how they will make sure that families are also aware of these messages around the misuse of vapes by under-aged users?

Thank you very much, Vikki. I entirely share your concerns about the rising prevalence of youth vaping. As you've highlighted, Public Health Wales have been working very hard in this area. They established an incident response group to look at youth vaping and what could be done through schools, and you'll be aware that they published guidance for schools last year, which was well received, and teachers have been able to use that information to guide important conversations with young people on the dangers of vaping. Public Health Wales is continuing to work with education practitioners and are currently working to develop a toolkit with a range of supporting materials for schools. Those toolkit materials will be aligned with the curriculum and we expect them to become available to schools in the spring term in 2024—so, this year.

But in addition, you've highlighted a very important point about how families can tackle the issues of young people vaping, and I'm pleased to let you know that Public Health Wales is also planning to develop a web-based information resource that will highlight some of the concerns associated with vape use amongst children and young people, and will provide information on how parents can support their children. As you know, we have plans to regulate vapes and to prevent them being accessible or appealing to children and young people, and while we continue to develop this legislative work, I'm really pleased that we're also taking these steps to make sure that young people and their families can make sensible, informed decisions about vaping.

Ensuring a sustainable future for general practice in local communities across Wales is a priority for this Government. We have taken steps to improve access to services and to incentivise GP recruitment, and we will continue to work with health boards and the GP profession to embed these changes.

Thank you, Minister. You've already heard from Jane Dodds, of course, about the huge concerns across the region that both you and I represent about the future of our GP surgeries, and the dispute regarding contracts. A recent report by the BMA notes that over 80 surgeries closed in Wales between 2013 and 2022. These problems are very apparent in our rural communities, which are very different to what we heard about the Aneurin Bevan area earlier. In the words of the Dyfed Powys local medical committee, and I met with them recently, as it happens, this is said.

'Sustainability continues to be a concern and is a symptom of the difficulty in recruiting GP partners in parts of Dyfed Powys'.

Now, in response to Jane Dodds's question earlier, you said there was a scheme in place targeting particular areas, including parts of Powys, areas in Betsi Cadwaladr and Hywel Dda. So, given the crisis that I've outlined here, can you give us an assessment of how successful that scheme has been, and if more work needs to be done, how will we recruit more doctors to rural areas?

Thank you very much. The first thing is that we have to ensure that people feel comfortable in their surgeries, and that is part of the reason why we're so pleased that we have come to an agreement with the general medical services. There's £20 million on the table, that's more than ever before, and we do hope that that will help. But we do understand that there are questions about sustainability, and that's why—and I think it's worth bearing in mind—we're seeing a move away from, for example, single-handed practices. People want to collaborate better, it's more sustainable for them. So, although you may be seeing fewer surgeries, what you are seeing are groups of doctors coming together. So, they are still sustaining the same communities, but they are coming together and they're more sustainable. So, I think that's important.

In terms of recruitment and the trainees, they have been very successful. There are 175 new trainees that have been recruited in 2022, and that, of course, is different to the 'Train. Work. Live' campaign that we're running as well. So, it has been very successful, and I know that you have been involved with the GP practice in Laugharne, and there are concerns there. I do know that the GP there has pushed for Carmarthen to be part of that plan to attract people, because Carmarthen wasn't part of that project originally, but it is now, as a result of the lobbying that emanated from there.

The four primary care services of general medical services, community pharmacy, dentistry and optometry are the most familiar and frequently used health services. We continue to work with health boards and professional bodies on the reform of the national contracts for these important services to improve access.

I thank the Minister for that response. I really want to highlight the importance of primary care. Where it works well, it provides a great service. Can I make a request to the Government to protect the percentage of the health budget provided for primary care in the same way as mental health is protected? And what further powers over primary care practices that are funded by the health boards can be given to health boards? I am fed up with a very poorly performing GP practice in my constituency that generates over 25 complaints a year.

Thanks very much, Mike. I think we've got to get to a place in relation to the health service where we stop talking about money going in. What I'm interested in is what do we produce as a result of the money going in; it's got to be about what are the outcomes as a result of that money. That's why, actually, the current funding is linked to contract values, and if that happens, then that creates, effectively, a ring fence.

I am very keen to see, as in our strategic document, which is 'A Healthier Wales'—. We want to see a shift from secondary care into the community, right? So, that's the strategic plan. Actually, it's been slightly blown out of the water, not because we're not doing it, but because we've piled a lot of money into trying to clear the backlog. So, because we've spent or we're planning to spend £1 billion over the course of this Senedd term on clearing the backlog, obviously it looks disproportionate, then, in terms of the percentage differences. But it doesn't mean that less is going into primary care, it's just that the percentage may look smaller because of the need to clear the backlog.

But I'm absolutely with you all the way, Mike, in terms of the need to get into that preventative space, into that community space. It's something that I ask regularly of health boards: ‘Demonstrate to me that you're on that journey, show me what you're doing.' But what I'm interested in is not the money; I'm interested in outcomes, and we've got to get back into that space.

And finally, question 8, Rhys ab Owen.

NHS IVF services are already freely available across Wales. They are commissioned by the Welsh Health Specialised Services Committee on behalf of all health boards. Patients across Wales who meet the access criteria are entitled to two NHS cycles of IVF treatment, and services are available up to a woman’s forty-third birthday.

Thank you for that response, Minister, and for the number of letters I've received from you on this issue. I'm sure we could all agree that IVF and fertility treatment is one of the miracles in medicine in our time. It fills a void within families. And I should declare an interest because I have experienced that joy myself and am extremely grateful to the NHS for what they did. But some prospective parents are paying up to £1,600 for the treatment. This has a disproportionate impact on lesbian couples, who too often have to pay from their own pockets, rather than receiving the treatment on the NHS. According to the Human Fertilisation and Embryology Authority dashboard, only 33 per cent of donor insemination or IVF treatments in Wales were funded by the health service between 2019 and 2021. While 37 per cent of women with male partners received their treatment on the NHS, it falls to 11 per cent for lesbian couples. So, will the Minister take steps to ensure that fertility treatments are fairer for lesbian couples? Thank you.

Thank you very much. I want to make it clear that we are a party that believes greatly in equity, and particularly when it comes to lesbians and the possibility of them having children as well. There are access criteria for the number of NHS IVF cycles that people can have, and there is clarity about who can have those. I know that we have been exchanging correspondence to ensure that we do understand the situation. I know that NICE at present is looking once again at fertility assessment and treatment. They expect to see that happening in the autumn, and we will look again at the situation then. But the situation in terms of equity is very important for us as a Government.

Thank you, Minister.

A point of order arising from questions from one of the Co-chairs of the COVID committee, Tom Giffard.

Diolch yn fawr, Llywydd. I wanted to make a point of order based on the comments made by Mabon ap Gwynfor in his spokesperson's questions, where he made reference to the committee, saying it had met four times, always behind closed doors. I have looked at the Senedd website, and the committee has met seven times, and the last three have been in public, including one yesterday morning.

Thank you for that clarification. I'm sure it's accepted by Mabon ap Gwynfor.

I accept that.

Thank you for the immediate correction of the record. Diolch yn fawr iawn.

Next, the topical questions. The first question is to be answered by the Minister for Education and the Welsh Language. Heledd Fychan to ask the question.

This is an issue of great importance to us. Evidence shows that it is the cost of living, rather than fees, which is the greatest barrier to accessing higher education. That's why we've focused our resources on support with the cost of living to undergraduates and postgraduates that is among the highest in the UK.

Thank you, Minister. Without a doubt, universities are in a critical situation. Time and time again, the former vice-chancellor of Cardiff University, Colin Riordan, warned that their financial situation was unsustainable. In an article in June 2023, he was very candid about the fact that they had to be overly dependent on international student fees, meaning that students from Wales were missing out on places. He said that this is

'a risky strategy, and arguably difficult to defend in moral terms.'

Students are also under increasing stress, affected, as you said, by the cost-of-living crisis, with 35 per cent of students telling NUS Cymru in June 2023 that they had considered leaving their courses because of that.Of course, our belief, in Plaid Cymru, is that education should be free, and that investing in young people is an investment not only in their future, but also the future of our nation.

Accepting that that is not something that's possible in this year's fiscal situation, may I ask why this is happening so late in the day when offer letters have already been sent out to students, and in the middle of a cycle of fee and access plans? When fees were raised in England, the UK Government told universities a year in advance so students and universities had a clear understanding of the situation.

What is your justification for introducing this so suddenly? What assurance can you give that what has been published is consistent with the fee and access plans of the individual universities and is practically possible to implement legally in all universities at the same time? It would be an unfair situation if individual universities in Wales were to charge different fees—unfair for students and dangerous in terms of their financial viability. Furthermore, when the draft budget was published in December, paragraph 58 stated in relation to tuition fees, and I quote:

'If we decide to increase charges, proposals will be brought forward for consultation.'

When was the consultation, and with whom? And if there was no consultation, is this the way to govern—to say one thing, but do another?

I thank the Member for the questions. Just to be clear, maintenance support for eligible undergraduate students will increase by 3.7 per cent and the tuition fee cap, which has been announced, will be increased only to the same level already charged by higher education providers in England, Northern Ireland and Scotland. We've protected our policy of partial cancellation of debt of up to £1,500 when a student begins repaying their loans—and this is unique to Welsh students no matter where they study. The fee limit changes will not result in an increase to the monthly repayment that students will make. Repayments will still be subject to the earnings threshold.

The Member makes important points on the pressures on universities in terms of resources—that's why this change has been introduced. The change is being introduced within this year because of the particular pressures on this year's budget and the need to ensure adequate support for universities in that context, as noted in the quote from Vice-Chancellor Riordan before he left Cardiff University. We have been in discussions with the vice-chancellors and we've also had discussions with NUS Wales on the changes in the pipeline.

Can I thank Heledd Fychan for tabling this question? It's very important. I sympathise with the general health of the university sector in Wales. Paul Boyle, the vice-chancellor of Swansea University and chair of Universities Wales said recently:

'Currently, the income for neither research nor domestic undergraduate teaching courses covers the cost of delivery.'

He warned that the financial environment for universities

'is one of the most challenging in recent memory'.

In light of the decision that's been taken, could you speak to your reading of the wider health, if you like, of those universities in Wales, and whether they are able to compete on that global stage, where we know that is very, very important for our universities.

But secondly, this decision, obviously—. The Welsh Government doesn't set course fees itself; it's important to say that. The Minister has obviously raised the maximum level of these Welsh Government tuition fees. I wonder what work the Welsh Government and the Minister have done to understand the proportion of courses that will now charge this new maximum fee.

The Member is right to say that that is a matter for universities and it is a matter for them whether they choose to increase the fee limit within the cap. As the Member will know, the tuition fee cap, when increased, will be the same as already charged by higher education providers in England, Northern Ireland and Scotland, and Welsh students studying outside Wales will already be paying fees at the increased cap.

It is a matter for universities how they approach charging for their courses; that is not a matter for me as the Minister. And to answer the point that I failed to answer to Heledd Fychan, the timing of any changes that universities wish to make is a matter for them and they will each have their own arrangements in relation to that. We've been open with them about the timing of this change.

In relation to the broader picture, which Tom Giffard is inviting me to comment on, universities are under funding pressure; they're under funding pressure right across the UK. We are in ongoing discussions with all our vice-chancellors in Wales, and with the Higher Education Funding Council for Wales as well, to make sure that we are sighted on challenges as they emerge. In my discussions with university vice-chancellors, they have welcomed the change that I have announced. It is not a change I was keen to make, but it is one that will enable more funding to go to universities without changing the monthly repayments of those students. In fact, most students will have their tuition fee loans written off before they get to the point where this extra charge is paid. So, it effectively operates as a means of providing more income to universities without, generally speaking, affecting students in their own pockets in the longer term.

Of course, I share a lot of the concerns that Heledd Fychan has raised. I take the point in terms of the focus on cost of living, but of course, a lot of the postgraduate support grants were around making it more affordable for people to continue on to postgraduate degrees. Of course, there is also a psychological effect when it comes to tuition fees. I think of myself now, looking at my student finance account and seeing a sum of £33,000 that I owe in payments. This, potentially, is going to have a long-term effect, isn't it, on the skills base we have here in Wales. We know there are substantial skills gaps in a number of sectors. So, I'd be really interested to know from the Government's perspective whether or not they've done an assessment on what potential effect this might have on that skills base, and also how this might align, then, with the economic priorities that were set out by the Government just last year.

I think it is really important that we are clear about what is being changed and what is not being changed. All the evidence that we have points to the fact that students are more likely to make the decision based on the costs of living and the maintenance cost implications rather than on the tuition fee element itself. I think it's important that we still, in the discussions that we have in the Chamber, encourage people into higher education and postgraduate study. Wales is the only nation in the UK that offers our students, wherever they have studied, a £1,500 write-off at the start of the repayment of their loans, which is twice the amount by which the cap is increased on a typical three-year degree. So, I think that is important context because, as he says, people considering going into higher education will want to know what the reality of the support available is. Maintenance support in Wales is set to reflect the national living wage and will be increased by 3.7 per cent, because we absolutely recognise that that is more likely to be a barrier to higher education that students face.

In relation to postgraduate support specifically, as he will know from previous exchanges in the Chamber—and we've had the opportunity to discuss this in committee as well—these are unenviable choices about the allocation of resources. The choice that I have made as Minister is to prioritise the resources we have available at the earliest point in the education journey, which all evidence tells us is the most progressive way of making the biggest change in the most lives for the longest term. That does mean, unfortunately, that students studying postgraduate degrees will now be supported by loans rather than grants. The bursary scheme that we have, which we've also reallocated, comes on top of postgraduate support that is already at a higher level than most students in the UK can access. These are not choices one wants to make as a Minister, but I'm absolutely confident that the choices we have made in this budget are the most progressive choices available to us within that context.

Thank you, Minister. The next question is to be answered by the Minister for local government and to be asked by Peredur Owen Griffiths.

I have formally consulted local authorities on the provisional settlement. Responses to that consultation included requests for the restoration of the social care workforce grant to the value of £45 million. Responses also reflected on a range of pressures being felt by all local authorities, including in social care and education.

Thank you very much for that answer.

I welcome the fact that the Welsh Government has recognised the need to further support local authorities during this period of extreme financial hardship—something that Plaid Cymru has been calling for ever since the draft budget was announced in December. I also welcome that the Minister has given reassurance in her statement that extra funding will be made available for councils, to allow them to make their final decisions on council tax rates and budgets for the next financial year.

We also need to keep sight of the bigger picture: that this money will barely scratch the service in terms of undoing the devastating impact of 14 years of Tory-driven austerity, and that local authorities across Wales will still need to make very painful decisions over the coming weeks on cuts to public services, substantial changes in council taxes or, in many cases, both.

I note that you've raised the funding floor to 2.3 per cent. How high did you consider increasing this before settling on 2.3 per cent? Or is it the natural increase when the extra £14.4 million is applied via the RSG to the original 2 per cent floor?

You also mentioned in your statement that the RSG uplift will help support local authorities meet the cost of funding the 5 per cent pay increase for teachers that was agreed in October. But local authorities have been making the case for some time that their core finance settlement for 2024-25 is simply insufficient to cover this expense. As my colleague Heledd Fychan mentioned in the draft budget debate yesterday, we'd urge the Government to restore the recurrent funding model that was agreed for the previous pay award to ease the extreme pressures facing local government. Will you consider, therefore, to at least part-fund the teacher pay award? Diolch yn fawr.

I'm very grateful for the question and particularly for the welcome that I know Plaid Cymru has given to the additional funding going into social services. I know that, listening to Plaid Cymru's responses in respect of the draft budget, social services, and local government in particular, are a shared area of priority. And just to confirm as well that I have had some discussions with the designated Member for the co-operation agreement on this particular issue, again reflecting our shared priority of social services in particular, but local government more widely.

I should just recognise that point, really, that local government will nonetheless be making some really difficult choices in the period ahead. We have provided the best possible settlement in terms of keeping our promise about the 3.1 per cent for next year and providing this additional £25 million, which has come through as a result of the consequential funding announced by the UK Government. We do also have to reflect that it does come with a bit of risk that the Welsh Government will hold, in the sense that this figure won't be confirmed until the UK Government's spring statement on 6 March. So, it could potentially be offset by cuts elsewhere. Local government can count on it. We were keen to make the announcement early so that they could plan it into their future budgets and so that they could consult on the basis of this new information. So, we felt it was worth us taking the risk in Welsh Government to be able to do that.

And to confirm that specific question, the floor that we had originally set was 2 per cent, and that involved providing an additional—well, more than £1 million into the RSG. But the impact now of the additional £14.4 million into the RSG means that no authority will have an increase of less than 2.3 per cent. So, the increase is the natural—I think you described it as the 'natural increase' as a result of that additional funding to the RSG.

We do know those key pressures that authorities are facing. So, when writing to local authority leaders today to notify them formally of the additional funding, I have set out that the additional funding is to support the pressures that they've identified in both social care and education, including teachers' pay, as local need dictates. And, of course, that supports one of our key priorities in developing the budget of protecting core front-line services as far as possible.

So, we understand that it won't meet all of the pressures. It is the case that teachers' pay should be covered from within the funding with the RSG. I said yesterday in the debate on the draft budget that, in previous years, we have been able to provide some in-year allocation as a result of underspends that have emerged across Government. We haven't been able to do so on this occasion, but we do hope that the additional funding, formally announced today, will at least help with some of those pressures.

Minister, I certainly welcome your announcement of the additional £25 million for local authorities in the next financial year. And as we've already heard, when the UK Government announced an increase to the local government settlement in England, of the £600 million, it has then released that £25 million in consequential funding for the Welsh Government, which of course is a substantial amount of money, but, as you say, and others say, not the full amount to deal with many of the pressures that councils are facing at the moment. My colleagues and I called for this money to be passported to local councils from the moment it was announced, and I'm pleased to see that this is going to happen.

Welsh councils are facing these huge challenges, as we've all acknowledged here today. We firmly believe this is not helped by what we see as an unfair funding formula from Cardiff Bay here, in particular affecting councils in north Wales and rural areas, who are feeling the sharp end of these funding disparities. So, I wonder, Minister, whether, on reflection, with this funding specifically identifying pressures in specific areas in local authorities, that's triggered any thoughts in your mind around the funding formula at the moment and its quality, in terms of what it's identifying as need in councils across Wales.

I'm grateful for the question, and again for the welcome that this additional funding is going to local government. There is no evidence to suggest that any authority, or group of authorities, in any particular geographical area of Wales, or any area that has political or social characteristics, is being disadvantaged through the local government funding formula as it is. We do update the vast majority of data within the funding formula on an annual basis. I think what we are seeing this year is the impact of population change in particular areas, and that's coming through in the formula, and it is impacting on the settlements that have been provided.

And that was one of the considerations, really, in terms of how we best go about using this additional funding. The £14.4 million is going through the RSG rather than raising the floor, as I know some colleagues have called for. And that's because those pressures in social care, in education and elsewhere do exist in all authorities, and I think that we needed to recognise that. And, of course, by raising the floor, essentially, you are making the potential gap greater in future years for those authorities. It gives them some time to plan for that, but, essentially, you might be baking in problems for authorities, and calling into question the fundamental basis of the formula as well. So, as we all know, funding floors are normally there to protect authorities who are receiving a decrease in their funding, to make sure that they don't go below that decrease. But on this occasion, we've used it to protect at least an increase to authorities, which we think was the pragmatic thing to do in these exceptional circumstances, recognising the impact of inflation in the recent times.

Yesterday I did ask about the £25 million consequentials being passported to councils via the funding floor. I know there is an uplift—2.1 per cent, or a floor of 2 per cent—but with inflationary pressures that is actually still a negative uplift, well, not even an uplift, really, when you take into consideration all those pressures, which is my concern. And at the Local Government and Housing Committee, Councillor Lis Burnett advocated using the floor, because she thinks that there are times when local authorities are adrift from everybody else, and in terms of funding, they need to make sure that they are not at a level below which they can sustainably deliver services, which is why I asked that. So, I'd like to know what process is there in place to make sure that they are not at that level below which they can sustain services, because I believe that some are at that level now—I'm really concerned about some in north Wales. And on the concept of a deficit budget, we know that health boards can, and that schools can, actually set a deficit budget, which they've got to carry over within the local authority's budget. So, what process is in place there? Thank you.

I'm grateful to Carolyn Thomas for raising these issues today. I know that they were issues that were raised in the debate yesterday, and then we also had a further conversation outside the Chamber as well, to hear the particular concerns that Carolyn is bringing forward, particularly from north Wales. I have had the opportunity to speak to some north Wales leaders, in various fora, recently as well, to hear their particular concerns. Again, it goes back to whether or not we should have increased the floor further. And I do understand the arguments to suggest that we could have, but, at the end of the day, authorities across Wales are seeing these kinds of pressures, and, actually, the gap, in terms of increase between the lowest and the highest, is actually very small in any case; it's less than 3 per cent. So, we don't see any authorities this year that are seeing significant uplifts that are kind of notably out of step, if you like, with other authorities.

So, as I say, we're continuing, though, to provide as much support as we can to local authorities, and, certainly, it's come through very strongly in the budget scrutiny and the debate we had yesterday, and the committee's reports and so on, that this is an area that people would like us to continue to look to, should there be additional funding at the spring statement, which, of course, is the day after we vote on our final budget. So, as I say, things may yet change next year.

Most of my questions have been answered—[Interruption.] Thank you, Lee. But I still want to reiterate my welcome for the additional money going to local government. It won't scratch the surface of the huge real-terms cut that you've passed on to them, or address the £260 million deficit they have, or the problem they have in social care.

I think I can assume that all of the money is going to councils. You're not got to retain a bit of that £25 million locally, because we know there's not a good track record of passing on consequentials, is there, when we look at business rates support or childcare money. So, I think councils are going to really struggle—we know that—and will need all the help they can get. So, I'm reassured that that money is going to them directly.

Yes, so just to reconfirm that, of the £25 million, just over £10 million will be going to restore fully the cuts that were originally made to the social care workforce grant to help manage the overall position and to provide that additional funding for the NHS, and also to maintain the 3.1 per cent for local government. And then the remainder will be distributed through the RSG as well.

Of course, I would take a different view on some of those consequentials. It often costs us more to deliver the same here in Wales. So, you'll be familiar with the large packages of support that we've provided to businesses in recent years, which have actually cost us more to deliver than the consequentials that we received, or, for example, in the budget for this financial year, we provided more than the consequentials that we received for education and social care to local government as well.

So, I think that there are various different examples, and the point, really, with consequential funding is that it comes to the Welsh Government, and we, then, allocate that in line with our priorities. And in-year, our priorities have clearly been to support education and social care, thereby providing more than we've received in consequential funding.

And finally, Mike Hedges.

Diolch. The money is very welcome, but it will go nowhere near answering the additional costs in social services departments across Wales. I do not believe that, in England, it will actually stop additional section 114 notices, which is the technical term for local authorities going bankrupt. I will again stress the importance of local government. Can I urge the Minister to put any additional money that comes in out via the formula? My question is: will you publish the standard spending assessment and aggregate external finance calculations for each authority, not just the final answer, but the calculations—following this additional money—to answer the Conservatives' assertion about the funding formula being unfair? If you don't show your workings, they're going to keep on saying it's unfair.

I'm very grateful to Mike Hedges for finding the opportunity to raise that particular concern in his question this afternoon. And, yes, we will, obviously continue to consider what more levels of information we are able to provide. I know this is something that Mike Hedges has been particularly interested in in previous discussions on the budget. We had a Finance Committee this morning, and, again, we explored what more information we could provide in different forms, so we'll keep that under review.

Thank you, Minister.

Item 4 is the 90-second statements, and the first statement is from Adam Price.

Thank you, Dirprwy Lywydd. Everyone who saw Barry John has a story—one moment that they can remember where they saw his mercurial talent on the field, performing feats that were nothing short of miracles. The price of a ticket to the Arms Park was always a bargain when Barry was involved in the game. To the boy from Cefneithin, the language was the secret of his incredible relationship with Gareth Edwards—the best scrum half and fly half in the world co-ordinating a team that dominated a decade through the medium of Welsh, 'You throw it, I'll catch it', as the famous quote goes.

It was wonderful to see clips of the Urdd match in the online video tributes, where the Barry John 15 played against the Carwyn James 15—two men from the same village who changed the history of Welsh rugby entirely. But, without doubt, Barry was the king, a man who had the ability to make electricity crackle in the air in that nanosecond before the ball reached his hands, one of those rare players where you could almost hear the crowd take a breath in anticipation of the inevitable,

'back rows—and mouths—rendered wide open'.

Welsh Dark Skies Week starts on Friday. It's a week of events that has taken place every year since 2021, giving us all the opportunity to celebrate Wales's wonderful dark sky reserves, as well as raising awareness of light pollution. There are various events across Wales's protected landscapes this next week, including walks and stargazing sessions, where people can learn more about the work that's being done to protect Wales's dark skies. North Wales, of course, has some of the best dark skies and spots in the UK for stargazing, and it's vital that we all make the most of this opportunity to promote everything they have to offer. And one way, of course, to do this would be to establish a national observatory for Wales in the dark skies of the Clwydian range, which, of course, will soon be Wales's newest national park. A national observatory there could be located close to Wrexham University, with its centre of excellence, which has been doing some fantastic research at the OpTIC Technology Centre in St Asaph. Establishing a national observatory offers potential not just for research, but also for tourism, and would be a major asset for bringing visitors to the region. So, this dark skies week, let us all take a moment to gaze upwards upon the magnificent night-time skies above, and let us do what we can to tackle light pollution and to protect and promote Wales's dark skies.

The fifth of February was World Cancer Research Day. I would like to use this statement to highlight leukaemia, a devastating blood cancer that claims, sadly, 250 Welsh lives a year. The most recent Public Health Wales Observatory data showed that Swansea Bay University Health Board has the second highest leukaemia mortality rate in Wales, with leukaemia being attributable to 139 deaths between 2017 and 2021. I have met with representatives of Leukaemia Care and Leukaemia UK, as part of their Spot Leukaemia campaign. Earlier diagnosis is linked to better prognosis, whilst diagnosis through emergency presentation is linked to adverse patient outcomes. A better understanding of how it presents itself and how it is diagnosed is needed to achieve life-changing early diagnosis.

Comprehensive data on emergency presentation, and use of this data as a proxy measure, is crucial to understanding how people are diagnosed with leukaemia and what needs to change to diagnose this devastating cancer earlier. Wales does not regularly collect or routinely collect data on the route to diagnosis for any cancer type, including leukaemia, thus it is of the essence that Wales collects and makes available more and better data on cancer, including emergency presentation data for leukaemia. Earlier diagnosis is vital to save and improve the lives of those with leukaemia and all other cancers. The one thing we do know about cancer is catch it early and you've got a better chance of living.

Thank you to all three Members.

Item 5 is the debate on the Local Government and Housing Committee report, ‘Diversity in Local Government’, and I call on the committee Chair to move the motion—John Griffiths.

Diolch, Dirprwy Lywydd. I'm pleased to open today's debate on the Local Government and Housing Committee's report on diversity in local government. And I would like to start by thanking all those who contributed to our inquiry, including those who provided oral and written evidence and the councillors who shared their personal experiences with us through the focus groups we held.

The under-representation of women and people with protected characteristics in politics has long been identified as an issue that needs to be addressed, yet we remain in a position where progress has remained stubbornly slow. Despite a general recognition that all democratic institutions should reflect and be representative of the communities being served, few actually do. Today will be the second time in recent years I've led a Senedd debate on diversity in local government, having chaired a committee that undertook a similar inquiry in the fifth Senedd. I'm pleased to say that some things have moved on since that debate in 2019, and I will go on to mention some of the areas where progress has been made.

Committing to increasing diversity requires strong leadership, and progress made by some local authorities is encouraging and demonstrates what can be achieved. Our report recognises where progress has taken place. We identified good practice and suggest ways of sharing that with peers across Wales. Many of our recommendations, therefore, call for good practice to be identified and shared by local government partners. The first recommendation relates to the local government candidate survey. Candidate data is vital to enable better understanding of how representative local authorities are of their electorate. The response rate between authorities varies greatly, however, and we believe there needs to be greater consistency. We recommend that the Welsh Government and the Welsh Local Government Association work together to improve the response rate by increasing awareness and promotion of the survey among candidates and councillors and sharing best practice between local authorities. I'm pleased that this recommendation has been accepted.

When I spoke in the debate on the Elections and Elected Bodies (Wales) Bill yesterday, I said we are pleased that the Bill includes provisions relating to the survey. We welcome the changes in that Bill, but would like to see questions relating to candidates’ caring responsibilities and their experience of abuse and harassment among the core questions. We know that abuse and harassment acts as a barrier to many from entering politics, particularly those from under-represented groups. However, evidence of such abuse is often anecdotal. We believe that including a question in the survey could provide more definitive data to help address this important issue.

We welcomed the commitment from some local authorities to increasing gender diversity, such as progress made by Monmouthshire County Council and the Vale of Glamorgan Council. Although those two took different approaches, both resulted in gender parity across those councils, and they both required commitment and leadership. We recommend that the Welsh Government and partners work together to identify areas of good practice to improve diversity, and to share and learn from those experiences. We are pleased that this has also been accepted.

We particularly welcomed the piloting of the access to elected office fund at the 2022 local government elections, and we are pleased that candidates were able to benefit from it. The availability of the fund was clearly useful in supporting disabled candidates to access the practical assistance needed to stand for election. We therefore welcome the inclusion of financial assistance schemes in the elections Bill. We believe that raising awareness of the fund will be crucial to ensuring success, and that all relevant partners should work together to promote its availability and benefits. It is also important that lessons learned from the evaluation of the fund are taken forward to ensure there is sufficient and timely support for disabled candidates before future elections.

Dirprwy Lywydd, since the 2019 report, arrangements for job sharing amongst members of council executives have been formalised. This is a welcome development. However, to date, this option has not been utilised by many authorities. It is clear that greater awareness of the potential benefits and challenges of job sharing is needed. The guidance recently published by the Welsh Government, which explains the overall principles and provides practical advice on managing its implementation, is therefore welcome. We believe awareness could be raised further by the Welsh Government and partners working together to promote job sharing and facilitate greater sharing of local authorities' experiences. We would also like to see better collection of data on job sharing to enable regular monitoring of its impact in contributing to improving diversity across authorities.

One of the biggest changes since the 2019 report is the move to hybrid meetings, partly a result of the requirements to work from home in 2020, but the ability to do so was overwhelmingly supported by the stakeholders we heard from. Attending meetings virtually as an option is very beneficial to councillors and an important factor for some potential candidates in considering whether to stand for election. Although it has been identified as a particular benefit to certain groups, such as disabled people or those with work or caring responsibilities, the universality of the provision means that everyone can benefit.

We also considered the benefits mentoring schemes can bring in helping under-represented groups to gain confidence, receive training and connect with role models. We recognise the significant contribution made by Chwarae Teg over many years in developing and running mentoring and training schemes, and as a committee we were saddened to hear of the charity's closure. We recommend that the Welsh Government should, in light of the closure of Chwarae Teg, assess the capacity across Wales to deliver mentoring schemes, and quickly identify how any gaps in provision may be filled.

We welcome the provisions in the elections Bill to promote diversity in persons seeking elected office, in particular the list of services that may be provided. Given the evidence we heard that online abuse and intimidation is clearly still a significant barrier for many, which deters them from putting their names forward for election, we recommend in our report on the Bill that specific training to assist under-represented groups in dealing with abuse should also be included in the services listed. We know that tackling online abuse is a priority for the Minister, and we welcome the work done to bring partners together to combat abuse in politics. It's unfortunate that the committee was unable to send a representative to attend the event held last month, which the Minister informed us of, but we would like to be kept informed of future events and their outcomes.

I'd like to start by thanking my committee Chair, John Griffiths, for opening this debate. I am pleased to see that the Government has accepted, or accepted in principle, all the recommendations in this report. I believe strongly that we need to encourage diversity in politics, local or otherwise, whether it's gender, race, thought or socioeconomic, because it brings together everyone's individual experiences and backgrounds to collectively help their communities.

In my remarks today, I want to particularly focus on recommendations 12 and 13, those of bringing together key partners to combat abuse in local government politics, and pressing the UK Government to take stronger action against social media abuse. It is undoubtedly human nature for people to react strongly against Governments and their policies. We heard yesterday in this Chamber from some Members who believe that the policies of the UK Government are evil, yet we are a society that fundamentally believes and encourages free speech. But with great power comes great responsibility, and we should be mindful of how our actions and words in this Chamber are viewed by those outside, and, more importantly, what reactions our words encourage. In today's digital age, we are seeing growing numbers of people now believing that they have the right to hurl vile abuse and threats whenever they feel like it, and we must, for the future of our democracy, take action in setting the standards of how we engage with others and how we express our frustrations and concerns towards each other. It will be mirrored by those watching us.

Diversity is a challenge in local government. There's very little incentive to put your head above the parapet and to advocate for your community. There is a widespread lack of respect for politicians. There's very little thanks shown, and you open yourself up to huge amounts of abuse for just trying to make your community a better place to live. Who in their right mind would do such a thing?

I imagine everyone here has suffered abuse in one form or another. I know I have, and it usually comes from people who would ordinarily see themselves as quite rational under normal circumstances. Yet the harsh truth is that a lot of this abusive behaviour is incited by politicians themselves. Members of all political parties have to understand that, when we make derogatory and personal comments about other politicians, we are setting an example for the public to follow.

And this is not a new problem either. In 1948, Tory voters, as far as Aneurin Bevan was concerned, were 'lower than vermin'. There are also many recent examples as well: Angela Rayner labelling Tories as 'scum' only serves to validate the hurling of abuse by Labour supporters towards Conservatives and, in turn, validates Conservatives in hurling it back—a vicious circle. We know the situation is bad when even a bishop, such as the former Bishop of St Davids, who should be proclaiming the gospel messages of love and care for our neighbours, is fully prepared and unashamed to incite hatred towards those with differing political opinions. Verbal abuse can so easily lead to physical abuse, and this hatred eventually boils over into violence and despicable acts, as we have so sadly seen with the horrifying murders of Jo Cox and David Amess.

A democracy that reflects the people it represents can draw on a wealth of personal experience, backgrounds and beliefs to implement more inclusive policies that better serve its citizens. Unfortunately, however, in parliaments and councils across the world, progress to achieving equality is slow, while in Wales it is noted that, at present, women's representation is highly dependent on the voluntary initiative of individual parties. And it's disappointing that some political parties have been reluctant to take such measures.

The Labour Party has used all-women shortlists since the 1990s, and it's led to a dramatic improvement in the gender balance of both the UK Parliament and this Senedd. There is unconscious bias and gender quotas are still needed. It's important that the best practice of local authorities who have made a positive difference is shared across Wales. The example set by Monmouthshire County Council, agreeing an unanimous motion to aim for gender parity, is an impressive one, and I would like to see other local authorities follow this lead.

Political parties also have an important role to play in increasing the number of elected representatives and candidates from black, Asian and minority ethnic backgrounds. Race Council Cymru surveyed over 300 ethnic minority grass-roots people, and 94 per cent of them reported not getting through upon showing an interest in standing for election.

I said in yesterday's Elections and Elected Bodies (Wales) Bill debate that I'm extremely pleased to see the success of the Welsh Government's access to elected office fund pilot to assist disabled individuals to run for office. This fund was administered by Disability Wales and covered costs such as assistive aids, training, travel, personal assistance and communication support. Feedback from candidates was extremely positive, with one candidate as a wheelchair user using the fund to pay for an assistant to help deliver her leaflets, which is exactly the sort of practical assistance the fund is designed to provide, and to make a real difference to whether an individual feels able to participate in an election.

I welcome the Welsh Government's commitment to learning from this pilot, and taking steps to improve the scheme, raising awareness of the scheme among candidates and making the fund available at an earlier stage in the process. This would ensure candidates have sufficient time to arrange the support needed.

But I would also like to see the financial assistance scheme extended to those who have caring responsibilities, as this can be a huge barrier to standing for election and does disproportionately impact women. As being a carer is not a protected characteristic, the additional challenges facing those with caring responsibilities are often hidden and not included in equalities monitoring. I want to see this change and I hope the Welsh Government will look into this going forward. I find that very often women are still the main carers of children and it's not needed for long, just until the children grow up and they become independent, and it would just assist a lot more women coming into politics.

I'd like to thank the Local Government and Housing Committee for this vitally important report. Democracy without diversity is no democracy at all, and as the grass roots of our democracy ecosystem here in Wales, it is essential that local government is at the heart of efforts to promote diversity in our politics.

This Senedd has a proud record when it comes to diversity. After all, in 2003 it became the first legislature in the world to achieve equal balance of gender representation. The percentage of women elected to the Senedd remains well above the global average. However, this does not mean we should leave this to chance. As part of our co-operation agreement, we remain committed to bringing forward plans to embed equality of gender representation as an integral part of the Senedd reform programme. We also recognise that this must go hand in hand with a firm foundation at the local government level, and it is an unfortunate reality that progress here has not been as rapid as we’d like.

In evidence to the committee report, the Welsh Local Government Association highlighted that only four of the 22 local authorities in Wales had appointed female leaders, and that only two authorities were gender balanced. Organisations like Race Council Cymru also raised concerns regarding the lack of black, Asian and minority ethnic representation in local government. They also reported that members of these communities currently involved in local politics often feel marginalised when participating in council-related activities. Much work remains to be done.

One of the key metrics against which we can measure the success of initiatives to promote diversity in local government is the local government candidate survey, as referenced by Carolyn. As has been noted in the report, it’s unfortunate that the number of respondents to the latest survey decreased compared to previous years. In the response, the Government have promised to take steps to promote the importance of the survey and encourage a greater level of completion. Could the Minister provide an update on this work and let us know how confident you are that we will see greater response rates in future elections?

The report also outlines some interesting views on the role that the voting system has in the context of representation. For example, Electoral Reform Society Cymru stated that the first-past-the-post voting system currently used in Welsh local elections perpetuates the lack of diversity in local government. There was also widespread recognition of the benefits that a more proportional model, such as the single transferrable vote system, could deliver in this area. As a party, we’ve consistently expressed our support for STV as our preferred voting system, and we’ll continue to make the case for its introduction in future Senedd elections.

I'd like to start my contribution by commending the Local Government and Housing Committee for an excellent report. This is a really helpful piece of work, setting out the progress that has been made to ensure our councils represent the communities they serve. It also shines a spotlight on some of the areas where additional work is needed to deliver change by removing barriers.

Before I turn to the report itself, I'd just like to make a few comments on why diversity in local government is so important. As mentioned, all tiers of our democracy should reflect the diversity in the areas they represent—that is crucial for engaging with the marginalised and tackling stereotypes. It also brings different viewpoints and perspectives to the table, leading to better decisions grounded in lived experience of the people. As the founder of the 50:50 Parliament campaign reminds us, representation shapes policy and diversity leads to better decision making.

Turning to the report itself, recommendation 2 around sharing best practice is very important. Considering the issue of gender, in my local authority of Rhondda Cynon Taf, just under 47 per cent of councillors elected in 2022 were women. In my constituency, that stands at a fantastic 56.5 per cent. This is an increase from the 2017 elections, where the figures were 43 per cent and 52 per cent respectively. But across Wales, the change still strikes that snail's pace the Chair writes about in his foreword to the report. We need to look at what works and prioritise those interventions.

With that being the case, I want to mention recommendation 6, which calls for an evaluation of the access to elected office fund pilot, so there is sufficient support for disabled candidates before local government elections. I was interested to read the evidence from witnesses, including Disability Wales, the WLGA and Professor Evans, that this fund was a game changer in enabling people with disabilities to overcome barriers so they could be candidates. I also note their comments around improvements to the fund, not least of all in promoting awareness of it in a timely fashion. I'm glad the Welsh Government has accepted this recommendation, and I look forward to seeing how the fund develops.

Recommendation 10 deals with the support for town and community councils so they are all able to access multilocation meeting technology. Again, this is crucial to attract and empower candidates from a diverse variety of backgrounds. Some Members may have met my late constituent Richard Jones. Richard was someone I was proud to call a friend. Born with brittle bones, he did not let that get in his way, and amongst his numerous activities served several years as a member and then chair of Hirwaun and Penderyn Community Council. Multilocation working was crucial to allow him to fulfil his role as councillor, and I know that that is true for many other councillors in all tiers.

I call on the Minister for Finance and Local Government, Rebecca Evans.

Thank you. I'm pleased to have the opportunity to speak in this debate. I'd also like to thank the Local Government and Housing Committee for its report, which builds on the report that it published in 2019 and looks to recognise the progress that has been made since the original recommendations, but also goes on then to develop those themes further.

In a country with such a diverse population, it's important that everyone has faith in the democratic arrangements that deliver the services that they rely on. It's important that the views of all parts of society are represented in the discussion and the debate that underpins the exercise of democracy locally. It's important that communities can identify with the people who are making decisions on their behalf. Without this, individuals from under-represented communities can be left feeling that their needs are not understood or catered for, which can lead to community isolation.

It's important to recognise that people go on a journey in choosing to put themselves forward to represent others. And that journey can only begin if people are aware of what an elected Member is, what they do and how they do it. For this reason, it's important that we all maximise those opportunities to raise awareness of the role of councillors and the positive difference that they can make in their communities.

Once interest is sparked, we need to ensure that we remove the barriers that prevent people from putting themselves forward as candidates, and then support successful candidates post election. We need to ensure that there are appropriate systems in place in terms of training and development, as well as emotional support and mechanisms to safeguard individuals' well-being. It's important to have cross-party collaboration on this issue and I look forward to working with everybody as we continue our work in this area.

In response to the recommendations in the report there are areas where work is already under way. We're working to raise awareness of and promote job sharing for executive roles, and the next step is to consider how we extend this approach to non-executive appointments. We are encouraging people to share valuable insights and views through the candidate survey and I share the disappointment expressed by Members and those who gave evidence to the committee about the level of engagement with the survey. With our partners we'll be exploring how we can increase participation in future, sharing ideas and building solutions together.

We have also heard about the work to make participation more accessible through the work that we're doing on digital innovations and making it easier for people to attend those meetings. And again, we've had very good feedback from local government, and particularly also from town and community councils in that regard.

The Elections and Elected Bodies (Wales) Bill is currently progressing through the Senedd. This will build on existing approaches requiring Ministers to put in place a fund to support disabled candidates who are seeking election. That will learn the lessons from the successful pilot access to elected office fund, and it will build on those arrangements.

I call on the committee Chair, John Griffiths, to reply to the debate.

Diolch, Dirprwy Lywydd. May I thank all those who have taken part in this debate for their contributions, starting with Joel James? I very much agree with Joel, who is, of course, a member of the committee, in terms of the importance of all of us thinking long and hard about what we say and the way that we conduct ourselves, in terms of the abuse that's prevalent in politics. It was, obviously, mentioned by other Members and the Minister, and the Minister mentioned other elected representatives, in terms of abuse that colleagues experience, so it's from within and without the elected bodies and it has to be addressed in the round.

I would say, I think, Dirprwy Lywydd, that in my own lifetime I can remember when employers saw it as a feather in their cap to have a councillor within their workforce—something that gave them a positive image and was respected by the rest of the community and valued. But now, unfortunately, we seem to have moved into an anti-politics age for very many reasons that make abuse more likely and seem to give people the idea that it's open season, as far as politicians are concerned. It's a real problem; I would say that a lot of it does come through the social media and then finds its way into our communities, and both feed off each other, but wherever it comes from we have to think long and hard, and anew, I think, in terms of how we tackle it. I hope our recommendations will go some way to helping that.

In terms of getting the diversity we need, it was good to hear Carolyn Thomas and, indeed, Peredur Owen Griffiths talk about the responsibility of political parties. I would say, from a Labour point of view, as Carolyn said, it hasn't been easy to take forward policies such as all-women shortlists and twinning for the Assembly, now Senedd, but those policies have borne fruit and we see the results; they do work, and we need to understand that.

Hybrid working and new technology are very important, and it's good to hear the Minister talk about some further digital improvements. I very much welcome what Vikki Howells said about the good performance at RCT; we add that to the examples that I gave earlier, in terms of how progress can be made and best practice shared.

When we come to look at these matters, Dirprwy Lywydd, I think it's absolutely important, as Members have mentioned, that we focus on what this is all about. It's a good in itself to have greater diversity and to have our elected bodies representing the communities they serve, but it's also practical; it's about better decisions, as we've heard. If we have greater diversity in our local councils, in the Senedd and in the House of Commons, indeed, we get better engagement with our communities, we get wider experiences brought to the table and it results in better decisions—better strategies, better policies and better decisions—and that's why we have to work ever harder to build on the progress we've made to date.

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

Item 6 today is the Welsh Conservatives debate on housing supply. I call on Janet Finch-Saunders to move the motion.

Thank you—diolch, Dirprwy Lywydd. A man's right to work as he will, to spend what he earns and to own property is increasingly harder for people to achieve in Wales. This is no surprise when considering that only 5,785 new dwellings were completed in 2022-23, one of the lowest numbers since records began. A person earning the average salary in Wales would have to spend over seven times their yearly earnings to purchase the average-priced home in Wales, which is £212,000. Affordability is clearly an influence in the fact that the number of houses sold is 35 per cent less than in January 2019.

Coinciding with a fall in house building and purchases is a rapid increase in demand in the rental market. According to the Royal Institution of Chartered Surveyors, requirement for rental properties increased by approximately 35 per cent in the three months to August 2023. However, during the same time period, the number of rental properties entering the market reduced by the same amount. We know why, and I've previously outlined to this Senedd the major reforms required by this Welsh Government as regards the rental sector.

Homelessness has reached record levels in Wales. In February 2023 the number of dependent children under the age of 16 who were placed into temporary accommodation reached over 3,000 for the first time. In March 2023 the total number of individuals who entered temporary accommodation hit 10,000 for the first time. Approximately 90,000 households are on a social housing waiting list in Wales—8,000 in Cardiff, 8,500 in Swansea and almost 10,000 in Newport. Those figures are unsustainable. The cost to mental health and well-being is serious. The impact on the lives of many families and children is one of absolute despair. Now, speaking to these residents who live in temporary accommodation for months on end, I've been provided with a lot of powerful messages, such as: 'Temporary feels very permanent'; 'My depression has deteriorated, but I was too scared to tell anyone. I needed to live here, because I simply needed a roof over my head'; 'My children will always remember this trauma. This is not an environment where my children should live'; and 'Sometimes you think, "Why am I living here? What have I done to deserve this?" It is very painful.' They are living there because of the failure of three decades of devolution under Labour, supported by Plaid Cymru.

Local authorities spent a minimum of £60 million on temporary accommodation in the last financial year. Yesterday I pointed out to the First Minister how, under his tenure, homelessness and spending on poor accommodation has spiralled out of control. Just look at Toys 'R' Us in Cardiff—how can any of you allow the people of Wales to live like this? As the late, very dear Rt Hon Baroness Margaret Thatcher said 40 years ago, I believe in home ownership because I believe in individual responsibility, and I believe that, by our actions, we can shape our future.

The Welsh Conservatives—

Would you give way on that?

Yes, okay.

One of the other things that happened under the late Baroness Lady Thatcher's tenure, of course, was the sell-off of council housing without actually replacing it. How does she now reflect on that, when it actually destroyed, decimated the affordable housing stock for rent?

Well, let's be honest, the houses are still there. And it was, in fact, in Wales where you were selling off the houses and not reinvesting. For every one house sold, you can build three. Speak to any developer. [Interruption.]

The Welsh Conservative policy forum—

I would like to hear the contribution, please.

—that I chaired with house building stakeholders, the registered social landlords, the private rented sector and charities from across Wales, delivered a number of solid evidence-based backed recommendations. As a result, the Welsh Conservatives have a new three-point plan and one of speed, aspiration and opportunity. Speed: we would create a joint action taskforce of planners to target the slowest performing local planning authorities. The planning system was repeatedly identified as the No. 1 barrier to house building in Wales—no surprise when the average time for planning permission to be approved is 374 days, with Bridgend, the worst offender, taking 1,800 days. Fast-track applications for affordable housing development—[Interruption.] I need to crack on. The action is simple. Planning authorities will be required to prioritise applications for affordable housing and cut out these delays. We would ring-fence revenue generated from planning fees for local planning authorities. The £460 fee paid per dwelling in planning fees is viewed as too cheap in Wales. Stakeholders highlighted that this could be increased and all planning fees ring-fenced for use by planning departments. We would also establish a planner apprentice fund for each local authority.

Now, stakeholders also raised their concerns surrounding the skill gaps in Wales. Flintshire council warned of planning delays due to a shortage of staff and high volumes of work. In 2021 Swansea councillors heard that the local authority was having to hire specialist staff to address the shortage. And during the policy board, we heard that there are around 130 vacancies in the planning departments here in local authorities.

Aspiration: we would develop a support scheme to enable small and medium-sized building enterprises to build homes, whilst prioritising them to be able to build on public-owned land. The aim here would be to address the fact that the industry is primarily made up of larger developers, with just 12 per cent of homes in the UK being built by the smaller businesses. In the 1980s SMEs built approximately 40 per cent of homes. We should help our SMEs to grow, to employ and to build here in Wales.

We will conduct surveys on all public authority land to determine suitability for housing. You've got the local authority, you've got the health authority, but the Welsh Government owns 437 acres of land that's been identified as suitable for housing. We need to build on that and identify other land in the public sector suitable for development.

And we must ensure that the right type of property is built. It was highlighted to me that Wales needs to construct smaller size houses in terms of the number of bedrooms. In particular, we have a massive shortage of one-bedroomed homes. The average household size in Wales, as of 2020, was 2.26. This has gradually increased since 1991. So, our action would be to ensure homes are suitable for all, with the percentage of each development to include one or two-bedroomed homes.

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

Thank you, Dirprwy Lywydd, and I move the amendment. We are living in the middle of not only a housing crisis but also the worst cost-of-living crisis in memory. Although two different crises on the face of it, they are also interrelated. Despite the significant increase in the cost of fuel, food and other costs, the biggest expenditure in most people's lives is the expenditure on putting a roof above their heads, be that through a mortgage or rent, and the increase in these costs has been huge over the past two years. This, in turn, means that the cost-of-living crisis has even greater effect.

Tens of thousands of people are living in a vicious cycle of housing uncertainty, they are forced to move regularly, they are living in rented accommodation of poor quality, or having to choose between having a roof over their heads or other essentials, such as heating and food. This housing uncertainty and inappropriate housing also has a detrimental impact on the physical and mental health of people, which in turn puts huge pressure on the NHS and other budgets.

Our amendment, therefore, notes the bare statistics,: the 90,000 households on social housing waiting lists, the almost 12,000 in temporary accommodation, and over 3,000 of them being dependent children. We hear regularly that the problem facing us is complex and multilayered, and that is true. But there is one solution that, on the face of it, is simple: we need to build houses that are publicly owned, social housing, at a scale that we haven't seen since the 1950s.

I understand that, for various reasons, which I don't have time to discuss here today, social housing has a stigma attached to it. We need to change that. Municipal housing, social housing, council housing and co-operative housing should be something that everybody should aspire to live in, offering the best quality, most energy efficient and best serviced, with the houses being the central point of a wider community serviced by access to health, education, recreation and transport. An utopia, some might say—[Interruption.] Go for it, Darren.

Thank you for taking the intervention. I appreciate what you say about social housing. I agree there should be no stigma attached to social housing at all. But isn't it a fact that most people do aspire to want to own their own home, rather than to rent a home on a permanent basis? And that needs to be where the focus of our efforts as a Senedd ought to be: trying to help people to reach that aspiration of owning their own home, even if they are currently living in social housing.

I think you're going against something that your colleague, Janet, said earlier, because the market has failed in that respect. We know that the market is failing to build one-bedroomed and two-bedroomed properties. The market is only interested in profit in four or five-bedroomed executive homes. So, we need to intervene in that market. But I will get on to your point in a minute, during my contribution.

As I was saying, what I've set out there with regard to social housing and the fact that that social housing should be accompanied by access to health, education, recreation and transport, some might call that an utopia. But if you look at Vienna, it is a reality, and others are now emulating their vision. And remember, Vienna only followed in the footsteps of Lloyd George and, before him, Robert Owen, here in Wales, and other pioneers. This is part of our heritage, our tradition in Wales, and sometimes it would be good for us to look back in order to find a way forwards.

Again, I understand that some might disparage my contribution, but consider this: as young people are today forced to tie themselves into a lifetime of mortgage repayments, taking away at least a third or more of their hard-earned monthly earnings, they will end up paying the best part of £600,000 at current prices for a three-bedroomed house by the end of that mortgage's lifetime, with all the costs, then, associated with owning a home, with that money going primarily to the shareholders of large banking conglomerates abroad. If we were able to provide the best-quality municipal house with next to no energy costs and low maintenance, that same young couple would pay less than £250,000 in current prices over the same time period, saving them over £300,000 and releasing to them that money to either save it in order to eventually buy a house of their own privately, or spend it on other things—holidays, children's education, a better car and so on—making the quality of their life better. That's something we should aspire towards. That's something we can achieve.

Increasing the stock of social housing in Wales, therefore, is an urgent and strategic response to the affordable housing crisis. With house prices and rents soaring beyond the reach of many, social housing offers a lifeline to individuals and families struggling to secure stable and reasonably priced homes. Affordable housing is a fundamental right, not a luxury. Housing is about more than just providing a secure place for people to live. It's about building communities, it's about ensuring that people have access to essential services, it's about improving people's quality of life and the contribution they can then make to society.

Mabon, I've given you extra time for the intervention. You need to conclude, please.

I'll conclude now. The current trajectory of rising house prices and rents is unsustainable and threatens to exacerbate social and economic inequalities. By bolstering the social housing sector, we introduce a stabilising force into the market, applying downward pressure on overall housing costs and ensuring that the dream of home ownership or stable rental accommodation is not out of reach for a significant proportion of our population.

I call on the Deputy Minister for Climate Change to formally move amendment 2, tabled in the name of Lesley Griffiths.

Formally.

I'm pleased to be taking part in this important debate, which, of course, affects so many people in Wales.

The Welsh housing crisis is more pronounced, clearly, in large cities like Cardiff, but the crisis affects everyone in our society. The housing crisis means that our children are unlikely to own a home before the age of thirty; people are competing for a smaller number of houses, and that has driven up costs to an eye-watering level in many areas. It seems that there is a lack of social housing for those on the lowest incomes in our society, with 90,000 households waiting for social housing in Wales. So, the issue needs to be taken seriously and we have an ambitious plan to get the housing crisis under control.

The figures in Wales are not encouraging. The number of homes being built is fewer than that of the Welsh Government's target. The last time the Welsh Government met the minimum house building requirement was in 2016-17. The number of affordable houses—homes, sorry—built each year is increasing far too slowly, by just 3,603 during the 2020-21 financial year, and this is the highest number on record. So, it's clear that standards have slipped, unfortunately.

We need to accelerate house building now more than ever. The more house building falls behind, the more expensive and unaffordable houses become as a result. A person in Wales earning the average salary would have to spend over seven times their yearly income to purchase an average-priced home in Wales. Aside from the construction of new dwellings, there are pre-existing unoccupied buildings in Wales that are ripe for the picking—103,000 of them, to be precise.

Construction of homes on brownfield sites is also not being fully explored. Building on brownfield sites and turning the bad into good is better than turning the good into concrete. We need to take—[Interruption.] Yes, certainly.

Do you agree that what's been happening, though, is that developers are developing greenfield sites rather than brown, because it's easier and I think more affordable? So, the brownfield sites could be prohibitive.

Well, the brownfield sites are the more obvious option, of course—

Yes, definitely. I agree.

—because they're sites where buildings have been situated before. So, naturally, when there have been dwellings, or, you know, for whatever use the previous buildings have been used for, it's more of an obvious solution than building on green-belt land, which obviously has its own controversies, with biodiversity and all of the other aspects as well. So, I think it's another can of worms, that one, I think.

We need to take advantage of this abundant source of potential housing land. The Welsh Government could do this via the simplification of planning consent and the conversion of land owned by the Welsh Government and local councils for development. The Welsh Government needs to look at simplifying the planning process in general to speed up the approvals and remove barriers to developers, as well as create a dedicated taskforce of planners to tackle the planning backlog.

I believe we need to start thinking about the housing crisis as an emergency. The foundations of our property-owning democracy are beginning to crumble and the demand in the rental markets has sky-rocketed, with properties on the market reducing by the same amount.

To close, Deputy Llywydd, bold and ambitious plans are needed in order to bring this slippage under control so that, hopefully, our children will have the option of purchasing their own affordable and beautiful home. I hope the Welsh Government will heed the advice put forth by the Welsh Conservatives this afternoon and recognise the importance of urgent action on this issue. I look forward to hearing the other contributions in this debate. Thank you.

The Welsh Government has not built any houses. Private developers, both large and small, individuals, councils and housing associations have built houses. There are the following types of tenure: owner-occupied, being bought via a mortgage, privately rented, social housing via housing associations and council housing and co-operative housing. Starting with co-operative housing, while places as diverse as New York, Scandinavia and Vancouver have substantial co-operative housing, the same is not true of Wales and the rest of Britain. There have been major changes since devolution; Merthyr Valley Homes took over the control of the former council housing stock, and in 2016 the tenants voted to create the first tenant and employee mutual housing association in Wales.

Already, the Wales co-operative housing model has been developing housing. Successes include Dol-llys Hall, situated just outside the historic market town of Llanidloes, and Home Farm Village in Cardiff, where 41 social rented houses were completed. With funding from the Nationwide Foundation and the Welsh Government, Cwmpas's Communities Creating Homes programme is offering free comprehensive support tailored to each housing scheme. The project is expected to lead to a thriving co-operative and community-led housing sector in Wales, which is desperately needed.

Not for the first time, I'm raising concerns about empty properties. There have been arguments over the number. Can I just say—one empty property is one too many? While some will be undergoing renovation and others are being marketed, there is still the problem of dwellings being left unoccupied for several years. There are reasons, including families inheriting properties and living abroad, and family disputes. Many of these properties are in sought-after areas and would sell easily. Empty homes are a wasted resource in a time of substantial housing demand. They can also cause nuisance and environmental problems, where empty homes can be a focus for increased levels of crime, vandalism, anti-social behaviour, drug abuse, overgrown gardens, unsteady boundary fences or walls, and, with a shared wall, damp can come through. I've had complaints from constituents about every single one of those, who have been attached to an empty house. They also represent a potential housing resource that is currently underutilised. Bringing empty homes back into use can help address housing and social issues by increasing the supply in areas where there are housing shortages, and provide an opportunity to link suitable empty homes with housing need.

If all efforts to persuade owners to bring their properties back into use fail, and such properties continue to prove to be a nuisance, or be in poor condition, councils need to consider their enforcement powers. Bringing in compulsory purchase powers for councils when a house or flat has been empty for four or five years would improve housing availability. Once a compulsory purchase has taken place, the property can then be sold on to a housing association, an owner-occupier, or a private landlord to bring the accommodation back into use. The key is getting it back into use. The ownership of it is much less important.

I'd like to say what a pleasure it is to be speaking in our Welsh Conservative debate on housing today, submitted by colleague, Darren Millar. As outlined by my colleague Janet Finch-Saunders in opening today's debate, we have a clear housing crisis here in Wales and, I'm very sorry to say, no-one in the Labour Party can pull their favourite stunt right now and point the finger at Westminster, because the blame directly lies within this Welsh Labour Government, who have been in charge here in Wales for the past 25 years. Wales needs at least 12,000 new homes to be built every single year. Regretfully, under the Labour Government here in Cardiff Bay over the last decade, they have barely built half of that number. This is all whilst figures from the Office for National Statistics in 2023 show that there are 103,000 truly vacant, unoccupied dwellings in Wales. Our Welsh Conservative housing plan, highlighted in our motion today, contains three action points that we believe will go a long way in tackling Wales's housing crisis that we, regretfully, see here every day.

I would be shocked here if any Member could look me in the eye and tell me that we have enough planners within our councils across Wales, and I doubt that any Member can, with any sincerity, tell me that we have the next generation of planners ready and raring to go. But we do need to do something drastic, and we need to do it now, because, as it stands, many seasoned planners are retiring, leaving the industry, or are finding the role too stressful, and new recruits undergoing training are being snapped up by the private sector. So, firstly, we need to establish a dedicated taskforce of planners to tackle the planning backlogs in Wales, the slowest performing councils, and create a planning apprentice for every single council here in Wales.

Secondly, we must develop and support small developers in Wales to build homes on land owned by the Welsh Labour Government and local councils that has been purchased by the Welsh public purse, so there should be focus on meeting a local housing need and with all sincerity.

Lastly, and thirdly, we must turn Wales's empty properties back into homes again. It cannot be right that there are over 100,000 truly vacant, unoccupied dwellings here in Wales. Wales does have a housing crisis, regardless of how much anyone mumbles—. Go on.

When you mention the numbers and the statistics around empty properties, I hope you realise that a large percentage of them are second homes, so I assume therefore that you agree with the actions that we've taken with the Welsh Government to bring those houses back into ownership with local people.

I appreciate your comment, however, the properties, and, as my colleagues have all been saying whilst you were making your comment, and these statistics are genuinely empty homes. So, I think that's something that you need to take into account with that.

Now, as I mentioned, Wales has a housing crisis, and the Welsh Government's lack of action in letting families and future generations is certainly being seen. When I was growing up, it was genuinely a dream of mine to own my own home, and it really saddens me, truly saddens me, that this will remain a dream for so many people across the country, if people within this Welsh Parliament don't pull their socks up.

Will you take an intervention?

No, I'm short on time, but thank you so much. That's why I'm calling on all Members to support our Welsh Conservative motion today and to tackle Wales’s housing crisis once and for all. Thank you so much.

I'm delighted to take part in this debate. It's a very serious issue, affecting people right across Wales. So, it's very important we get the detail right, because only then can we successfully use the powers and the limited resources available to Welsh Government to ensure that we meet, as far as possible, tacking this problem.

The figure quoted in the motion conveniently ignores the second homes, as Mabon has pointed out, which the ONS pointed out are vacant for large portions of the year and, undoubtedly, exacerbate housing need in areas that attract a lot of tourism. We need to know exactly what the gap is in the housing stock and the number of homes needed to house people appropriately. So, we know the ONS figures are dubious, as they are two years out of date and based on a 2021 census during the pandemic. This ONS health warning is conveniently ignored by the Tories in their motion.

It seems to me that the Valuation Office Agency provides the most reliable data, otherwise why would both Welsh Government and local authorities rely on the VOA council tax dwellings report to estimate the amount of council tax they need to levy to meet their obligations? So, the real figure of empty homes is roughly 22,500. So, less than 23,000. And I agree with earlier speakers who say that it is a disgrace, that these properties that have been lying vacant for over six months should be brought back into use where possible, when there are so many people who desperately need a permanent home rather than temporary accommodation.

So, obviously, the VOA data enables local authorities to assess how much supplementary council tax they need to levy in order to mitigate the cost of these second homes, based on the impact it's having on exacerbating local housing need, but we do—. I think we can all agree that there are, actually, less than 23,000 properties vacant for more than six months that we should be using to mitigate homelessness.

Affordable housing is in short supply in my constituency. My constituents who are unable to be the privileged living in social housing are living in private rented properties, and they are the most precariously housed. Some are at the mercy of landlords and letting agents who neither provide safe, healthy nor energy-efficient housing, and routinely raid tenants' deposits at the end of tenancies.

Students, unfortunately, are easy prey for disreputable landlords. There they are having their first experience of renting their own place, and they and their families often don't have the time or resources to fight the endless pile of bureaucracy necessary to prise their deposits back. Rent Smart Wales is under-resourced to go after these people, despite the obligatory deposit scheme.

Jenny, will you take an intervention from Gareth Davies?

Yes, happy to. Yes.

Thank you, Jenny. I'm just wondering if you could clarify your comments on private landlords because, like anything in life, you've got good landlords and bad landlords, but you seem to be tarring them all with the same brush and demonising some good people there, Jenny.

No, no, I'm not at all; you weren't listening. I said 'many'; I didn't say 'all' at all. I absolutely agree that there are some landlords who are providing affordable, warm housing in the private rented sector, but in Cardiff Central, they are like a needle in a haystack, frankly; there are almost none of them. But, I admit they do exist, and they exist in other parts, I have no doubt. In Cardiff Central, it's virtually impossible to find homes that are affordable for anybody who's relying on the housing allowance, which doesn't begin to cover the cost of renting in Cardiff.

I congratulate the Minister on the efforts she's making to reform the rental market and ensure that landlords do actually take care of their properties and their tenants, and don't simply use them as money spinners. I'm disappointed that only 69 private landlords in Cardiff have taken up the Welsh Government leasing scheme, which is one very good way of ensuring that there are more social homes available and better quality private rented homes, which will eventually revert to the people who own them.

I agree absolutely that more housing stock is needed, but how and where we do this is of the utmost importance. The Welsh Government has offered to share the learning from its innovative social housing programme, but the big six house builders continue to want to build them by—

Jenny, you need to conclude now, please.

Sorry?

You need to conclude.

Okay. The limits of people's ability to pay. It is essential that we use the local development plans to ensure that they aren't simply endeavouring to breach all the planning regulations we have to avoid more congestion, more air pollution, a lack of public transport links, and I support the motion as amended.

Thank you, Jenny. Sam Rowlands.

Thank you, Deputy Presiding Officer. We've clearly heard many problems and issues around housing outlined so far here today, but let's be clear: the roots of these issues sit with the Welsh Government and their refusal to enable enough homes to be built for the people of Wales. And instead of addressing the real problem by tackling the planning backlogs, by backing small developers and turning empty properties into homes, they instead decide to tinker around the edges and then attack others, like those in the tourism industry, and drag them into—. They pretend there's a crisis around self-catering businesses that work hard in that sector to attract people to Wales and provide a place for them to stay, so they can spend money and boost our local economies.

Data shows very clearly that housing supply in Wales remains far below the delivery levels achieved during the 1990s and into the mid 2000s, and that the number of planning permissions for new projects is on a downward trend. And, sadly, there's very little sign of this changing, despite what Labour at a UK level have to say on this issue. I was intrigued to read a commitment from UK Labour to blitz planning reform; to build the next generation of new towns; to unleash mayors—a package of devolution of mayors—with stronger powers over planning control; and a planning passport for urban brownfield development. Many of these things sound fantastic, and if they're truly the Labour plans, I've no idea why they're not doing it here in Wales, where they've been in power for 25 years. It's clear to me that the Cardiff Labour Government and their coalition partners in Plaid Cymru aren't serious at all about building homes and providing a future for the people of Wales—

Sam, will you take an intervention?

Certainly, Jenny.

Are you suggesting that we should simply allow the house builders to go on building homes that are not carbon neutral, which we've then got to retrofit? Because that's an utter waste of money, and it's just dumping the problem onto the hard-pressed people who are stretching themselves to buy them in the first place.

I think it's a really important point you've made, Jenny, but let me remind you: I was quoting from the Labour Party manifesto, so you should probably take that up with your colleagues in Westminster, I would suggest.

It seems to me that Labour are not serious about tackling this issue here in Wales. And let's be clear again: we haven't, just as a Conservative Party, today, presented problems and issues, we've presented a plan to deal with this. We'll tackle those backlogs, we'll be backing those small developers, and we've a plan to turn empty properties into homes, and that's why I'd encourage everyone to vote and support the Welsh Conservative motion in front of us today.

I've been visiting new homes built across north Wales, and with Welsh Government funding, lifetime homes, well insulated, with solar panels, and that's what we need to be doing. Homes not just for now, but futureproofed, and I'd like to see more being built in the private sector like that. But also built with the infrastructure of schools, health and roads that can be adopted by councils as well.

Going back to planners and having planning and drainage officers in place, public services are fighting over the same officers. Being employed by the council used to be a prestige job—you knew it was usually a job for life, a career with good terms and conditions—but now they're struggling to recruit, as austerity has bitten. Jobs have been lost to the private sector or registered social landlords, who can afford to pay them, give them annual reviews, but vacancies are now taken as cost savings.

The apprenticeship levy has impacted heavily as well. I remember it being introduced when the council was growing apprentices in planning and technical officers. The impact was significant, adding a pressure of £100,000 when it was first introduced.

The housing crisis is rooted in the 1980s. The social housing shortage started under Thatcher. Her Government withdrew funding for councils to build housing, and the disastrous right-to-buy policy saw a 45 per cent reduction in social housing available between 1981 and 2014. Most of the homes sold under this policy were never replaced. It represented a mass sell-off of state assets into the private sector, which, as a result, cost local people—

Will you take an intervention?

Yes, I will, Tom.

You'll know Margaret Thatcher came to power over 40 years ago. You've been in charge in Wales for 25 years. What have you been doing?

Okay. I'll carry on and I'll tell you. Okay.

So, I'd just like to say as well that the money from the sell-off of council houses wasn't able to be kept by local authorities for investing. It wasn't until 2016 that local authorities could keep the rent from the properties that they still owned, to reinvest into bringing them up to the Welsh housing quality standard, and to start really investing in council house building, because the restrictions on borrowing weren't lifted in 2016.

Unfortunately, by this time, Tory cuts under austerity were biting. High interest rates, which are currently in place because of the Truss budget, have impacted on borrowing and the cost of materials, and there are workforce shortages because of Brexit, all of which will affect Welsh Government's target of building 20,000 zero-carbon homes for rent, and the affordability of building new houses is impacted. The local housing allowance has been frozen by the UK Government and the discretionary housing payment fund for Wales, which provides local authorities with top-ups towards rent payments, has been significantly reduced. And the situation is fast moving and critical.

I also believe that council tax could be replaced with a land value tax, paid for by the owner of the property, and it would also help stop land banking by developers. I'm also concerned, like Gareth is, about not developing on brownfield sites. Developers choose greenfield sites, which are much simpler, easier and cheaper to develop, which is a huge concern, but I know Welsh Government have set policies in place and funding, so that brownfield sites should be developed first as a priority.

And Welsh Government is taking action, Tom. For instance, last year, the Minister for Climate Change announced £65 million to ensure that everyone has a place to call home. Living in bed-and-breakfast accommodation is incredibly difficult for people to move on, but this fund helps them to move on from temporary accommodation and supports a wide range of projects by local authorities and registered social landlords to create much-needed extra housing capacity across Wales. Welsh Government have also provided funding for landlords to renovate empty properties and bring them back into use. There's also funding available to purchase private rental properties to bring them back into the public sector. Those are the ex-council houses, so that they can come back into the rental market.

Despite the positive ambitions we have in Wales, the housing system is under significant pressure, and I am pleased to say that the Local Government and Housing Committee are shortly doing an inquiry into social housing supply, going forward.

Can I begin my contribution, and I welcome this debate thoroughly, just by noting the £3.5 million of funding that was announced towards the end of last year for the Ewenny Road brownfield site? It's massive remediation. It's been empty for 10 years since the former industries on it went. It's at the top end of the Llynfi valley. But with the allocation of that £3.5 million confirmed now by the Cardiff capital region, I mention that because many people have said, 'Nothing comes out of the Cardiff capital region to our area.' Well, it's £3.5 million to develop a brownfield site ready for over 200 homes, of which a proportion will be affordable homes as well, plus an enterprise unit, plus a park-and-ride and transport interchange next to the Ewenny station, and so on. So, I commend the Cardiff capital region for signing off on that, and also the work of the local authority who've been working with the developers behind the scenes, to make sure that that can be ready when the money has been announced. I hope, Minister, that you'll continue to work with the local authority and with developers there to bring that site to fruition as soon as possible.

The other one I want to touch is in the east of the constituency of Ogmore, which is the Llanilid development. And it was great to have the announcement last week, and it shows how we can actually build sustainable communities with affordable housing, and develop sites, but do it in a sustainable way with sustainable transport right at the heart of it. Because when the roads review happened, that meant we had to stop and think again about actually completing—the money was there for it—what was known as the Llanharan bypass. Now, with the engagement of the Minister, I have to say, but also with the leadership of Andrew Morgan in Rhondda Cynon Taf County Borough Council and some hard work by officials in Welsh Government, and also within the authority of RCT as well, we are working through a way in which we can take this forward with the development, and link up those communities, not in a traditional bypass way, but actually looking at proper bus infrastructure, proper cycleways as part of it, maybe reductions in speed along the final stretch, and so on, but we will open that site up for housing development as well. That's a major thing, as we see along much of the M4 corridor, where people want to live because of the access to jobs, to social activities, and so on.

But the thing I wanted to really focus on today, Dirprwy Lywydd, was something that hasn't been mentioned so far. We are undoubtedly right across Britain—not just in Wales, but right across Britain—struggling not just with housing supply, but access to affordable housing for rent as well as purchase—rent and purchase. Sometimes, these debates focus on one or the other. We actually need both, and we need both to be affordable as well. We are seeing rents soaring, we are also seeing leaseholders exploited. Colleagues from my own benches and others have highlighted this time and time again. And we’re seeing people priced out of home ownership.

No, he's out of time already. He's going to conclude shortly.

Thank you, Dirprwy Lywydd. I'll conclude by saying we need all sorts of models within the housing market, but I think we should be doing more—and you'd expect me to say this—on the co-operative and community-led models, because I think that can disrupt and make better the housing market, and deliver affordable housing for rent and sale.

I call on the Deputy Minister for Climate Change, Lee Waters.

Diolch yn fawr. Let me first thank Darren Millar for the opportunity to debate such an important topic today. We clearly agree on the need to build more houses, and I think we agree on at least some of the barriers.

In the last few years, the house building sector has faced supply chain disruption, inflation in material costs and labour shortages following Brexit, and of course we all know the impact increased mortgage interest has had on the market, too. I’m bound to point out that this is a direct result of the Truss-Kwarteng mini-budget. The Conservative benches groan, but that is a clear conclusion drawn not just by me, but by the Bank of England itself, who have said that is the case. It sent the pound to record lows, which made things more expensive to buy, which pushed inflation up and increased the cost of borrowing. So, there’s no denying that the Conservative Government at the UK level has caused an economic crisis that has made the challenge of building more houses all the more difficult, and they need to take responsibility for that. Andrew R.T. Davies and others who supported Liz Truss through thick and thin need to accept the consequences of those decisions.

Despite all of this, we have been clear in terms of our responsibilities—

Will you take an intervention?

No, I won't.

Social housing is our priority, and should be a priority that we all support. We've made an ambitious commitment to deliver 20,000 new low-carbon homes for rent in the social sector this Senedd term, and I believe the case for investing in social housing is as strong as it has ever been. It's interesting, the comments from the Conservative benches—Janet Finch-Saunders trying to say that liberty depended upon the ability to own your own home. There is ideological dogma getting in the way here of what people want, which is a decent place to live. I'm afraid this market dogma is one of the reasons why we're in the pickle that we are in today.

Will you take an intervention?

I will.

Talking about people being able to live where they want, I'm sure that you're aware that through the buildings development grant from the Welsh Government, Pembrokeshire County Council, in 2022, bought 46 former Ministry of Defence houses that are going now to local people with extreme need, some in case of homelessness, which will be renovated to meet their new housing quality standard. Is that the sort of ideological thinking that you support, Minister?

Thank you. That's a very good example of the positive impact our decisions and our investment has made: almost £1.2 billion allocated to the social housing grant over the first four years of this Senedd term.

In the context of the economic pressures that we are facing, maintaining funding levels last year and this year demonstrates our fierce and unwavering commitment to delivering more social housing. And I note that the latest figures published in November showed an increase in the number of affordable homes delivered in Wales—our second highest figure to date in the year 2021-22. There were 3,212 delivered of those that counted towards the target, bringing the total units delivered since 2021 to 5,775. That is a tangible difference we are making to the people of Wales.

We need more homes and we need to get them more quickly, and it's important to say that whilst the social housing grant is central to this, there are other programmes and policies that support the delivery of social housing. Our transitional accommodation capital programme, housing with care fund and our regeneration programme support a wide range of projects to meet the needs of people in Wales. The leasing scheme Wales, which Julie James has mentioned many times, is improving access to longer term affordable housing in the private sector. There's a practical initiative we are doing to increase more houses for rent. And crucially, our homelessness prevention and our housing support services are supporting councils to deliver the 'no-one left out' approach and the provision of temporary accommodation.

As part of the co-operation agreement, we're exploring how financial transaction capital can be used to provide loans. Nearly £16 million of financial transaction capital has been secured over this year, and next, to support registered social landlords in the delivery of more social homes. We've launched the Help to Stay Wales programme, a mortgage support scheme for homeowners struggling to afford their mortgage payments and at serious risk of losing their home, something the Conservatives in England could learn from. And we are the only UK nation to continue our Help to Buy programme, providing vital support to first-time buyers, but also SME house builders in Wales. I'll just draw attention to the Conservative speakers on that. We recognise the importance of the mixed market and the role of the SME, and we are doing practical things to help that.

The other thing that was mentioned a number of times was the situation of empty homes, and I completely agree. As chair of the Valleys taskforce, I was able to scale out Rhondda Cynon Taf's excellent approach on bringing empty homes back into use. In January last year, we announced a national scheme, based on that Rhondda Cynon Taf and Valleys taskforce model, with investment of up to £50 million to bring up to 2,000 long-term empty properties back into use. So, again, there's a lot of talk from the Conservative benches of more needing to be done, but we are doing more. Again, that is not something the UK Government in England are doing to bring empty homes back into use. We're providing grants of up to £25,000, as well as a loan scheme, which Mike Hedges mentioned, of £43 million to bring empty properties back into use through providing interest-free loans. That's brought 1,700 homes back into use, as well as 1,800 commercial properties and 395 town-centre units, again providing a tangible boost to our town centres. So, we are doing a great deal.

I call on Mark Isherwood to reply to the debate.

Diolch. I thank Janet Finch-Saunders for opening the debate and all speakers for contributing. Janet highlighted one of the lowest completions of new dwellings in Wales since records began, and the rapid increase in demand for rental homes as the number in the rental market reduced by a similar amount because of Welsh Government reforms. And, boy, do I remember moving amendments in those legislative debates, and seeing every one of them—nearly 200—ideologically defeated by the Welsh Government. She talked about this being unsustainable and creating despair and homelessness because of the failure of a quarter of a century of devolved Labour Governments, periodically supported by Plaid Cymru. And then she highlighted and outlined the Welsh Conservatives' three-pronged approach to kick-start house building in Wales based upon speed, aspiration and opportunity.

Mabon ap Gwynfor rightly said that we're living in the middle of a housing crisis and the biggest increase in cost people are facing is putting a roof over their heads. He said tens of thousands are living in housing uncertainty, that we need to build social homes at scale, and that the current trajectory of rising house and rent prices is unsustainable.

Gareth Davies pointed out that the housing crisis affects everyone, with young people unable to buy, a lack of social housing, rising housing costs and the number of homes being built even lower than the Welsh Government's own targets. And the more that house building falls behind, the more unaffordable housing becomes. We need to access brownfield publicly owned land, he said, and to look at the housing crisis as an emergency.

Mike Hedges pointed out that the Welsh Government doesn't build houses, but he didn't mention that their policies, funding and direction determined the levels of housing supply. He said that one empty property is one too many—quite right—that we need to match suitable empty homes with housing need, and that councils should utilise housing enforcement powers. He referred to the near end of council house building but failed to note that the priority for council house building—a point that Carolyn Thomas doesn't also appear to be aware of—switched to housing associations under legislation in the 1980s.

Natasha Asghar said that blame for the housing crisis directly lies with Labour Welsh Government policies over 25 years and how she's truly saddened that the dream of home ownership is beyond so many young people today.

Jenny Rathbone claimed that the ONS figures for truly vacant unoccupied dwellings quoted in our motion were dubious because they're out of date, yet the motion quotes figures from 2023. She said many landlords are bad landlords, when research shows that almost 90 per cent of these do not fall into this category.

Mark, you need to conclude now.

—and they cynically slashed funding for social housing from 1997, setting in train the housing supply crisis that was to follow. I suggest all of you look at the StatsWales figures and compare the new social housing provided and total housing provided 40 years ago, 30 years ago under the Conservatives, even the year the Conservatives left power, and the collapse in social housing and overall housing in the years that followed, right up to the present day. Diolch yn fawr.

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

Item 7 today is the Plaid Cymru debate on the health service, and I call on Mabon ap Gwynfor to move the motion.

Thank you, Dirprwy Lywydd, and I formally move. Dirprwy Lywydd, we have brought forward this debate today with one clear purpose: to try and convince the Government that we need to recognise the existential threat facing the NHS, which is so fragile and valuable to us, by declaring a health emergency in Wales.

Perhaps Members in attendance will recall that, at the beginning of last year, when the health service was creaking under the huge winter pressures, we introduced a similar motion to the Senedd at that point. Although the Government voted against that motion, the Minister did announce soon after a new set of priorities in order to force through changes in the NHS in Wales. But the sad truth is that, a year later, the Government has entirely failed to tackle those problems. Across all measures, the forecast for the provision of healthcare in Wales has deteriorated.

Since the priorities were first announced in February, waiting lists have hit record highs in July, August, September and October. And while the latest figures do show a slight drop-off, they are still higher than at any point before February. There are currently 582,000 individuals waiting for health treatment in Wales—that's almost a fifth of our entire population that are stuck in this ever-expanding limbo zone, uncertain as to when they'll be able to receive treatment.

Let's turn to cancer services—another key priority for this Government, we're told. As we're all aware, early diagnosis and treatment is an essential factor in determining survival rates. With the World Health Organization predicting a rise in global cancer cases of more than 75 per cent by 2050, this is an issue that will be of critical significance over the coming decades. But the latest statistics show that less then 54 per cent of cancer patients in Wales started their first definitive treatment within the recommended 62 days of first being suspected of cancer in November 2023. This is not only lower than the 54.3 per cent recorded in February 2023, it is also well below the Welsh Government's target of 75 per cent, which, of course, has never been met.

Then there's the fact that ambulances across Wales spent a combined total of over 22,000 hours in December parked outside hospital waiting to drop off their patients; the fact that only 66.7 per cent of patients were waiting less than four hours in accident and emergency departments, down from 71.5 per cent in February; then there's the fact that full-time GPs have declined by 21.7 per cent over the past decade. But I don't need to stand here and reel off these figures, the sheer scale of the problems are plain to see, and the experience recently shared by the Labour MP for the Gower of dealing with A&E departments in Hywel Dda, which she described as an 'utter failure of the system', is typical in this respect. I'm sure that every single Member in this Chamber will have no shortage of similar stories to hand, whether from their constituents, from loved ones or based on their own personal experiences.

To quote the Labour shadow health Secretary,

'You would have to be living on Mars not to see that the NHS is in an emergency'.

So, when is the Welsh branch of the Labour Party going to come back to Earth and open their eyes to what is happening here on their watch?

Just like the last time we brought forward a debate of this kind, I expect the Minister to accuse us of being alarmist and claim that the terminology of emergency is somehow inappropriate or inaccurate. But we don't use these words lightly. We're simply echoing what people working in the healthcare sector have been saying for some time. As I've emphasised many times before, the NHS is nothing without its legions of dedicated staff. They continue to perform heroics on a daily basis under the most challenging of circumstances, but they're being badly let down by this Government's inability to heed their warnings about systematic issues in the health service and to confront them with the honest seriousness they deserve.

I have selected the three amendments to the motion. If amendment 1 is agreed, amendments 2 and 3 will be deselected. I call on the Minister for Health and Social Services to move formally amendment 1.

Formally.

Yes, it's moved formally. So, next I call on Russell George to move amendments 2 and 3. Russell George.

Diolch, Llywydd. I move the amendments in the name of my colleague Darren Millar. As Welsh Conservatives, we'll be supporting Plaid Cymru's motion today, and I certainly echo the first point in the motion recognising the heroic efforts of NHS staff in Wales, often working against a backdrop of a challenging environment, and also recognising that they're doing so as a result of, in my view, a lack of planning from the Government. And, of course, the Welsh health Minister set out her priorities for the NHS almost one year ago, but we're still seeing, of course, those outcomes worsening, frustratingly. And just last week, we saw one lady in her 90s with dementia and breast cancer left on a care home floor for 24 hours, waiting in pain and discomfort for an ambulance. But, sadly, her story is not unique, Llywydd. There are reports on a regular basis of those unacceptably long waits and ambulances queuing outside hospitals.

In Plaid's motion, they also mention the GP crisis, and it is a crisis. And it is a fact that the number of patients per GP in Wales has risen by a third in less than a decade, despite Wales's population barely moving in that time. And I'm afraid the Government has failed to sufficiently—more broadly than GPs—recruit, train and retain NHS talent.

Now, as Welsh Conservatives, we have added to this motion today, and I hope those amendments will be supported, because we believe that the NHS desperately needs a workforce plan. And as the Minister knows, I've long advocated and called for this, and the staffing crisis in our NHS is so acute that we do need to act now to prevent the collapse of our NHS. Those aren't actually my words, those are the words straight from the British Medical Association.

Our second amendment today calls on the Government to set a target to eliminate two-year waits by September of this year and create a taskforce to deliver it. The Government needs to put every weight behind it in order to eliminate these two-year waits. This has got to be the single focus, I would have thought, of the health Minister and the Government, because we've still got those 25,000 people waiting for over two years for treatment, and, of course, we know that across the border in England, and in Scotland, those were virtually eliminated some time ago. And, of course, when we talk about 25,000 people—. It's wrong, sometimes, to talk about statistics, because there are real people waiting in pain, affecting the quality of their lives, but not only their lives but their families' lives as well. They want to go back to work, but they can't go back to work. They're waiting for that operation and it's affecting the wider quality of not only their health but of their well-being as well. So, certainly, I do hope that the Minister will give attention to that in her closing remarks today.

Let me begin by saying that, in recent months and, indeed, in recent years, I've seen the NHS at its very best and its very worst. I've seen the individual stories where I, like others, have had to contact the hospital, contact the health board, contact social services and say, 'Can you help?', because the delays we've had have been so severe. And I've had good responses, I have to say, as well, from Cwm Taf and from my local authorities in doing that. I've seen it at its most strained, and heard some of the stories that we've heard in the Senedd, but I've got to say that I have seen it at its very best as well. I've had constituents say to me, in light of everything that they hear every single day on the national media, UK-wide media, as well as within Wales and what they hear within this Chamber, 'My treatment was superb; my treatment was fast; I was seen fast; I went through A&E fast; I went through the emergency services fast; I came out the other end, and I've been transported back home with care and repair.' And sometimes—. I guess my request would be that we see the balance in this. Because—. And this isn't to do with talking up or talking down. There's a hard reality behind the challenges that the NHS and care is facing, but it's getting the balance right. Because there are—I was just about to swear—there are miracles being performed every day.

I'm currently receiving treatment myself, have been for years, actually, but the treatment I'm receiving at the moment is for something that's come up at the last—. Unexpected, as it happens to many people when they turn 60 or whatever. I've had amazing treatment. I haven't experienced those long delays. And it isn't because, as somebody will say, 'Well, you're an MS, your name goes up the list.' It isn't that. The NHS treats me like any other citizen and it's seen me and it's seen me promptly and it's getting me through the system as fast as it possibly can, and I'm having the best of service, and I do think we need to reflect that in the debates that we have and the conversations we have with constituents. Because, when I have constituents coming to me, I don't hide from them the challenges that we have. They are real challenges and they're worse at the moment. And it's not simply because of the pandemic, but that had a major effect, it's because of the sheer expectations that we have now of the NHS, the treatments that we have available, the demands on the NHS. So, for every £1 billion extra we throw into it, there's more than £1 billion more demand coming on it. We have to be real about this, and I think the Minister's been right recently as well in saying that means we have a responsibility to drive efficiency through the system, to demand of our NHS managers, to demand of our social care providers, that they work together well and deliver efficiently as well. And there is also an expectation on me, as a plus-60-year-old who's in relatively good health, to actually look after my health as best I can so that I don't put the load on my wife when she's working in A&E, so that I don't have to wash up there, I can normally, actually, look after myself and keep myself going as long as I possibly can.

Huw Irranca-Davies is, of course, correct in saying that miracles are being performed daily by the NHS, but this is against all odds, because we can't shy away from the fact that, for many people, there is a health emergency. They are not receiving the care that they need and deserve in a timely manner. And this isn't an overstatement, or, as Mabon said, it's not a headline-grabbing statement in our motion. It's what constituents are telling us, but also it's what NHS workers tell us directly when we've joined them on picket lines or visited NHS settings. We'll all know that casework relating to health is heartbreaking, and often involves bereft families who are left fighting for answers after losing a loved one prematurely because of a long myriad of different reasons. But we also have as casework people working in the NHS coming to us to outline just how impossible their workload is and the conditions in which they are working, and the toll this is having on their own health and well-being. Seeing NHS workers broken surely suggests that the NHS itself is at breaking point. That's why retention and recruitment is proving so difficult. It's why, when we join junior doctors on picket lines, they tell us that Australia is sounding so appealing when they hear from others who have taken that big leap.

The statement that there is a health emergency should not detract in any way from the heroic and, frankly, miraculous work taking place each day. All of that needs to be celebrated. As the health Minister frequently reminds us, every month there are 2 million contacts with the NHS, but what I would like to know is: how many people does that equate to each month? That is, how many of those 2 million contacts are related to the same person? Because what patients and staff are telling me is that people are deteriorating whilst waiting to be seen, or waiting for treatment—sometimes for years—and that then, as they continue to worsen, they then need to be seen, or their condition needs to be discussed on the phone, multiple times a week by a GP, or, of course, they end up in A&E. This only adds to the strain felt within the NHS, and also means that patients die without ever receiving a diagnosis, or receive a diagnosis so late in the day that it's too late for them to receive treatment. This is not only heartbreaking for their families, but also the NHS staff, often GPs who've seen these patients decline over time without the treatment or care that they need. All they can offer them are medicines to manage pain and to keep increasing those doses.

Another issue of concern is the shortages that we've seen with medicines. I know I've raised previously with the Minister urgent casework, with examples of patients who would die without access to the medicines they need, but also, for example, at present there is a shortage of a drug used to treat attention deficit hyperactivity disorder in my region. A constituent had to contact 14 pharmacies before being able to find any. Luckily, he was able to drive, and there were some still available when he arrived from Treorchy to Aberdare, but he would have had to go without otherwise, which would have then impacted his ability to work. And this is something other constituents have raised with me, and something that has a major impact on them, if they're unable to access the prescription they need. On top of this, these medicines, specifically with ADHD, can only be prescribed by psychiatrists rather than GPs. It's incredibly difficult to secure an appointment with a psychiatrist, and, in one example, a patient hasn't had a follow-up appointment or a review of his medicine in two and a half years, despite multiple requests. We are leaving people vulnerable in our communities because of a failure to follow up in a timely manner.

I can't speak as a clinician here, because so much is going wrong in our NHS. So, let me start. I welcome the opportunity to contribute to this important debate this afternoon. Despite assurances from the First Minister, our NHS is not in safe hands. Health outcomes for constituents have worsened in the quarter of a century Labour has been in charge of it. This debate is taking place this afternoon to mark the anniversary of the Welsh Government setting out its priorities for the NHS. All that has happened in the intervening 12 months is more misery for patients and medical staff in the health services. You have a 50:50 chance of an ambulance arriving on time and, from recent media reports, it seems that you're not always guaranteed one will show up on the same day. Just over half of cancer patients start definitive treatment within the 62-days target. That is if they can get to see a GP in order to start the clock in the first place. And that GP should be able to diagnose that and also should have those tools to diagnose that cancer, which he doesn't have.

One of the biggest complaints we receive as Senedd Members is about access to GPs. Over the last 10 years we have seen a 93,000 increase in primary care patients, but, at the same time, we have had a loss of 84 GP surgeries, or a fifth fewer GPs. General practice now only accounts for around 7 per cent—just 7 per cent—of NHS funding, despite accounting for the vast majority of people's interactions with the NHS. When I challenged the First Minister on the decline in GP numbers, he told me

'on every single measure, numbers are growing, not falling, and certainly do not bear out any suggestion that people are somehow leaving the service in droves.'

But the facts are the facts. We now have only 1,429.6 full-time-equivalent GPs practicing in Wales, a massive decrease over the past decade.

Without a clear plan, general practice is facing potentially insurmountable problems. Our population is not only growing, but is also ageing. If we can't accommodate the health needs of our current population, then what hope do we have of addressing future demands? Patients are already unable to get a routine doctor appointment. We need to reverse the decline in GP numbers if we are to save our surgeries and guarantee patients access. To do that, we need a clear plan from the Welsh Government, but the first step in addressing a problem is admitting that you have a problem in the first place. All the First Minister wants to do is deny the fact and then point any blame at the UK Government.

We have heard time and time again that Wales spends more per head on health than England, so, clearly, money is not the issue. The UK Government does not run the Welsh health service, so exactly how is it they are to blame for its dire state in Wales? It is not the UK Government who are at fault—it is the Welsh Government, a Welsh Government without a plan. It is all well and good having priorities, but these past 12 months have shown they are meaningless without a proper workforce strategy. Our NHS does not exist without its staff, and no amount of bureaucracy can replace the clinicians who should be in charge. Diolch yn fawr.

I just want to respond, initially, to the important contribution made by Huw Irranca at the outset, and I agree with a lot of what he said. All of us, either on a personal level, or we know someone or a family member who have had excellent treatment from the NHS, and we're very grateful that we are here, perhaps, because of that very special care. But, of course, we have to recognise the reality as well that there are major challenges facing the NHS, and unless we draw attention to this—. And the Minister, of course, is very aware of those challenges, but it's important that we do have the conversation in order to move things forward and come to an understanding on how we can resolve some of those challenges.

I just want to talk very briefly about the situation of Hywel Dda health board, namely the health board that covers the area that I represent and where I live. The problems facing that health board are evidenced in many ways. I could spend an entire day talking about many of them, but I want to talk about three aspects in particular, namely the optometry services, GP services, and dentistry. As you know, one of the Government's priorities back in February last year was to ensure that those services were available to people in an unfettered way, but, in Hywel Dda health board, the situation in each of these services has deteriorated over recent times.

Let us start with optometry services. According to the recent statistics, only 44 per cent of patients suffering from health risk factor R1, the highest risk level in relation to blindness, had an appointment within the target time that Hywel Dda had set. Of course, the story was that there was a workforce shortage, and, indeed, that is certainly a problem because the number of optometrists working in Hywel Dda has fallen from 636 to 595 since June 2021, so getting staff in this particular area is a challenge. The RNIB estimates that the number of people in Wales living with sight loss will double by 2050. So, without urgent reform in this sector, we will face

'a tidal wave of blindness',

which were the words of Gwyn Williams, president of the Royal College of Ophthalmologists.

Turning now to GP services, the Save our Surgeries campaign has highlighted the impact that years of underinvestment has had on the sector, namely a 21.7 per cent decline in full-time GP levels. So, we are approaching a situation where there will be entire areas, particularly in rural areas, without GP surgeries, some kinds of surgery desert across Wales. The chief executive of Hywel Dda has already admitted that residents will need to travel further to receive care.

Since the statement by the Minister in February 2023, the number of GPs employed by Hywel Dda has decreased further. I'm very grateful to the Minister for answering a question from me earlier this afternoon about surgeries and the work of targeting and recruiting GPs in rural areas, and I recognise the plan in place, and I'm pleased that there has been some success, but, of course, we need to go further to mitigate the uncertainty that rural communities do feel as present. As Mabon has already mentioned, the obvious result of this lack of investment in primary care is increasing the pressure on front-line services, and the extreme costs that stem from this.

So, to close, I just want to touch on dentistry. Once again, the problem is particularly evident in Hywel Dda, where only 34 per cent of people who have registered with NHS dental services have managed to obtain treatment in the last 24 months, and it's the fact that the NHS workforce has shrunk considerably over the last few years that is the main reason for that. Therefore, unfortunately, it's clear that the Government's plans have not improved the deplorable situation facing the health sector in my region, but the point I want to make is that we all need to collaborate in order to ensure that there are solutions available for the benefit of our people. Thank you very much.

I'd like to follow up from what Cefin Campbell has said, in that we can all work together here in order to look at solutions and ways forward. I, like Cefin, want to concentrate my contribution on rural communities, which continue to face significant challenges in accessing primary healthcare services.

In the earlier question session today with the health Minister, I was grateful for her response, as Cefin has also said, concerning my question around a GP rural premium. I heard from her about a scheme that offered £20,000 to GPs whose first general practice post was within a specific target areas in the three health boards of Hywel Dda, Betsi Cadwaladr and Powys. I've found out since that the scheme has been running since 2017. But, despite this scheme running for seven years, and only in specific towns and areas within the three health boards, there are still serious challenges in recruiting GPs to rural surgeries. So, recruitment and retention of GPs still remains a significant issue for our rural GP surgeries. A rural GP premium would help with recruitment and retention. And staying with the challenge of maintaining a GP workforce, this is offset by those leaving. Increasingly, GPs are continuing to say they've had enough. A survey, last year, from the Royal College of General Practitioners found that one in four did not expect to be in their current role in five years' time.

But a rural GP premium is not just for recruitment and retention of GPs; it is also for the recruitment and retention of those other roles and those other professionals who make our rural surgeries, and other surgeries, so important to our communities. A rural premium could also be for enhanced services that rural GPs provide that are essential to our areas and which cannot be accessed due to distance to secondary services, such as phlebotomy, and a rural premium would be to help with those additional transport challenges. So, I would ask the Minister again to reconsider the concept and idea of a rural GP premium.

And, as Cefin has said, we've got dentists in terms of challenges in our rural areas. I'm grateful to the Minister for her support to expand our NHS dentistry services, but it really is still not enough. In rural areas, and in urban areas, there are challenges. A shortage of dentists and a continued reduction in service provision has led many patients travelling miles to be able to access NHS dental services. Dentistry also has similar retirement challenges. Of the 1,389 dental practices undertaking NHS work in 2020-21, more than 14 per cent of those dentists were approaching retirement age, and that number rises to 20 per cent in rural areas.

Finally, primary care services are a source of comfort and reassurance for rural communities. We know that increased isolation itself carries health risks, especially for vulnerable older residents with reduced mobility and reduced income. The campaign to end loneliness has stated that lacking social connections can be more harmful than physical inactivity and obesity, and there is an increased risk of early mortality by 26 per cent.

I suppose that health and Betsi Cadwaladr is the issue that I've spoken most about in the 12 years I've spent in the Siambr, and that, of course, is partly because the board has been in and out of special measures on more than one occasion, and most recently now, a year ago, back in February of last year, when the board was returned to special measures. And the record of the board isn't one to take pride in, I fear, in terms of many of the most important statistics, when we look at performance. It's in Betsi that we see the longest waiting lists in Wales, with over 175,000 people waiting for treatment—a figure that's increased since the board was placed into special measures. In the last 12 months, we've also seen longer waiting times in emergency units. We've seen a reduction of between 4 and 8 per cent in the number of patients that reach the targets of four, eight and 12 hours in the health service too.

In March of last year, Betsi's expenditure on agency staff was £72 million. That is a staggering sum, the largest of any health board, of course. Now, it does highlight the problem that we all know exists, of course, namely the serious long-term staffing problem in the health service. But, between March and June of last year, the first four months of being in special measures, only two full-time additional doctors had joined the board. And the number of dental workers has reduced to only 306 in the past six years too.

Now, these long-term staffing problems do place huge stresses on the remaining staff—those staff that we depend on to run the health service we have. There are 500 vacant nursing posts in Betsi Cadwaladr, a gap that not only puts pressure on the staff that have to fill those gaps, but also, just to remind ourselves, brings a financial burden with it too for the board and, as a result, for the taxpayer. The Welsh Government, of course, needs to focus remorselessly on recruiting, training and retaining staff. I know that the Minister is painfully aware of that, because if that doesn't happen, then I have no doubt that we will see a continuation in these trends of doctors and nurses leaving Wales to seek better working conditions.

In addition to staffing problems and long waiting lists, other challenges have arisen regularly over the years: issues related to mental health services at Betsi Cadwaladr health board, and vascular services are an issue that we raise regularly here in the Chamber. I remember raising problems around C. difficile and hygiene on wards, and, of course, the huge fees that were paid to consultants in order to try and get them out of the hole that they have been in for far too long. Many of these issues emerged directly from management failings—mismanagement by the board—and also a lack of adequate oversight by the Welsh Government.

Over a decade of underfunding against need has impacted on health across the UK. It desperately needs a lot more funding, not just because of the massive inflationary pressures that everyone is facing, such as utility bills, but we also have a sicker, older population in Wales, and on top of that we need to fund new technology and new medicines to help our residents. We also need to invest in our buildings and continually upgrade the estate, just as we’ve done with the twenty-first century schools programme, but have limited capital funding and borrowing powers here in Wales.

I welcome the interventions that the Welsh Government are making regarding training new nurses, providing bursaries, building a new medical training school in Bangor, and trying to overcome the shortages in staff that Brexit and the pandemic have brought about, including complications with visa applications. But we do need to retain good staff. There is burnout, and I hear that for exhausted health professionals morale is low. I’m also worried about working hours and wages in the social healthcare sector, which is also at breaking point. They are joined together, really—you can’t address one without the other.

So, Minister, I’d like to ask what conversations you have had with the UK Government to properly fund the public sector following years of cuts under austerity, and to ensure that adequate funding is made available in Wales. I hear that funding has been made available in England, to give pay rises for doctors, but none for Wales, which seems to be happening quite a lot at the moment.

I don’t want to criticise the health service, because I want to promote it. Betsi Cadwaladr University Health Board employs 19,000 people and we need to be able to recruit and retain them. One of the best things we can do is offer more reasonable working hours, job shares and employ couples into the health service, which I’ve mentioned to the Minister before. Very often people train together, and if we can offer jobs to both those people, that would help with recruitment.

I don’t support the call for a health emergency. I don’t want to frighten people. I want to make sure that, if they think they’ve got a health issue, they get it checked out, and know that they need to do that. And every day, thousands of people do receive treatment, as Huw Irranca-Davies mentioned earlier.

More is being done in the community. We need to celebrate that as well, and celebrate the progress that is being made. In Flintshire, there are two new integrated health and social care community facilities backed by more than £14 million of funding, a new residential care home in Flint, and another for individuals with learning disabilities, autism and mental health support needs in Mold. Croes Atti residential home will be expanded to house 56 older people on the site of the much-loved former community hospital.

We all heard the harrowing story that was reported in the news yesterday, about the experience of one of my constituents, Theresa Jones, a 91-year-old woman from Port Talbot, who was lying in pain, and in mental anguish, on the floor of her care home for almost 24 hours while waiting for an ambulance to arrive. It was heartbreaking for her family and the staff who were trying to look after her. Heartbreaking and unacceptable.

Unfortunately, while this case appears to be an exceptional one, it is very similar to many of the stories that I regularly hear from constituents, and is symptomatic of shortcomings in the services that patients in the Swansea Bay University Health Board area receive. Announcements by the health board on social media asking people not to call 999 if they can, or not to attend the emergency department in Morriston in the wake of acute pressure, are no longer a rare occurrence. When I used to see those announcements, I used to share them everywhere, but now it happens so often that people don't pay much attention to it. And they also mention every time they go to the emergency department the queues of ambulances waiting outside for hours, and that's now almost to be expected.

I heard the First Minister say yesterday that the Government does not have direct responsibility for the performance of ambulance services in Wales, but I have to say that my constituents just don't understand that. That attitude is not appreciated by them or by the workers in the ambulance services themselves, who continue to work so hard to help patients in times of crisis, when they're in pain and in fear, even though there is considerable pressure on their resources to be able to support these people. They don't want to hear the same old song from the Government that things are improving, because they're not experiencing that. That's not their reality, and our duty is to reflect what we hear from our constituents. They want the Government to recognise the scale of the challenge facing their health board, that is, in terms of patients and staff, and the example of ambulance waiting times clearly highlights this, I think.

Back in February 2023, when the Minister's priorities for the NHS were published, 51.8 per cent of red calls at Swansea Bay University Health Board received a response within the ideal eight minutes. But according to the latest statistics, the figure is now 47.2 per cent, and much lower, of course, than the Government's target of 65 per cent.

Another issue of grave importance to Swansea bay is that of maternity and neonatal services, which were placed in a state of increased monitoring before Christmas after numerous concerns were raised by families and in a report by Healthcare Inspectorate Wales. The report stated that staffing levels at the hospital had been unsafe since 2019, and attention was drawn to staffing pressures as being critical in June last year during a meeting between the Welsh Government and the health board. The board has commissioned an independent review of the services because of that. I visited the maternity and neonatal unit at Singleton Hospital at the end of last week, meeting patients and staff. I have also met with Sian and Robert Channon, who have spoken about their experiences at the hospital during the birth of their son, Gethin, who suffered significant brain damage during childbirth.

I now call on the Minister for Health and Social Services to contribute to the debate. Eluned Morgan.

Diolch yn fawr, Llywydd. I welcome the opportunity to respond to today's debate and to share with you how the NHS, despite continued pressures, delivers for the people of Wales.

Firstly, I want to acknowledge the excellent work of all staff in the NHS whose commitment and dedication in such challenging times is essential. Our NHS has seen demands that we've never seen before, and although achieving performance targets has been really difficult, record levels of activity have been achieved over the last year. And I, like you, meet almost every day with patients who cannot praise the service they've had enough, and I think it's really important that we don't lose sight of that. But I also accept that there are too many occasions when the service is not delivering as it should, and we've heard some examples of that this week.

But I don't accept there is a health emergency and I'm not really sure what we hope to achieve by declaring a health emergency, especially if we are not prepared to put the money in when it comes to political priorities. Yesterday, we had a very expansive discussion on the budget, and there was a whole list of other areas where people did not want to see services cut. We as a Government have prioritised the NHS in the face of over £1 billion of cuts in real terms. It is our priority. We have set it as a priority, and that is not necessarily where everyone else is.

Now, looking at demand over the last year, referrals have increased by over 10 per cent. That's over 1.5 million referrals in a population of 3.1 million people, yet our total waiting list has increased by less than 2 per cent. On average, each month almost 300,000 people—that's about the population of Cardiff—are seen as out-patients. And over 31,000 procedures were performed in the last 12 months. The most common access points for people seeking NHS services are either GP services, NHS 111 or 999. On average, around 1.5 million contacts happen through GP services each month. And when I told the former chief operating officer of the NHS in England that last week, he almost fell off his chair. Over 2,500—[Interruption.] No, if you don't mind, I'm going to plough on a bit. I may allow you to come in later.

Over 2,500 people attend an emergency department and around 1,100 people call 999 every single day. I think the vast majority of these people would say that there is not a crisis. People fall over themselves, as I say, to tell me how great their treatment has been, but, as Huw says, you've got to balance it. We've got to balance all of the criticism with the great work that is being done in the NHS.

But the good news is that we now have alternative pathways that have been developed as part of our strategic national transformation programmes to take pressure off GPs. In December, over 41,000 people used the new clinical community pharmacy service for common ailments, like access to the morning-after pill and oral contraception, or emergency supplies of medicines and flu vaccinations. And the number of consultations delivered through pharmacists or independent prescribing services has almost doubled.

Over 300,000 new patients have accessed NHS dental care since April 2022, and it's interesting to see that the UK Government is deciding to recognise that there are real challenges in England. But, unlike in England, we don't announce things, we deliver them and then we tell people what we've done.

In December, the ambulance service had, on average, over 1,200 calls every day and responded to the highest number of red calls within eight minutes on record. So, I think what's amazing—. You've got to keep on remembering, actually, that performance is better than it's ever been before. More than ever responded to in eight minutes, but because the demand has gone through the roof, of course it's difficult for them to hit the targets we've set.

I think this is quite an achievement in the current climate, but despite all of this, I'm highly aware that some people are being let down by the service. I am concerned about those people who have to wait in an ambulance or a corridor, or can't get a bed; people who find it difficult to move around while awaiting a hip replacement or cataract surgery and patients who are waiting to hear if they have cancer. I'm the first to admit that the waiting lists in the NHS aren't where we want them to be, but I do think we have to recognise and appreciate the progress that's been made across Wales.

Llywydd, we are determined to continue do everything within our ability to support the NHS. We have provided £425 million in addition this financial year and £450 million in addition will be available for next year. We do have a joint 10-year strategy for the health and social care workforce, which is supported by a national action plan. This will lead to the creation of a long-term plan for the workforce. The NHS workforce is now at its highest level ever, with 110,000 people working in the service. There has been an increase of 32 per cent in medical and dental staff; an 11 per cent of increase in the past 10 years in the number of nurses; a 25 per cent increase in consultants. People ask about GPs—.

I'm afraid, Altaf, your statistics are just wrong. In 2022, there were 1,808 GPs; in 2021, there were 2,038 and it's gone up last year by 1.6 per cent again. In Wales, we have 63 GPs per 100,000, compared to 57 per 100,000 in England.

I am going to ask the Minister to bring her contribution to a close here. I've been very generous.

Thank you. The frustration is that, actually, I could go on for a really long time, because—[Interruption.] I'm more than happy to; blame the Llywydd. [Laughter.] I do think that people need to hear the good news—that, actually, there's been a massive amount of improvement, and we've got to celebrate that. And the one sure way of demoralising those 100,000 people working in the NHS is to say that there's an emergency and it's not working. I don't think that that would be constructive way of us appreciating the incredible efforts that they've made over the past year. Diolch yn fawr.

Mabon ap Gwynfor to reply to the debate.

Thank you very much, Llywydd, and thank you to everyone who's contributed in this debate this evening. It has, generally speaking, been a very constructive debate, and I appreciate every contribution made. If I could agree, first of all, with what Huw Irranca-Davies and Carolyn Thomas said in terms of the heroic work that is done by the workforce, of course, we agree, and that's why we put it at the top of our motion that we do want to acknowledge those heroic efforts, and Cefin mentioned some examples of that.

But, despite that heroic effort, the truth is that these statistics, whatever the Minister said, do speak for themselves. We heard Heledd Fychan talking about how those stats do demonstrate that we are, actually, in a crisis or emergency, and Altaf going on to mention the numbers of GPs, and that the funding provided to them is now 7 per cent rather than the 8.7 per cent it was in the past, and that people have only that 50:50 chance, as he put it, to get an ambulance to arrive on time. So, it's those statistics that show that things aren't working at the moment. Llyr then talked about the waiting list statistics in Betsi Cadwaladr.

The clearest element in of all this is the workforce, and that's why we would agree and support the Conservative amendments. One of the Conservative amendments mentioned that there has to be a workforce plan, and that workforce plan would also be central in order to ensure that we raise those levels again.

The Minister tried to reel off some stats, and yes, we know that we've seen certain increases, but the fact remains that we still don't have enough nurses. We're 2,000 nurses short. The Minister says time and again that the one sure way to demoralise the staff is by us pointing out the weaknesses within the health service. No; the sure way to demoralise staff is by not honouring the contracts that you promised them—giving GPs, for instance, the pay that they deserve, the pay that you promised them, making sure that the contracts of the nurses are amended so that they can have more flexible working hours. How you demoralise the staff is by not giving them what they need and what they require in order to fulfil their jobs to the best of their capacity.

The stats speak for themselves. We've got longer waiting lists, and those waiting lists—. I appreciate the fact that the Minister says the health service has received around 2 million contacts over the last month, I think you said, in December—

It's 1.5 million.

Okay, that's a significant number, but a lot of them are the same people. Because they're on a long waiting list, because they can't get that treatment, they're going back, returning to the GPs, because they have increased pain, because they have other ailments, because they are then suffering from things like mental ill health because of the long waiting list. So, we have more contacts because we are in this health crisis.

I'm a bit frustrated that the Minister said that she doesn't understand why we need to declare a health emergency. This Government was the first in the world to declare a climate emergency. Why? What was the point of doing that if you don't believe in declaring an emergency, that it has a purpose? The Government has declared a nature emergency. The first motion we put forward in this Senedd was supported by the Government, declaring a housing emergency. We've got a cost-of-living crisis, another emergency, which the Government keeps talking about, quite rightly. But for some reason there's a reluctance there to admit that we have a health emergency. If there was that admission, then we would have the proper focus. We would be able to focus on what's needed to get us out of this situation, to identify what we need to do to de-escalate and work together to find a way forward.

That's why we have brought forward this motion, and that's why we need that statement, a health emergency declaration, a clear statement, so that we can have that focus that we need in order to give the necessary attention, so that we can co-operate and find a solution. But without that, then I'm afraid the Government is putting its head in the sand again and is denying what's clear for everyone to see in terms of our experiences, whether they're direct, or whether it's friends or family members, which is that we are facing a health emergency here in Wales. So, I encourage you all to support the motion, and also to support the amendments. Thank you.

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

Unless three Members wish for the bell to be rung, we will move immediately to voting time. The first vote this evening is on item 6, the Welsh Conservatives debate on housing supply. I call for a vote on the motion without amendment, tabled in the name of Darren Millar. Open the vote. Close the vote. In favour 14, no abstentions, 37 against. Therefore, the motion is not agreed.

We will now move to a vote on amendment 1 tabled in the name of Heledd Fychan. If amendment 1 is agreed, amendment 2 will be deselected. So, I call for a vote on amendment 1. Open the vote. Close the vote. In favour 12, no abstentions, 40 against. And therefore, amendment 1 is not agreed.

We'll move now to amendment 2 tabled in the name of Lesley Griffiths. Open the vote. Close the vote. In favor 37, no abstentions, 15 against. Amendment 2 is therefore agreed.

The last vote on this item is on the motion as amended.

Open the vote. Close the vote. In favour 37, no abstentions, 15 against. And therefore, the motion as amended is agreed.

We'll now move to the votes on the Plaid Cymru debate on the health service. I call for a vote on the motion without amendment tabled in the name of Heledd Fychan. Open the vote. Close the vote. The vote is tied, and therefore I exercise my casting vote against the motion. The result of the vote therefore is that 26 are in favor, no abstentions and 27 against. The motion is therefore not agreed.

The next vote is on amendment 1, tabled in the name of Lesley Griffiths. Open the vote. Close the vote. The vote is again tied. I will exercise my casting vote against the amendment, and therefore the amendment has been defeated by 27 votes to 26.

The next vote is on amendment 2, tabled in the name of Darren Millar. Open the vote. Close the vote. The vote is tied. I exercise my casting vote against the amendment. The result of the vote is that there were 26 in favour and 27 against. Therefore, amendment 2 is not agreed.

Amendment 3 is next, in the name of Darren Millar. Open the vote. Close the vote. In favour 27, no abstentions, 25 against, and therefore amendment 3 is agreed.

We will now vote on the motion as amended.

Open the vote. Close the vote. The vote is tied, and therefore I exercise my casting vote against the motion as amended. And therefore the motion is not agreed.

That concludes voting for today.

We have one remaining item on our agenda for this afternoon.

I'll ask Members to leave the Chamber, if you're leaving, quietly, so I can call on Janet Finch-Saunders to introduce her short debate. Janet Finch-Saunders.

Diolch, Llywydd. I'm pleased to be giving Natasha Asghar, Mark Isherwood, Joel James, Russell George, Peter Fox and Mike Hedges a minute in this debate.

According to the National Community Hearing Association, there are currently 527,100 adults in Wales, which is 17 per cent of the population, with a degree of some hearing loss that would benefit from treatment such as with hearing aids. Over 95 per cent of those with a hearing loss in Wales are over the age of 40 and hearing loss is the fifth leading cause of years lived with a disability in Wales.

Wales also has a particular issue with an ageing population. The incidence of age-related hearing loss is roughly 1 per cent per year of age; so 60 per cent of 60-year-olds, 80 per cent of 80-year-olds and 90 per cent of 90-year-olds and so on. Wales is the nation in the UK with the highest percentage of its population aged 65 or older, so it is imperative that we have the best hearing services possible.

Three years ago, just over 4,000 people were waiting on appointments to receive their hearing aid. In September 2023 nearly 10,000 now are waiting for the same; a third of whom are waiting over 14 weeks. So, there has been a 150 per cent increase in those waiting. Waiting lists have risen steadily since 2019 and continue to grow. In November 2019 not a single NHS patient waited more than 40 weeks, however, in September 2023, there were 35.

The number of audiologists employed by health boards differ across the nation. So, you have in Public Health Wales, three; Powys, five; Hywel Dda, 18; Betsi Cadwaladr, in my region, 65. So, on top of the inconsistent spread of audiologists, it is a complete postcode lottery as to how long you have to wait for any hearing support needed. In November 2023 the number of adults waiting longer than 14 weeks were just one patient in Swansea bay, 583 in Hywel Dda and, again, a staggering 1,674 patients at the Betsi Cadwaladr health board.

So, let's look at what the Welsh Government have in place to try and improve audiology services. Last year you advised that once the wax-management pathway is in place, patients will be referred to a primary care audiology service, where it would be performed free of charge by advanced audiology practitioners, thereby freeing up unnecessary patient appointments in primary and secondary care.

I'm aware, also, that NHS Wales pathways with national clinical standards for the delivery of a hearing care service are being implemented across all health boards, with advanced progress having been made by Betsi board and Swansea bay. This means that patients can now be referred to a primary care audiology service, where hearing care will be provided free of charge by these advanced audiology practitioners. So, the Welsh Government model is focused on NHS advanced practice audiologists seeing patients at initial presentation with hearing problems. The problem is, though, that primary care audiology still comprises locating hosptial hearing loss practitioners in GP surgeries, and, as you can imagine, you need a model that removes that pressure from GPs. The move improves local access, but does not add capacity to the service.

So, I believe you could go a step further. Both Boots hearing care and Specsavers have approached me to highlight that, by working with primary ophthalmic service contractors, opticians, and private audiologists who already provide this community audiology to adults who choose to pay for their hearing loss care, health boards can add capacity as well as improving access. The risk of investing in additional colleagues and premises would fall entirely to those contractors already placed there, with their hearing booths, with their ophthalmology units there in the high street. So, the service delivery model, already in use by England and Ireland, has proven to be safely delivered by these independent providers, and at as much, Minister, as a third of the cost per patient of providing this service through a hospital.

Based on the evidence from NHS audiology services, the unit cost per patient would fall significantly. Access to support would be quicker, which is what we need. And also, why would you have people needing hearing aids, batteries, and all that maintenance, wandering down corridors of hospitals, at risk of infection, and, indeed, adding more pressure to those hospitals, when they could go onto the high street and work with our audiologists and our ophthalmic providers, and, actually, be livening up our high streets?

The National Deaf Children's Society has found that 26 per cent of families were dissatisfied with waiting times for paediatric audiology. Now, whilst I understand that they are in the process of contacting people to discuss waiting times, we need to see some action now. In fact, 45 per cent of families who were satisfied with waiting times still shared at least one concern for their child whilst waiting for an appointment. They include delays in finding out the reasons behind their children's hearing loss, if their child was able to access all that was said in their education setting, missing out on improved social communication with friends and family, and understanding whether hearing technology would benefit their deaf child.

I'm sure you will agree that it is imperative that no time is lost in ensuring that children and young people requiring audiology assistance receive it. So, there needs to be cross-departmental action. For example, health needs to work with education, which has seen a 17 per cent reduction in teachers of the deaf in Wales since 2011. No surprise, then, that, in December, Ros Hannam from Caldicot launched a campaign calling for more investment in specialist teachers who have helped her and her family, which includes two deaf children. Another example of where schools are not effectively supporting health is through the individual development plans. The NDCS has found that, despite the commitments of the additional learning needs code to provide IDPs to all learners with sensory impairment by virtue of said impairment, some children are still being denied these. This cannot be right in 2024.

Left unsupported, hearing loss cuts people off from each other. This can increase the risk of social isolation, cognitive decline and other mental issues. And I'm given to understand that it can actually bring on early dementia and Alzheimer's. Too often, deaf people who simply cannot hear quite often feel that they are referred to as 'daft' people, and that's the stigma that we've got to get rid of. I believe that you could be delivering hearing services in Wales through this much easier model, on the high street, working through private contractors, at a third of the cost. And, therefore, Minister, I would ask that you consider giving that model some consideration. Diolch.

I'd like to thank Janet for letting me contribute to the short debate today, and thank her for bringing this important topic to the Chamber. I had the pleasure yesterday of sponsoring an event in the Welsh Parliament about adult hearing loss and tackling the stigma around it. It was a very interesting event, and I must pay tribute to my colleagues Russell George and also Joel James MS for speaking so openly, particularly about his experience of hearing loss. It was really, really moving, Joel, and honestly meant a lot.

Hearing loss is a huge issue here in Wales, with there being more than 0.5 million people with some degree of hearing loss, and there is a huge demand on our NHS for ear care, with nearly 10,000 people waiting for appointments to receive hearing aids as of September last year. Now, every health board in Wales commissions Specsavers to provide eye specialist health services within the community, and I must commend them, because they started something very new in Newport, and that is within their flagship store. I must commend also my predecessor in South East Wales who, apparently, was the linchpin between the Aneurin Bevan Health Board and Specsavers in creating such an incredible new outlook, which is, when you walk into an opticians, at the bottom you have your eyes tested, you get your glasses, your contacts, but then upstairs, in collaboration with Aneurin Bevan Health Board, you can also go and have small procedures done with your eyes and also your ears as well. I was invited to the actual flagship. I would suggest you go as well, Minister, if you get the opportunity. I'd love to take you there, because it shows great collaborative working, and it certainly can be done. I just wish it would be done everywhere, as opposed to just in Newport as well.

I'd like to ask you today, Minister, if the Welsh Government has explored implementing something similar when it comes to actually providing good ear services as well to residents across Wales. It's clear more needs to be done in Wales to support those with hearing loss, and I look forward to the Minister outlining what steps the Welsh Government is going to be taking to achieve just this. Thank you.

Two years ago I met Specsavers with the chief executive officer of the Wales Council for Deaf People to discuss how the optical industry could help NHS Wales improve access to NHS hearing loss services. Early last year, however, a written response from the Minister told me she had agreed not to seek private providers’ assistance at this time, despite every health board in Wales commissioning optometry services from the same providers. Last June, during a visit to Specsavers in Mold, they demonstrated their comprehensive community audiology hearing loss services, the audiology pathway they provide, and how they work with and care for audiology patients every day. Although community audiology service providers hold NHS audiology contracts elsewhere in the UK, NHS hearing loss services in Wales are exclusively provided within NHS Wales, forcing some patients to go private, and other to suffer in silence. A responsible Welsh Government would recognise that demand for audiology services is only going to increase. Many, unlike myself who lost my hearing as a younger person, lose their hearing as they grow older, and although the primary care audiology model improves accessibility, it fails to provide the additional capacity needed.

I'd like to start by thanking Janet for allowing me a minute of her time and for raising such an important debate, and also to thank Natasha for her kind words just then, really. I suppose I just want to take my opportunity to reiterate the valid points that Janet rose in her debate in terms of just tackling hearing loss quickly. If we look at child development, we know of social isolation, the impact in terms of speech and language, and then also the social skills that can be impaired. And then if we look at when we become adults, in terms of the working environment, there are 4.4 million in the entire United Kingdom that have hearing difficulties. Many of them feel that they're being discriminated in the working environment, in terms of being passed over for promotion, losing out on the office atmosphere—the banter, the conversations. And then, as Janet highlighted, hearing impairment is linked to cognitive decline, but the statistics show that, as soon as those hearing aids are fitted, cognitive decline ceases almost immediately. So, those are the key points I'd like to just reiterate for the Minister. Thank you.

Thank you, Janet, for giving me a minute in this debate. I am president of the Swansea Hard of Hearing Group. People's hearing deteriorates with age. Age-related hearing loss, also called presbycusis—I hope I got that right—is the gradual loss of hearing in both ears. It is a frequent problem linked to ageing. One in three adults over 65 has hearing loss. Because of the gradual change in hearing, some people are not aware of the change at first—they just turn the tv and radio volume up. The hearing range is also reduced as we age, so do you inner ears. Because of this there are certain sounds we simply cannot hear as we get older: 17,400 Hz is a frequency that only teenagers can hear; 12,000 Hz is hard for anyone over 50 years of age to hear. Tinnitus is the term for hearing sounds that come from inside your body, and is often associated with hearing loss. Adult hearing loss services in Wales are mostly provided by NHS health boards, mostly as hospital-based services, even though 94 per cent of adult onset hearing loss is age related, which can be safely and effectively treated in community locations. We need to support more community-based treatment.

I was really pleased to attend the event yesterday, hosted by Natasha Asghar, and any Member walking through the Oriel yesterday may have seen the inside of my ear on a big screen. It was a really delightful picture, wasn't it, Janet? I think Janet saw it and was horrified. But I do support some of the comments others have made, especially Mark Isherwood, in terms of what Specsavers and the private sector can do, not only to support the NHS but actually to save the NHS money. The case seems quite clear to me, so I hope it is something the Minister will be able to examine.

But I also met with Auditory Verbal UK today, and they spoke about the need for early intervention and diagnosis on hearing impairment for younger people. Now, if that's done early, and that diagnosis can come early, that can also bring a saving later down the line as well. But they spoke about the need for 30 AV specialists across Wales. At the moment, they told us there are zero in Wales, so I hope that the Minister may be able to comment on that as well—perhaps not, but if the Minister can—. The Minister's indicating not, so I'll make sure I drop the Minister a note on that.

Finally, Peter Fox, before the Minister responds. Peter Fox. Just one more. Just one more, Minister.

Sorry, Minister. Thank you. Thank you, Janet, for giving me some time, and, like Russ, I wanted to raise the important issue related to therapies to support deaf babies and children. Clearly, it's so important that our youngest citizens have access to all the support they need, as their whole life lies ahead of them, and how we support them at the start of their lives will determine how their life progresses—positively or, possibly, negatively. To that end, I would like to understand if steps to increase access to auditory and verbal therapy for deaf babies and children are being considered, and, if so, will this specialist support be adequately supported with Government funding, to ensure all deaf children have the opportunity to access it via publicly funded services?

The Minister to contribute to the debate.

Diolch yn fawr. I'm grateful for the opportunity of the short debate today to focus on this important topic of faster access to hearing services. The Welsh Government recognises that loss of hearing at any age can be devastating and, as a result, can leave people feeling isolated and detached from the world around them. Early intervention and diagnosis are paramount for the health and well-being of these individuals.

Now, since 2017, when the 'Framework of Action for Wales, 2017-2020: Integrated framework of care and support for people who are D/deaf or living with hearing loss' was launched, we have worked hard to become a leader in hearing care. As Janet set out, audiology services here are delivered differently from the rest of the UK—a much stronger emphasis on more treatment and care delivered in primary and community care, underpinned by those prudent healthcare principles. Now, this puts new emphasis on what would work best for patients and makes the most effective use of all available resources across primary care and in hospitals. Actually, the other devolved nations have followed our lead in replicating the work we've pioneered.

Some people have asked about exploration with the private sector. I've got to tell you that I have looked into this, and I don't have any principled objection to it, but I am very keen to see can we do this, first of all, through the public sector. If they can't do it, then, obviously, let's look at alternatives. But I would like to give this a fair wind, and I guess the health boards are on notice that they've got to deliver on what we're asking them to deliver.

I think people living longer is a cause for celebration, but it also places renewed pressure on services, and we're all aware that the incidence of hearing loss is increasing because of our ageing population. I loved your statistics: I didn't realise 90 per cent of people who are 90 have hearing loss, so those are some easy statistics to remember. So, obviously, we've got to progress transformational change, as we are aware of that ageing population.

We've developed direct referral criteria and pathways to and from audiology departments, to ENT, clinical psychology and radiology, and agencies, including social services for assessment and assistive equipment. Patients have been empowered to increase their self-management skills with improved information, accessing services only when necessary. There's also local support to complement audiology services; examples include local authority and third sector collaboration on signposting individuals to advice and support.

Now, we have developed and implemented a nationally agreed pathway for hearing aid battery provision and ongoing hearing aid maintenance, including volunteer peer support. So, I'm not thinking of seeing people in hospitals fixing batteries; the whole point of this is that we're getting it into the community. Ear wax management services are being rolled out in primary care clusters, combined with self-management advice, an important part of treating problematic ear wax. So, that's happening in clusters already. Betsi Cadwaladr and Swansea Bay health boards lead the way, and are sharing best practice. It's my expectation that all health boards deliver wax management services. And where services are already rolled out, they're reducing the number of patients being referred to GPs and ENT departments.

Will the Minister take an intervention?

Sure.

I'm pleased to hear that you have a plan, and that there will be ructions if it's not delivered on. What's the timeline that you're going to give, though, for that plan to be tried and tested, to see if it's delivered? Because that's fair to say, if the plan's there, give it space, but it can't be an open-ended amount of space that you give it.

No. I'd be disappointed if, within a year, this is not something that we've seen rolled out. We know that two health boards are doing it already. They all know what to do. I think we've got to give them a little bit of space to get on with it, but there have got to be consequences if things don't follow through. And I'm very clear now that we've got to be a little bit more forthright—once we've got these clinical pathways, people must be expected to really focus on them.

The Welsh Government will continue to ask for updates on progress against the recommendations in the operational framework. If there isn't significant progress made, then we will need to consider other funding options too within the health boards' budgetary allocation this year, in order to strengthen audiology services in primary care. Our next step is to plan an approach for audiology services for the future. Our operational approach for the future will be for the next 12 months—I think somebody asked me about that issue.

So, to conclude, I think we can agree that we are aware of the problems, and that there's a broad range of measures being developed to improve access to hearing services, and there is more to come. In addition to improving access for individuals, my ambition is that these improvements will make a positive difference to those people who provide those services too. Their ceaseless commitment to supporting people in their communities is truly excellent. Thank you.

Thank you, Minister, and thank you, Janet Finch-Saunders, for introducing that interesting short debate. Good evening.