Questions now from the party leaders. The leader of the Welsh Conservatives—Andrew RT Davies.

Thank you, Presiding Officer. First Minister, today is the first day of the UK COVID inquiry. I had very much hoped that I would be able to say that today is the first day for the Welsh independent COVID inquiry, but clearly, that's not going to happen on your watch as First Minister.

One of the points that has come out that the inquiry will spend some time looking at in the early part of the COVID inquiry is the decision by Governments across the UK to discharge patients from hospitals to care homes without testing. There was a full pandemic preparedness exercise undertaken in 2016, as I understand it. That preparedness exercise highlighted that this was a major risk and major concern. Do you agree that that was a risk too far, and that discharging patients from hospitals to care homes without testing should not have happened?  

First of all, I welcome very much the fact that today is the first day of full hearings at the independent UK inquiry. I hope very much that it will be able to provide answers for those families who lost loved ones and whose lives were affected by the awful experience of COVID. I think that they will be at the forefront of our minds, as well as the minds of the inquiry today.

The matters that the leader of the opposition raises are now matters for the inquiry. That is why there is an inquiry, and I'm not going to be able to offer him a running commentary on individual aspects of the inquiry's work that he chooses to raise with me. The issue of care homes and care home discharges, I agree with him, is a very important issue. It is identified by the inquiry as such. It is in the programme of modules that the inquiry will pursue in the autumn. I have no doubt at all that it will require evidence from the Welsh Government and, no doubt, witnesses from the Welsh Government on the decisions that were made here. But the point of an inquiry is for the inquiry to pursue those issues now, and that's where the Welsh Government's efforts will be focused.

First Minister, I didn't ask you to comment or offer running commentary on the inquiry. I asked you about a specific Welsh Government decision that was taken by you as First Minister, and by a Minister who is sitting in the Cabinet, when he was health Minister—now he's economy Minister. This is First Minister's questions. It is perfectly reasonable, surely, on the floor of the Welsh Parliament, for the opposition to ask the Government about policy decisions that were taken. I am merely seeking to see, given the passage of time, whether you believe that that was the right decision taken at that time. That is a perfectly reasonable line of questioning, and I will offer you a second time to answer that question, because if, all of a sudden, all this is going to be taken off the table, what is the point of the Welsh Parliament?

It's a reasonable question, and here is my answer, and it's the same answer I gave him the first time: that these are matters now in front of the inquiry. Personally, I think it is disrespectful to the inquiry to try to shift the responsibility that they have into questions to me here. I will answer those questions in front of the inquiry that has been set up for this purpose. I won't second-guess what will be said there, I won't anticipate what the inquiry will want to know from me. There's an inquiry established, I want it to succeed, that is where my attentions will be directed. That's where answers to questions on this and many, many other aspects of the COVID experience are now properly to be answered.

I can't believe that on the floor of the Welsh Parliament we cannot get—[Interruption.] The Member for Ogmore is going, 'Work it out, Andrew', and this is the Member who stands up time and time again and talks of disrespect from Westminster to the Welsh Parliament in his role as Chairman of the legislation committee. How on earth can it be legitimate in every other legislature, whether it be Westminster or Holyrood, to have Members stand up and ask the respective Government Ministers about the biggest event that has happened to this country in a generation or more? It is perfectly reasonable for me and other Members to question, and the arrogance of the response from the First Minister will be noted by those COVID bereaved families in you not providing those answers.

So, I'll ask you again, for the third time—and you can turn me down again, but three times—it reminds me of many interviews that are done on the tv where people try and stonewall—are you hiding from something, First Minister? Because we deserve the respect of putting the answer on the record to make sure that people hear what their First Minister says. So, was it the right decision to discharge patients from hospital to social care homes without testing that you took and your health Minister took at that time?

I think the leader of the opposition lets himself down, and, more importantly, he lets down the families who look to the inquiry to give them answers to those questions. When Ministers are asked that question in Holyrood and in Westminster, they will have the same answer, that the establishment of independent public inquiries to investigate these matters means that that is where these questions must now be answered. They are not to be answered in a piecemeal fashion by shadow-boxing on the floor of the Senedd, when there is an independent inquiry with all the expertise that has been assembled around it to explore those questions and to give people the best answers that they can get. He can ask me the question every week, he will have the same answer: the right place, the place I believe where those questions are to be pursued, is where they ought to be, in the independent inquiry that has been established for that purpose. That is what Ministers in his Government will be saying in Westminster as well.

The leader of Plaid Cymru, Llyr Gruffydd.

Diolch yn fawr iawn, Llywydd. Last week, First Minister, the Royal College of Radiologists published its 2022 workforce census, with some damning results, actually, from a Welsh perspective. It revealed staggering discrepancies in the proportion of oncologists across the UK, first of all: London with over 10 oncologists per 100,000 population compared with north and west Wales with just over two per 100,000 people. More worryingly, there are also striking regional disparities within Wales itself. While the number of clinical oncologists in south Wales is 6.1 per 100,000 older people, it stands at a mere 0.8 per 100,000 older people in north and west Wales.

The statistics on vacancy rates are equally alarming. Wales currently has an oncology vacancy rate of 11 per cent, with 80 per cent of these vacancies having remained unfilled for over six months. These trends are projected to leave Wales with a 41 per cent shortfall in oncology staff within the next four years, the highest by far within all of the UK nations. We know that the Welsh Government has set a target for cancer diagnosis and treatment to be undertaken within 62 days for 80 per cent of the population by 2026. It currently stands at just over a half. So, my question to you, First Minister, is how on earth do you expect to achieve this target in light of these of these alarming figures around oncology staffing levels in Wales?

We will do that, Llywydd, by the investment that we are making in the cancer workforce of the future. Since August 2021, we have had a five-year programme of expansion in the training of medical oncologists and clinical oncologists. Every year, more people will enter training in Wales, and more people will therefore emerge in order to provide the treatments that will be needed in the future. We will have seen a 34 per cent increase in diagnostic radiography between 2017 and 2023, and we will go on expanding the workforce to make sure that we will be as well prepared for the additional demand for cancer services in Wales, which we know will be there in the future because of demography and other factors, as we are able to be.

And hopefully with equitable access, wherever you live in Wales. Your Government has often asserted that there are more people working in the Welsh NHS than ever before. I don’t dispute that overall picture, but it’s important, I think, to scrutinise the granular detail to understand why increases in the total number of staff employed in the NHS haven't led to any discernible improvement in workforce pressures. Plaid Cymru recently submitted freedom of information requests to each of the Welsh health boards asking for a year-by-year breakdown of full-time equivalent staffing levels for each staff group between March 2015 and 2023. A noticeable trend in the responses has been the extent to which levels of administrative and clerical staff have increased, whilst the levels of medical and dental staff have gone down. For example, in the Cardiff and Vale University Health Board area, while full-time equivalent levels of administrative and clerical staff rose by 37 per cent, there’s been an almost 20 per cent decrease in medical and dental staff over the same period, and that’s a picture that’s replicated in Velindre and other places as well. Does that not show, First Minister, that your Government needs a more targeted and strategic approach to solving this crisis in our NHS workforce, rather than simply relying on throwing more bureaucrats at the problem?

There are two points, Llywydd. First of all, I don’t need to rely on FOI figures, because we have the official figures that are published every year on workforce, and in the first 20 years of devolution, we saw a 31 per cent increase in the number of GPs working in Wales, a 44 per cent increase in the number of nurses working in the NHS in Wales, a 92 per cent increase in the number of medical and dental staff, a 98 per cent increase in the scientific, therapeutic and technical staff, and a 152 per cent increase in the number of people working in the Welsh ambulance service. Those are the figures that I rely on, and they show a massive growth over 20 years in the medical, clinical workforce available here in Wales.

Actually, I think it’s a cheap shot, Llywydd, to refer to people who are supporting those people as simply bureaucrats. When those additional oncology clinicians become available, how does the Member think that they get to see the patients who come to see them every day? When a doctor turns up at the Heath hospital to carry out five cataract operations in a morning, how does he think those five patients and their notes and everything that is needed for those operations to be carried out—? Does he think it would be a good idea to ask doctors to do all of that? No. Those are the bureaucrats that he refers to. 

When you have an expansion in the number of front-line clinicians in the health service at the extent that we have, of course they need people to support them in the work that they do. No doubt his bureaucrats include the people that the Welsh Government has now funded to pursue Welsh language services in each of our health boards. Does he think it would be a good idea to take them out of the figures? One person’s bureaucrat is another's person providing and supporting an essential service, and that’s what we see in the figures that he has outlined this afternoon.

And one person’s number of additional staff does not necessarily equate to full-time equivalent staff either, First Minister, in the figures that you quoted earlier.

In tackling the pressures on the NHS workforce, we must also have public health campaigns that are robust, that prevent the need for healthcare in the first instance. Effective intervention by the Government to decrease the number of preventable diseases is vital in that regard—conditions such as type 2 diabetes, which affects around 180,000 people in Wales at present and costs around 10 per cent of the entire current NHS budget. Now, there is a quality statement for diabetes that will be the focus of an oral statement later on. I've had a look at what has been released by the Government already, but there's no mention made in there about the preventative agenda. May I ask you, therefore, about the latest information about the progress of the all-Wales diabetes prevention programme by your Government? And have you investigated options to increase the budget allocation for that, as you outlined that you would do in your 'Healthy Weight: Healthy Wales' strategy for 2022-24? Because, investing to prevent type 2 diabetes would not only improve the health of the population, but would save money for the health service in the future.

Well, first of all, Llywydd, I agree entirely with Llyr Gruffydd on the importance of public health in helping us to avoid problems where they can be avoided, and for many people who suffer diabetes, there are changes that they could make in their lifestyle that would prevent the risk of diabetes in the future. There will be a statement this afternoon from the health Minister on diabetes services, covering everything we're doing in the area to support people who want to do the things that they can do within the sphere of public health, and also, in all of the other specialist services in that area too. So, there will be an opportunity for people to hear that update from the Minister and to question her during this afternoon's session.