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

Diolch, Llywydd. Minister, yesterday, Andrew R.T. Davies, on three occasions, tried to extract an answer from the First Minister, and the First Minister failed to answer on three occasions. You're the health Minister, so I will ask you, Minister: when is the Welsh Government going to eliminate two-year waits in the Welsh NHS, and when can we expect you to issue your revised target?

Thanks very much. I'm more than happy to send you the revised target that I've sent out to the NHS. I've made it clear to them that we have got to stick to a plan. We've discussed this with them, in terms of what the targets are, and whether they think they've got the ability to hit the targets. We're going to be doing this in the context of a very, very tight financial situation, so I think we've got to understand that. But, as health Minister, I've got to acknowledge that having people wait for longer than two years is not acceptable, and so we are expecting them to speed up their processes. We are putting more money into things like diagnostics, and more into surgical hubs. I was very pleased to go and open officially the surgical hub in Neath Port Talbot recently. So, there are lots of good positive things going on, but obviously we're very keen to make sure that they speed up the process, and I've made it very clear to them that, this time, there will be no excuses for missing those deadlines.

Thank you, Minister. It would be very helpful for you to write to me, but, of course, if you could verbally give the answer in the Chamber this afternoon in terms of what the date is for the revised target for two-year waits, that, of course, would be appreciated, because, of course, we are not seeing the progress—and you've alluded to it yourself, and I appreciate that—that's needed. We saw the last set of data with only 245 people coming off that two-year waiting list. We've still got tens of thousands of people waiting for treatment in Wales, when you know, of course, the target's been virtually eliminated in Scotland and in England. Often, we talk about numbers, don't we—tens of thousands of people; these are individual people, and often many of them are waiting in pain, which impacts their lives and their wider families' lives as well.

Minister, you committed to ensuring that 80 per cent of cancer patients will start treatment within two months by 2026. That's a laudable aim, and if that is reached, I will be the first in this Chamber to congratulate you on the efforts of the Welsh Government. But cancer waiting times have actually gotten worse—they've fallen from 59 per cent in April last year to 55 per cent this April. So, can you commit, Minister, to setting out annual milestones for the delivery of the target that 80 per cent of people with cancer will start treatment within two months, and provide an update on actions being taken to improve cancer waiting times, specifically for the cancers with the longest waits—gynaecological, head and neck and urology? But, ultimately, Minister, please do give us that target this afternoon. Tell us when the two-year wait target is set for; that would be appreciated. Thank you, Minister. 

On two-year waits, we're expecting 99 per cent of people to be seen by the end of this financial year. We're expecting, by September, anybody waiting over three years to have an appointment, so that they know exactly when they're going to get their treatment. And we have made it clear that we want to see significant improvement when it comes to cancer.

Cancer is quite interesting, because some areas of cancer are doing much, much better than others, so it depends on the specialist area, and the same thing is true also for the number of longest waiters. There are, amongst the 40 or so specialist areas, about 24 where, actually, we're down to zero. The real issue is with about seven specialist areas, and that's where I've asked them to concentrate now: 'Go for those areas'. We've got GIRFT in, Getting It Right First Time, making sure that they're getting the pathways right, putting pressure on them, looking at what's happening in terms of use of theatres in Wales, maximising that use of capacity that is available, because there's no point in having new hubs if people are not working efficiently. We've got to make sure, first of all, that we get the efficiency right wherever they're working. There's no point in investing in brand-new centres if they're still not working to top capacity.

So, that's what we're looking at now; we're driving it. The NHS executive is up and running. They're putting a lot of pressure on these people just to make sure that we see that productivity improvement that we expect to see. And, of course, you've also seen, in particular, when it comes to cancer, that diagnostics is absolutely key. The difference between us and England is that we count diagnostics and we count it from the beginning, because, if you've got cancer, you've got to start from the time when you suspect it, not from the time when you're actually put on a treatment path. So, the way we count is different, and that's why we're putting a lot of money into diagnostics. We've got to speed up the diagnostic centres and you will have seen that we're in the process of putting significant investment in that space. 

Thank you for your answer, Minister. I'm just going to pick up on the seven specialist areas that you referred to, because, as I understand it, and you can correct me if I'm wrong, in your previous target, those seven specialist areas weren't included. [Interruption.] You say it's not true. I look forward to your answer, because, as I've understood it, Minister, because you said it yourself, the recovery target was most specialties by 2023. So, if it says 'most specialties' it means some aren't included. I suppose I'm asking you, therefore, what are those specialist areas that weren't included, because, as I understand it, there are seven areas that weren't included in the target, and one of them was general surgery. So, it would be good to understand the areas that weren't included in your original target that you were due to meet by March 2023. You said in answer to Altaf Hussain earlier on today that data is important. You said that at an event we were at this morning. I agree with you entirely. So, surely it would be right to have a target that includes all 17 specialist areas and to break that down by speciality as well. I hope, Minister, that you will be able to commit to doing that, because data is king if we're going to get on top of some of these issues. 

You're singing from the same hymn sheet as I am on this. Just to give you reassurance, those 30,000 that are on the two-year waiting list include all specialities, including the seven that we know are challenging. So, they're not excluded from the numbers. I think that's really important. It's not 30,000 plus a whole load more in the seven specialist services.

I think what's important is for us to acknowledge that there is a huge amount of work being done in those areas. You'll have seen that already there is a breakdown now on the basis of health boards. I've asked now for more transparency, all the time—let's just get some transparency on this, let's have a look. I think the public need to know where are they on the lists—where are they, around where. We may not be able to give a definite number. And, of course, the other thing you've got to remember the whole time with this is that, actually, clinicians make calls on this. If there's an urgent case, they're going to take priority. And that's the challenge.

Actually, if you look at the numbers on waiting lists, they are coming down in Wales compared to England, and that's because we're seeing more urgent cases. That's the situation. I have been asking them, 'Listen, I know that in England they've been very focused on just doing the longest waits', and actually, it means that some of the more urgent cases perhaps haven't been seen. And if you speak to the BMA, it's quite an interesting conversation with clinicians, who sometimes say, 'Hang on a minute, you've got to see the urgent cases'. So, there is a little bit of a dialogue that we have. What I'm saying is the balance is in the wrong place at the moment. We need to get the longest waits seen, because enough is enough. 

Plaid Cymru spokesperson, Mabon ap Gwynfor. 

Thank you very much, Llywydd. Today, the BMA launches it's Save our Surgeries campaign. There was an event today here in the Senedd, and it was good to see the Minister attending that event. This crucial part of our health service has suffered a decade of decline and they are now reaching a critical point. This isn't a new crisis. The sector has been warning us of this for over 10 years. 

The proportion of the NHS budget committed to GP services has fallen to historic lows in recent years, compared to the 8.7 per cent level in 2005-06, which has not only led to swingeing cuts in provision, but also an increase in the number of practices handing back their GMS contracts. So, can I ask the Minister, therefore, whether she will commit to restoring the proportion of the NHS Wales budget spent in general practice to its historic level of 8.7 per cent by the end of this Senedd, as has been recommended by the BMA?

Thanks very much. Well, I had the very same conversation as you, and, before I go any further, I’d like to welcome you to your new position. 

Best of luck to you in your new role. You'll have a lot of work to do.

So, just in terms of the BMA, and I was very happy to attend that event earlier, I think there are a few things that we need to bear in mind. First of all, actually, 'A Healthier Wales' is very clear about the direction of travel here—it is about the need to move resources from secondary care into the community. And rather than talk about that, you’ll have seen very recently that I’ve just done it—I have just ring-fenced £30 million and said, ‘Enough. This actually needs to happen. I’m not waiting for the health boards to do this anymore, I’m moving that money.' So, that’s happened, and I think the key thing for us to remember in relation to primary care is that, with primary care, it’s not just about GPs; it’s got to be about the wider group that supports the GPs. And if you look at the number of GPs in Wales, there are more fully qualified GPs per head of the population in Wales than there are in England. The number of GPs have gone up from 1,926 in 2017 to 1,974 in 2022. So, we’ve got more GPs. The real issue is that the demand, demand, demand just keeps coming. And the demand is absolutely unstoppable. We had the case of a week in December when there were 400,000 contacts with GPs in a week—in a week. Can you think about the pressure on those 1,900 workers? That is a lot of people to get through. So, everybody acknowledges this, which is why what we’re trying to do is to do things slightly differently and not put all the pressure on GPs.

Thank you for that response. Of course, it's not just money that's important, as you've emphasised; it's the GPs who are important—that workforce. But as you've noted yourself, whilst the registered patients on GPs' books have increased hugely—over 100,000 in 10 years—the number of practices has declined from 470 to 386. And despite the fact that you say that the number of GPs has increased, this has led to a fall of almost 22 per cent in the workforce.

Wales is now 664 GPs short of the Organisation for Economic Co-operation and Development average. It's a damning indictment of the extent to which the vitality of our health service has been sapped in recent years. It's no surprise that GPs are complaining of heavy workloads and that many of the younger GPs are finding employment in Australia, New Zealand and elsewhere where they are better appreciated. Eighty per cent of respondents in the BMA survey have claimed that their high workload is compromising their ability to provide quality and safe care to patients. And with almost 27 per cent of respondents seriously considering leaving the profession in the near future, it's inevitable that these pressures will soon intensify. So, will the Minister agree to develop a workforce plan to specifically address the glaring shortfall in the GP profession, with the aim of reaching the OECD average within three years?

Diolch yn fawr. Well, you'll be aware that there is a worldwide shortage of healthcare workers, so we're in a very competitive market here. And we did have a target for the number of GPs we wanted to train and we exceeded that target last year by 90, and that's not for the first time. So, the question then is: with this incessant demand, what does the workforce of the future need to look like? Well, Health Education and Improvement Wales is working on that already, looking not just at GPs, but at the broader need within communities. And I think that is where we need to go now, not just to focus on GPs. And I think it's probably worth thinking also about not the numbers of surgeries, because, actually, what's happened is a lot of amalgamation. So, lots of surgeries have joined up together and it makes the system more robust. So, on the number of single-handed practices, for example, there is definitely a weakening of the appetite of people to do a single-handed practice; they do want to work together. So, you will get a reduction in the number, but I think you'll get a more robust system where people can, for example, at least go on holiday if they're in a bigger group of workers and they can get a bit more relief.