Item 4 this afternoon is a statement by the Minister for Health and Social Services: health and social care system resilience. I call on the Minister, Eluned Morgan.

Thank you very much, Dirprwy Lywydd, for the opportunity to update Members on the system during the winter months.

Dirprwy Lywydd, thanks for the opportunity to update Members on health and social care system resilience plans to cope with the pressures that we're expecting to face this winter.

Now, we've learnt the hard way that starting to plan for winter in September is simply too late. So, in Wales we've ensured that health boards build their winter plans into their annual plans, so that they can start to prepare from the beginning of the financial year in April. You'll all remember how challenging last winter was for the health and care service, and let me reassure you that this happened despite the fact that we had put significant plans in place. But a combination of COVID, a massive wave of flu at the same time as concerns around strep A, industrial action and cold weather meant the system was under extreme pressure. By starting early and working hand in glove with local authorities, we managed to deliver 670 community beds, which is not an insignificant additional number when you consider that there are around 9,000 beds across the whole of Wales. But anyone who works in the NHS today will tell you that things don't ease up anymore during the summer months. The pressure is relentless, and I heard this loudly and clearly in a conference I attended yesterday with leaders from our emergency departments.

But we all know that winter always brings significant additional pressure. This year, we will be facing that additional pressure at the time when the NHS in Wales and across the United Kingdom is under significant financial strain, and that's why we're gearing up already. We expect there to be a peak in COVID infections over the winter, which are likely to be driven by a number of variants. We hope the public will help us out with this. Today I have published a respiratory framework that outlines the public health context and our approach to responding to respiratory infections.

Infection prevention and control measures remain key to reducing transmission of respiratory infections in health and care settings, and the framework highlights priority areas of focus and key actions to help mitigate acute pressures in the system. We've already, for example, started on our COVID booster vaccination programme; we started this on 11 September and already 50 per cent of our elderly care home residents have received their COVID vaccination booster. We really need everyone eligible to come forward, and we're particularly keen for those people who work in health and care to take up the offer so that they can protect themselves and they can protect the people that they serve. Our flu programme will also offer protection to the most vulnerable. We need eligible people to come forward to give themselves the best chance of getting through the winter without suffering too much, which, in turn, will help us to protect the broader system.

We have a comprehensive programme to deliver a better performance in emergency departments. And, again, this year we've invested £25 million in the six goals programme, aspects of which are specifically designed to take pressure off the system through supporting people, particularly the elderly, so that they don't need to come into hospital in the first place, or supporting them to leave quicker if they are admitted. Keeping the system flow in our hospitals is one of the biggest challenges we face, and we have plans in place to improve the flow. Despite the financial challenges, we are holding on to some of the Further Faster ambitions, which means a deliberate shift of support from hospitals and secondary care to support people in their communities—hopefully again helping to avoid hospital admissions.

Health boards have been working with regional partnership boards to develop their own winter resilience plans. They're developing front-line services in the community that can respond to local sensitivities and respond to the needs of individuals, working often through the cluster planning groups. This will pleat in with the ambitions for the regional integration fund, which is a fund that is shared between health boards and local government, and also includes the third sector and aspects of the private sector.

I'm very pleased to see the health, social care and the third sector jointly planning, and this is happening regularly through regional partnership boards. Partners are now using the summer months to plan well ahead for the seasonal pressures that we know will inevitably arrive over the winter. On top of this, each health board has a joint ambulance improvement plan, and these were developed with the Welsh Ambulance Services NHS Trust. Key actions in these plans will include: enhancement of services or pathways for respiratory and falls patients; clinical screening hubs to effectively clinically screen and signpost patients to the appropriate care, whilst reducing the number of people being conveyed to emergency departments. There will also be a specific and enhanced focus this winter on supporting care home residents to stay well, and where urgent care is needed, to access this in the care home; when appropriate, avoiding ambulance transport and admission to hospital; improving triage and assessment times in emergency departments; and safely reducing admissions through same-day emergency care services. 

Now, £3 million has been allocated to health boards through our six goals programme, and we expect them to use this funding to enable these actions. But I am keen to ensure that people are aware of how challenging this winter is likely to be. We are anticipating an even more difficult winter this year than last year. To this end, I am appealing to the public to ‘help us to help you’ and to always consider an alternative.

Two years ago we didn’t have any urgent primary care centres, nor did we have same-day emergency care centres. We were making very little use of pharmacies in the community, and we didn’t have the 111 service online and by phone for support for physical health, nor the '111 press 2' service for mental health support. Today we know that hundreds of thousands of people in Wales are taking advantage of these new methods of interacting with the NHS in Wales. For example, there have been 399,000 hits on the 111 website, and 71,000 calls to the 111 phone line in August alone. This is taking pressure off the ambulance service and emergency departments, but there are still some people who need help to navigate these new systems. That is why we will be switching back on our 'Help us help you' campaign again this winter.

We also expect health boards to deliver a major focus on planning patient discharge from the point of admission to hospital and on reducing pathway of care delays. This will ensure that patients and service users are receiving the right care and support in the right place. We know that prolonged periods in bed decondition older frail people, and reduce muscle mass, creating a need for more comprehensive social care packages. Long hospital stays also increase the risk of catching viruses. So, I am appealing to families to support their loved ones and relations by getting them out of hospital as soon as possible when they are clinically ready. This will help improve their experiences and clinical outcomes.

Each health board, therefore, has an action plan focused on reducing the proportion of hospital beds used by long-stay patients, i.e. those spending longer than three weeks in a hospital bed. We now have an all-Wales view and database of the reason for every delayed discharge. We can therefore hold those organisations to account. It may be that the patient is waiting for medicines, or waiting for a care home placement, or transport. But one of the biggest challenges we are facing at the moment is waiting for patients needs to be assessed.

I expect these plans, along with our trusted assessor model, to make a tangible difference this autumn and winter. A significant portion of the £145 million regional integration fund is being used to play a key role in supporting and increasing community capacity and enabling good system flow this winter. This winter, for example, we'll be investing £36.1 million in preventative community co-ordination; £24.3 million in providing complex care closer to home; and £29.6 million on home-from-hospital pathways and models of care.

I know that this winter will be another challenging one. However, I have been clear about my expectations, and we have a range of actions in place across health and social care to make sure the impacts can be mitigated this winter.

Can I thank the Minister for her very detailed statement today? I don't think it's possible to have too many statements when it comes to dealing with winter preparedness. Of course, I agree with the Minister; it's very important to start planning very early in the cycle. Now, we know it's going to be a tough winter, and I put on my record my own thanks to the great work of our NHS staff. But we are currently seeing some very significant long waiting lists. We're aware, of course, of those missed treatment target times, and we've all seen, of course, the chronic shortages of hospital beds and the limited critical care capacity. So, we know that this is all going to be a very difficult position for the Welsh NHS this winter. 

Now, Minister, you say in your statement that you expect there to be a peak in COVID infections over the winter, which is likely to be driven by a number of variants. So, perhaps you can give us a bit more information about any projections in terms of COVID infections and any particular peaks that you might expect. I know, during the course of the pandemic, much of those projections were available as well. But, in terms of the number of variants, perhaps you can give a bit of detail about those and are there any particular variants of concern that you think need to be addressed, or to be made aware of. Now, we do know, of course, sadly, during the course of the pandemic, that 25 per cent of those that sadly passed away from COVID caught COVID in a hospital setting in Wales, which was considerably higher in comparison to other parts of the UK. So, perhaps you could tell us, Minister, a little bit more about the measures that you've got in terms of preventing people catching COVID-19, and, equally, other respiratory viruses as well, in a hospital setting.

Of course, I'm concerned about workforce challenges in healthcare, so it would be helpful to know about what plans are in place to address potential greater workforce shortages in the healthcare sector in the event of sustained pressures over the winter. 

Now, collaboration across the UK on key data and best practice sharing, I think, will be pretty crucial in the event of extreme pressures, so I wonder if you could tell the Chamber this afternoon, Minister, how you are collaborating with neighbouring regions and the UK Government to co-ordinate responses to potential spikes in COVID-19 cases that may occur, of course, over the border, and other implications. 

Minister, you rightly talk about the need for healthcare staff to take up vaccination, and I wonder if you could tell us if you have any concern about the level of uptake amongst healthcare staff, obviously for their protection, but also the protection of those they serve—are there any particular concerns in that regard—and then, perhaps also, Minister, how you're addressing potential challenges relating to vaccine hesitancy or misinformation. We're aware of this, so that might be helpful as well, perhaps in terms of detailing what take-up is like compared to previous years, and any other information that there is in regards to hesitancy among those vulnerable groups in taking up the vaccination. And in the event of a surge in COVID-19 cases, I wonder what communication strategies you have in place to keep the public informed about the situation. 

We will have, of course, seen chronic shortages of hospital beds and limited critical care capacity, and this is of course going to put a strain on our healthcare system during emergencies, making it really challenging to accommodate a sudden influx of patients, as seen during the COVID-19 pandemic. So, we have seen cases rising. I wonder what is being done in terms of increasing hospital bed capacity. I know that you did say in your statement today that you've managed to deliver 670 community beds. I wasn't quite clear on that. Is that an additional 670 beds for winter pressures that will be stepped down after the winter? And in terms of the total capacity of bed capacity across Wales this winter, how does that compare to other years, comparing it with the pandemic, and pre pandemic as well?

And finally, Minister, perhaps you could tell us a little bit more about the current state of the roll-out of the booster jab and flu vaccination. Is take-up as expected in those vulnerable groups? And do you have particular targets in terms of take-up? And finally, I think the one issue—

You've said 'finally' once before, and you're well past your time, Russell.

Okay. I promise this will be the final question, but it will be a very long question—no, Presiding Officer, it will be a very quick question. Flu—one issue that there is, Minister, is that people will go for their flu vaccination on one date to one location, and then their COVID vaccination on an other date at another location. So, of course it's much better for the public to have both at the same time. Now, I know there are real complexities around that, in terms of the supply of those vaccinations, but there was some earlier discussion around there being one vaccination. Now that, of course, would really help in terms of ensuring that people got their vaccination, take-up was improved, and it would certainly help the workforce in rolling out those vaccinations as well. So, perhaps you could tell us, if that is not ready for this year, if you're aware of any discussion of that being available in future years.

Diolch yn fawr, Russell. Yes, we are expecting there to be significant winter pressures. We are expecting there to be another COVID peak during the winter. We are monitoring the particular variant BA.2.86 at the moment—you might have heard quite a lot about this. We haven't still found any cases in Wales as yet, but we're very much hoping to keep an eye on that. Our scientists are well informed as to how that is progressing—a lot of testing being done elsewhere in the United Kingdom. I think that there's a bit more confidence that it's perhaps not the variant that we feared that it might be, but it's still being monitored and still being developed. But who knows what other variants could come through during the winter. But we are expecting an uptick and a peak at some point during the winter.

You're quite right—infection control is absolutely critical in hospitals, not just for COVID but also for flu and other respiratory viruses. That's why there's very clear guidance on respiratory control within hospitals, and hospitals have been reminded of that very recently.

You talked about the workforce challenges. You're quite right—there are workforce challenges. It'll be perhaps more challenging this year because we are in a very different situation financially, so our ability to recruit will be more limited than perhaps it has been in the past. I've got a meeting coming up with the Scottish and English health Ministers very shortly, and I'm sure some of these things will be touched upon then.

Just in relation to the vaccination, health and care staff—I'm always a little bit disappointed, if I'm honest, in the uptake among people who are eligible for this vaccination, so we're trying to make sure that health boards can make it as easy as possible for their staff to take the opportunity, to increase the percentage of people who take up that opportunity. Just in terms of vaccine hesitancy, we do see that, every time we're offering a booster, it goes down slightly, but it's still not at a bad level, so I think we're reasonably pleased. But, obviously, one of the things we learnt during the height of the pandemic was how to chase down those hard-to-reach people, so we've now got quite a lot of experience in terms of how we get to those hard-to-reach people, and to get through to those people who perhaps were a little bit vaccine hesitant in the beginning.

Just in relation to bed capacity—. So, we switched on around 670 community beds last year. Some of those are still in the system. I think around 450 or so are still in the system. The number of beds we have at the moment is around 9,000. That's around 309 per 100,000. If you think about the Nuffield study that was done about 2019, they suggested that we were on 207 per 100,000 and England was on 170 per 100,000. So, we're still significantly above where England is at the moment. Listen, I think there's going to be a lot of pressure on the services. The financial situation is going to be very challenging. I just think we've got to bear in mind that that is going to increase the pressure in terms of our ability to make sure that we can keep the service where it is at the moment.

So, the take-up in terms of vaccinations so far, since 11 September, I think, is quite heartening. So, 50 per cent of all care home residents have already had their vaccination. So, I think that's exactly where we expected it to be, and, just in terms of co-vaccination—flu and COVID—there was a hope that that would be developed in time; it hasn't been developed in time. We keep in close contact with the Joint Committee on Vaccination and Immunisation, and there was very clear guidance from the JCVI that, actually, we should switch the order in which we vaccinated people, because we were a little bit concerned about this new variant. So, we've started with care home residents, which are our most vulnerable cohort, and then we'll be moving on to other cohorts after that. Whereas, before, we were going to vaccinate them in the run-up to the heat and the peak of winter, but we weren't sure what was going to happen in relation to the new variant. So, JCVI, we generally follow their advice in terms of when things are available. We were hoping to have a more up-to-date vaccine by now; it hasn't materialised. So, we just thought, 'Listen, we need to give the protection as soon as we can; that's more important.'  

I thank the Minister for the statement and thank you for the opportunity to see it beforehand. We, in Plaid Cymru, of course, welcome this announcement. We led a debate, back in May, on lung health and pulmonary health, and we welcome this statement as a response to parts of that debate. And of course, as a grey rhino event, we see what's coming towards us. Like a grey rhino, it's huge, it's running quickly, it creates huge damage and, most importantly, it's entirely predictable. So, we must make preparations for what is anticipated, and hearing this announcement and hearing that you have been preparing since April is to be welcomed. 

As the Minister said, last winter was particularly hard for our health services for all sorts of reasons and forecasts suggest that this winter will be even more difficult. But, during January of this year, for example, we saw a number of examples where elderly and vulnerable people were being sent home from hospital without the fundamental care provided so that they could live their daily lives. This, in turn, led to people returning to hospital. So, whilst the Minister's statement today mentions social care and the need to provide packages of social care, it's very concerning that there is no talk here about prioritising and preparing the workforce in the social sector for the hard winter that we're facing. So, I'm eager to hear about the Minister's plans for the social care workforce, if there is such a plan in place. Does the Minister believe that the workforce is in a position to respond to the demand? 

As I mentioned last week, we are far too reliant on an army of volunteers when it comes to social care—people who don't have the training but have to undertake these very difficult duties of looking after their loved ones or neighbours, and they do so without remuneration. Today, we heard the Minister appealing to families to do more. Does the Minister feel that it's fair to expect people who don't have the expertise or the ability very often to do more—people who are, very often, old and vulnerable themselves, having to undertake those caring responsibilities without financial assistance? By failing to invest properly in the pay and conditions of carers, we have seen more people leaving the sector, placing more stress on unpaid carers. Does the Minister believe that our carers are paid sufficiently? If not, what plans does the Minister have to change that?

When it comes to respiratory problems, very often it's an issue that impacts women more than men. More women suffer from asthma, for example, than is the case with men, and have more asthma attacks than men. They are more likely to have to go to hospital, and almost twice as likely to die as a result of asthma than men. Indeed, as we heard in that debate back in May, one in five people in Wales live with a respiratory condition and more people die as a result of respiratory conditions in Wales than in any other nation in western Europe.

So, while the Government has introduced a quality statement on lung health, there is no implementation plan. So, when will the Minister publish an implementation plan? Will the Minister develop an improvement plan for respiratory disease to transform and improve the lives of people living with lung conditions?

Russell George mentioned vaccinations, so I won't repeat those issues, but the Minister referred to reducing the transmission of respiratory infections in health and care settings and the need for preventative measures. The Minister will undoubtedly remember the campaign by Nefyn GP, Dr Eilir Hughes, to ensure fresh air in all closed spaces. With an increasing number of COVID variants and cold and flu, we need to ensure that this message isn't forgotten. The Minister said that she will provide clear guidance. Will this guidance be shared to other public places as well, not only hospitals but schools and elsewhere, and will it also emphasise the need to ventilate buildings properly in order to help dilute, for want of a better word, the infectious aerosols? And will there be guidance on face masks and other preventative measures for places like care homes or places with particularly vulnerable individuals? 

The Minister mentioned the need for beds, or the fact that here in Wales we have some more beds than other UK countries, but Wales is still way below other European averages. We are already at capacity in many of our community hospitals and, in those places, we are seeing an increased level of hospital-acquired infections, and COVID and flu are two of those hospital-acquired infections. So, what plans does the Minister have to open more community beds?

Finally, we can't keep looking at the short term, we need a long-term approach. We know that respiratory illnesses are linked to poor housing, with increased reporting of mould and damp, for instance. The climate change Minister mentioned this earlier in her statement. So, what discussions has the Minister had with the Minister for Climate Change on tackling this and ensuring that each house is insulated properly and is in a liveable condition, so that we get to the root cause of many of these problems? Diolch.

Well, thank you very much, and you are entirely right that it is important that we focus particularly on those people who suffer with respiratory conditions. So, that's what we're concerned about, particularly in winter.

Just to be clear, we didn't send people from hospitals when they weren't ready in terms of clinical care last year, but it is important—and I hope this is something I made clear in my opening statement—and we do need to recognise that, if you remain in hospital for a long time, you are more likely to be exposed to COVID and flu, and you are also more likely to see a decline in terms of muscle use. So, it is beneficial to the patient to be discharged as soon as they are ready to be discharged. And I think it is important that families hear that message too. So, it is very difficult, and I understand that that means pressures on carers. And we understand that, in terms of care, even though we have increased how much we pay people for the care that they provide, there are still problems in attracting people to work in that field of endeavour. So, I do think that there is already an army working without remuneration to care for their loved ones, and it's important that we support them, and I know that Julie Morgan does that. 

I was trying to work out what 'y fogfa' is.

Asthma.

Asthma. That's it. And, yes, you are entirely right.

It is important to recognise that, actually, it is one of those things—. I have made it clear, in terms of the women's health plan, that, actually, there are a whole load of conditions where women respond differently or they are more affected by them, and asthma was one of those. So, you are quite right, and I hope that that is something that health boards will take into account when they are developing their response to the quality statement on women.

Just in terms of ventilation, I think that hospitals will be aware of this, but you are quite right, that it may be something that we need to think about cross-government a bit more in terms of giving that guidance. It's very difficult, isn't it, when you are going into winter and you have energy bills, and what you are saying is, 'Open your windows.' It's a really difficult message, I think. So, this is something that we will have to discuss, perhaps cross-government, in terms of how you land that kind of complicated message.

It may be that there will be times during winter when we see a significant increase in terms of the virus of COVID, and then we will have to take further measures, and we will have to consider things like whether you have to introduce face masks, and whether you step in, in a much more intentional way. We have already, for example, increased the number of PPE gloves just to make sure that we have got the stockpile exactly where we need it to be, for example. We may expand the community sentinel surveillance survey just to make sure that we know what's going on where.

We will, of course, take advice from the JCVI in terms of revaccination if we were to see that things were to increase beyond what we are expecting. So, there are lots of things that we can step up even further if it came to a point where we were to see the kind of increases that we have seen in the past. With testing, for example, we could reintroduce testing pre-admission to hospitals and care homes. We are not suggesting that we do that now, but we have got lots of things in our back pocket ready to go if that were the case.

You are quite right in terms of cross-government activity. Lots of the things in relation to health, if you are going to fix them, you have got to fix them early on. It's about prevention. It's about cross-government working. And you will see through the introduction of the clean air Act, for example, that that's exactly one of the measures that is being put in place to make sure that there's a response to making sure that we can get into that prevention space. Health results are not just going to come from the health service.

The WLGA statement last week said that overspending on social services in the last year alone was estimated to be about £93 million, with local authorities drawing approximately £193 million from their diminishing reserves. Furthermore, there is a severe recruitment and retention crisis. They also emphasised the need for investment in home and community support, which I hear today is the Welsh Government way, which is really pleasing to hear in your statement.

But, Minister, would you join with me and the WLGA in saying that public services as a whole need to be properly funded by the UK Government Treasury, and that it's not just about funding the NHS; it's about funding social healthcare and all of those public services, regarding preventative services, and that, working cross-government, we need to get that point across to them? Thank you.

Thanks very much. You're quite right: local government is under significant pressure. Everybody is feeling the effects of inflation. So, the effects on the health service—. You think about a £10 billion budget, and you think about inflation rates of about 10 per cent. That's a big number. That's a really, really big number. Local government is really up against it as well. So, we are all struggling with the impact of inflation, and that explains a little bit of why there is such a significant overspend.

That is why, actually, us working together with local government is absolutely crucial, and making sure that we link up as far as possible. I'm absolutely clear that we have to start shifting resources from secondary care, from hospitals, into our community. If people are ill, they would rather be ill at home than in hospital. What we have to do is make sure that we can wrap the care around them in the community. So, that's what our Further Faster programme is meant to do, to really make sure that we have that community support in place. So, it's expanding the number of community nurses, for example, and expanding the number of hours that they cover, so that they're working weekends and they're working late at night—all of those things—because people aren't just ill from Monday to Friday, 9 a.m. to 5 p.m. If they're not there, if the cover's not there, they're straight to A&E and then the whole system gets much more difficult to cope with.

So, you're absolutely right: public services need to be properly funded. We know that, under the last Labour Government, we saw a massive increase in public service spending and what we've seen under the Conservative Government is a huge reduction, relative to what they're spending on the continent. And there's a reason why our public services are in the state that they're in today; it's because they have been starved of public money to the extent that, actually, we are now up against it. Ten years of austerity, we're paying the price for that; we're paying the price for COVID and now we're paying the price for inflation. All of those things have a huge impact and I'm afraid, as a result of that, the public are likely to have to pay a price as well.

Thank you for your statement, Minister. I think it's fair to say that our health and social care system lacks resilience. Every year, we have a statement talking about winter pressures and urging people to stay away from hospitals. The messaging changes, but the problem remains the same. Minister, what discussions have you had with health boards about accelerating the creation of diagnostic and surgical hubs? What discussions have you had with local authority housing associations regarding the expansion of extra-care housing to relieve the pressure on social care? And finally, Minister, this lunch time, the Royal Pharmaceutical Society were telling Members about the role that pharmacists can play in relieving the pressure on primary and secondary care. Minister, what discussions have you had with the sector on accelerating both e-prescribing and pharmacist prescribing? Diolch yn fawr.

Thanks very much. Well, you're quite right, we prepare for winter pressures, and you worked in the health service for a long, long time and you prepared for winter pressures—everybody gears up for winter pressures in the NHS. So, you're quite right, we are developing diagnostic and surgical hubs; one, I was very pleased to go and open in Neath during the spring-summer and it's good to see that that's up and running now, and you'll be pleased to hear that it's an orthopaedic hub, so that's exactly, I know, what you've been calling for. We are also, of course, ploughing on with developing the diagnostic hub in Cwm Taf Morgannwg, so all of that is moving ahead and I'm pleased to see that happening as well.

We have constant conversations with local government. In fact, we had a meeting with them yesterday, preparing for winter, making sure that everybody's lined up and making sure that, for example, the trusted assessor system is something that is respected on all sides. But the responsibility for a care-home assessment, for example, is with local government. If they don't do it, the people stay in hospital, so we have to work together to make sure that we unblock that particular blockage. So, those are the kinds of discussions that we have in those particular meetings.

On the Royal Pharmaceutical Society, you're quite right, I think we make significant use of community pharmacies in Wales. We were way ahead of the rest of the United Kingdom when it came to pharmacy use. Ninety-nine per cent of our pharmacies now offer the common ailments system; one in six of them are offering a prescribing service and 47,000 people took advantage of that offer, and 26,000 people had their throats tested in community pharmacy last year. So, people are starting to hear about this, and part of what we need to do this winter is to make sure that people know that those alternatives that mean that you don't go to the GP are available. So, community pharmacy, for me, is absolutely fundamental to the way that we address this coming winter.

I too spoke to a couple of community pharmacists who are doing excellent work, working in GP practices, but also going into people's homes to ensure that polypharmacy wasn't resulting from the stock of old medicines in the larder that then get mixed up with the new medicines. That's one of the reasons why people go into hospital, unfortunately, if you're elderly.

I just want to pay tribute to the pink army of social care workers who work alongside clinicians in the emergency department in the Heath to identify people, particularly elderly, as you said in your statement, who don't need to come into hospital by providing additional support at home. It's fantastic to hear that people can be invited to turn around, knowing that they're going to get the support for their loved one or for the individual at home, because they do need additional support, but they don't need to come into hospital. Also, the pink army is doing fantastic work going on the medical ward rounds at the Heath to ensure that all the right questions are being asked to plan the individual's discharge as soon as they're medically fit, not just benefiting the individuals, but also making beds more available more quickly for those who need hospital operations.

My question to you is around how these winter resilience plans in the community and the cluster planning groups are ensuring that vulnerable individuals are getting one hot meal that is freshly prepared a day. Because I had a really heartbreaking conversation with somebody at the Maelfa gardening club around somebody with Alzheimer's who was waxing lyrical about the joys of having mashed potato, but she'd had her gas cooker disconnected for her own safety, and there didn't seem to be anybody available locally to do such a simple task as just give her the odd bit of mashed potato and other hot things to go with it. It's those sorts of people who can end up in hospital because they're not eating properly.

Thanks very much. You're quite right, and I think drawing attention to the issue in relation to medicines is really important. We know there are significant financial pressures. We spend about 10 per cent of our budget on medicines, so we need to make sure that people are using the medicines they need, but, actually, they need to stop using the medicines and tell us that they've stopped using medicines that they don't need. All of that is quite complex, and they're difficult conversations to have, but I think there are opportunities for us to make sure that we do a lot more in the medicines space. There's a huge amount of work being done, not just in our community pharmacies, but a huge amount of work being done in our pharmacies in hospitals—a significant amount of work being done there.

You're quite right to pay tribute to the pink army, and it's great to hear that. I am particularly concerned with the elderly coming into hospital. It just breaks my heart to think of some of them, particularly those with dementia who get confused, so it was really interesting to have a conversation yesterday with people from emergency departments who came together to try and start talking about a quality statement for emergency departments—what does that look like, what does 'good' look like. I'm hoping that frailty will be something that they consider in the context of emergency departments.

What we do know is, for example, with ambulances now, with about 15 per cent of the people that they go to pick up, they listen and they treat them on the spot. Trying to avoid hospital admissions for our frail is actually ideal, and if we have to bring the hospital out to them, that's what we should be doing. So, I'm very keen on that. There are lots of plans in place to do far more of that.

You're quite right; what most health boards are doing now is planning the discharge from the moment they arrive, and that is crucial to keep the flow going. There's a lot of work that community groups can do. We do have the RIF funding, which is the regional partnership boards co-working with health boards and local authorities. But 15 per cent of that money goes to the third sector. So, I think there's an opportunity there to talk about some of the things that you're concerned with in terms of making sure people get fed.

And finally, Gareth Davies.

Diolch yn fawr iawn, Deputy Llywydd. Thank you very much for your statement this afternoon, Minister. Winter is upon us, so I'm pleased this statement has been made in good time and in anticipation of dealing with our winter pressures, or at least attempting to. I'd like to ask what local factors the Minister is taking into consideration in regard to winter preparation. I ask this as I have Glan Clwyd Hospital in my constituency, with acute pressures in A&E and other departments with staff facing burnout and patients struggling to be seen in time by medical professionals. What assurances can the Minister make to my constituents in Denbighshire that local health services are resilient enough across Betsi Cadwaladr University Health Board to deal with increased winter pressures and that it doesn't compound existing issues that are with us all year round?

Thanks very much. I hope winter's not upon us yet. I'm not putting my heating on for several more weeks, I can assure you. I'm sure lots of people in the country feel the same. But just in terms of local factors, you're quite right; I'm particularly concerned about Glan Clwyd, so I'm putting a lot of attention on that. I was pleased to go and visit the emergency department over the summer. The sense I got was that the atmosphere is changing there and that they're in a different place. They seemed far more buoyant than they had been in the past. That, for me, was the beginning of something far more positive. One of the things I'm concerned about is that actually there's not enough of an alternative to the emergency department in that area, so that is something I've asked the chair of the health board specifically to pick up on. We've got a new chief operating officer in Betsi now, and she's an expert in this area, so I know that she's on it. I'll be having a meeting, I think tomorrow, with the chair of Betsi, and this is one of the subjects I'll pick up on.

Thank you, Minister.