Therefore, item 4 will be next, which is the statement by the Minister for health on winter pressures in healthcare. Eluned Morgan to make that statement. 

Diolch yn fawr, Llywydd. Thank you for the opportunity to update Members on the winter pressures being faced by our health and social care system. It's important to point out that, despite the significant increase in demand for services at this time of the year, the NHS continues to perform well for the vast Majority of patients. NHS staff support over 2 million people every month, including 1.5 million in primary care and at least 70,000 calls a month to the 111 service.

More people than ever before are employed in the NHS in Wales, with more doctors, nurses, ambulance staff and support healthcare workers delivering quality care on a daily basis. Planning for winter starts from April to enable a collective, whole-system response. This year, £25 million was allocated to support the six goals for the urgent and emergency care improvement programme, enabling an increase in capacity in key parts of the system.

NHS '111 press 2' was rolled out across Wales, and it is worth noting that more than 400 people accessed urgent mental health support through the service in December. We've established 13 new urgent primary care centres and new remote navigation hubs, helping around 10,000 people a month to access care away from the emergency department. And we've set up 23 new same-day emergency care services, diverting around 5,000 patients a month from hospital.

Last year, we also invested £3 million in additional ambulance staff, with an extra 76 whole-time equivalent staff recruited since last winter. This winter, funding has been provided to increase transport capacity for patients who have been discharged from emergency departments, and for health boards to also introduce the latest technology-enabled care to support people to safely avoid admission or return home from hospital when ready.

Over the last couple of weeks, I've visited a number of emergency departments. I know the pressures staff are facing and how hard they're working to make every patient experience a positive one. I've listened to patients and staff, and, in an effort to support better experience, emergency departments and minor injury units have received an additional share of £2.7 million to enhance their environments over the winter period.

It's a well-established policy ambition to support more people closer to home. Some £8.24 million was made available to health boards and their regional partners to increase their ability to plan, monitor and provide enhanced community care for people with the most complex needs in our communities as a safe alternative to hospital admission. The funding also increased capacity within our district and specialist palliative care nursing workforce to enable a more robust service seven days a week.

So, where is the system at now? Over the festive period and into the new year, despite the fact that we've seen sustained and record-breaking demand on our services, the vast majority of people received safe and timely care. But clinicians have been keen to emphasise that it's not just increases in demand that they're coping with; they report that there's a significant increase in acuity and complexity of patient need, which has resulted in some organisations declaring business continuity incidents over the past three weeks. As an example, during the first few days in January, the ambulance service responded at times to 12 per cent above the top-end forecast of ambulance activity. In terms of the nature of the demand, there was an increase in people calling 999 with breathing difficulties and acutely ill patients with complex needs needing to attend emergency departments.

I published the public health respiratory framework in September, which set out our approach to responding to respiratory viruses for the winter. Overall, COVID-19 infection indicators remain stable, but at a national level during the latest reporting week the number of confirmed case admissions to hospital and the number of cases who are in-patients increased. BA.2.86 remains the most dominant variant in Wales and accounts for 59.5 per cent of all sequenced cases.

There's been an increased prevalence of flu in recent weeks, but at relatively low levels compared to previous seasons, and flu hospital admissions have decreased in the most recent reporting week. In accordance with Public Health Wales advice, an alert was issued by the chief medical officer to GPs on 15 December to trigger antiviral treatment availability for flu. Encouragingly, the number of invasive group A streptococcal and scarlet fever notifications remain at seasonally expected levels, and, following an early winter peak, respiratory syncytial virus activity in children under five years old has reduced.

We continue to invest in our surveillance system to monitor any changes in the prevalence and epidemiology of viruses to support the planning process. Vaccination is one of the safest and most effective ways of protecting our citizens and health service, and I’m delighted that 1.6 million influenza and COVID-19 vaccinations have been administered in Wales as part of the current programme, enabling people at the highest risk of suffering severe illness to be protected.

In pharmacy, there's been a significant increase of around 50 per cent in the use of the common ailments service. The service was used more than 25,000 times in December 2023.

NHS information also shows that the 111 service remained resilient throughout the festive period; that the ambulance service is responding to exceptionally high volumes of people with immediate life-threatening complaints; and that, although there is variation in data, health boards are freeing up more ambulances to respond more quickly to people who are waiting.

This information is encouraging and suggests that preparedness and planning for winter have had a positive impact. There are signs that things are gradually recovering as we reach the middle of the month. However, we continue to see some long delays for care in the community and in admitting patients to hospital from emergency departments. This is partly as a consequence of patient flow issues and challenges with infection control, which are limiting available bed availability and space available. Having said that, we have seen a reduction of around 60 per cent in delays in those awaiting social worker allocation, compared with our baseline in April.

In addition to that, analysis of waste water data shows elevated presence of norovirus in the community. Health boards should be implementing infection prevention and control guidance to prevent the spread of all infections and to protect patient pathways over the winter months.

Clearly, we are expecting a significant impact from junior doctor strikes this week. Whilst we understand the strength of feeling amongst junior doctors and genuinely appreciate the work they do on the front line, it has been impossible for us to offer more than 5 per cent as an increase in salary this year. Five per cent has been in their pay packets since September and it's the same offer as to everyone else in the health service. Whilst it is true that this year the offer is less than what was offered to junior doctors in England—6 per cent—it should be noted that last year England only gave a 2 per cent increase, whilst we in Wales awarded a 6 per cent increase plus an additional one-off payment of 1.5 per cent to junior doctors here.

Whilst we are keen to move to pay restoration for junior doctors, this year, with the extreme financial pressure on our budgets, it has not been possible to offer more than that 5 per cent. Health boards have worked hard to protect patient safety and ensure emergency and urgent care is protected. However, we know that planned care is going to be very disrupted. Yesterday, around 6,500 out-patient appointments were cancelled—usually, there are around 14,000 out-patient appointments a day—and on top of this, around 400 operations were cancelled, when usually around 1,300 are carried out. But I would like to reassure patients that they will not be sent to the back of the queue by health boards and that efforts will be made to reinstate those appointments as soon as possible. 

In the meantime, health boards remain very pressurised in relation to pathways of care delays from hospital to the community. However, there is evidence of positive integrated working between health boards and local authorities to alleviate pressures. We have already seen a reduction in the overall discharge delay figures since the start of formal reporting on this last April. 

Although the pressure on services has been intense, fewer healthcare workers in key parts of the system have been absent from work because of COVID and flu this winter, and that has helped with the resilience of the system.

Finally, primary care remains busy, but demand is in line with typical yearly patterns for the winter. There has been no escalation beyond the high levels we see at this time of year. Continuous monitoring is in place to support GP practices in delivering effective services over the winter, and I will continue to update Members about the situation as the winter progresses. Thank you.

Thank you, Minister, for your statement today. I'd like to put on record my own thanks to the hard-working NHS staff across Wales at a very difficult time for them over the winter period. There, of course, will be concerns and increased anxiety from them at this particular time of the year. Of course, we have this statement today in the context of one in five people being on an NHS waiting list and still having those over 25,000 people waiting for two years for treatment—particularly, of course, the people who are waiting in pain for longer, with greater anxiety as well.

Minister, in your statement today, you mentioned that money was available for monitoring in primary care, but I'm also keen to see a more streamlined process for overall monitoring across the NHS. For example, in NHS England, they have a daily NHS situation report to monitor bed capacity, critical care occupancy, A&E closures and diversions, bed occupancy by long-stay patients, flu admissions, et cetera. So, can I ask you what thought you have put in to expanding your monitoring processes? What have you considered in terms of a similar method here? I mentioned NHS England, of course, but there's the impact of the winter pressures here. You often say, Minister, you want to hold health boards’ feet to the fire. By having that monitoring report, I would suggest that would better enable you to do that.

I'm glad, in your statement, Minister, you mentioned COVID, flu and respiratory viruses. You mentioned vaccinations for the most vulnerable, and you mentioned that 1.6 million this year have had the influenza and COVID vaccinations. Can we have a bit more detail on that, and take-up, perhaps, in percentage terms of those that are eligible for the vaccination? I think that would be more helpful to us. And particularly as well on what could be done to increase that take-up, because you said yourself in your statement that the best way to keep people who are in that vulnerable category safe is to take the vaccination. And, of course, it then takes pressure off the NHS, which is the purpose of the statement today.

I'm very keen to know what you're doing, Minister, to align the two vaccinations for influenza and COVID. I know it can be difficult because of different supply time frames, but where that is possible, can you give us some information about people being able to take both vaccinations at the same time and at the same location? And perhaps also what conversations that you've had with colleagues across the UK, your chief medical officer, and pharmaceutical companies about the progress towards a combined vaccination, because I think that would increase take-up as well.

I'm glad you mentioned the elephant in the room, Minister—the junior doctor strikes. I went out, as did other colleagues around this Chamber, at lunchtime to speak to some of the 450 junior doctors that were at that demonstration. There is a feeling from them of despair. I'm disappointed that you weren't able to offer at least the pay level that the review body had recommended. You have detailed the impact of those strikes in your statement today, but unless there is a resolution, the chances are extremely high that there will be further strikes, so I wonder if you could set out what other contingency plans you have in place in that regard. But, ultimately, what is your plan to end the strikes?

Minister, you also talked about waiting times recovery. The recovery target to reduce out-patient waits to below 52 weeks by December 2022 was not achieved. The revised targets for December 2023 were not achieved. The two-year wait elimination targets from March 2023 were not achieved. We've still got those 25,000 waiting in Wales. I suppose, Minister, the question is when are we going to have revised targets for those areas. If you don't think that targets are appropriate, why were there targets in the first place? I would go back to your mantra: you often say you want to hold health boards' feet to the fire. Surely, targets is the way to do that. So, when are we going to see those revised targets? And what impact do you think, Minister, the investment of the £170 million for the recovery of planned care is going to have towards the progress of achieving planned care recovery targets?

Finally, Minister, I heard the exchange today between Andrew R.T. Davies and the First Minister, citing that the Healthcare Inspectorate Wales report, very clearly in that foreword, identified no evidence that Welsh Government strategies and initiatives to combat pressures in acute healthcare settings were having an impact on the front line. That is a significant statement to make in a foreword of a report. What is your specific response to that element of the report? How will you monitor, evaluate and assess the impact that these initiatives are having on the front line to ensure that taxpayers' money is being spent effectively and efficiently?

Thank you very much. Obviously, this is a time of extreme pressure without strikes going on, so, clearly, we've put a huge amount of planning anyway into winter, but I can assure you that, in terms of monitoring, I'm currently getting three updates a day in terms of what's going on in the NHS across Wales. So, that monitoring is happening very, very regularly. I'm pleased to say that, on things like delayed transfers of care, one of the things we've got now is a whole-Wales approach. We know exactly why people are in hospital, and it's all been codified—I don't think that's a system that they have in England—so we can really drill down on some of those things. So, I can assure you that there is a huge amount of monitoring that goes on by the NHS Wales Executive and by my officials and we are constantly challenging the system.

In terms of the take-up of vaccination, I can tell you that, so far, in the 65 and older category, 74 per cent of people have had their flu vaccination update. I think it's fair to say that we are disappointed that NHS staff with direct patient contacts is at 41 per cent. So, really disappointing to see that. And I'm also disappointed that the number of people at clinical risk—only a 41 per cent uptake there. So, we would encourage people to come forward. There is still time. In relation to COVID, 85 per cent of vaccinations have been taken up amongst care home residents, and 69 per cent amongst the 65 and over. Only—very disappointingly there again—33 per cent of health and social care workers, front line, have taken up that opportunity. So, again, we would encourage them to take up that offer, because it is a preventative action, and it takes pressure off the system.

Just in terms of taking up the vaccinations together, obviously we wait for the expert group from the UK to come up with that new vaccine. It varies around Wales in terms of whether people do those vaccinations at the same time. There are some areas where GPs take the lead in particular on flu vaccinations. So, that's why it is separate, and we do give them the opportunity to make those decisions at a local level.

In relation to the industrial action, we absolutely understand doctors' frustration. We are frustrated that there's been a massive deterioration in terms of the real-terms funding that we've had from the UK Government. We're disappointed that we haven't been able to meet the pay review body recommendations, but, as I said, we went much further last year compared to England in terms of that increase. I'm very keen to keep talking to the BMA, not just in relation to the junior doctors, but also obviously in relation to consultants and specialty and associate specialist doctors, who also will be going out to ballot very soon. I do think we probably need to negotiate a new contract, and that's something that I hope we will be able to put on the table in future. 

In relation to targets on waiting lists, well, you'll have seen reports this week that the targets have not been met anywhere in the United Kingdom. That is disappointing to us all, and also demonstrates the fact that, actually, what we've seen is a massive, massive increase in demand. So, as soon as you're taking people off, you see the huge increase in demand, and obviously it's interesting to note that the increase in Wales has gone up by 1 per cent, and it's gone up by 6 per cent in England. We have put in, effectively, new targets. One of them was to try and make sure that 97 per cent of people would have had their treatment—those waiting for over two years—by the end of the calendar year. So, we're just waiting for the latest data to see if we've hit that target. So, we're hopeful that we may get there. Obviously, part of my job is to drive the system. I have fortnightly meetings with my staff to really push on the longest waits: 'What's happening?', 'Where are the problems?' We do deep-dives every fortnight to make sure that we are absolutely breathing down the necks of the health boards, and that £170 million obviously has helped to contribute to that.

In relation to the HIW report, obviously we'll have a more detailed discussion on that tomorrow, but I do think that it's important to point out that had we not put in measures like urgent primary care centres, which have taken so many people away from our emergency departments, newer SDEC systems, the 111 system, which has diverted 70,000 people away from the normal services, the '111 press 2' service, the pharmacy service—. All of those things I don't think have been acknowledged in quite the way that they should have been in that report.

There are few things more certain, when it comes to public health policy, than the fact that the winter months exacerbate the pressures on health services. It is disappointing, therefore, that this year, like last year, we are hearing the Government making a statement discussing the status of things after they have started to unravel, rather than talking about a solid action plan that has been developed and discussed well beforehand. Of course, the Minister objects to this and says that they started preparing for the winter back in April. But, if so, why do we once again find ourselves in a situation where wards are closing and patients are waiting in ambulances for hours because of winter-related infections? There must be something seriously wrong.

The inevitable result of poor planning here is a health service that is creaking, as we've seen recently at Morriston Hospital and Wrexham Maelor Hospital. In fact, I recently had a constituent who had to wait two days in the ambulance outside Wrexham Maelor Hospital, and sleep in the vehicle outside, because of norovirus. Is this the result of the whole-system approach that the Minister is talking about? Now, if the Government is serious about tackling winter pressures, then the truth is that we must fill the vacancies in nursing. There are almost 3,000 vacant nursing posts in Wales. Without these nurses, there is enormous pressure being placed on community services and services on the floors of the wards in our hospitals, and, without this, infections are more likely to spread in the overcrowded hospitals that we have. So, could I ask the Minister: what are the Government's plans to fill these vacant nursing posts?

I note, in the answer to Russell George now, that the Minister has said that she's eager to look at the waiting lists, and those who have been waiting longest. Wouldn't it be more sensible to look at those with greatest need waiting for treatment, rather than those who have been waiting longest? Someone can be waiting for two years needing treatment, but somebody can be waiting six months needing urgent treatment. So, wouldn't it be better to look for the ones in greatest need?

The Government are obviously aware of the scale of the risks associated with these kinds of winter-based diseases. For example, the Government's own scientific modelling revealed that, last year, there were nearly 15,000 admissions to Welsh hospitals due to seasonal influenza and pneumonia. So, why has the Government not designed a specific winter plan for the health and social care sector since 2021-22?

Let's turn to another known quantity: the relationship between cold conditions and adverse health outcomes. A temperature drop of 1 degree is associated with a 5 per cent increase in respiratory illnesses, a 3 per cent increase in deaths from respiratory diseases, and a 2 per cent increase in cardiovascular disease in the over-65s. We also know that 30 per cent of excess winter deaths are due to cold homes, and the NHS spends at least £2.5 billion a year treating people with illnesses directly linked to living in cold, damp and dangerous conditions. It is for this reason I find it inexcusable that the Government has yet to implement its updated Warm Homes programme, over 18 months after the recommendations of the Equality and Social Justice Committee on this issue were first published.

When I talk about insufficient urgency on the preventative agenda, this is a classic example. By dragging their feet on measures to bolster the long-term resilience of public health in Wales, this Government is having to commit ever greater resources from an increasingly constrained budget to short-term sticking-plaster solutions. What has been the cost to the health service as a result of this Government's failure to implement the Warm Homes programme in time for this winter?

Finally, I'd like to reflect on the impacts of winter pressures on NHS staff. As I've mentioned many times in this Chamber, without its dedicated legions of staff, the NHS is nothing. That's why I was proud to stand on the picket lines with junior doctors outside Ysbyty Maelor yesterday morning, and with them again on the steps of the Senedd earlier this afternoon. The demands for a reversal of over a decade of eroded wages are fair and deserve to be heard. You can't expect them to cope with workloads that have become even more intense, especially during the winter, for less money in real terms. 

I also know that the decision to initiate strike action will not have been taken lightly. Their warnings about the state of the workforce and the link to winter pressures have fallen on deaf ears over many years. And the fact that this last resort of strike action was supported by an overwhelming Majority of the British Medical Association demonstrates the extent to which their members feel undervalued and underappreciated. It would be entirely irresponsible and dishonest for the Government to try to pin the blame for the problems we're seeing today with record times in the NHS on striking workers. 

So, in the interest of ensuring that negotiations are put back on track and can reach a satisfactory conclusion as soon as possible, will the Minister acknowledge today that these strikes are an inevitable symptom of escalating winter pressures in the NHS and not the cause? And will the Minister agree to renegotiate and go back around the table with the BMA as soon as possible? 

Thank you very much. I want to confirm that we have been preparing well in advance for the winter, but what we're doing is ensuring that we don't have a separate plan for winter but that this is prepared in advance. There's no point having a separate plan unless you start to prepare in April, because it simply wouldn't be ready if you did it any later. 

It's true to say that some wards have been affected by norovirus, and certainly that's had an impact in north Wales, and we have seen people asking the public not to visit hospitals. And I think that's the right thing to do; we do have to ensure that we do try and prevent the spread of these infections in our hospitals. 

Just in terms of filling vacant posts, of course, we have recruited a lot of additional nurses in recent years. It was good to hear, as I visited a number of hospitals over the new year period, people on the front line telling me that they had now cut down on the use of agency staff and that they had recruited more nurses on a permanent basis. So, that does help. Of course, some of those are newly in post and don't have the same experience as others, but that will come in time. And in terms of what we're doing to improve the situation, of course, we are training more than ever before, and at the beginning of March I will be going out to Kerala to seek to recruit more there and to speak to the Government there to encourage those excellent nurses from India to come and work for us here in Wales. 

In terms of flu, you're quite right that we are seeing more people, and, as the temperature decreases, it does have an impact on respiratory issues. And that's one of the reasons why it's disappointing to see that more people haven't taken the opportunity to take up the flu vaccine. 

Just in terms of who has responsibility, we're quite clear that there is responsibility across Government to plan and to consider health, and that's why at the moment there is a consultation on the health impact assessment to ensure that, whenever anything is considered in terms of a new policy, it will have a health angle to it. So, the Warm Homes programme will be part of that. And one of the things we do have to consider is that, if you want more money in the Warm Homes programme, you do have to consider where you will take that money from. We just have to get the balance right between the prevention and all of the other things that we are currently considering.  

The Deputy Presiding Officer (David Rees) took the Chair.

Just in terms of the strikes, obviously we're disappointed that the junior doctors have decided to take the action that they have, but we understand it; we understand their frustrations. And we are indeed frustrated by the lack of additional money coming from the UK Government. Obviously, I understand that you would want to be on the front line, but I do hope that they challenge you on where you would cut. If you were going to find that additional money, where would you find that additional money? Because the only other place for that to come from now is from the health budget itself, and I’m genuinely not sure if we would be thanked by the public, nor indeed by the BMA, if we started cutting other parts of the health budget.

I met with the BMA last Thursday. I’m always open to meet with them to see if we can get to a better position with this. Clearly it’s in all of our interests to try and settle the strike as soon as we can.

Thank you, Minister, for the incredible hard work that you’re doing, and to all the NHS staff who have worked so hard to respond to the increased demand and complexity.

Firstly, I just wanted to ask for clarification on the amount of money that England has offered to its doctors, which I believe adds up to 8.8 per cent. Did Wales get a consequential sum reflecting that offer that was paid to English NHS doctors, and if so, could you explain why it’s not possible to pay a similar sum to our doctors? It may reflect the fact you paid them more money last year. Anyway, it’s very important to hear about the cut down in agency staff and more substantive posts—I really welcome that.

I just wanted to ask you about something that I read about just before Christmas, which I think didn’t get quite the publicity it deserved as a result of that, which is that in a national newspaper it was reported that over 800,000 patients in England and Wales have been admitted to hospital with malnutrition and nutritional deficiencies in the last year. You mentioned the increased acuity and complexity in your statement, and I just wondered whether you’d had any reports about that, because that’s clearly something that we need to take proactive action on, not just around winter—it’s a ‘never event', as Professor Hawthorne, who’s the chair of the Royal College of General Practitioners, has said. It’s absolutely appalling that, as a nation, we should be having malnourished children. So, I wondered if you could just clarify what information you’ve been receiving from the front-line health staff as to whether we are indeed getting an increased number of people coming into hospital because of malnutrition.

Thanks very much, and I too would like to extend my thanks to the NHS staff, who have been under incredible pressure over the winter period. It was really heart-warming to meet some of them when I dropped in without warning to several hospitals over the winter period, and it was really great to be able to get to the front-line workers to listen to their frustrations. In particular, I was very struck by an ambulance worker who broke down with frustration at the situation and the difficulty, and the fact that they’ve been trained for something and they want to get back out on the front line. It was a real pleasure to have spent the day with the ambulance service before Christmas as well. So, there’s amazing work being done by these people day in, day out.

In relation to the consequential, I know that the finance Minister has been pressing the UK Government for clarity on this, but we have not had that clarity yet. So, it’s unclear in terms of the consequential funding, not just whether what was in there last year will be baselined—that is not clear to us, so it makes it very, very difficult for us to plan—but there’s no clarity either in terms of the offer that’s been made to consultants in England, whether that is money coming from the NHS budget or coming centrally. If it comes centrally, obviously we will get a consequential. It’s very difficult and it just proves that, actually, the system needs a radical overhaul, so that we can all be transparent and we can all understand what is going on. There’s too much smoke and mirrors in relation to how health is funded in England.

I'd like to thank you for your statement this afternoon, Minister. As you're well aware, our GP practices are under huge pressure this winter with the increased demand on their services. I've been contacted by a large number of constituents concerned about the potential reduction of services in the Llandrindod Wells GP practice due to the financial constraints that they're under. And there's a lot of concern that they won't be able to offer some of the services that they have offered before, during this winter. So, I'm just wondering, Minister, if you can outline today what the Welsh Government is doing and the proposals that the Welsh Government have got to support our GP practices through the winter, to make sure that they can get through the precarious financial situation that they're currently in.

As James will know, most GPs are independent consultants. They work independently and they have to balance the books once they have made a contract with us. So, we have contractual negotiations with them. One of the things that we've done as a result of that contractual negotiation is to change the way that the public interact with GPs, so that we haven't seen the kinds of problems that they're still encountering in England in relation to the 8 a.m. block. So, things are very different here now in Wales and it's significant, the reduction in volume when it comes to patients getting access to GP services in Wales. So, that really has to be a decision for them in terms of where they put their money, how many people they employ, but, obviously, we do an all-Wales negotiation in relation to that.

I just want to come back to Jenny's point in relation to malnutrition, and I apologise for not addressing that earlier. There is a particular issue, I think, with older people. So, what we have, perhaps, are many people with dementia, and there are lots of people who come into hospital with dementia who are not aware of the fact that they need to balance their diet. So, it's very interesting to see some of the support structures that are being put in place in the community, ready for when people come out of hospital, before people come out of hospital; dieticians being a part of that care in the community team. Certainly that was something really positive I saw in Pembrokeshire before Christmas. 

Last week, Minister, as a result of the closure of wards in Morriston Hospital and the prevention of visits, I asked you about the recent advice from the World Health Organization to consider making mask wearing mandatory in health settings. It's a call that's been echoed by the Royal College of Nursing in a letter to the chief nursing officer. They are also calling for improved ventilation in wards, out-patient clinics and waiting areas, to the same end. This would, of course, prevent the spread between patients, keep wards open, and would also, of course, help to protect the workforce from falling ill and that, perhaps, is more important than ever now that we've heard the disappointing figures that you reported this afternoon in terms of the workforce response to the vaccination programme. This would, of course, reduce pressures generally. And, therefore, why don't you believe that mask wearing and ventilation, which would reduce the spread of viruses, would be a sensible step, particularly in the winter, given the disappointing response, which I mentioned, to the vaccination programme?

And in terms of the flu and COVID vaccination programme, I had some casework where people who had chronic conditions such as asthma hadn't been invited for a vaccination, had caught COVID and been very ill, before they were told that the wrong advice had been provided. So, how does the Government monitor that everyone who does qualify does get the right information and is encouraged to go for a vaccination? And in terms of the programme, has any consideration been given to extending vaccination to more of the population, if people who did qualify have now been invited and it sounds like there are spare vaccinations available?

Diolch yn fawr. I take advice, obviously, from my officials and from health boards in terms of when they think it's the appropriate time for us to initiate mask wearing within our hospitals. And I think there are occasions, and we have to make sure that we wait for the right occasion for that to happen, when levels are significantly higher. At the moment, COVID is relatively low compared to previous years and so is flu, although there was, obviously, an issue with norovirus, and what happened under those circumstances is that places like Treforys just said, 'Listen, just don't come in, just don't visit.' That's the best protection of all, rather than coming in and wearing a face mask.

Just in terms of vaccinations, just so that you're aware, Public Health Wales is about to do another drive to try and get people to take up that opportunity of vaccination. We follow the Joint Committee on Vaccination and Immunisation advice in terms of who should receive those vaccinations, and we will stick to that as a proposition.

And finally, Andrew R.T. Davies.

Minister, in previous responses you've given, you've talked about the junior doctors' strike, with the protests outside the Senedd today. I understand the financials of it; it is a challenging environment. The BMA have a claim that they've put forward that other parts of the United Kingdom have also rejected, but what other parts of the United Kingdom have been able to do is deliver the independent pay review's settlement. Irrespective of the funding formula, could you please say how much, if you were to deliver that recommendation, the Welsh Government would have to find in terms of money to meet that recommendation? I understand it to be about 1 per cent, or a little over 1 per cent. What is that in monetary terms that the Welsh Government would have to find to settle the dispute, if it were agreeable to the BMA—that that figure would be accepted by them?

Thanks very much. I think one of the things that needs to be borne in mind is that it's not just about what's given this year, but that, actually, we gave a significant uplift last year. So, in Wales, we gave a 6 per cent uplift, and on top of that there was a 1.5 per cent non-consolidated uplift, compared to the 2 per cent in England that was given. So, if you compare last year with what's happening this year, it's very different. Of course, in England—you're quite right—they have offered significantly more this year, but I think it's probably worth noting that the strike is still not settled in England. Obviously, the other thing is that we don't know where that money is coming from, so it would be very helpful if we knew where that was coming from and if there's going to be a consequential.

Part of the problem we have is that everybody else across the Welsh NHS, in terms of 'Agenda for Change', has accepted that 5 per cent offer. Now, if you start saying, 'No, but we're going to give those a bit more', you can be damn sure that other parts of the NHS will say, 'What about us? Are we not as worthy or as valuable?' So, we do have to recognise that what we are talking about is several million pounds that we'd have to find, not just this year, but ongoing into the future. But, more than that, it's unlikely to settle the strike and, on top of that, it would open the doors for other people. We can work out the figure quite easily, but, obviously, it's very difficult to see that that would settle the strike.

Thank you, Minister.