The following amendments have been selected: amendment 1 in the name of Lesley Griffiths, and amendments 2 and 3 in the name of Mabon ap Gwynfor. If amendment 1 is agreed, amendments 2 and 3 will be deselected.

Item 6 this afternoon is the Welsh Conservatives debate: healthcare inspection and funding. I call on Gareth Davies to move the motion.

Motion NDM8452 Darren Millar

To propose that the Senedd:

1. Notes the Healthcare Inspectorate Wales Annual Report 2022-2023.

2. Regrets that the report:

a) highlighted risks relating to emergency care, staffing concerns, poor patient flow and the accessibility of appointments;

b) states that there are often delays in patient discharges due to shortages in social care staff and social workers to assess discharge needs; and

c) did not find evidence of Welsh Government initiatives making a clear and significant difference to services at the front line.

3. Calls on the Welsh Government to:

a) scrap cuts made to Healthcare Inspectorate Wales in the 2024-2025 draft budget, and expand their remit to investigate complaints;

b) establish a timetable with Healthcare Inspectorate Wales for the inspection of the nearly 60 per cent of healthcare services that have not been inspected in the last 5 years;

c) ensure the full Barnett consequential 20 per cent uplift for health is spent on the Welsh NHS; and

d) bring forward a substantial workforce plan with a tuition fee refund for healthcare workers that stay in Wales for five years after their studies.

Motion moved.

Diolch yn fawr iawn, Deputy Llywydd. I'm pleased to be opening this debate and I move the Welsh Conservatives' motion, tabled in the name of Darren Millar. But I'm sure we would all rather be discussing the state of our NHS in Wales with more positive news. The healthcare inspectorate report has illuminated some pretty dismal findings, and a lot of reflection by the Welsh Government is needed as a result of this, because this report couldn't be clearer that the current strategies are not working.

I would also like to express on behalf of the Welsh Conservatives our opposition to plans to cut Healthcare Inspectorate Wales made in the 2024-2025 draft budget. This report highlights, if anything, the need to expand the remit of Healthcare Inspectorate Wales, introduce a complaints investigation procedure and establish a timetable for the inspection of nearly 60 per cent of Welsh healthcare services that have not been inspected in the last five years, which is, frankly, shocking. I must also make clear that making cuts to Healthcare Inspectorate Wales is dreadful optics for the Welsh Government as it currently looks like a Government that has lost control of any ability to run a functioning health service, so has instead turned to reducing transparency and restricting the ability of the public to assess the performance of the health service. 

We know the statistic that has been repeated in this Chamber time after time, but I will remind anyone who may have forgotten: over 25,000 people in Wales waiting two years or more for treatment, compared to 227 individuals waiting the same amount of time in England. The Labour Government receives £1.20 for every £1 spent on the NHS—how many times have you heard that—in England, yet the Welsh Government spends only £1.05 for every £1 spent in England. The new budget sees this set to decrease yet further.

Every single Welsh NHS health board is currently in some form of enhanced monitoring or special measures; my own health board, Betsi Cadwaladr, is just one example. When these figures are put to the Welsh Government, we hear the same wooden and perfunctory responses: the lack of funding from the UK Government and that initiatives are in place to address these problems. Again, how many times have we heard that?

Perhaps the most damning finding in this report, and the most depressing, is that Healthcare Inspectorate Wales did not find any evidence of Welsh Government initiatives

'making a clear and significant difference to services at the front line'.

Clearly, enhanced scrutiny inspections and a better complaints procedure are imperative, particularly in the aftermath of the regrettable Channon family case, and my colleague Russell George has continually scrutinised the Welsh Government and Swansea Bay University Health Board's failures.

Some may recall the scathing remarks expressed in the foreword to the 2022-23 report by Alun Cairns—not the Member of Parliament. This latest report sadly shows precious little improvement, with many areas that have continued to deteriorate. The shocking lack of inspections of Welsh health facilities needs addressing urgently and that's why we are calling for an urgent timetable to be drawn up to ensure these facilities meet the standard expected. We also want to see the full Barnett consequential 20 per cent uplift for health actually being spent on its intended recipient, the Welsh NHS. The Welsh Government should reverse its plans for real-terms cuts to the Welsh NHS and, perhaps, reroute the cash that they've planned to throw away on 36 more politicians and other vanity schemes, like the 20 mph roll-out, when our NHS is in dire straits. If the Government were really serious about saving lives, the money spent on vanity schemes would be spent on our NHS.

We need to hear something new from the Welsh Government. Their 75 per cent target for those with a suspected cancer to be seen and start treatment within 62 days has never been met; one in five people in Wales is on an NHS waiting list; and failures in social care are leading to bottlenecks in hospital wards as patients fit to be discharged are being kept in valuable bed space, an issue that the Welsh Government has been aware of for a considerable amount of time. We now know for certain that progress isn't being made and our situation gets more dire each year, and the Welsh people deserve better. And it brings me great sadness that a lot of my remarks are depressing today, but that's the current state of affairs, unfortunately, Minister.

But to close, Deputy Llywydd, the Welsh Government's strategies need radical rethinking and the proposals that the Welsh Conservatives have put forward will move our NHS in that direction, and I look forward to hearing the contributions of other Members during this debate this afternoon. Thank you very much.

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

Amendment 1—Lesley Griffiths

Delete all after sub-point 2b) and replace with:

Appreciates the important work of HIW and notes the challenges identified.

Recognises the challenging financial position across the Welsh Government which continues to prioritise frontline care and staffing requirements in our NHS.

Notes the Welsh Government continues to work with healthcare providers using inspections to learn and improve.

Amendment 1 moved.

Formally.

I call on Mabon ap Gwynfor to move amendments 2 and 3, tabled in his name.

Amendment 2—Mabon ap Gwynfor

In point 3, delete sub-point c), and replace with:

formally request from the UK Government a comprehensive review of the Barnett Formula to ensure fair funding for all budget areas in Wales, including health and social care;

Amendment 3—Mabon ap Gwynfor

Add as new sub-point at the end of point 3:

increase the availability of degree apprenticeships in the healthcare sector to provide greater opportunities for young people to enter the profession and remain in Wales to work.

Amendments 2 and 3 moved.

Thank you very much, Dirprwy Lywydd. I'm very pleased to move the amendments to this Conservative motion.

Well, on the face of it, it's difficult to disagree with the substance of this motion—of course we want to overturn cuts to the HIW budget, of course we want to see improved efficiency of HIW and to see further increases in the NHS budget. But there is an elephant in this Chamber, one that neither the Conservatives nor Labour want to address, namely the fact that it is impossible to get the dynamic, resilient and operational NHS that we all want to see without seeing a fundamental reform of the Barnett formula, which means that Wales is underfunded on an annual basis. Without that honest recognition, then I'm afraid that the substance of the Conservative motion today loses all credibility.

First of all, as the pot of money allocated to Wales annually is fixed, the Conservative motion would mean transferring funding away from social services, which would, in turn, exacerbate the situation further, with more funding being spent on front-line services, rather than on preventive services.

Perhaps if the Conservatives were willing to commit to strengthening Wales's ability to make substantive adjustments to the block grant through the further devolution of taxation and borrowing powers, they would have far more credibility on this matter. But they're not. So they haven't.

Secondly and most importantly, while it's true that Wales does receive proportionally more per head in funding compared to England, this is based on the minimum floor recommended by the Holtham commission back in 2010, which, even at the time, the commission recognised was the absolute bare minimum solution to prevent Wales from falling further below the lowest of all the estimates of relative needs—and I quote. Since then, we've had 14 years of Tory-driven austerity and the COVID pandemic, the aftershocks of which will be keenly felt for years to come. We also have a population that has the oldest median age of all the UK nations, which is ageing at a faster rate than the UK average and which has a proportionally higher prevalence of long-term sickness rates. As numerous academics and experts have conclusively concluded, therefore, the current funding model from Westminster simply doesn't cater for Wales's societal needs. There's a good reason why the Tories haven't been upfront about the limitations of the Barnett formula, because it would involve confronting the reality that Westminster consistently gives Wales a raw deal. It would also entail them owning up to the responsibility of their party—

Would you give way?

—for the catastrophic legacy of austerity that has had a clearly detrimental impact on public health across the UK. Mark.

Do you recognise that, at the time of the Scottish referendum on independence, which, of course, you took a different view to myself on, the leaders of the UK Conservative, Labour and Liberal Democrat parties pledged to retain the Barnett formula as an offer to the Scottish population because, obviously, they do relatively better out of it than we do, and that's what's holding back all the UK national parties at UK level?

No, I don't accept that. I accept the fact that Scotland is doing better out of that than Wales, but we need to see a reform of the Barnett formula for the reasons I'm listing here now, because we're not funded properly in order to fund our NHS here in Wales.

In contrast to the Conservatives, the Welsh Government has, at least in words, echoed our call for a review of the Barnett formula on the basis of societal need. But, as has often been the case with this Government, when it comes to the systemic unfairness of Wales's treatment by Westminster, the tone of these words is not always matched by urgency of deed. It's all well and good to point to the intransigence of the Tory Government, but what about the deafening silence of the UK Labour leader on practically anything that's related to Wales, let alone the specific issue of fair funding? If Labour Members here were truly motivated to improve the poor lot we currently receive, they would be lobbying Keir Starmer relentlessly to make reviewing the Barnett formula a key priority for an incoming Labour Government. But instead, all we're hearing is the wishful thinking that Starmer will somehow turn out to be a passionate Keynesian when in office, which is, obviously, contrary to every facet of his leadership so far, from pledging not to turn on the spending taps to parroting Tory fantasy economic thinking that growth can somehow be conjured up without investing in our dilapidated public service. And today we heard Rachel Reeves signalling that she won't raise corporation tax either.

And it tells you so much, doesn't it, that not one of the candidates for the leadership of the Wales branch of the Labour Party has committed to calling for a review of the funding formula and putting pressure on their leader Keir Starmer to commit to that. By introducing our amendment, therefore, Plaid Cymru, once again, is showing that it is only us who are serious about fairer funding for Wales. This includes not only keeping the skills of those individuals studying here in Wales, but also expanding the opportunities available to our young people to work in the NHS, as we will hear in a later debate this afternoon that will be led by Plaid Cymru.

The people of Wales are crying out for an opportunity to develop and to play their part in developing the best possible health service that will meet the requirements of the twenty-first century and are calling on Westminster to give the necessary resources in order to deliver this. As elected Members, we have a duty to respond. By supporting our amendment today, you too can show that you are listening to them and insisting on financial justice for Wales in order to enable us to provide the best possible health service. Thank you for your patience.

I would like to thank Healthcare Inspectorate Wales for not only their annual report, but all the hard work they undertake to ensure patient safety. Sadly, as our motion alludes to, cuts to HIW's budget will undermine this work and add to the growing deficit of inspection work. Nearly two in three healthcare services have not been inspected in the past five years, and without such vital inspections, who knows what patient safety issues are going unaddressed?

It is only through the diligent work of inspection teams related to the maternity service at Swansea Bay University Health Board that wider failings got addressed. Who knows what would have happened had HIW not investigated patient concerns? We do know that when the health board looked into the care provided to Gethin Channon and his parents, Sian and Robert Channon, they ignored many of the findings. Nearly a year and a half after the health board received a report that highlighted serious failings and with around 300 incidents being investigated, HIW has reported on the dire state of maternity services at Swansea bay. It still took Welsh Government two months to act upon HIW's findings. But at least action was finally taken.

With 17 per cent of Welsh hospitals and a staggering 73 per cent of Welsh general practitioner practices never being inspected, who knows what other patient safety scandals are going unnoticed? What is clear from HIW's latest annual report is that the Welsh Government initiatives to improve patient care are not having any impact at all. We can't rely on ministerial diktat to improve patient care, nor can we allow safety concerns to go unaddressed. We need a properly funded and fully staffed healthcare inspectorate to ensure that services are safe and meet the needs of patients, not those providing them.

One in five of the people in Wales is on a waiting list for NHS treatment, and many of us are waiting longer than two years for treatment. Despite spending more per head on NHS care than in other parts of the UK, our outcomes are much worse. We can't rely upon the Welsh Government nor senior leadership at health boards to ensure safe and timely treatment without being forced to, which is why HIW's work is so vital to our NHS. Yet, Welsh Ministers want to cut the service rather than expand it. We can't allow the short-term financial priorities of this current Welsh Government to undermine the inspection regime.

Sadly, when dealing with health issues, things will go wrong, but it is essential that we ensure that any failings are not systemic. That is why HIW provides the assurance that when service provision is not up to standard, action will be taken. And it is our duty as Members of this Senedd to ensure that HIW is equipped to do its job. I urge you to support our motion this afternoon and put pressure on Welsh Government Ministers to properly resource our healthcare and inspection regime.

There is a health crisis right across the UK, not just in Wales. All evidence shows this has worsened over the last 14 years since the start of austerity and cuts to public services. The Welsh Government's budget in 2024-25 will be £3 billion lower than it would have been had it grown in line with the economy since 2010.

We can't look at the NHS in isolation: all public services across the UK are facing unprecedented pressures under the current cost-of-living crisis. We know that one in five councils in England are looking at bankruptcy, yet the Tories in Westminster seems set on making matters worse, with the autumn statement leaving Wales £1.3 billion worse off in real terms than expected at the time of the 2021 spending review. Devolution means that different choices and decisions are taken based on the need of people in Wales. The Welsh Labour Government will always invest in and protect health and social care and spends 8 per cent more on health and a massive 43 per cent more on social care than in England. And you can't separate them, really. And this October, the Welsh Government announced a package of changes to increase their funding to NHS Wales this year. Its budget will increase by an additional £425 million, despite pressures on all service areas. I believe it will be the wrong decision, as the Conservatives are suggesting, to move funding away from the health service itself and instead spend it on inspectorate services.

The austerity being imposed upon us means tough decisions like this are being made right across the Welsh Government, and priority must be given to front-line services. The Welsh Government has recommend—[Interruption.] Sorry, I will give way. Sorry.

I'm grateful for that, Carolyn. Don't you see the inspectorate is an integral part of the health operation and health service here in Wales, given that you represent an area that's had so many disasters in the provision of health services, especially mental health provision? The health inspectorate is a vital part of the fabric required to test the system and make sure it's safe and secure for both patients and staff. Don't you accept that?

I will respond to that—I think it's more important to invest in the services, as Welsh Government is doing, by investing in the '111 press 2' service, which I will go on to mention now. [Interruption.] If I can just carry on.

The Welsh Government has recognised that Healthcare Inspectorate Wales, like others across the public sector, will have to think carefully about how to focus limited resources over the next year, as every agency is having to do across the public sector. They will be one of many organisations taking a share of the pain caused by the hole in our budget. The report from Healthcare Inspectorate Wales recognises the challenges our health service faces, but as the First Minister highlighted yesterday, the report also shows the progress being made, with new initiatives making a real difference, such as the '111 press 2' service for mental health, the urgent primary care centres, and the same-day emergency care provision in our hospitals. There's much work being done.

The report also reminds us how important the Welsh Government's workforce plan will be in meeting staffing challenges going forward, as pressures on the service continue to rise. As well as cuts, service pressures are continuing to rise year upon year. Improving both recruitment and retention within the NHS workforce will be key going forward. This is why Wales didn't cut the NHS bursary in 2017, like England did. We have carried on providing the NHS bursary, and provide a social work bursary in Wales.

The Welsh Government has also increased the NHS training and education budget for nine years in a row, because Welsh Labour understands the importance of investing in the NHS workforce of the future. In 2023-24, the budget increased by a further 8 per cent. In north Wales, the commitment to recruit into the workforce is clear. We have a new medical school and dental academy in Bangor, new training places for social care workers, and pathways to continuing education and development—[Interruption.] No, I'm running out of time. And new allied health professionals training places at Wrexham university, including nurses, paramedics, ambulance training and physiotherapists, which is really welcome. Despite all the challenges the NHS faces and huge budgeting pressures that have been inflicted on Wales by Westminster, we should be recognising the progress being made and the incredible people who keep the health service running day in, day out. And we need to stop attacking the health service, because day in, day out—[Interruption.]—day in, day out, great service is being provided to our residents in Wales every day. Thank you.

Isn't it a good job that we have the Welsh Conservatives here to scrutinise and challenge the failing health service in Wales? So, we know that the Healthcare Inspectorate Wales website lists 1,572 healthcare services in Wales. Of those, 660 services have never even been inspected, and 342 services have not been inspected since 2018, five years ago. During the last financial year, HIW's team of investigators undertook 178 pieces of inspection and assurance work; 41 of those pieces of work were quality checks. Only 137 onsite inspections took place, meaning that HIW scarcely has the capacity to inspect 10 per cent of facilities annually. And it gets worse. Of the 95 NHS hospitals in Wales, 16 have never been inspected, and 18 have not been inspected in the last five years. At least 86 per cent of NHS GP practices have not been inspected in the last five years, and 73 per cent have never been inspected. 

Why does this matter? Well, it matters to me, actually, because, for many years, we had a very good watchdog and patient support system with the community health councils, on which I was actually proud to serve a four-year term. They would make on-call visits and, really, people respected them as an organisation. But what happened? Perhaps they were doing too good a job, and they were dumbed down, actually, with a lack of funding and a review of their service.

It's important also because HIW inspect NHS services and regulate independent healthcare providers against a range of standards, policies, guidance and regulations, to highlight areas requiring improvement. In 2022-23, HIW carried out 19 acute hospital inspections across Wales. And shockingly, the organisation had to use its immediate assurance process in 58 per cent of those inspections—that is, 11 out of 19. As they state themselves, this is a highly concerning figure and demonstrates that, at present, acute—acute—in-patient healthcare carries the highest level of risk in services across Wales. 

In May 2022, they designated the emergency department at Ysbyty Glan Clwyd—Betsi board—as being a service requiring significant improvement, SRSI, which is a service with the most significant levels of risk. And I remember that report, and I remember it stating that equipment was dirty in the units. So, I ask this Chamber to consider what would be the situation in these medical facilities today should HIW not have brought those to our attention in their reports. Bearing in mind that they do not have enough capacity to regularly inspect all medical and care facilities in Wales and the genuinely impactful nature of the organisation's work, the cut of £25,000 to their budget for 2024-25 is both illogical and is not based on, really, any good evidence.

Minister, I would be grateful if you could clarify whether HIW have made it clear to you themselves how much money they would need to ensure that all facilities at some stage can be investigated and checked against. If I was running a health service, I would want to know that these areas and various different delivery places were actually giving the best quality service, and, over the last two or three years, we've heard the opposite. So, I would be wanting more and more and more inspections and I certainly wouldn't be looking to cut their budget.

When there is such pressure, it is unsurprising that inspections continue to note low levels of compliance with mandatory training for staff. We know the serious staffing crisis across the Welsh NHS. The team we have there—. And if you're watching, anybody, thank you for all you do in our health service, and I know that you do it against a background of sheer exhaustion, pressure and, in some cases, some governance issues that really need to be sorted. For example, it is because of a lack of staff that the opening hours of Llandudno minor injury unit have not been extended. Wales has an NHS workforce strategy, yet we rely too much on agency staff. How do you think I feel when one of my constituents comes and tells me they are very loyal to the health board, they work very long long hours, however, people can skip over from the border and earn more money per hour than they do?

You could also help to entice more staff by taking measures such as offering a tuition fee refund for healthcare workers that stay in Wales for five years after their studies, offering degree apprenticeships to healthcare careers in the Welsh NHS, and offering jobs at specific hospitals rather than health-board-wide.

Janet, can you conclude now, please?

Okay. So, while Wales has an NHS workforce strategy and an NHS workforce implementation plan, it lacks a comprehensive NHS workforce plan such as the one developed for England under the UK Conservative Government.

Anyway, I would like to record my thanks to HIW for being our platform for patient voices, and, Minister, please, if there's one thing I would ask you to do, it's to make sure that you have enough funding. Despite all these moans and groans about not enough money coming forward, please make sure you have enough funding to allow these inspections to go ahead. Diolch yn fawr.

It's important that we have debates like this, isn't it, focusing on the healthcare system, and I'm sure this won't be the last one. Today's focus is entirely appropriate as the Healthcare Inspectorate Wales's annual report demonstrates that it does an incredibly important job, scrutinising and assessing the safety of healthcare services that we all rely on. We heard in questions to the First Minister yesterday how important their work is, but also how much more there is to do, with so many health settings that haven't been inspected over many years. With this in mind, and as we heard yesterday as well as today, it's incredibly disappointing that the Welsh Government have chosen to propose cuts to the health inspectorate in this year's budget. I genuinely believe this is a retrograde step and a false economy, especially at a time when our health service is struggling so much.

I would strongly encourage the Government to reconsider this proposed cut, ensuring that the Healthcare Inspectorate Wales can continue its work to ensure that the people of Wales get the healthcare service that they deserve. Scrutiny may be uncomfortable, but it's a necessity. Without it, how do you ensure continuous improvement?

Dirprwy Lywydd, we will all know too well the various pressures and shortcomings within all facets of health provision. Be it the lack of social care provision and unmet need, to GP practices facing such pressures that they are forcing practitioners out of the system, to colossal ambulance waiting times and huge waiting lists for treatment, the inspectorate is critical to drive the improvements needed.

The HIW annual report gives an honest assessment, which praises where praise is due, but exposes poor practice or systemic failure. It was pleasing to note—not that I doubted it—that the staff treat patients with dignity and respect. This was especially noted at the Grange hospital in my constituency in its last report, a reflection I completely agree with. I rarely hear of negative comments about our NHS staff. They do their very best at all times in the face of great pressure. We see, though, in the annual report, that patients continue to struggle to obtain appointments and often experience anxiety and stress as a result, and our inboxes clearly support this. The stress of not knowing if and when you can see a doctor has an emotional toll, and, as the report says,

'can further impact their ability to cope with health issues and make informed decisions about their care.'

The shortcomings of our health service are certainly not down to our staff, but direct results of a series of institutional failures. This is particularly true at the Grange University Hospital, where the HIW report found that responses from patients about their care were mixed, including negative comments about waiting times and personal protective equipment, but positive comments about staff. We also know that staff at the hospital had concerns, and the report found that they complained about the lack of space and assessment areas, which was impacting patient safety. Also, there was an inadequate level of staff and a lack of appropriate training. While these comments are never good to hear, I am glad that we have Health Inspectorate Wales there to expose these issues and concerns, as, without their findings, would we see the improvement we so desperately need? I doubt it.

It is clear that Labour's prioritising of the wrong things has left our health service vulnerable and lacking resilience. Increased moneys to health in this year's budget are welcome, but let's be clear: this will not suddenly undo the consequences of historical underfunding. Dirprwy Lywydd, the motion raises a series of incredibly important issues that we must agree to if we are to save our NHS and get it off its current trajectory. Thank you.

I call on the Minister for Health and Social Services, Eluned Morgan.

Llywydd, I want to start by welcoming Healthcare Inspectorate Wales's annual report, and thanking everyone in the organisation for the huge amount of inspection and assurance work they do every year. Of course, it will be disappointing to HIW that the budget will be reduced, but it was a political decision to focus funding on front-line services. I recognise absolutely the important role that HIW play in ensuring safety and quality for patients. I would suggest that Members read the report, because it states very clearly in the report, and I will read it out:

'We visited all Health Boards and Trusts where inpatient care is provided.'

So, they do get to all of the health boards and trusts. That is clearly stated, and you should read the report before throwing stones. Thank you.

It doesn't say that they visited every facility. You've just said it engages with every health board. That doesn't mean that it's visiting every building, does it?

It says:

'We visited all Health Boards and Trusts'—

Visited all health boards and trusts—not buildings.

—'where inpatient care is provided.'

I think that's—[Interruption.] I think that's clear enough, and I think people should accept what they have written in their report. Now, the report and its findings show the pressures and challenges that our NHS faces, and I would like to remind Members that the NHS undertakes 2 million contacts with the public in Wales every month, in a population of 3 million, and a vast majority of the public receive a very good service.

Now, these pressures and challenges are present in every part of the United Kingdom, all the year round. As we all know, the NHS has changed massively since it was set up 75 years ago. It's continually evolving to meet demand for its services and the changing nature of healthcare itself. Now, today, we live longer lives but we tend to have more complex healthcare needs. So, we have to accept, I think, that the era of the paternal health service is over. Today's NHS has to be a partnership between the service, the healthcare professional and the individual, each working together to improve outcomes.

We've also seen greater collaboration between health boards, local authorities and the independent sector to improve and enhance current service provision to ensure our NHS is fit for our future generations. That's why Healthcare Inspectorate Wales and the reports it produces are so important. They help us to understand where we should place our focus and where we need to work with HIW and the NHS to improve and to share best practice in the provision of healthcare.

Will the Minister take an intervention?

No, if you don't mind, I'll make some progress. I'm happy for you to come in a bit later. You can save all your interventions up and bring them all in a bit later.

Now, such a focused approach based on evidence from HIW and other sources, I think, is more essential than ever, due to the current extremely challenging economic and financial outlook. As you'll know, as a result of inflationary pressures, the Welsh budget in 2024-25 will be worth £1.3 billion less, in real terms, than when it was set in 2021. And you'll be aware that we have directed, in the Welsh Government, money from all other parts of the Government to shore up the NHS. All parts of the NHS across the UK are struggling financially.

I was disappointed, however, that there wasn't recognition in HIW's report of the considerable efforts that have been made to take pressure off. So, the 111 service, 70,000 patients a month diverted; the '111 press 2' service, 6,000 people making use of that call centre; 13 new urgent primary care centres, making sure that 20,000 patients a month are diverted from those emergency care centres; and 23 same-day emergency care centres, making sure that 5,000 people a month do not go through the front doors of emergency departments. So, all of that, had we not had that in place, would have meant additional pressure.

Llywydd, the work that HIW does, ultimately, helps to underpin the planning of future services in the NHS. I think it's probably worth just correcting a few points, that healthcare students, for example, in receipt of the NHS Wales bursary are not required to pay tuition fees, and they are entitled to a bursary for living costs if they are studying in Wales. And they have to commit, as a result of that, to working in Wales for two years after graduation.

I issued the NHS planning framework on 18 December, and this sets out the priorities, and there is a focus to help NHS organisations as they prepare their three-year plans. The planning framework is underpinned by the national programmes, which, in turn, have been developed in response to many of the issues identified in the HIW annual report, including accessibility, workforce, flow and discharge.

Now, I just want to take accessibility as an example. Patient feedback has shown an appreciation for a blended model of access to GPs, whether through telephone consultations, digital software, or face-to-face appointments. And whilst an appointment is ultimately down to the clinical judgment of a GP, it is important that we listen to patients and their request for a choice of method to consult with their GP. We also need to acknowledge that ongoing high demand for GP services can make it difficult to get an appointment. We know that 1.5 million people consistently access primary care services across Wales each month, but I think the noise around access to GP services and the 8.00 a.m. bottleneck has decreased significantly in volume since the new GP contract was introduced last April. And I think it was very interesting to note that the concerns that had been raised with HIW were up until March 2023, which was, of course, before that contract was pinned down. Data from the past year also shows that, on average, around 80,000 people don't attend their appointments each month, so we've been working to encourage people to help improve access to GPs by attending all appointments or cancelling appointments if they can no longer make them.

Another key area that has received attention from HIW is improving patient flow in hospitals, and we've developed a national initiative with an additional £25 million in funding. There is specific emphasis on starting to plan to discharge patients from the time when they are admitted to hospital and operating on a home-first basis now as part of the strategy in every health board. The work is supported by the new data that is now gathered on the length of stay and delays in care pathways. The health boards and the regional partnership boards are responsible for the action plans.

A third example is ensuring that mental health services are more accessible. More than 38,000 people have used the '111 press 2' service for urgent mental health support services, and we've also extended accessible support services such as online cognitive behavioural therapy, the Beat eating disorder helpline, and CALL 24/7 listening and advice services. We'll be publishing our new mental health strategy before long, and I know that Lynne Neagle, who's listening now, is busily working on that currently.

Now, I want to close by talking about the remit of HIW. Expanding the remit to include investigating complaints would not be a good use of resources at a time when we have to make the best use of the funding and capacity that we have. There is already a robust process to deal—[Interruption.]

She is well out of her time, so I was going to remind the Minister that she's due to finish.

Sorry. There is already a robust process for dealing with NHS Wales complaints—a process that has been set out in regulations. HIW's annual report does play a key part in terms of noting where improvements are needed. I will continue to work with my officials and the NHS to ensure that we do learn from the issues that are given attention in the annual report, and that we continue to collaborate to build an appropriate NHS for the future that is treasured by the people of Wales.

I call on Russell George to reply to the debate.

Can I thank Members who have taken part in our debate this afternoon? The HIW annual report highlighted some significant areas of concern, which were a part of the subject of our debate today and our motion. Most significantly, I thought, the report stated that HIW 'did not find evidence' of Welsh Government initiatives

'making a clear and significant difference to services at the front line.'

Well, that is a significant statement to make. Andrew R.T. Davies raised this with the First Minister in questions yesterday, and the First Minister's response to that, I thought, was dismissive. The First Minister suggested that Andrew had taken this somehow out of context. Well, it wasn't taken out of context; it was there, a quotation, directly cited, lifted from the report, and also front and centre of the report: it was in the chair's foreword, so a significant, key part of HIW's findings.

Further, I did feel as well that there was, perhaps, an insinuation from the First Minister and from Carolyn Thomas today that, somehow, a body that's there to investigate and monitor health services is somehow less of an important body. That is not the case at all, because HIW is a body that has a significant role to play in making sure that our health services are safe and patients receive good care. And what could be more important?

Now, also, of significant concern to us is the cut in funding to the body that has a vital role to play to keep patients safe. We, as Welsh Conservatives, don't simply put in our motion that we're unhappy that a body has had its funding cut for no reason at all; we do that, and we've debated this today with good reason, because we're also aware that a staggering 60 per cent of healthcare services have not been inspected in the last five years. Sixty per cent of services, healthcare services, not being inspected in the last five years. Janet Finch-Saunders, in her contribution, dug into that detail and set out exactly what sat underneath that heading.

Our motion today also asked for the expansion of HIW and to increase their remit to investigate complaints as well. Well, why is that the case? The situation at the moment is, when somebody has a concern or a complaint against a body, they have to go to the body first, to the body that they're making a complaint against, to investigate, and only then—only then—would they be able to go to the ombudsman—[Interruption.]

Russ, will you give way?

Yes, I will. Yes.

Do you agree with me, on that point—and I know the Minister was making some comments there—a lot of my constituents feel that, when they make complaints to health boards directly, it feels like the health board are marking their own homework, sometimes, and actually don't fully investigate the complaints properly that are actually put forward to the health boards?

This is the—. Did you want to make an intervention, Minister?

Am I allowed to make an intervention?

Yes. You are allowed to make interventions, Minister, if you wish to, and it's up to the Member whether to accept it or not.

I accept it.

So, within the report, within the HIW report, it's very clear that, actually, a lot of the work is all risk based, and some of it is based on what they hear from the public. There is a whistleblowing facility, where people can go directly to HIW, and that informs whether they go in. And if they get lots of complaints about one place, then they're more likely to go and inspect. So, I do suggest you read the HIW report before bringing it to—[Interruption.] Well, make sure you do, because you would know about the whistleblowing opportunities, if you'd read it.

Thank you for the two interventions, and I'll address the Minister's in a moment, but I agree with James Evans in terms of his comments. It's very difficult, isn't it, when you've got a patient with a concern who raises an issue with the very body that they've got the concern with. But that's what I'm suggesting: I'm suggesting that the public services ombudsman does not have the capacity to take patients' concerns seriously and investigate adequately. That's why I'm suggesting that HIW expands its remit in that regard, and I'll come on to the Minister's comments in a moment. But, to me, HIW do have the expertise, and they have the expertise to investigate individual complaints, I would suggest; they have that ability to do that, if they have that remit to do that and the funding to do that as well.

And this is where I'll take Altaf Hussain's comments, and bring in the Minister's intervention as well. Altaf Hussain mentioned, of course, the case of the Channon family, the Channon family who raised concerns with Swansea Bay University Health Board, after their own son was born with brain damage following complications during birth. The family were informed, of course, by the Welsh Government officials, that a review had taken place and that no concerns were identified, and then it emerged that no review had actually taken place at all. Well, the Channon family's case exemplifies exactly the consequences of what happens when NHS organisations abuse the trust that has been placed in them to investigate, address and resolve patients' complaints and concerns surrounding some of the services that they provide. And the HIW report, I think, vindicates what the Channon family were saying. And if whistleblowing is working so well, why didn't it work so well in the case of the Channon family? So, this is what I would suggest today, in my comments back to the Minister's comments about whistleblowing: I don't think we have an adequate whistleblowing policy, or a whistleblowing facility that adequately works to address the needs that we're referring to today.

We also, I would say, suggest as well—. There were quite a few comments as well from other Members—Carolyn Thomas and Mabon ap Gwynfor—in terms of funding, and I won't spend too much time on that, but our motion also addresses that today. We, as Welsh Conservatives, would of course spend the full allocation from central Government that's earmarked for health on health, and that is a political decision that's been made here, to divert that funding away into other areas. And I'm not—. I'm just looking at what else I wanted to say.

And the other comment I'd make in closing, Deputy Presiding Officer, is that there seems to be an element from what the Minister was saying today, and it touches on what the First Minister and Carolyn Thomas said yesterday, that it seems to be as if, somehow, HIW is separate and sits outside of the health service. But I would suggest—

It's independent. It's independent.

It's independent—that's not the point I was—[Interruption.] The Minister is saying, from her position, that it's independent, but the point that I was coming on to make, Minister, is that you shouldn't see the separation, with HIW sitting over here and the health service there; HIW is part of the health service in terms of it being integral, an important part of the health service.

Will you take an intervention?

Yes, I will.

I think one of the concerns about HIW's lack of independence is that, of course, elsewhere in the UK, inspectorates can place organisations into special measures without seeking permission from Ministers, which gives the opportunity for political interference. That isn't the case here in Wales. We've seen delays in organisations like the Betsi Cadwaladr health board being placed in and out, like the hokey cokey, of special measures at the whim of Ministers in an inappropriate way. That's the sort of political interference that we're fed up of, frankly, in north Wales. We want to see the independent inspectorate having the opportunity to sort that out. 

Thank you, Darren. Our motion is on the order paper today. I do hope that Members will support the motion on the order paper, because what we want to see is adequate resources for HIW put in place not only to make sure that they can adequately investigate and monitor health services effectively across Wales, but also to expand their remit to take on patients' concerns and complaints seriously, because at the end of the day we need to make sure that if there are problems—and there will be problems in the health service—when we do find those problems they are addressed and then we learn lessons from those problems as well. Diolch yn fawr iawn. 

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

Voting deferred until voting time.