Questions now from the party spokespeople. The Conservatives' spokesperson, Sam Rowlands.

Diolch, Llywydd. Cabinet Secretary, this is my first opportunity to question you in my new role as shadow health spokesperson and I'm certainly looking forward to our exchanges in this Chamber. I'm looking forward to working constructively with you on areas and on issues where I can, but also looking to hold you to account, and the Welsh Government to account, on areas that need improving.

One such area that I want to start on here today is around accident and emergency. Only yesterday, Cardiff and Vale University Health Board issued an urgent warning regarding the emergency unit at University Hospital Wales—the largest hospital in Wales—and that was on the same day, yesterday, that, in this place, we had four hours allocated for us to debate putting 36 more politicians in this Chamber at the cost of tens of millions of pounds. So, do you think you have the right priorities?

Well, thanks very much. First of all, can I welcome Sam to your new role as Conservative spokesperson? And before we get into a discussion, I just want to pay tribute also to Russell George, with whom I worked over a number of years. I just want to pay tribute to him on the way you carried out that role, Russell, and thank you for the kind of relationship that we were able to—. You held me to account; you kept me on my toes, but we were able to make sure that we did continue a dialogue. I know that my task is challenging, but I have a small army to support me, and I don't underestimate the kind of work that opposition spokespersons, including Plaid Cymru, have to do without the kind of support that I can rely on. So, thank you also for taking on what is a difficult task.

Just in relation to accident and emergency, I think probably one of the things to point out is that performance in major emergency departments, of course, is challenged at the moment. We have real issues in relation to delayed transfers of care—that is always part of the reason why there are hold-ups—but it's probably worth also noting that performance in emergency departments was better in Wales than in England in eight out of the last 12 months against the four-hour target.

Thank you for your response, Cabinet Secretary, and thank you also for acknowledging some of the challenges that do exist in our accident and emergency rooms at the moment. But this goes back to having the right priorities and having a Government that is focused on dealing with the areas of concern that the people of Wales have.

And one such person wrote to me just last week, a member of the public, who, sadly, has terminal cancer, who wanted to express his experiences at a north Wales hospital, where they attended A&E with a letter from his GP to secure a bed on a ward to counter an ailment, but the hospital refused this and put him in the A&E waiting room, where they waited for 11 hours. By midnight, they were told they were better to go home. So, they came back in the next day and had a very similar experience, with people waiting more than 12 hours. Sadly, this isn't a one-off occasion, and there are far too many people having these experiences in our A&E waiting rooms. So, I wonder, for the sake of our doctors and nurses, who are having to work through this, and certainly for the patients, who are having to experience these conditions, could you outline what plan you have to tackle these excessive A&E waits?

Thanks very much. We've actually got a whole strategy around this. It's called the six goals programme. It's a very comprehensive programme, and it's made a huge difference already. So, I know it may not feel like that, but if you think about things like the 111 system, which meant that 90,000 people were diverted from potentially going to A&E in just one month, in February, that gives you a kind of idea of new initiatives that have been introduced. We also have urgent primary care centres that have been introduced; we have same-day emergency care centres that have also been introduced.

And of course, if you're talking about priorities, I've made it very clear that one of my key priorities is to get the waiting lists down. I spend a huge amount of work really trying to delve into the detail of where the problems are. I've spoken to Besti just this morning about some of the really difficult issues that they're confronting in particular areas. Of course, part of the problem is these delayed transfers of care. We work very closely with local government to see if we can work together on that, because it is a joint responsibility. But there are too many people in our hospitals who are ready for discharge but who can't be discharged, and that's a challenge for us, but it's also a challenge for local government. And certainly, working hand in hand with councils is absolutely critical, and that's what we do, certainly through the winter months, on a fortnightly basis.

I thank you, Cabinet Secretary, again for outlining the challenges there are at the backdoor of the hospital, as it were, in terms of those discharges. I'm certainly willing to work with you to see what approaches can be put together to see that improve. Because we all want to see a better A&E system here in Wales and those waiting lists and waiting times reduced.

But you referred to your plan, and there clearly has to be robust monitoring and oversight of the plan and the implementation of that plan. Our leader of the Conservatives here, Andrew R.T. Davies, recently submitted a question to you, asking what are the three leading causes of accident and emergency attendance in Wales this calendar year. Certainly, knowing those causes allows you to understand the robustness of the plan that you described having in place. But your answer, sadly, Cabinet Secretary, was that you do not hold this information. So, I just wonder if you can be confident in the robustness of your plan to deal with A&E waits when you don't hold what I see as pretty basic information about what are the leading causes of people attending accident and emergency waiting rooms.

Well, of course, I would expect the health boards themselves to be holding that information. But what we do have now is the NHS Wales Executive, which is really honing in on some of that detail. And the six goals programme that I referred to is an example of where there is a national approach, where there's an expectation of delivery on the local level. We've put £25 million into that, and it is making a significant difference.

So, obviously, one of the things that we've been involved with also is trying to roll out things like Professor Shepherd's programme of identifying violent behaviour, for example—where that's happening, how do we work with police and other authorities to identify where the problems are coming into emergency departments. It's not all violence; some of it is elderly people falling and tripping. It was very interesting last week to attend a conference that looks at the fracture liaison service. What do we do to intervene to stop people before they break a leg or they break a bone? There's a huge amount of evidence-based work that is going into that. We've put £1 million into that, to try and avoid people from going into hospital. So, it's all trying to push things into the prevention space, which is quite difficult when you've got the heat of the moment in ED really upon you, and those waiting lists. 

Plaid Cymru spokesperson, Sioned Williams. 

Thank you, Llywydd. Welcome to your new role, Minister. I'd like to raise with you the great concern that exists about the number of day centres closing across Wales. These centres have been more than just buildings for so many people who need support in the community. They have been at the heart of people's lives, offering a vital community contact point, offering activities, company, and a chance to laugh, and helping to ease the pressure on unpaid carers. Age Cymru has found that a number of local authorities have not reopened centres since the pandemic, even though the delays in accessing social care services has meant that the centres are needed more than ever. Restrictions on local authority budgets mean that they are cutting day services, with at least one local authority in Wales suggesting it will close all centres, and another saying that it will almost halve the budget for providing carers with respite.

As a result of this, do you agree that we need more of a focus, and not less of a focus, on early intervention and preventative work and support in the community, of which day services are a central part? And what data are being collected by the Government to ensure that those who need support in the community do receive it, in view of the closure of day centres?

Well, can I thank Sioned Williams for that question? And I very much look forward to working with you in your portfolio. I think I'm covering some aspects of it with Mabon as well, so I look forward very much to working with Mabon, because, I think, across my portfolio there are issues that are of common concern to all of us, and I hope we can work collaboratively together, not just with Plaid Cymru, but also with the Conservatives. We have many programme for government commitments and co-operation agreement commitments across the portfolio, particularly in relation to improved outcomes for children, which I know is a particular interest of yours, so I'm very much looking forward to that. 

But the points that you make are obviously very important. The operation of day centres, of course, is a matter for local authorities, and we know, absolutely, that local authorities' finances have been under tremendous pressure, despite the fact that we have tried to prioritise their funding, along with funding for the NHS, within the budget constraints that we have. All of local authorities' budgets, as you know, are within the rates support grant, so they're not ring-fenced for any particular service. So, it is a matter for the local authority themselves—they're unhypothecated—whether they choose to prioritise social care and so on. 

But I can be very clear that both the Cabinet Secretary for health and I have an absolute priority around the issue of delayed transfers of care, and I think that ties in very much with your question. You will have seen, for instance, over the weekend, last week, in the area that I represent—the Cwm Taf health area—Cwm Taf health board made it very clear to Rhondda Cynon Taf local authority that there were some 300 people in hospitals in the Cwm Taf area—that's the equivalent of a single general hospital—occupying beds who shouldn't have been there. And we know that that is an issue that has been going on for far too long. I met with the Welsh Local Government Association well-being and social care leads just last week, and talked about the need for us to press forward on this agenda of reducing the waits for people that are no longer required to be in hospital to come out. And day-care centres and social care provision are absolutely key to that. 

So, all I can say to you is that I am having those conversations with local authorities. It is very much a priority that both the Cabinet Secretary for health and I have in terms of moving forward on the pathways for care, and we are continuing to have as constructive a dialogue as we can with local authorities about how, within the constraints of their budgets, and the constraints of our budget, we can both meet those joint objectives.

Thank you very much. Yes, the point is that those day centres do play such an important role in that preventative work to prevent people from having to access health and care services in the first place, and ameliorate that pressure. A number of people have asked Age Cymru for support due to the fact that they have not been informed in advance that they would have to pay for social care. They have also cited cases where elderly people have had to pay significantly more than what the legislation allows for. And, in their annual engagement survey, 34 per cent said that they find it difficult or extremely difficult to understand the payment arrangements for care. Given that the payment system has been in place for some time, what work is being done to ensure that the process is clear and fair? And, of course, the Government is currently consulting on amending the regulations and the code of practice that govern what local authorities can charge, and, specifically, on raising the weekly maximum to £120. This is something that the Government promised not to do, of course. 

Now that you have this portfolio, do you believe, Cabinet Secretary, that it is fair to ask carers and older people, and disabled people, those who feel the greatest financial and emotional pressure in our society, to pay more for their care, considering that this, in its entirety, is not a huge amount of money for the Government to find?

I thank you for that further question, which I think, again, is very important when we're looking at the whole way in which social care is currently delivered. Again, in co-operation with Plaid Cymru, we are moving towards a national care service in due course. It's a 10-year programme, and it may take us some time to get there. But we have a shared objective around that and in making sure that that provision is available for the very people that you've just been talking about. I would want to be very sure that people do understand very clearly what they have to pay for and what they don't have to pay for. And, if I can find that that is not happening, I would certainly want to have that conversation with officials to make sure that local authorities are producing very, very clear and understandable guidance. I know, from my own experience—

[Inaudible.]

—yes, absolutely, absolutely. I absolutely know, Sioned, from my own experience, when my father was going through the system before he died. And this is somebody like me, who probably does have an idea of how the system works. And I really struggled to try to get to speak to the right people, at the right time, with the right information, being passed from pillar to post, and that is extremely stressful for individuals and their families. So, we do need to make the system more transparent. We need to ensure that absolutely—you're right—that the staff themselves have all the information that they need, and, if that is not happening, I would want to make sure that it is, that it becomes clearer and is a simpler and more unified process for people to navigate.

On the consultation around domiciliary care in particular, that hasn't closed yet; that's going on through until May. This is something very much that local authorities have been asking for. I tend to agree with your analysis that what is being suggested, in terms of the lifting of the cap, is not a huge amount of money, but it is something that local authorities are saying that they need. But there is very robust process within that, which does ensure that people that can't afford to pay more than the current maximum level shouldn't pay. Now, I would want to ensure that, absolutely, that stays, and if that means that we have to review those rules to make sure that nobody falls through the gaps, then I'm absolutely clear that we should do that, because nobody should be denied care because they can't afford it.