8. Plaid Cymru Debate: NHS waiting lists

– in the Senedd at on 18 September 2024.

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(Translated)

The following amendments have been selected: amendment 1 in the name of Jane Hutt, and amendments 2, 3 and 4 in the name of Darren Millar. If amendment 1 is agreed, amendments 2 and 3 will be deselected.

Photo of Elin Jones Elin Jones Plaid Cymru 5:06, 18 September 2024

(Translated)

The next item will be the Plaid Cymru debate on NHS waiting lists. I call on Mabon ap Gwynfor to move the motion.

(Translated)

Motion NDM8652 Heledd Fychan

To propose that the Senedd:

1. Notes that the First Minister and her predecessors have prioritised cutting waiting lists in the NHS.

2. Regrets that:

a) the latest NHS performance statistics show that waiting lists in Wales are at a record high; and

b) the UK Labour Government's decision to embrace austerity policies, such as cutting back the winter fuel payment, are intensifying the pressure on the NHS.

3. Calls on the Welsh Government to urgently review its plan to reduce waiting lists and to honour the commitment made by past First Ministers and the current First Minister.

(Translated)

Motion moved.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:06, 18 September 2024

(Translated)

Thank you, Llywydd. It's interesting to note, isn't it, that there are six Members on the Labour benches who have held the health portfolio at some point over the past 25 years, including two former First Ministers and the current First Minister. It's one whirlwind of ministerial change, which includes the brightest, they say, from the Labour Party ranks, and has whirled wildly recently. But although we have seen different faces coming and going over the summer, it's the same old story when it comes to the health service: standards going down, waiting times getting longer, staff being pushed to the extreme, and from the Government, nothing but repeated empty promises. 

(Translated)

Joyce Watson took the Chair.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:07, 18 September 2024

For example, the First Minister's predecessor made the following announcement back in April:

'It's clear that the NHS, and reducing waiting times, is a top priority for the people of Wales, and the same is true for us as a Government.'

Similarly, upon taking office over the summer, the current First Minister pledged a refresh in office, with a relentless focus on addressing the backlog, and yet, since February of this year, NHS waiting lists have hit record highs for five consecutive months, which now account for almost 20 per cent of our entire population. A record-breaking Government for all the wrong reasons.

We all understand the scale of the challenges facing our health service: an ageing population, high rates of long-term sickness and the continued fall-out from the pandemic, to name but a few. They have been well rehearsed by several of the health Minister's predecessors, and I'm sure we'll hear more of the same in his response. But the Government would have far more sympathy from the Welsh public if it was not for their stubborn refusal to learn from their mistakes and for missing so many opportunities to show the necessary vision, dynamism and drive to chart a better future for our NHS.

This was on full display last week, as the First Minister asserted that cutting waiting lists could be achieved in lieu of structural reform. It typifies this Government's habit of placing the horse firmly before the cart, of fixating on the outcomes without actually plotting a credible path to get there. By suggesting that health board executives are at fault for high waiting lists, the First Minister has yet again demonstrated this Government's aptitude for apportioning blame to everyone but themselves.

It is for this reason that we have brought this motion before the Senedd today, to urge the new health Minister to finally break the cycle of failure and ducked responsibilities, by revising the Government's strategy for tackling NHS waiting lists, because anything less would represent a continuation of the tired policies and empty platitudes that have led us to this point.

Plaid Cymru is clear about the bold action required to put the NHS back on its feet. So, if this Government is serious about driving lasting improvements in our health system, it needs to listen up to what a refreshed approach truly looks like. It means investing properly in the preventative agenda to keep people out of hospital, rather than stripping away funding from public health programmes to prop up the false economy on which our overburdened front-line services currently teeter. It means working constructively with the royal colleges to tackle deep-rooted issues of staff retention, rather than castigating them as part of the problem, as the previous health Minister did in a recent committee hearing. It means harnessing technological innovations to bring care closer to home, rather than allowing hospital beds to be overloaded by patients who are fit enough to be discharged. It means developing a strategy to fix the foundations of the NHS estate through more ambitious use of the Senedd's borrowing powers, rather than letting our crumbling health infrastructure fall into further disrepair. And it means demanding a fair funding deal for Wales from Westminster, rather than timidly acquiescing to the outdated Barnett formula that falls well short of the needs of our population.

The people of Wales are crying out for this Government to show that it is capable of a change of direction from the current trajectory of chronic decline in our health system. Give them a reason to believe by supporting this motion.

Photo of Joyce Watson Joyce Watson Labour 5:11, 18 September 2024

The four amendments to the motion have been selected. If amendment 1 is agreed, amendments 2 and 3 will be deselected. I call on the Cabinet Secretary for Health and Social Care to move formally amendment 1, tabled in the name of Jane Hutt.

(Translated)

Amendment 1—Jane Hutt

Delete all and replace with:

To propose that the Senedd:

1) Notes:

a) the First Minister and her predecessors have prioritised cutting waiting lists in the NHS; and

b) the number of people waiting more than two years for treatment has fallen by 67% since the peak in March 2022.

(Translated)

Amendment 1 moved.

Photo of Joyce Watson Joyce Watson Labour

I now call on Sam Rowlands to move amendments 2, 3 and 4, tabled in the name of Darren Millar.

(Translated)

Amendment 2—Darren Millar

Delete point 2b) and replace with:

spending decisions such as cutting winter fuel payments to pensioners will lead to an adverse impact on the Welsh NHS;

(Translated)

Amendment 3—Darren Millar

Add as new new sub-point at end of point 2:

on three occasions, the Welsh Government cut the health budget in real terms: the only government in the United Kingdom to have ever done so;

(Translated)

Amendment 4—Darren Millar

Add new point at end of motion:

Calls on the Welsh Government to ensure the full Barnett consequential 20 per cent uplift for health is spent on the Welsh NHS.

(Translated)

Amendments 2, 3 and 4 moved.

Photo of Sam Rowlands Sam Rowlands Conservative 5:12, 18 September 2024

Well, diolch yn fawr iawn, acting Presiding Officer. I move the Welsh Conservative amendments in the name of Darren Millar.

It's incredible, isn't it? Wales has a new First Minister and apparently a new Cabinet in place, but we have the same old problems with the NHS waiting lists in Wales. And, of course, this new Cabinet's only been here a matter of weeks, but there's not a great deal of light at the end of the tunnel when we look at waiting lists at the moment. And I think there's a lot to say about Welsh Labour that they reward the person who's given us the longest NHS waiting lists on record by making that person the First Minister of Wales. But it's not just about the First Minister and her role in this place. As Mabon ap Gwynfor pointed out, there is a plethora of health Ministers sat amongst the Labour benches and 25 years of Labour mismanagement have led us to this point that we're at today: consistently missed targets and seemingly zero plan for fixing the state of the health service here in Wales.

We heard some lovely warm words from the First Minister yesterday, and I'm sure they were reassuring to us all in this place, but those are words we've heard repeated time and time again by a bevy of Ministers and Cabinet Secretaries who, seemingly, have only made the situation worse. And what I find saddest of all is that we've kind of got used to this being the way it is; this is just the way it is in Wales, we have long waiting lists and we have a health service that, unfortunately, isn't always there when we need it, and that makes me saddest of all. And that is not acceptable, that is not how the health service has to be or should be here in Wales.

Again, we've heard, as already outlined, a First Minister who seems happy to pass the buck onto NHS managers and chief executives of health boards, and clearly, they have a significant role to play—health boards have a big job to do to work through these waiting lists—but a First Minister and a Government must not abdicate its responsibility, first and foremost, in this place, elected by the people of Wales to see these services delivered well, and currently, they don't seem to be taking that responsibility. I do hope that we hear a different tone from the new Cabinet Secretary and I hope he'll be willing to take on that responsibility for the performance of our health service, rather than passing the blame elsewhere. Because we know that, as always, sadly, it's patients and hardworking staff who are left at the sharp end; they're the ones languishing in pain on waiting lists or working under serious pressure without the full support that they need. As our amendments point out in front of us here today, let’s not forget that the Welsh Government is the only Government in Great Britain to have ever cut the health budget. It’s this Welsh Government that refuses to spend the full 20 per cent Barnett consequential uplift that it has on health.

Talking of British Governments, of course, it seems like we should be in a land of flowing milk and honey with a new British Labour Government at the other end of the M4. This doesn’t seem apparent just yet. But it’s interesting, isn’t it? One of the first things that Keir Starmer instigated when he came in as Prime Minister was a review of the NHS in England, with the recently released Darzi report. Unfortunately, there is no sign of a similar report being instigated here in Wales, and that’s despite every major metric being worse in the Welsh health service than it is in England.

We have heard already about the number of people on a waiting list in Wales—at least one in five people. And we know that over 23,000 people in Wales are waiting on those waiting lists for more than two years. We on these benches would certainly have welcomed Lord Darzi casting an eye over the Welsh NHS and making a judgment on the failures of Labour’s last quarter of a century in charge. I would be interested to understand from the Cabinet Secretary whether this is something that he is seeking, as Sir Keir Starmer has sought for the NHS in England—an independent report by someone like Lord Darzi to outline where those failings have been taking place.

We have only just finished a debate in this place, to compound issues, on the impact of the winter fuel payments being slashed. That is going to provide no help whatsoever to the health of our older people here in Wales, and will certainly compound the issues when it comes to waiting lists. We know that, according to the Department for Work and Pensions, the equality analysis of this policy of slashing this means that 1.6 million disabled people across the UK will lose their payments—71 per cent of those who were entitled to it. That’s going to make a significant impact across the UK, but certainly here in Wales as well.

So, in terms of the motion here today laid by Plaid Cymru—and, of course, we are grateful to them for bringing this debate forward—we are happy to support their motion. But we are also seeking support for our amendments in this place today, so I call on all Members to support our amendments as well. Diolch yn fawr iawn.  

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 5:17, 18 September 2024

(Translated)

We saw last week—and we’ve heard reference to this already—Lord Darzi publishing his damning report on the health service in England, a report that set out clearly how long years of neglect and ignoring the fundamental problems—and let’s remember that that happened under both parties in Westminster—had led to a service and workforce in England that is on its knees. But what is concerning for us in Wales, of course, is the fact that so many of the key problems that Lord Darzi shed light on, such as clear signs of the failures of Labour and the Conservatives, one after the other, in dealing with the NHS in England, also shine a very bright light on the situation in our own health service too.

Yes, Keir Starmer is right to say that the situation in England is disastrous—11 per cent, more than 10 per cent, of the population of England on waiting lists. But in Wales, of course, the figure is 20 per cent. In England, there are major challenges in terms of cancer treatment, with 34 per cent failing to receive treatment within 62 days. But here, the figure is 43 per cent who don’t get that treatment in the same timescale. So, the health service in England is far from being a model of what we should be emulating here in Wales. There have been great problems in the service over the border, and that is as a result of underinvestment over a number of years. But there is a major difference in the attitude of Keir Starmer and Eluned Morgan. We haven’t heard from the new health Minister in Wales, but there is a major difference between what we hear in Keir Starmer’s words and those expressed by Eluned Morgan.

Keir Starmer, through commissioning this work and in responding in the way that he has to the work of Lord Darzi, is trying to put a focus on what can be done in the ensuing period to resolve some of the problems in England. Of course, there is a political motive in blaming previous Governments for those failings; one would be very naive not to recognise that. But I also hope that there is a sincere effort to try and get to the heart of these issues now. But whilst Keir Starmer can blame his Conservative predecessors, the truth of the matter is that Eluned Morgan can't blame anyone other than her predecessors and herself, as health Ministers in Wales. And if the truth is too difficult to stomach after 25 years in power, it does raise serious questions about the desire of this Government to improve the situation for patients. 

Members will remember that Plaid Cymru had called on the Welsh Government to call a health crisis here in Wales, and that was for a very good reason: in order to raise the level of gravity. And that was echoed by staff within the health service, and certainly by patients, but, again, there was no willingness from the Government at that point to recognise the gravity of the situation. If it's not an emergency, then how can the situation be described? And how can Labour describe a situation in England as a crisis when the situation in Wales in so many ways is so much worse? Ministers surely must see that change is necessary. In the heat of the electoral campaign, we had that incredible sight of the then health Minister—the now First Minister—holding a placard calling for the modernisation of our health service, and Labour Members here praising Keir Starmer's plans to transform the health service in England, whilst simultaneously insisting that everything is fine here in Wales, but that someone will actually carry out a miracle of modernisation—someone other than the Minister herself, apparently.

I'm going to close with a statistic that will be sobering for us all. Do you know how many people were waiting over a year for their first appointment in 2012? Three hundred and sixteen. The corresponding figure for Wales now is 74,000. Behind each of those statistics, there is an individual in pain, or someone who's concerned about the state of his or her health, or is concerned about the health of loved ones, or who sees their health deteriorating further whilst they wait. There is a real duty on Government for everyone waiting longer than the target times, and a responsibility on the new health Minister, quite simply, to work differently to his predecessors.

Photo of Jenny Rathbone Jenny Rathbone Labour 5:22, 18 September 2024

I'd like to welcome the new health Secretary to his post; I'm sure he'll do a great job. This is difficult work. I'm glad that we are having this debate. But the idea that we can simply get away with saying, 'Bold action is required', without saying what that bold action is, is really not advancing human knowledge. Of course, I completely agree with you, we need to have much more effort on the preventative agenda, but that's not going to resolve the current situation. That is a very long burn. That is going to be seen in a healthier nation in 10, 15, 20 years. And, obviously, it is a major challenge to try and ensure that there is more money going into the preventative agenda, but that has to then come from the secondary sector, which is what this motion is about. So, I don't quite understand what you're trying to say here. 

I think, Sam Rowlands, you are being unfair to Eluned Morgan. You are not giving her her due for the heavy lifting that she has done on this issue, whilst she was health Minister—turning up on unannounced visits in the emergency departments, turning up in the dedicated surgical units supposed to be doing the elective work on a production-line basis. And that is why, in the Labour motion, it acknowledges that the waiting lists have gone down by two thirds. That's very significant. But, obviously, that is no consolation to the individual who's waiting in discomfort for a bed to have an operation.

Photo of Sam Rowlands Sam Rowlands Conservative 5:24, 18 September 2024

Thank you, Jenny, for taking the intervention. I mentioned the First Minister in my contribution because, under her watch, we had the highest ever level of people on waiting lists in Wales. That, for me, is not success. If you define that as a success, we have very different measures of success.

Photo of Jenny Rathbone Jenny Rathbone Labour 5:25, 18 September 2024

Nobody’s saying we have arrived, but what we're saying is we have made progress.

This is a really, really difficult issue, for several reasons. As is demonstrated in Saving Lives in Cardiff, you cannot be admitted to hospital for an operation unless there is a bed for you to recuperate in. That simply wouldn't be ethical. And the Darzi report highlights that 13 per cent of people in English hospitals are there long after their secondary care has been completed, and the need for them to move back into the community. There's absolutely no reason to doubt that there isn't a similar figure happening in Welsh hospitals. I happen to know that there are several hundred people in the Heath hospital in Cardiff who don't medically need to be there, but it is extremely difficult to move them on, for ethical reasons. That's in a health board that has the lowest ambulance waiting times because of its whole-system approach to bed management. They are freeing up space on the wards in the hospital as soon as possible so that another patient can be admitted, either from the emergency department or from the waiting list.

The reason this is so difficult is because we don't have the community health and social care services that we need, and that is the challenge that we absolutely have to crack. But it is not something that we're going to be able to do easily. I recently had a meeting with the the person in charge of the community nursing service—something that I'm absolutely passionate about—that I visited in Cwm Taf just before the lockdown. I've seen just how amazing it is and how efficient it is, using the latest technology to allocate people according to the needs of the individual. But we have hugely expanded the number of community nursing teams, hugely—particularly in North Wales, you'll be interested to know—but it is not nearly enough, and we still have lots and lots of people who don't need to be in hospital, some of whom are admitted because the services don't exist in the community to prevent them having to come into hospital. This is something I am personally dealing with at the moment, and I can tell you just how complicated it is.

One of the reasons it's so complicated, and one that's going to be really difficult to resolve, is you have the health service, who are focusing on getting people out of hospital as soon as they no longer need to be there, and you have the local authority, who is having to assess every single individual case to work out whether they really need to be paying for the social care that that individual may need. This is really complicated stuff, because most of the people who are stuck in hospital are over 80, and even in a young population like Cardiff I can recall the previous chief executive saying the average age of people in hospital is 85. And that's in Cardiff; it would be more than that in other parts of Wales. So that is the dilemma we face. How we're going to do that without the extra money to double-run services, setting up new ones and having to maintain the existing ones, is really, really complicated, and anybody who thinks this is just easy and it's just a failure of will is for the birds.

Photo of Sioned Williams Sioned Williams Plaid Cymru 5:28, 18 September 2024

(Translated)

I’d like to speak specifically to the part of our motion that regrets the decision made by the Labour UK Government to continue to apply austerity policies, and the impact that this has on our national health service. Austerity is damaging to people’s health and poverty makes people ill. Read any number of studies on the long-term impact of the previous Conservative Government’s austerity policies and you're bound to come to the same conclusion. Austerity measures are directly responsible for exacerbating health inequalities that cost the NHS in Wales £322 million every year, and most damaging of all, for causing 190,000 additional deaths between 2010 and 2019.

One might expect that the priority of any party that is interested in rebuilding the foundations of our stricken health service, that believes in social justice, that takes pride in its socialist beliefs as the party of Aneurin Bevan, would be to ensure that this disastrous dogma is immediately consigned to the dustbin of history. But what we had all feared throughout the general election campaign has now come to pass, because it appears that Keir Starmer’s party is as enamoured of austerity policies as their Conservative predecessors. After all, one of their first actions on gaining power was to reconfirm their commitment to the two-child benefit cap and the cap on benefits, the main cause of high levels of child poverty in Wales, according to the former First Minister, Mark Drakeford, and harshly reprimanding those few voices brave enough to stand up against this betrayal of some of the most vulnerable in our society. 

Even George Osborne, the architect of austerity, hadn’t considered taking the winter fuel payment away from pensioners, and they're expected to live on almost half the level of the minimum income. It's a measure that will, as correctly assessed by the Cabinet Secretary for social justice, drive even more pensioners in Wales deeper into fuel poverty and, of course, will intensify the pressure on our health and care service. The fact that this decision was made without an impact assessment underlines that it's clear that austerity, far from being driven by an unwilling pragmatism, is the guiding principle of Keir Starmer’s agenda in Government. It's a political choice; this was true in Cameron, Clegg and Osborne’s day, and it's true now. 

Photo of Sioned Williams Sioned Williams Plaid Cymru 5:31, 18 September 2024

Given Keir Starmer's continued refusal to scrap the outdated Barnett formula and replace it with a funding arrangement that truly reflects the needs of our population—and the First Minister's refusal to speak up for the people of Wales when the Labour Prime Minister makes decisions that harm our citizens; she told us very clearly yesterday that wasn't her job, although Barnett reform commands cross-party support across this Senedd—it’s clear that Labour's choice in Westminster to pursue austerity will have dire implications for Wales and our ability to properly fund and fix our NHS.

Even if the meagre consequentials that will derive from Labour’s plans for the ring-fenced NHS services are passed on in full by the Welsh Government, they'll still be insufficient to meet the £1.5 billion of additional spending required from 2024-25 to 2027-28 to simply meet current demand. So, I'd like to hear from the Cabinet Secretary what he plans to do about that. Meanwhile, non-ring-fenced areas of the Welsh budget, which include social care, vital to getting waiting lists down, as you rightly pointed out, Jenny, are now facing a real-terms reduction of £683 million over the next five years. The First Minister shows no appetite to challenge her Labour counterpart in Westminster on austerity measures, which worsen health inequalities, which literally kill—no inclination to insulate Wales from the worst excesses of Westminster—we are tired of this—or to push, for example, for social care reform, which would result in crucial funding to do the same in Wales. Indeed, the much vaunted special relationship of two Labour Governments on both sides of the M4 simply seems to mean an entrenchment of the failing status quo for Wales of underinvestment in our vital health and social care services and an entrenchment of the health inequalities and ill health caused by austerity measures, which however Labour want to spin it, duck it or deny it, is a political choice.

Photo of Cefin Campbell Cefin Campbell Plaid Cymru 5:33, 18 September 2024

(Translated)

As we've heard very eloquently already from a number of speakers, all parts of Wales are suffering as a result of this Government's persistent inability to reduce waiting lists, which have now reached unsustainable levels. But unfortunately, it's our children and young people who are losing out and suffering the most. The latest statistics paint a very sorry picture in this respect. At present, there are 8,241 young people under the age of 18 who have been on a waiting list for over a year, and a further 1,278 who have been on a waiting list for over two years. The situation is particularly severe in Betsi Cadwaladr, where 62 per cent of people under the age of 18 are having to wait longer than two years. Sixty-two per cent—it's shameful.

A recent survey by the Royal College of Paediatrics and Child Health has corroborated the detrimental implications of these delays on this particular age group. The majority of paediatricians in Wales reported seeing children negatively impacted by longer waiting times for treatment, and that they felt frustrated that they don't have the appropriate level of capacity to meet demand. For far too many of our young people, what should be the happiest and healthiest period of their lives is being blighted by the debilitating uncertainty of prolonged waits for treatment.

And mental health, of course, is a particular area of concern. There can be no doubt that there are low levels of public confidence in our mental health services, and this is entirely unsurprising when we consider the extent to which young people are being let down in this area. And as we all know, young people experienced the largest average deterioration in their mental well-being as a result of the COVID pandemic, and yet waiting times for local primary mental health support services are disproportionately longer for Welsh children as compared to adults. Also, only 57 per cent of Welsh children and young people are able to start therapeutic interventions within 28 days following an assessment. Furthermore, the recent perinatal mental health project in Wales has found that 61 per cent of health professionals had not received any training on infant mental health. Consider that fact.

I'm sure that you will agree that ensuring effective and timely provision of healthcare early in life is instrumental to the preventative agenda. And truth be told, the future sustainability of the health service as a whole is entirely dependent on this agenda as we look to the future.

The unacceptably long waiting lists that we see for young people and children therefore demonstrate to us how unstable the foundations of this Government’s approach to early intervention are, and why a revision of this strategy for tackling waiting lists is so urgently needed, and it should be a matter of priority to safeguard the prospects of our future generations.

Photo of Joyce Watson Joyce Watson Labour 5:37, 18 September 2024

I call on the Cabinet Secretary for Health and Social Care, Jeremy Miles.

Photo of Jeremy Miles Jeremy Miles Labour 5:38, 18 September 2024

(Translated)

Thank you, acting Dirprwy Lywydd. I welcome the opportunity to reply to this debate in the name of Plaid Cymru on one of the most important issues for us and for the public, namely cutting waiting times. I look forward, after a week in post, to work with the health service to ensure that it continues to provide excellent and timely care for the people of Wales.

There are more staff than ever working in our health service. They are working hard every day, changing lives and saving lives, and that is done very often in very difficult circumstances. They are the beating heart of the health service. I was pleased to see the First Minister last week announcing a pay settlement that is above inflation for all 'Agenda for Change' staff, and for doctors and dentists. It shows how much we trust and appreciate the service of the staff and the value we place on those staff.

The majority of people seen by the health service will receive good-quality care in a timely manner. For the majority, that means primary care from their GP, a nurse, a pharmacist, physiotherapist, a dentist, or even an optician, perhaps. Some will need further treatment in hospital. At the moment, the average waiting time is 22 weeks for planned treatment. Unfortunately, many people wait longer than this, mainly as a result of the impact of the COVID-19 pandemic. So soon after a decade of austerity, it's cast a long shadow over our health service.

Although services have been restored, to a great extent, to pre-pandemic levels, we still have lengthy waiting times and an increasing waiting list, which reflects the general health of our population. Our work to reduce waiting times is having an impact. Long waits of over two years have reduced by 67 per cent since the high point in March 2022, and long waits for diagnostic tests have reduced by almost a third. Now, around 3 per cent of people on waiting lists are waiting longer than two years, compared with almost 10 per cent in March 2022, over two years ago. This has happened in difficult circumstances. New referrals for treatment have increased significantly. We are in the most difficult financial situation since the beginning of devolution, and we still see waves of COVID infection, and delayed transfers of care are at a very high level. These are very difficult circumstances for any health service, but the truth of the matter is that we must go further and more swiftly.

Photo of Jeremy Miles Jeremy Miles Labour 5:41, 18 September 2024

Over the summer, as part of the First Minister's listening exercise, the public told us clearly how much they value the NHS, but they were clear they wanted to see waiting times come down. We heard first-hand from them about a friend, about a family member, or about their own experience of waiting for a bed in a hospital, about having an operation cancelled at short notice, about trying to live a normal life while in pain. These stories are difficult to hear because this is not the level of care that we want from our NHS.

Our planned care recovery plan has driven the reduction in waiting lists to date. We've provided almost £900 million extra for the NHS this year and last. Some of this is being used to increase capacity, to reduce the backlog. But my view is that, whilst short-term measures are essential, they will not be enough on their own. In parallel, we need to change the way we deliver services to ensure we have a sustainable health service for the future. We will support the NHS to adapt to the pressures it faces. That means digital transformation, it means looking at the way out-patient departments work, it means continuing our programme of reforms to move care out of hospitals and into local communities, closer to people's homes.

While services have, as I said, returned to their pre-pandemic operating level, there is still too much variation across Wales in terms of productivity and performance. As part of our work to reduce waiting times, we are targeting that variation specifically, whether that's in theatre productivity, day-case activity, or procedure times, so that we can increase activity levels to those recommended by the royal colleges, which Members have referred to today. In May the national planned care programme set out objectives to improve productivity and efficiency, using best practice, technology and a move towards longer working days. This recognised that many of our pathways are overcomplicated, they are difficult for people to understand, and can result in multiple appointments in different hospitals. So, pathways will be streamlined to remove unnecessary steps and, wherever possible, the NHS will introduce a one-stop approach to reduce the number of appointments needed.

Tomorrow we will publish a new waiting times bulletin that provides data about how individual health boards are performing in a format that is accessible. It will help us identify good performance and where health boards need to do more to learn from those that are making the best progress. But we also need to maintain our focus on prevention, a principle that we've already heard referred to in the Darzi report, which has featured in this debate, in order to improve the underlying health of our country. The UK Government's ban on paid-for junk food advertising online and before the watershed is an important step in the work to tackle the obesity epidemic, and I look forward to the introduction of a strengthened UK tobacco and vapes Bill that will support our ambitions of a nicotine-and-smoke-free Wales.

More than 6,000 procedures were cancelled at the last minute last year, many because of ill health. Empowering and supporting people to make meaningful changes to their lifestyle, such as giving up smoking, losing weight and taking gentle exercise means they're often fitter and better prepared for the planned treatment and more likely to recover faster.

Llywydd, this is my first week in my new job as health Secretary, and cutting waiting times is at the top of my to-do list. This morning I met with NHS chairs. I attended a ministerial cancer summit, experiencing the commitment of our clinical teams to improving cancer outcomes specifically. They were both an opportunity for me to set out our priorities as a Government, to ensure faster access to care and treatment. I want to build upon the good work that is already under way. I will highlight good practice, but be clear in my expectation that all parts of the system must learn from those parts making the best progress. And I will work with my colleagues across the Government and across the NHS to achieve that.

Photo of Joyce Watson Joyce Watson Labour 5:45, 18 September 2024

I call on Mabon ap Gwynfor to reply to the debate.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

(Translated)

Well, thank you very much, Llywydd dros dro, and thank you to everyone who has responded in this debate. I want to begin my closing comments by welcoming the new Cabinet Secretary for health to his post, and wishing him the very best. I'm looking forward to working with him in that role. But I'm afraid to say that the response we've received today wasn't a shock but it was also disappointing, because we haven't seen any kind of vision being set out.

(Translated)

The Llywydd took the Chair.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:46, 18 September 2024

(Translated)

If I refer to some of the comments that the Cabinet Secretary made before I continue, you started your contribution by saying that one of the good things that the NHS does is providing timely care, but that's the exact point: it isn't providing timely care to hundreds of thousands—over 0.5 million—of people in Wales who are on waiting lists for months and years. That's the exact point that we're making in the motion in front of us. You also spoke about the important steps that have been taken over the summer, namely that there has been a decision made on a pay award for workers in the health sector. But, of course, that has been entirely dependent on Westminster. Now, if you agreed with this motion, with Plaid Cymru, and were to demand a change to the funding system in Wales, and a change to Barnett, then you wouldn't have had to wait until the summer for this pay award. You would have been able to do it much sooner. But, for some reason, you wait for Westminster to take action.

You mentioned that Wales has been suffering under the long shadow of austerity over the past few years, and that's entirely correct. Fourteen years of austerity have had a detrimental impact on our ability to provide quality health services in Wales. But, unfortunately, your Government in London, under Keir Starmer and Rachel Reeves, are continuing with that austerity policy, and Sioned made it clear, so that everyone understands, it is clear to everyone, that austerity policies that have been implemented, and will continue under the Labour Government, will be harmful to the health of people and will make those waiting lists longer. And once again, you mentioned the difficult financial situation that Wales finds itself in, but once again you're refusing to stand up to your masters in London and demand a fair settlement for Wales.

And finally, you mentioned at the end the importance of the preventive element, and we all, of course, agree that that is what the priority should be, but it's this Government, your Government, that has cut preventive programmes within the health service and local government, which leads to this crisis. So, you can't have it both ways. Of course, it's no surprise to hear what the Cabinet Secretary has said, trying to paint a picture that our waiting lists are being cut in some elements, and trying to paint some picture that all is rosy. That's what we get from this Government, time and time again. Rather than taking responsibility, this Government points the finger towards everyone else and blames other people. We've heard the First Minister blaming managers in the health service, we've heard Ministers in this Government blaming the people of Wales, blaming the people of Wales for having the wrong diet, blaming the people of Wales for being obese, for not looking after themselves, blaming the people of Wales for attending A&E for different reasons, rather than taking responsibility for your own failings.

I'm not sure, from hearing the Cabinet Secretary or the previous Cabinet Secretaries, whether you understand truly the impact of these waiting lists. If I give you one example—a neighbour of mine who is a constituent—he was a patient waiting for a knee replacement. He was on the waiting list for two years. Because of that, he was putting weight on. He couldn't walk, he was putting weight on, he became obese, which meant that he had to go and see his doctor more often. Because he couldn't walk, because he was becoming obese, his mental health was impacted detrimentally, too, which meant that he had to again go into the health service. One patient having to turn to the health service several times because you had failed to ensure that he received timely treatment. 

You said in your contribution, Cabinet Secretary, that—I quote—

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:50, 18 September 2024

'we need to change the way we deliver services'.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

(Translated)

Yes, you're doing that. The result for that patient, my neighbour, was that he had to go privately to access a service for a knee replacement. And that's the legacy of 25 years of Labour Government, that we're seeing privatisation in our health service—a two-tier health service; one for those people who can afford it and another tier for those people who can't. That's the Labour record in Wales. That's why we need to tackle these waiting lists. We need to see a programme being set out by you, a clear programme that does demonstrate the steps in terms of how you will tackle these waiting lists. That's why we've put forward this motion, and I hope and we ask everyone to support it. Thank you very much. 

Photo of Elin Jones Elin Jones Plaid Cymru 5:51, 18 September 2024

(Translated)

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections. We will therefore defer voting. 

(Translated)

Voting deferred until voting time.