Item 6 is next, a statement by the Cabinet Secretary for Health and Social Care on winter preparedness in the NHS. I call on the Cabinet Secretary to make the statement. Jeremy Miles.

Thank you, Llywydd, and I welcome this opportunity to update the Senedd about how the national health service and social care services are preparing for winter and the particular pressures we traditionally see at this time of year.

Planning for winter is a year-round task. Early on in the spring, health and care services start to learn lessons from the season just past. And planning to mitigate the risks of the coming winter then becomes an ongoing process, and this is part of the annual planning process undertaken by organisations. I want to take this opportunity to acknowledge and thank all of the staff who work in our national health service and across social care. They work very hard all year round, often under difficult circumstances, to look after us when we are at our most vulnerable.

We are anticipating that this winter will be another challenging one for a number of reasons. Even though we have been able to increase funding by more than 4 per cent for front-line NHS services this year, the wider financial climate remains challenging, especially for local government. NHS and care services have seen unlrelenting demands for services throughout the year, and there are high levels of delayed discharges in our hospitals, which add to the pressures. And we know that the seasonal mix of respiratory viruses, which includes COVID, will place services under significant strain.

NHS organisations, local authorities and their partners have been working through regional partnership boards, pan-cluster planning groups and clusters to identify joint actions for the 2024-25 winter season. This helps to ensure that the right level of capacity is available to meet predicted changes in demand. To help organisations develop these plans, we have today published modelling scenarios for winter. These highlight the potential impact of flu, RSV, COVID and other viruses. The Welsh Government has also issued a winter respiratory framework, which will support services to prepare for winter. This summarises the surveillance and monotiring arrangments for respiratory viruses and how we expect services to respond. It sets out guidance that will help services to protect the most vulnerable in our society from serious illness.

In light of the additional challenges we know that services will face over winter, I have asked organisations to focus on a number of key areas. Firstly, vaccination. Our children's flu programme is already under way, of course, and the COVID-19 and adult flu programmes will begin on 1 October.  In the years since the pandemic, we have seen a decline in the number of eligible people coming forward for these vaccinations. The pandemic phase may be over but, unfortunately, we haven't seen the back of COVID yet. It continues to cause waves of infections that can cause serious illnesses for some. I would encourage everyone who is eligible to take up the offer of vaccination, to help protect themselves this winter. I would also encourage pregnant women to take up the offer of an RSV vaccine. This is available for the first time and will help to protect newborn babies against this virus, which can lead to serious complications for babies, especially during the winter. 

The second key area is building capacity in primary and community care. GP practices receive extremely high numbers of calls every month. In a typical month, there are 2.3 million calls to practices across Wales, resulting in 1.6 million appointments. This is a phenomenal amount of activity for a population of just over 3 million people. To help support GP practices and manage these demands, we continue to build capacity and increase capability in other local services. This winter, people will be able to get free advice and treatment for 27 common illnesses from their local pharmacy. Pharmacies also offer a wide range of over-the-counter remedies, and more than one in four pharmacies are now able to prescribe treatments for conditions such as ear infections or skin infections.

I have been clear with health boards and local authorities about the need to work together to ensure that people can leave hospital as soon as they are clinically fit to do so. We have too many people in hospital at the moment who are ready to leave, but their discharge has been delayed. Unfortunately, delayed discharges can create poorer outcomes for people kept in hospital longer than they need to be, knock-on delays at the front door of hospitals and inside emergency departments, and ambulances queuing outside.

My third aim for winter is for NHS Wales to continue to deliver safe services, supported by effective urgent care services, to help manage more people in the community; a new focus on community response to people who have fallen and do not need ambulance or hospital care; and safe and effective front-door services, with rapid assessment and provision of same-day emergency care, to help conserve essential bed capacity. Health boards were given an extra £2.7 million at the start of the year to help them plan and deliver these priorities.

Finally, effective infection prevention and control is key to patient safety and a fundamental component of high-quality care. As we move into the winter, we must do all we can to reduce the burden of infection. Healthcare-associated infections can reduce available bed capacity, increase the length of hospital stays, delay recovery and compromise patient flow through the system. The incidence of some infections remains stubbornly high. Clostridium difficile rates are a particular concern. To address this, we have recently issued a Welsh health circular that sets out our clear expectations and improvement goals that health boards must work to. Refreshed NHS escalation guidance will be published shortly to support organisations to determine the appropriate clinical response and the actions necessary to protect core services during times of intense pressure. It will enable more proactive decision making by health boards and NHS trusts, as well as targeted support for poorer performing organisations, when required.

Llywydd, the winter, as we know, is always the most difficult time of year for the NHS and social care. The Welsh Government, supported by the NHS executive, will continue to closely monitor the performance of health and care services. I will provide a further update about winter pressures and resilience early in the new year.

Thank you for the statement, Cabinet Secretary. It was remiss of me last week not to mention this: I'd like to start by welcoming you to your new role, and I certainly wish you well in this. I think it's probably the most significant role within the Welsh Government, because we all know that the NHS and the health service broadly face huge challenges, and I certainly look forward to working with you, as you take on this role. I'd also like to join you in recognising the hard work of our NHS staff, and social care staff, especially during the increased pressures caused by winter, as you outlined in your statement.

We know those pressures that face the NHS every winter aren't new and they are predictable. Indeed, I noted the then Welsh Assembly Health, Social Care and Sport Committee conducted an inquiry into winter preparedness back in 2016. I'm at risk of sounding like Mark Isherwood here, referencing dates from a few years ago. But reading through that shows how little the challenges have changed, and the same calls for improvements seem to have been made every year since. The most important point that was made in that report in 2016 still holds to this day—and it's exactly as you mentioned, Cabinet Secretary—that pressures facing the Welsh NHS are year-round pressures. A health service that struggles in the spring and summer is clearly going to be at absolute breaking point in the winter. There's that broader issue of support that our health service needs all year around, as well as, of course, at the acute time of winter. And with people languishing on record NHS waiting lists, it's clear the health service here is not firing on all cylinders, heading into what's going to be a difficult time ahead.

One of the things that would help NHS resilience, not just in the winter but throughout the year, as you mentioned, is people being in better health in the first place. Unfortunately, we've seen over 100 GP surgeries close in Wales since 2012, which has greatly damaged primary and preventative care. So, I'd like to know, with a view to future years, how you're planning to bolster primary and preventative health. You mentioned some of the support you're putting in place already, which is welcome. But I'd like to know, not just for this winter, but for future winters as well, for the long term, how that primary health service is going to be bolstered so we don't continue to see, as we've seen so far, over 100 GP surgeries close across Wales, because for people in rural areas, access to GP surgeries is so important.

I welcome the emphasis on vaccinations in your statement, Cabinet Secretary, and I should perhaps declare an interest—my children have already welcomed the flu programme. I'm not sure how much they welcomed it personally, but I certainly welcomed it on their behalf. It is really important for people in those target groups to take up the offer of those vaccinations to keep themselves and wider communities safe, particularly, as you mentioned, those pregnant women being offered the RSV vaccine. I'll join you in encouraging people to take up those vaccinations that are available to them. I see that the COVID-19 vaccination is being offered from next month, anticipating a further wave of coronavirus. This certainly poses challenges, but I'd like to know specifically, Cabinet Secretary, what's being done to support people who are currently suffering from long COVID, as the winter will be a time when those conditions are exacerbated. I appreciate there is still work to be done to completely understand long COVID and some of the issues surrounding that, but we do know many people in Wales, sadly, are suffering from the ill effects of COVID now from years ago.

And finally, Llywydd, bed space is a problem that is particularly acute at wintertime, as acknowledged in your statement as well, so I want to know what plans there are to deal with any spike in demand, and what support is given to health boards to increase bed space this winter and into the future as well. The guidance rightly calls for safe and timely discharge from hospital, which you mentioned in your statement, but there are various pitfalls that mean that that fast, swift discharge from hospital doesn't happen as much as it should do. So I'm interested in what sort of innovations you're seeking to undertake so that people can get out of hospital as quickly and smoothly as possible at the appropriate time. Diolch yn fawr iawn.

Thank you to Sam Rowlands for his welcome and for the constructive tone in which he has put those important questions. He's obviously right to say that the resilience and efficacy of primary healthcare is essential at all points in the year, but, in the way that his question was indicating, is under increasing pressure at this time of year. I mentioned in my statement just the volume of contact that GP surgeries have on any given month, which is actually extraordinary compared to the population of Wales overall.

The negotiations that we have for the general medical services contract provide an ongoing opportunity for us to be able to refine the support that general practice is able to provide. Developments such as the pay award, which we've been able to announce in the last few weeks, will increase the resilience and attractiveness of practice for clinicians, but at the heart of the longer term resilience of the model is the diversification of the ways in which primary healthcare support can be accessed by the public, and I touched on a number of those in my statement. Pharmacies are one of them, but there are a range of others as well. We've provided additional funding to increase the capacity of allied health professionals in the workforce so that we can make sure that the right blend of primary care practitioners are available to the public, and that multiprofessional service in the community I think is an absolutely critical part of that.

It's a challenge to deliver that, because people's expectations are slow to change, and perhaps that's understandable. But I do think that is a critical part, and actually that ties in with the second question that Sam Rowlands asked, about the support available for those who are suffering from long COVID. The Adferiad programme that the former health Minister, currently the First Minister, was able to announce additional funding for last year continues to, I think, perform well, and I think our understanding of a patient's experience of those services is that it is a positive experience. Those services are delivered in the community in the way that that set of primary care interventions is best delivered, if it's at all possible, and it's recurrent funding, which is obviously important in terms of the feasibility and sustainability of those services.

He made a point, I think, finally, in relation to the availability of beds. In a sense, you could argue that a key focus of the planned care recovery programme is enabling us to make sure that bed capacity is used in the most effective way for the best possible purposes. So, a number of the reforms across the system about looking at day surgery will free up the use of beds, but also the work that we are doing to encourage collaboration between the health service and local government obviously is critical with that purpose in mind.

So, there's a huge amount of effort in the system to make sure that bed capacity is available, but we have invested an additional £11 million in community capacity that creates what we refer to often as virtual wards, which enables patients to have that care out of a hospital setting. And we've provided additional funding as well to each of the health boards to enhance same-day emergency care capacity, again with the intention of freeing-up beds over what will be a difficult season. 

I thank the Cabinet Secretary for his statement this afternoon. You mentioned during your reply and during your opening remarks the numbers who are visiting surgeries, and you said that they are disproportionate—these millions of people who are going every month as compared to the size of the population. But, of course, the reason for that is your failure to tackle waiting lists. The reason that people go back time and time again to see GPs is because they can't get treatment done. So, until you tackle waiting lists, then that will be the situation.

I have to say that the documents published by the Government for modelling for the winter are very interesting indeed, and I want to quote parts of the modelling document for last winter for the Cabinet Secretary.

Last year's winter modelling references the cost-of-living crisis, and it states:

'In 2020-2021 figures for Excess Winter Deaths in England and Wales from the ONS report an estimated 13,400 more deaths occurred in the winter period (December 2021 to March 2022) compared with the average non-winter periods. Fuel poverty charity National Energy Action reports, based on modelling from the World Health Organisation, cold homes cause 4,020 excess winter deaths last year in England and Wales.'

So, around a third of the excess winter deaths can be attributed to cold homes. It goes on to say:

'A Local Government Briefing paper published in 2019 stated the NHS spends at least £2.5 billion a year treating people with illnesses directly linked to living in cold, damp and dangerous conditions. Over 25,000 people die each year in the UK as a result of living in cold temperatures, such as a living in poorly heated homes. The most common aliments seen for poorly heated homes are circulatory diseases, respiratory problems and mental ill-health. Other conditions which are influenced or exacerbated by cold housing include the common flu and cold, as well as arthritis and rheumatisms. These would most likely lead to increased GP appointments, A&E visits, potential hospital inpatient stays and the need for (further) social service support.'

Of course, I don't need to re-read this to the Labour Cabinet Secretary for health—it's his Government's document—and he clearly knows this already. 

Now, in your introduction, you said that you expected a challenging winter for a number of reasons. Well, I'll add one more reason to the host of others, and that's the winter fuel payments that your Government is cutting in London. So, what modelling has the Welsh Government carried out on the likely impact of the UK Labour Government's cuts to the winter fuel payments on our health service, and can the Cabinet Secretary tell us what extra support he will be providing the NHS this winter in anticipation of greater demands on our health service as a consequence of the UK Labour Government's callous cutting of the winter fuel payments? 

Finally, if I can mention one thing that you referred to in your contribution—you mentioned that your intention was to try and get services closer to patients' homes, but this week we heard that Hywel Dda is considering the closure of the minor injuries unit in Prince Philip Hospital overnight and to close beds at Tregaron Hospital, as well as perhaps looking a paediatric beds in Ysbyty Bronglais. Now, if you lived in the Llanelli area, it would be far easier for you to go to the minor injuries unit in Prince Philip rather than having to travel further, but, of course, that option won't be available to them. So, your rhetoric is entirely contrary to what the health boards are actually delivering. What steps are you going to take in order to ensure that these community services remain within our communities over this winter, to serve the people of those areas?

I thank the Member for those questions. In terms of access to GPs, I think it's an oversimplification to use the example that the Member gave. There are a number of reasons behind the intention that we have as Government to move towards a preventative system that gets to the root of the pressure on GP services, and that's challenging to deliver in a context where there is an increase in demand and pressure on resources, as we are currently seeing. But that is the right objective for us to work towards.

I refer back to the debate in this Siambr last week, when my colleague the Trefnydd mentioned the range of steps that the Welsh Government is taking to support those who are in the most pressured situation over the winter months. The cold, and the challenges related to the cold, is an element that is of concern to all of us. Jane Hutt outlined in a very fulsome manner the support that the Welsh Government is providing specifically in that regard.

In terms of the question that the Member asked about the steps that Hywel Dda health board intend to discuss in their meeting this week, it's not appropriate for me to make a specific comment on those discussions; I'll have an opportunity to have a conversation. We have regular meetings with every health board, and I will have an opportunity to have a conversation with that health board on Wednesday of this week. So, there will be an opportunity to have that conversation. But it's right to say, as I said in my statement, that services in the community are specifically important at this time of year, to ensure that we can ensure less pressure on those services that are under those seasonal pressures, as well as those year-long pressures.

I'm grateful to you for your statement, Minister. It's very reassuring that the Welsh Government has been working so hard to ensure that the national health service and all of our services have this preparedness for winter. But I feel that there is a great fear amongst people, as this winter approaches, particularly amongst older people, and we know that the front line of the NHS is the surgery and the pharmacy, the primary services serving communities up and down Wales. Whilst I recognise the work that's been done within the secondary sector, and to ensure that we have all the structures in place to ensure that we have the maximum preparedness, are you confident that we have the capacity in the primary care sector to ensure that we are able to deliver these services in the community, where people need them, that people can access a pharmacist and that people can access a GP, so that the secondary services are not placed under undue and unnecessary pressure because the primary services are not able to meet the need? Thank you.

Well, I think it is—. As I was seeking to convey in my statement, primary care services are under incredible pressure, and in particular, GP practices face a huge level of demand. That's why making sure that primary care can be provided in different settings is absolutely essential. And it's been a challenge for a number of years, hasn't it, to be able to move from a model where people's expectations are that they will go to their GP for the full range of primary care services, to a more complex model, in some ways, but actually one that is more resilient in the long term, and I would argue also better reflects patterns of life as well.

So, I mentioned in my statement that one in four pharmacies are now able to prescribe for a range of conditions—that is a very positive thing, I think. And as well as the common ailments programme, specifically the work that community pharmacy do around urinary tract infections, around sore throat test and treat—you know, a continuous extension of the services that are available is absolutely vital. And I think you will have heard what my Cabinet colleague the Cabinet Secretary for finance said in his statement a few weeks ago, in relation to the pay settlements, that, although community pharmacy staff aren't included within the pay review ambit, he is keen, as obviously am I, to make sure that community pharmacy staff have access to a fair and proportionate pay uplift as well, and I think that will help with resilience and with recruitment as well.

Cabinet Secretary, I was interested to learn that you've provided extra money to health boards to prepare for the winter. It was disappointing, however, that Powys Teaching Health Board, instead of investing in healthcare this winter, have decided on planning a six-month temporary closure of the minor injuries units overnight in Brecon and Llandrindod, and that will mostly be over the winter months. This temporary closure is going to have a huge impact on my constituents' access to healthcare.

Cabinet Secretary, we don't get much in Powys in the way of public services, and to many, including myself, all I am seeing is more and more services being taken away. So, Cabinet Secretary, I'm asking you directly: will you help to fund the services for MIU within Brecon and Llandrindod overnight, because I want to make sure that my constituents can access healthcare when they need it during the winter? We hear a lot from the Government about people not going to A&E departments to relieve the pressure there, but closing these services overnight will push more people into A&E departments, and put more pressure on our healthcare service this winter, so will you please look to fund this vital service in my constituency?

As the Member is aware—and he's written to me, I think, on this topic, recently, or a related topic, certainly, and a response will be coming to him very shortly—clearly, the planning and delivery of services is a matter for local health boards, but as I said in my statement, we have been able to make some funding available for the priorities that we have identified for the coming winter months, but we recognise that, even with that, the system will be under incredible pressure, both of demand and resources.

Winter is hard, but winter is harder if you're poor. If you're a family where there are two or more children and you can't get child benefit for that third child because of the cuts and because of the unwillingness of the Labour Government to scrap the two-child benefit, then it's harder still. If you're an older person and you're living in a cold household and you're poor, then, again, it's hard, and that is another cut that your Labour Government has taken. The Royal College of General Practitioners have said that the decision to limit the roll-out of winter fuel payments to people on certain types of benefits will have a far-reaching consequence on the health and well-being of some of the most vulnerable in our society.

If you live in a cold household, which is not insulated, and that the Welsh Government will take around 120 years to insulate fuel-poor households, then we have another blight on our society. We can't just stand here and pretend that, with one hand, we're giving to our health services in order to make sure that we've got winter preparedness, and then, on the other hand, creating a situation where people are desperately poor and need fuel and food in order to be healthy. We're going to stand here and keep raising this. We have to raise it for the least and the last, and it won't go away. So, please can you agree to take this forward to your Labour colleagues in London? Diolch yn fawr iawn.

Well, the Member makes an important point. She will have heard what the First Minister said earlier today in the Chamber in relation to part of the point that she makes in her question, and I think what we are seeing in Wales, as in other parts of the UK, are public services—in this case, the health and care services—seeking to respond to the product of many, many years of underfunding of public services across the UK and also changes in our economy and in the support available for people, which has left people in grave difficulty. The consequence of that is felt this year, as it's felt every other year. What I'm outlining in the measures that we are describing today is the best possible support that we can provide as a Government, working with the health service and working with local authorities, to make sure, taking full account of those pressures that Jane Dodds is reminding us of in her question, that the services that we provide are best able to respond in a very, very challenging context.

Thank you for the statement, Cabinet Secretary. I agree with the piece where you said that health boards and local authorities need to work together to unlock bed space, but clearly that's social care, isn't it, and the need to do more with social care. I was pleased to hear the First Minister say earlier that there's a ministerial-led action committee now looking at things, however local authorities, to make headway into that, need to have the tools to do it. We know that last year they faced a £260 million hole in social care needs, and I think the Government gave them somewhere around 10 per cent of that. Cabinet Secretary, can you assure local government, to reach your aspirations, that you will give them the tools and the resources to address social care better?

Peter Fox asks an important question. The First Minister spoke earlier today about the care action committee, which I'll be chairing next week, which will focus very much on how local authorities and the NHS can work more closely together. That has met periodically over the last two years, and we have seen improved outcomes. Obviously, they're not where we need them to be, clearly, but there has been an improvement as a consequence of that. I would like to see reduced pathways of care delays, in particular those due to assessment, and a reduction in the number of days delayed over the next few weeks and months, so we can start to really make progress in relation to that. I've had conversations already with the First Minister, with my ministerial colleagues in the health and social care department, about how we can catalyse the system to work more closely together and what creative solutions we might be able to look at to assist with that.

The point that Peter Fox makes in relation to funding—clearly, there is a pressure on local government that is very, very significant. He will also know that councillors recognised that the settlement that we provided last year was at the better end of expectations, although, despite that, still an incredible level of pressure. And he will also know that the health budget also makes provision into the social care budget in order to be able to try and mitigate some of those particular pressures.

Cabinet Secretary, I recently tabled a question to you to ask you what was the longest a person had to wait in the back of an ambulance at the Grange hospital last year. I received a reply from the Government saying that the Welsh Government did not know. I was able, however, to get an answer directly from the Welsh ambulance service, who said that one individual entered the Grange at 2 p.m. in an ambulance and wasn't handed over until 2 p.m. the next day. This can only be described as borderline torture—24 hours waiting in the back of an ambulance is simply not acceptable. And to make matters worse, the Welsh Government was completely unaware of this. Cabinet Secretary, if this Government don't know the answers to such basic questions, how can any of us have confidence that you're taking the right steps to prepare for a winter surge that will surely be made worse by the decision of your colleagues in Westminster to remove the winter fuel payment for our pensioners?

I thank Laura Anne Jones for that question. Obviously, different health boards will have different levels of performance against the target. Clearly, it is unacceptable to be waiting for that long in the back of an ambulance to have admission to hospital.

We have seen, across parts of the system, improvements, sometimes quite significant improvements, in relation to handover times. That is a positive, but they aren't sufficiently widespread, and that is one of the reasons why I wanted to publish performance data at a health board level in a more accessible format so that we can identify where there is good practice and the system can learn from that. But that is a long-term plan.

She makes an important point about the steps that the ambulance service can take: optimising the use of the 999 clinical support desk; a targeted workforce plan to reduce sickness absence, which is a particular challenge, as she will know, at this time of year; and other steps, including funding from us to pump prime the recruitment of additional staff. So, there are particular measures under way to tackle that particular challenge from an ambulance point of view. But, as she will know, it's a much more complex challenge than that, and, if there are no beds in the hospital to take a patient in, then there is a limit to what the ambulance service can do. That's why the joined-up discussion that we've been having today and the importance of working collaboratively across the system is so fundamental.

I thank the Cabinet Secretary.