Committee for the Scrutiny of the First Minister

Diolch, Dirprwy Lywydd. I'm joined this afternoon by two senior officials of the Welsh Government: Judith Paget, who's the director general for the health service in Wales, and Reg Kilpatrick, who leads on the overall Welsh Government response to the pandemic.

Thank you, First Minister. Before we go into questions, I just want to make sure that the public are aware of the structure of the sessions, as we're following the same structure that operated in the fifth Senedd, where we will have two parts to the afternoon. The first part will be focused on a theme. That theme this afternoon is the COVID-19 recovery and winter pressures on our public services. And the second part will be focused on topical areas of questions.

With that, we will start the first part, and I'll start the questions, if that's okay, First Minister. Obviously, approximately 12 months ago, we had the recovery plan produced by the then Minister, Jeremy Miles, and since that time, obviously, we've seen the vaccination programme. We have seen the change in the economy as it opened up as a consequence of the success of the vaccination programme, and since then, we've seen more pressures being put upon our services, as winter comes upon us, and we've had the election and you were re-appointed as First Minister. What assessments have you made of the original recovery plan and the plans that were put into place at the start of the autumn, now that we are seeing the additional pressures of a new variant coming into the country and what that means for our services?

Thank you, Chair. So, the recovery plan was produced, as you said, in the final months of the last Senedd term. It has been overtaken by the programme for government that was created following the election, and the latest version of the programme for government was published in the last 10 days. The programme for government takes up the themes of the recovery plan and codifies them into the work of the Government for this new term, taking into account the result of the election and the manifesto on which my party fought that election.

As to the current plans for this winter, I think it is two weeks, is it, since we first all learnt the word 'omicron'. The winter plan that was published for the health service on 21 October was drawn up in the context of the ongoing delta variant, and of course, we are, all of us, having to very quickly adapt our plans in the light of the new variant. That means changes for all public services, because of the likely impact of that variant. And in the health service in particular, it means, for the moment, that there is an enormous effort going on to offer every eligible adult a booster vaccine before the end of this calendar year, at the same time as the health service is dealing with every other pressure that comes with the winter, on the one hand, and the recovery from coronavirus on the other.

Thank you. As I highlighted, it's not just the health service that we'll be considering today, it's other public services such as education and local authorities as well. To lead on the first set of questions, can I ask Russell George?

Thank you, Chair. Good afternoon, First Minister. Following on from the Chair's questions, First Minister, are national and regional plans, in terms of the winter plans, sufficiently joined up, do you think? You talked about amendments that were needed as a result of the new omicron variant. Can you tell us a little bit more about when those plans, which will now have to be updated, are likely to be published, and when we can see sight of any updated plans in that regard?

On the first part of Mr George's question, Chair, when we published the winter plan on 21 October, we also provided just under £10 million to regional partnership boards, because those are the vehicles, the primary vehicles, for bringing together national and regional plans, and to make sure that not only do those plans involve the footprints of the local health board, but they involve the local authorities that are within those footprints. So, they integrate national and local, but they also integrate those two key winter services.

The regional partnership boards had until 25 November to submit their plans—not confined to the £10 million, of course, but their wider plans for making sure that services work together on that regional footprint. Those plans have been submitted, they're live documents. They've been updated since they were submitted, in some cases. They've been scrutinised already by Welsh Government officials, and it's an iterative process, so I know that they will have gone back to the RPBs with comments and questions, and the latest version will then be reported to Ministers in the coming days. I am confident that the system that we have is a maturing system. These bodies have now been in place for a number of years, they needed time to settle in, to gain a rhythm of working practice, but I think they will have stood us in good stead for this year.

Everything we're learning about the omicron variant is that its impact is likely to come upon us very quickly and very steeply in the month of January. So, frankly, there is not going to be a great deal of time for people to be spending on writing plans and publishing them. They are going to have to, in real time, be dealing with the impact of the variant. And that impact, I think, will be twofold at least. It will drive more people into public services. In the health service, more people are going to fall ill as a result of the variant, so there will be more demand, and at the same time, the supply of services is going to be affected because the people we rely on will themselves be likely to be ill.

There are some estimates that suggest that, during the coming wave, half of the population of the United Kingdom will fall ill with coronavirus. That is the most enormous number and it will be compressed into a much shorter number of weeks than was the case with either alpha or delta. The work that is going on, and it's going on across the United Kingdom, is to try to model that to get some idea of what the demand will be and what we might be able to do to suppress it. But also to give us a sense of the impact that there will be on the available workforce and how we will cope with circumstances in which people we rely on—and it won't be just in the health service; it will be true of refuse collection services, for example—. If there is a third of the workforce unable to be in work, how will we organise those services over that very intense, if relatively short, number of weeks?

Thank you, First Minister. If I can just pick up on some of the points you’ve raised in terms of the workforce issues. There are two question here, I suppose: there are the immediate issues in regard to the workforce and then the longer term issues. I suppose, more broadly, there are significant vacancies within the Welsh NHS. I know that you’ve repeated a number of times that the workforce is as its highest level ever, but then the Royal College of Nursing points out that there are 1,700 current vacancies. So, just to ask if you can verify that that is your assessment as well.

But in terms of some of the workforce issues at the moment, with the huge challenge that is now ahead of us and yourself, as the First Minister, in terms of making sure that the vaccination centres are fully operational, and the impact there on taking staff away from other areas of the NHS, can I ask, really, what your assessments are and plans are in terms of dealing with the immediate workforce issues in the context of the new variant, and the longer term issues as well, and perhaps talking about whether you think some of the, in a longer term context, training places for doctors and nurses announced by the health Minister are sufficient? So, there are two parts to that question: the immediate and the longer term.

Thank you very much for that. I think we can be very proud of the immediate response we have had within the health and social care field and more widely to a call to people to come forward to staff the very much stepped-up vaccination effort that we are mounting over the rest of this month. We’ve had a fantastic response. And this from a workforce that is exhausted by everything we’ve asked them to do already. We are of course using the vaccinators that we know we have. We’ve changed the rules so that non-registered vaccinators can be part of that workforce. We’ve drawn people in from outside the health service itself—from the fire and rescue service, for example. We are mobilising people in other parts of the health service—optometrists, people who work in dentistry, for example, on our Designed to Smile programme. They are all being mobilised to staff the extra capacity, the longer opening hours that we will need, alongside greater use of pharmacies.

Right across the board, people have stepped up to requests we’ve made of them, and I think we should be hugely grateful to them for that. Does it come at some cost? Well, of course it does. On GPs in Wales, we’re taking a slightly different attitude than across our border. We are asking GPs in Wales to use their morning sessions for their normal GP work and then to use afternoon sessions freed up to do vaccination, and particularly with GPs, to do some home visiting vaccination, to make sure we continue to offer maximum coverage to healthcare and social care workers, care homes and so on.

The messages I have had back, Russell, from the front line of people who are cancelling their leave, doing all these extra things—their biggest fear is, while we can turn on the supply in this way, will the demand be there. Are they going to be sitting there with empty spaces, because people don’t come in for the appointments that they are offered? In some ways, that is a larger anxiety. The UK Government is mounting a huge media campaign, which will run in Wales and, hopefully, will communicate the urgency of that message. But from where I sit, if there’s anything that I worry about, it is less that we won’t have the people to do the job, it's have we succeeded in communicating to the Welsh population just how important it is for them to come forward when they get that appointment, and not to do what we have seen quite a lot of recently, which is either not to turn up at all, or to want to rearrange your appointment to a time that is more convenient to you. I’m not against convenience, but in a public health crisis, I always say, 'There’s nothing you will do today that is more important to you, for your health and the health of others, than to come forward and take up the appointment you’re offered.' So, that's the immediate issue. Do you want me to pause there? Do you want to ask—

No, I'd just agree with you in terms of the frustration with those that are not turning up for appointments and the challenges there.

The second point of the question, in terms of the longer term issues, was about recruitment of doctors and nurses. Are the numbers announced by the health Minister sufficient, in your view, to deal with the backlog?

I’ll ask Judith to come in, if you don’t mind, in relation to the question you asked originally about vacancies, but the figures announced by the health Minister are the eighth year in a row in which training places for the Welsh NHS have risen. They have risen very steeply indeed in some areas, and they are planned with the service to make sure that we have throughput of people ready to take up the jobs that are available for them here in Wales. But, by itself, it is not the only answer. We have to use the workforce we have in different ways. So, it’s not just numbers; it’s how we design the job as well. We have to make maximum use of the skills that we have in the service.

I’ll give you just one example of that. Our optometry workforce is highly skilled, highly trained and, in many ways, underused. So, we are working with the profession to make sure that it is in a position to draw more work to it that would otherwise be in a GP surgery or on a waiting list for secondary care. We are actively contemplating bringing a very short Bill in front of the Senedd, during this Senedd term, to change some of the rules around high-street optometry, so that we can make better use of that workforce. It’s a combination of making sure we’re training enough people and recruiting enough people, but also then how we use the skills of the people we’ve got. And that’s a big job—redesigning that, making sure everybody is operating at the top of their clinical licence, that people aren’t using their time to see people that somebody else could just as clinically effectively see. That has to be part of that picture as well. Chair, if you want to ask Judith for a view on the vacancy rate, I'm happy to pause now.

Okay. Judith.

Thank you, First Minister. Thank you, Chair. Just to add to what the First Minister said about the training places announced by the Minister on 5 December, that work culminates from a sequence of detailed planning work undertaken by NHS organisations, which is co-ordinated and pulled together by Health Education and Improvement Wales. Therefore, the investment that the Minister has announced is to deliver the plans of the NHS. So, it's important that that point is made. And just to say in relation to nurse training places, through the ongoing year-on-year investment made by Welsh Government, those nurse training places have increased by 69 per cent since 2016, so a substantial increase in nurse training, and similar increases in midwifery and also in physiotherapy and clinical radiology. So, the NHS guides where that investment or that increase is needed, based on their own plans to change and develop their services.

In relation to vacancies, clearly there are vacancies in nursing. We've heard the calls from the Royal College of Nursing and, from my own experience, working in the role I had in my health board previously, clearly there are vacancies. And health boards have worked really hard both to recruit to those vacancies, but, clearly, overseas recruitment and other options are still there, and I think we are planning a more co-ordinated approach to working on overseas recruitment across the NHS for those vacancies.

Just to point out and expand on something the First Minister said, of course, the prudent approach to how we use our workforce is really important, and taking nursing, for example, talking to ward staff in one health board area and saying to senior nurses on the wards, 'So, what would help you?' They were saying, 'Well, we're spending a lot of time doing rosters, so if we could have somebody to help us with our rosters, then that would free up our clinical time to actually do what only registered nurses do'. So, it's looking for opportunities all the time to make sure we're being prudent in our approach to using the workforce we've got, maximising that workforce and making sure that people are working to the top of their licence. There's a whole host of examples across the NHS in Wales, and in other parts, which are changing the way roles are being used, changing the way services are being delivered, and making the best use of the workforce that we've got. So, I hope that's helpful, First Minister.

I have two supplementaries on this area, and I'm sure they'll be succinct, the questioners, to make sure we have sufficient time for all the questions. So, Llyr—

Chair, can I come back?

After I've done the supplementary, Russell.

Diolch, Cadeirydd. Mae un peth mae angen ichi glirio lan inni heddiw, Brif Weinidog, os gallwch chi—y dryswch yma ynglŷn â'r walk-ins ar gyfer y boosters. Roedd eich Gweinidog chi'r wythnos yma'n dweud nad oedd yna walk-ins, bod yna grwpiau'n mynd i gael eu blaenoriaethu. Ond, wrth ei bod hi'n dweud hynny, mi oedd Aelodau o'r Senedd yn derbyn e-byst gan fyrddau iechyd yn dweud y byddai yna walk-ins, a hefyd roedd GPs yn hysbysebu ar y cyfryngau cymdeithasol, 'Dewch. Mae yna ddiwrnod gyda ni yfory, dewch i gael eich booster', ac yn y blaen. Felly, mae angen eglurder, dwi'n credu, ynglŷn â beth yw'r drefn, neu o leiaf beth yw’r drefn rŷch chi'n gobeithio fydd yn cael ei rhoi yn ei lle, achos ar hyn o bryd mae yna wahaniaeth rhwng beth mae'r Llywodraeth yn dweud a beth sy'n digwydd ar lawr gwlad.

Ac yn gysylltiedig â hynny, i bigo lan ar beth roeddech chi'n ei ddweud gynnau am bobl ddim yn troi lan ar gyfer apwyntiadau ac yn y blaen, lot o beth dwi'n ei glywed o lawr gwlad yw bod pobl, efallai, wedi penderfynu nawr i ynysu a so maen nhw angen cysylltu i ddweud nad ydyn nhw'n gallu dod i gael y booster, neu mae pobl wedi cael COVID ac felly'n methu â chael y booster am efallai fis neu faint bynnag o amser sydd angen pasio, ond maen nhw jest yn methu â chael drwyddo ar y ffôn i newid yr apwyntiad neu i ganslo neu i hysbysu fyddan nhw ddim yn gallu dod. Nawr, mae hynny'n rhywbeth sydd wedi peri tipyn o ofid i bobl, eu bod nhw jest yn methu. Mae yna un person wedi dweud wrthyf ei bod hi wedi cymryd tridiau iddyn nhw i gael drwyddo i newid yr apwyntiad. Felly, rŷn ni'n gwerthfawrogi bod y system yn gweithredu o dan straen aruthrol a bod yna surge aruthrol o ddiddordeb ar hyn o bryd, ond yn amlwg dyw'r system ddim yn gweithio fel y dylai hi, nac yw?

Well, Chair, as far as the first point is concerned, the Welsh Government continues to want to follow the advice of the JCVI, which is that, even with this rapidly accelerated booster campaign, we should vaccinate people in clinical priority order. So, that is the major thrust of how we will do things in Wales. However, in order not to allow appointments to go unfilled, health boards do have the ability—and it's the same system we've used all the way through—where they can call other people in out of order, and sometimes that will be through walk-in centres, to make sure that we don't have vaccinators standing with nobody to vaccinate, and that we don't have vaccine, because this is all Pfizer vaccine, that has been opened and needs to be used. That is the basic system. The main system, the appointment system, is people called in order, working our way down the clinical priority groups, but, in order to make sure that we don't have spare capacity that we could use, there will be some walk-in capacity to mop up appointments that otherwise might go unused.

On the second point, of course, I recognise the fact that there are so many people wanting to get through, so many people wanting to contact, and it's just impossible to turn on the tap of capacity overnight in that system and there are people who are having to wait far longer than they or we would wish. It's a bit of an appeal to people for patience with that. The system is working as fast as it can, as flat out as it can, and it is getting through hundreds and hundreds and hundreds of calls every day to try and make sure that, where people are genuinely unable to attend, we offer them another appointment—of course we do. But just the sheer numbers at the moment do mean that the system is not able to respond as quickly as it would in more ordinary times.

Jenny Rathbone.

Thank you. I just wanted to pick up on the use of pharmacists. You said you want to make better use of optometrists. What are the barriers to more intensively using pharmacists particularly for this vaccination programme, given that there are some people who can't simply drop everything for an appointment that they heard about yesterday—if you haven't got a car or you've got caring responsibilities for people who you can't leave unattended? The pharmacy is on the high street and it can be a much easier place to get to. What are the technical barriers to using pharmacists, given that we're using Pfizer?

Well, Chair, the single biggest practical barrier is the fact that people have to wait for 15 minutes after they have been vaccinated. Many, many of our high-street pharmacists have quite a small consulting space, and just the number of chairs they have for people to be there clog up very quickly when everybody has to have somewhere where they can sit and be observed. There are two solutions to that. One is that we are going to issue revised guidance on waiting times. There will still be quite large numbers of people where a 15-minute waiting time will be required, but we are able to reduce the waiting time to five minutes from 15 minutes for others in the population. For example, for people who've already had two doses of Pfizer and are now having their third dose and have had no previous reaction to it, the advice is it is clinically safe to observe those people just for five minutes. That will free up more time, even in small pharmacies, to be able to do more of this.

The other way in which we are using pharmacists, though, is that lots of pharmacists are vaccinating in our mass vaccination centres. So, the fact that they're not able to do it in their own high-street location doesn't mean that they're not vaccinating; they are very much part of that wider group of professional staff who we have recruited to work in other settings where they're able to do, truthfully, far more vaccines in a day than they would be back in their high-street location.

Russell, I'll come back to you for a final question.

Thanks, Chair. First Minister, if I can just pick up on the question I asked about training places for doctors and nurses that were announced by the health Minister. We had quite a detailed answer on that. Can I just ask for clarification from you, in your view, on the numbers that were announced by the health Minister? Do you think they are sufficient to deal with the current gaps caused by the backlog by the pandemic? And the second quick question, in regard to COVID-lite surgical hubs that were announced in your winter plan, when might we be in a position to have more detail on those COVID-lite surgical hubs, or is there any detail you can provide now?

I'll ask Judith, probably, to answer the second question. Truthfully, Chair, I don't think my view is the determinative one here; it is the view of the national health service in Wales, because that's how those plans and those numbers are derived. The workforce planning exercise starts in the health board. They are asked to identify the numbers of not just doctors and nurses—it's physiotherapists, occupational therapists and speech therapists and all the other professions that we train in Wales. Health boards are asked to identify the numbers that they think they will need over the planning horizon, and those numbers are brought together, they are interrogated by Health Education and Improvement Wales, and Ministers get the very best expert advice, and I would never think of intruding my personal view into whether those figures are right or wrong, because they are the figures that people who know the business and do the work at the front line provide to us. On that basis, they have my endorsement.

Judith, are you able to help on the surgical hubs?

Yes, certainly, First Minister. So, all of the NHS organisations are currently considering what opportunities they have to develop additional capacity to support recovery, including where they might be able to develop what was described as a COVID-lite surgical hub. That work and the outcome of that work will be reflected in their integrated medium-term plans that will be submitted to us early in 2022. The committee may be aware that we have now reinstituted that three-year planning framework that was paused during the early part of the pandemic, but has now been reinstituted, and that's the process by which organisations will signal to us how they want to take that forward.

Thank you. I want to move on to questions now from Jack Sargeant.

Diolch yn fawr, Cadeirydd. Prif Weinidog, if I can have a look at managing the pandemic in the short term, in relation to education, learner well-being and the continuation of education, we know schools do remain open currently, apart from those young people who are isolating for various reasons. In the run-up to today's meeting, we have seen some announcements from local authorities about what next week, in the run-up to Christmas, looks like. And then, just today—. I'm just reading a piece from the South Wales Argus, which is reporting,

'Schools in Wales have been told to prepare for a return to remote learning after the Christmas holidays.'

It does go on to say they will get two days of planning at the start of term. Can you explain a little bit further where the Welsh Government's thoughts are around what education looks like for young people in the early part of the new year?

Thanks very much, Chair, and thank you, Jack. So, some colleagues will have seen the letter that the education Minister, Jeremy Miles, sent yesterday to headteachers. That is where the two days for planning at the start of the next school term come from. In his letter, Jeremy urges schools to plan on two different bases. The first is to plan for children to be in school but with an elevated level of mitigation. So, you'll know that we have a local decision framework in education and that that has a spectrum of measures that schools can take. If there's very little coronavirus in a school, then the measures are at the bottom end of the spectrum; if there are more significant numbers, then there are measures at the top end of the spectrum. Jeremy's letter says, essentially, 'Plan on the basis that you will need a maximum level of measures in school to have children back in school.' He said in the same letter that the Welsh Government, or that he, as the Minister, would issue a Coronavirus Act 2020 notice to allow schools to operate staggered start and finish times from the start of the new term as well. That was a measure we did have in place earlier in the pandemic. It was not thought necessary when we returned in the autumn; it's being reinstated by the Minister now.

But the Minister's letter also says to headteachers that they should use those two days to plan for what would be necessary if schools had to move to remote learning. And I think that that is all just very sensible, really. Schools will have two days at the start of term where they have the very best information about their local circumstances, the number of teachers that they will have available, the extent to which coronavirus is circulating amongst their school population, and then they will be able to plan for whichever of those futures they think they will face in the days and weeks ahead.

The issue of staff availability will be as acute in schools as it is in the health service. Ninety-three per cent of school staff are doubly vaccinated, and we will have offered every one of them an appointment for a booster—those who are eligible—before the end of this year. So, we're doing everything we can to sustain that workforce. But we know that the speed at which omicron will overtake us will mean that some schools will have significant numbers of staff unable to be in the workplace; those two days will give them a chance to plan for the best arrangements they can use in the local context that they face.

Thank you for that, First Minister. I appreciate the clarification there, and I'm sure parents will. It's certainly reached my inbox, as I'm sure it has Members from across the Chamber. One of the important conversations I've had with the Chair of the Children, Young People, and Education Committee, Jayne Bryant, in preparation for this meeting was that there is major concern around attendance at schools and, of course, exam anxiety. And that's only going to be increased, I believe, because of the variants such as omicron. So, not only does that need to be addressed in the short term, but certainly in recovery. So, perhaps, in my next phase of questioning, you could briefly touch on that. So, in terms of recovery, how do we look to that long-term recovery from the pandemic in our education system, not just the emotional and social and academic development, but, of course, the Welsh Government does have a long-standing objective to raise the educational standards—so, is there a focus there, and what does that focus look like? And also, just briefly touching on the objective to narrow attainment gaps as well, please, First Minister.

Thank you very much again, Jack, for that, and to Jayne Bryant as well. So, you will have seen that, yesterday as well, Jeremy Miles issued a written statement on an additional package of support for learners in the short and medium term of £24 million, £7 million of that specifically aimed at attendance and further measures that schools or education authorities can take to make sure that we are doing everything we can to get those young people who have missed out on school back into school and to prepare them for their futures, and £7.5 million to support exam-year education. And again, that is with resources and with additional teaching time over the next term to help young people to keep learning in the circumstances we just discussed.

At the same time, some colleagues will know that the WJEC has very recently announced further adaptations to help young people prepare for exams—so, further adaptations to course content, relaxing conditions for the completion of non-examination assessment, and more advance information for young people on exam topics in a wider range of subjects. So, we're acutely aware of the fact that young people sitting exams this year will have missed out on exams maybe over two years, so they're not used to that way of doing things. We are very keen if we can—and this is reviewed very carefully all the time—to keep examinations as part of the way in which we award qualifications, partly because it's really important that qualifications offered to young people in Wales are usable in other jurisdictions—if you're applying for a university place outside Wales, you want your qualification to have equal status with everybody else's; so, other jurisdictions are using examinations, we want to do that as well—but also because it does go directly to Jack Sargeant's point about equity.

One of the striking features of the centre grade system we used in this calendar year was the way in which the performance of young men from working-class backgrounds fell back, and, truthfully, that is at least partly a reflection of the assessment method. Young people from those backgrounds do better in exams; they often exceed the expectations of their teachers, and exams give them the opportunity to do that, and, for reasons of equity, we want to go back to an element of exams, because we think it will help young people from those backgrounds to show what they can do. Because of our concern at the gap that widened further in this calendar year, the education Minister has asked his officials to prepare a strategy for educational equity, which he plans to publish early next year, and that will be a further part of our effort to make sure that for those young people on whom the impact of coronavirus and the way schools have had to operate has been even more disproportionate than on other young people, we find other ways in which we can go on trying to close that gap.

Jack, I'll come back to you in a second. Jenny had a short supplementary.

Yes. I just wanted to go back to the situation we'll be facing in January. Can we assume that however difficult and challenging it is for schools in terms of the numbers of staff available that it'll still be possible to have vulnerable children coming into school in person, whether they haven't got the technology to have online lessons, or they have learning difficulties, or all manner of other reasons?

That is absolutely part of the plan, but this is very complex, as Jenny will know; there are so many moving parts and so many uncertainties in it. But planning is definitely going on that, if schools in significant numbers have to move temporarily to remote learning, those vulnerable children, and children of key workers as well, there will be on-site provision for them, so that those young people are looked after and their parents are released to do all those other vital things we need them to do.

Thank you.

Jack, back to you.

Diolch, Cadeirydd. First Minister, just very briefly, just touching on exam anxiety, again, a brief question and brief response. I just want to ask—you mentioned the complexities of the reviews and the careful consideration going on: is there a mechanism in place to hear direct from the learner to the Welsh Government in making those decisions?

Yes, Jack, there are. I can tell you there are many ways in which we talk directly to young people. I've been lucky enough myself to do that on a whole string of occasions, and the themes are very clear, and they come through every time: anxiety about exams, anxiety amongst young people who haven't sat exams about what they will be like and how they can be prepared for them; anxieties about mental health and well-being. There are very strong common themes, and a range of Welsh Ministers take part in these discussions with different groups of young people, and the education Minister, of course, takes a lead in that.

Thank you.

Thank you. Moving on now to John Griffiths.

Diolch, Cadeirydd. First Minister, local government delivers many important services to our communities, and, thankfully, I think we've seen very good partnership working between Welsh Government, our local authorities, and indeed the third sector and others, which has helped us pull together, as we say, to get through this pandemic. But there's a longer-term picture for local authorities in terms of the effect of COVID-19, and I wonder whether Welsh Government has done any assessment of that longer-term impact and what it might involve.

There are a number of ways, Chair, in which we are able to have that long-term assessment. We are in—as John Griffiths said—very, very regular dialogue with local authority leaders in Wales. Indeed, ministerial colleagues have met local authority leaders on a weekly basis, particularly in the more recent weeks. I myself have attended a number of those meetings, so we have a very direct and engaged way of assessing the current position and then projecting that into the needs that local authorities will need to meet in the future. There is the more formal engagement, of course, through the partnership council, through the finance sub-group system that we have with our colleagues in the WLGA; there's a great deal of official-level contact between officials in the Welsh Government and their counterparts in local authorities, and there's the work of Audit Wales as well, who have a formal role in relation to audit, performance, value for money and so on. So, there is a wide range of evidence that we are able to draw on in working with, as key partners, our local authorities in meeting the immediate challenges—and they're very, very real—that they face, and what they will need to do beyond the immediate crisis.

Could I ask you as well, First Minister, whether Welsh Government is considering extension of the hardship fund?

Well, I have to give you a slightly provisional answer here, Chair, because, had you been asking me even a couple of weeks ago, I think I could have given you quite a straightforward 'yes', that that is under consideration. I've been in meetings with the Finance Minister today, who has a series of allocations that she was planning to make—you saw one yesterday announced by Jeremy Miles, the £24 million he announced—and that's one of a series of things that the Finance Minister is considering. She's having to just pause briefly to look at the competing calls for support for businesses in the omicron context. The economy Minister announced £45 million at the end of November, but that was to allow businesses to get back on their feet and look to the future. As you know—I know John Griffiths will know in the Newport context—there are businesses that rely on the Christmas period for much of their business model and where people are cancelling engagements and so on because of omicron. So, we're having to look at whether we have to mobilise a package of support for businesses because of the immediate crisis, and there's only so much money we've got. So, the Finance Minister is having to stand back from some of the things she was looking at, and that would have included more help for local government in the short run, to see how we now calibrate those plans in the light of the urgency of the business calls for help.

Okay. Thank you for that, First Minister. I wonder if I could move on to homelessness and rough-sleeping. Again, we saw some very impressive progress, I think, during the pandemic in terms of getting rough-sleepers into accommodation, and indeed then shaping services around them, and joining up services around them, to meet whatever particular needs they might have. But, obviously, there has been some slippage back onto the streets, First Minister, more recently, and I just wonder what you might say in terms of Welsh Government's thinking, again with the pandemic in mind, in terms of how local authorities can continue to be supported by Welsh Government to meet these challenges, whether it's the availability of emergency temporary accommodation or a continuation of the sort of Welsh Government support that's enabled the progress that we saw in the pandemic. What's your sense at the moment of how will Welsh Government will continue to work with local authorities to meet these challenges?

Chair, could I first of all agree with what John Griffiths said? It was the most fantastic effort by our local authorities and third sector partners in finding emergency accommodation. Since March 2020, when the crisis began, over 15,300 people have been brought into emergency accommodation. That is the most enormous effort, a practical effort of finding accommodation, but we know that many of the people who have been housed in that way have needs that go beyond just a simple place to live. I regret every person who lives without somewhere proper to be in, and John is right that there has been a small drift upwards in the numbers—128 people at the end of September, and that was, I think, about 20 people more than at the end of August—nevertheless, very, very much lower than they would have been in the pre-pandemic period, and September and October historically have been the months when the highest number of rough-sleepers is recorded. So, as I say, I regret every single person who hasn't got a proper place to live, but the numbers in comparison remain at the low end, and that's despite the fact that homelessness presentations continue to run at around 1,000 a month in Wales, and that's a huge number for local authorities to absorb.

We published the ending homelessness action plan on 30 November. We're investing a record amount of money: housing support grant up by £40 million this year, an increase of nearly a third; £250 million in the social housing grant. So, all of that is about building more affordable social housing because, in the end, that is the key, isn't it? We just have a supply problem. We need to build more units so that people who need them can be housed, and 20,000 low-carbon homes for social rent is a very ambitious target, and we are funding it to meet it. And, on top of that, there is the £185 million we are providing in housing support and homelessness services. So, as I said, this is not just a matter of finding a roof for somebody to be under, but it's making sure that there are the services that are then needed to allow those people to get back on their feet and to be able to live the sort of lives that they would wish to see for themselves. So, major investments from the Welsh Government, with really big ambitions not to slip back to the sort of patterns that we were all too familiar with in the period leading up to the pandemic.

Moving on to questions from James Evans.

Diolch, Cadeirydd. Prynhawn da, Prif Weinidog. Mae gen i gwestiwn ar yr economi.

Prif Weinidog, with the spread of omicron across the country getting greater and greater, obviously, there are major concerns from our hospitality sector about any future restrictions on their businesses. As you're well aware, they have suffered greatly during the pandemic with potential job losses and everything else. First Minister, I'd be interested to know what discussions you've had with the UK Government and with the wider Cabinet on what support could potentially be provided to the hospitality sector while we manage the current threat from omicron to make sure that we do not have mass job losses or people going out of business during the period as we follow on, going forward? Diolch, Cadeirydd.

Diolch i Mr Evans am y cwestiwn, wrth gwrs.

Presently, the threat to the hospitality industry doesn't come from restrictions at all, because there are almost none. The threat comes from people making their own decisions and seeing the threat that omicron represents and voting with their feet, and that is a real challenge for the hospitality sector. As I said, Chair, the Cabinet met earlier today—we'll be meeting again at 4 o'clock this afternoon—and we discussed there the extent to which we are able to mobilise fresh assistance for those sectors that are most directly affected at the moment and who could go on being affected should the omicron wave materialise in the way that we fear. That was part of my slightly hesitant answer to John Griffiths about help for local government, because, as I say, in the end there is a fixed amount of money that the Welsh Government has, and we're trying to find the greatest priorities for a call on that money. I do expect, when the Cabinet resumes at 4 o'clock, that there will be further advice on what help can be mobilised.

More widely, there was a meeting of the COBRA committee yesterday, at the end of the afternoon. The Treasury were there, and they showed no signs to me in that meeting of preparing to offer help to industries that are affected, at least in the short term. Powerful cases were made, and not just by devolved Ministers either, but from other Ministers too, for the need for financial help across a whole range of different aspects of Government. I'll say again this afternoon, as I try to whenever this question comes up, that the help that the UK Government mobilised during the pandemic, through the furlough scheme and other schemes that operated on the UK level, was very important here in Wales and did a great deal to sustain those jobs and those businesses. If we are entering the sort of period that omicron brings, with the impact it will have, it will be only the Treasury that will have the fire power to step in and support businesses from that sort of impact. And while there was no immediate sign yesterday that there were announcements about to made, the case for that sort of help was certainly made.

Diolch, Prif Weinidog. I just want to move on to tourism businesses. In your co-operation agreement with Plaid Cymru, you mentioned local tourism levies, and I'd just like to know what assessment you and the Welsh Government have made of any potential threats or opportunities that come from the introduction of local tourism levies in Wales, particularly in the context of recovery from the pandemic.

Well, of course, Dirprwy Lywydd, we made many assessments of a potential tourism levy, drawing on the very successful experience of such levies in other parts of the world. The approach we intend to take is to offer local authorities a discretionary power to raise a tourism levy in their local areas, if they believe that there is a case for them to do so. So, it will be for people closest to the ground. And tourism circumstances vary hugely across local authorities in Wales, so if a local authority wishes to take advantage of this new opportunity they will be able to do so, but there will be no compulsion on them, of course, to do that. We intend to bring forward a formal consultation on legislative proposals in the autumn of 2022, and then to put a Bill in front of the Senedd in 2023. Hopefully—hopefully—by then, the impact of coronavirus will be something in the rear-view mirror and there'll be no coincidence between the immediate impacts and the change that the levy will bring about.

Diolch, Prif Weinidog, and we all hope that coronavirus will be in the rear-view mirror by then, and the sooner the better. And in trying to be succinct, Cadeirydd, I will finish there. Diolch.

Jenny Rathbone.

I want to move on to the proposal to expand childcare to two-year-olds. In the context of the shortage of provision that already exists, particularly in rural areas, as well as for children with disabilities, how does the Welsh Government plan to increase the provision quite substantially in a way that will enable everybody to be able to take up this offer?

Well, Chair, childcare is a market, isn't it? It is not a public service. It is not directly provided, in the main, by public authorities. It is a market, and the Welsh Government's ability to intervene in the market is constrained to the sorts of measures that we are able to take. So, amongst the measures that we take are, I think, generous help for the sector in capital funding: £80 million-worth of capital funding since 2018, over half of that invested in Welsh-medium settings, some of it in the more formal public provision through Flying Start, but all of it designed to assist the sector in expanding and to make sure that there are more places available. So, there is help from the Welsh Government in that way. There is help from the Welsh Government with running costs as well. We have extended our 100 per cent rate relief arrangements to the sector to 2025 and that is a very significant help to many childcare providers.

And the other way in which I think the Government is able to help is on the supply of staff in the sector, because the other constraint in many parts of Wales is not just buildings and equipment, but it's employing people to do this work. So, since 2019, we've introduced a number of new qualifications in childcare and for play workers to try to widen the recruitment routes into this occupation. Social Care Wales has recruitment campaigns that it runs on our behalf and will continue to do so.

For children with disabilities and complex needs, whom Jenny Rathbone referred to, then we do provide an additional support grant to local authorities alongside the money that is provided for the childcare offer, and that is specifically in order to fund the needs of those young people with more complex needs, whether that is in the purchase of equipment—the specialist equipment that may be needed to be able to support a young person in a childcare premises—or to have additional staff so that young people who need one-to-one provision during the day can have that as well. So, that is relatively modest funding—it's £1.5 million—but it sits alongside the childcare offer and it's there to try to respond to the young people that Jenny mentioned.

In terms of raising the quality of provision across the piece, how do you envisage the statutory sector working more closely with the voluntary and private sectors so that we have a community approach to meeting the needs of all children?

Well, the community-focused schools programme I think is really key here. I vowed earlier this year that I would never again write a sentence in a manifesto about the need to promote community-based schools, because I've written it too many times during the last 20 years, and this is the term when we really have to make a reality of that. And Jenny will know that, as part of community-focused schools, we are working hard to try to co-locate childcare provision on those sites. It's not always popular as a measure with private providers, but, in order to provide single locations where parents don't have to move their children from, in Cardiff's case, one part of the city to another halfway through the day, then co-location alongside public services in community-focused schools is a key way of doing that. And it means that the people who work in the childcare aspect have indirect access to all the expertise and sometimes some of the facilities that go with that community-based facility. So, trying to align what we do directly through public provision alongside the private provision, which is still the bulk supplier of childcare, is very important for convenience reasons, for expansion reasons, but also for quality reasons, in the way that Jenny Rathbone suggested.

Okay. Just finally on that point, how do you think we can really ramp up the numbers of Welsh-speaking childcare and early education workers so that two and three-year-olds, who will learn Welsh without even thinking about it, can really get that opportunity from day one?

Well, as I said in an earlier answer, Chair, half of the £80 million has gone into the Welsh-medium sector, so we are prioritising it because of the growth that we see there, and want to see there, in order to arrive at our 1 million Welsh speakers by 2050. But part of it is by persuading Welsh speakers to regard that ability as an economic asset to them, that this is something that they can use to help to develop their future careers. It is surprisingly difficult sometimes to persuade native Welsh speakers, people who use the language all the time, that actually that's an economic asset to them as well as a cultural asset. So, a lot of work is going on.

Dirprwy Lywydd, I might just put this cautionary note in here—that a lot of the work that we do in that field is done through European funding, through European social fund funding, and we're about to lose that, and we know for certain now that that won't be replaced by the current UK Government. So, lots of the very good work that has gone on to try to make sure that people who, as I say, have that natural asset that they can turn, through training and preparation, into something they can use to get work—we've relied upon those European Union funds to do that, and that's going to be a challenge for us in the future. But, part of the solution lies, as I say, in just getting people to recognise that, if you are a Welsh speaker, then you're going to be sought after and your skills will be really, really useful in the childcare sector and in other care sectors as well.

Thank you. My second question is what we can do to support those who've been worst affected by the pandemic, who are people with learning difficulties, people who are suffering from dementia and their carers, who during lockdown have been left to their own resources, largely. For example, the provision for people with dementia is down to nine places for the whole of Cardiff in our own local authority, and I'm sure that there's not much difference in other parts. How can we become a dementia-friendly society so that all provision can be made available to people who have particular needs?

I thank Jenny Rathbone for that, because I think it has been one of the most difficult areas during the whole of the crisis that those day centres and other facilities that unpaid carers relied on and that the people they looked after looked forward to attending—it's been just so difficult to sustain those services in a safe way. I'll probably ask Judith, Chair, if you're prepared for me to do that, to come in on the dementia services specifically.

We have tried our best to bolster the services available to unpaid carers to help them to manage through these really, really challenging times. I've met myself, with Julie Morgan and others, at various times with groups of unpaid carers. They have done the most astonishing job, and they will tell you that it's not all been bad news, that they've managed to do some wonderful things because of the circumstances of the pandemic, but the day in, day out demands on them without those respite services are very real. So, we have provided extra funding and we support the third sector organisations that mobilise unpaid carers as well.

We've asked the Association of Directors of Social Services Cymru to review the availability of day centres and support services for us, and their report has just come in. I think they published it on 7 December. I know that advice went to Julie Morgan as the Minister responsible at the start of this week. It does offer us some practical ways in which we might be able to recover some of those opportunities for socialising, forming friendships and getting time out of the house that are so valuable to people. I don't know that the Minister has had the chance to agree or disagree with the advice, but I believe that it suggests some further funding to allow the ADSS to lead or put into practice some of the practical ideas that their report has uncovered

Chair, if you're happy for Judith to pick up on—

Yes. Judith.

Thank you. In fact, the First Minister has probably said the majority of the things I would have said, but just to say, of course, included in that work from the ADSS is particularly looking at what more we can do to support people living with dementia in terms of access to services and support. There was a lot of really rich and valuable comment from carers and families in that work, which I think will allow us to build back something that's more in keeping with some of the changes that have been made through the pandemic. So, I think there's a lot to work on. Hopefully the Minister will come back with a view very shortly, but I think it gives us a really good blueprint for how we move forward.

My concern is that statutory bodies are very good at risk assessing the state of provision in the middle of a pandemic, and the risk to staff as much as to users, but there's less emphasis on the risks involved in not reopening services, because most of these unpaid carers are elderly themselves, and the strain on them of not having any respite is a huge risk.

Absolutely, and I think the report acknowledged how important day services, respite and overnight services were. So, it's about how we design something that takes account of people's views. Things have changed; perspectives have changed in terms of what people want during a pandemic as well. It's about how we design the new services to actually meet the needs of both carers and the people that they're caring for.

Moving on to Llyr Gruffydd.

Thank you, Chair. I want to start with public transport, if I may, and trains particularly. You may be aware that a number of us are regular users of trains, particularly if we travel from north Wales to Cardiff. But it's becoming increasingly frustrating, as you may have heard me speak about in recent weeks. Even before COVID, people were critical of Government in terms of overpromising and underdelivering in terms of improving rail services in Wales. Clearly, COVID hasn't made things easier at all, quite the opposite, but I'm just wondering at what point can we expect not to see negative coverage in the way that we have, particularly over recent months, around rail services in Wales.

That's not a question that I can answer, really; I'm not responsible for the coverage, so I have no idea when coverage of that sort will end.

Do you accept, then, that services aren't what they should be? We're seeing, aren't we, a car-led recovery from COVID. There was a moment where people were hoping, when cars were off the road in a way that they haven't been for generations, that public transport would be there to step in and hopefully create that cultural shift that we wanted to see, that modal shift. Clearly, that hasn't happened. We're seeing a car-led recovery, and one of the reasons for that is because three of the four trains I caught in the last month were at least an hour late.

Most of the concerns that I've seen about trains in recent times are about them being overcrowded. So, far from it being that there are no people on the train because they're all in their cars. There are often concerns, and very often expressed from north Wales, about people finding the train they're on has too many people on it, not too few.

There are too many people because there are not enough carriages.

Every carriage that Transport for Wales has available to it is out there on the tracks. As I know the Member knows, you cannot expand the number of carriages available quickly, although there are more carriages and more services available on trains in Wales. The truth of the matter is that if it were not for the enormous amount of money that the Welsh Government has poured into public transport, including train transport, there would be no trains at all running in Wales because the pandemic would simply have rendered the whole system completely bust. The farebox has collapsed. The ability of companies to provide a service through what they raise commercially has gone with it. If it were not for that—and we're not talking tens of millions of pounds here, we're talking over £100 million—then the system wouldn't exist at all. There are imperfections in it, and coronavirus compounds many of those. There are trains being cancelled in Wales today because drivers are ill with coronavirus. And again, you can't just whistle up another driver because of the skilled job that they do. I'm not for a minute saying that it is not a struggle, and that there aren't imperfections in the system, but when you see what the system has been up against over the last 21 months, it would not have survived at all if it was not for the enormous amounts of money that have had to be taken from elsewhere in order to sustain a public transport system in Wales.

Okay. Thank you for that. I want to move on to flooding as well. Clearly, that's something that we're, unfortunately, very familiar with in Wales. I don't want to ask you a general question about how prepared we are, or how resilient we are. I know you tell us about moving to a catchment-area approach and managing nature-based solutions, et cetera. I just want to ask a more specific question, really. Natural Resources Wales, of course, have a key role to play in the work that we have around flooding here in Wales. They were provided with additional funds last year to make up that £1 million gap in resource that they had, to be able to meet what was needed to be delivered. I'm just wondering whether your intention is to ensure that that funding remains, and is even baselined into their budget. Because you will know, as much as I do, that they've experienced a 35 per cent real-terms drop in funding since their inception in 2013. I'm worried, as many others are, that, clearly, with a diminishing resource like that, there'll be a diminishing level of contribution that they can make.

I definitely agree about the importance of the work that NRW does in flood risk management. The money that has been provided to NRW has, to a significant extent, been used to augment their staffing capability in the flooding field. They've been able to increase their establishment by 52 new posts in the flooding area, and 39 of those are currently filled. I mustn't, I'm afraid, anticipate what the finance Minister will set out in her draft budget on Monday, but I can put it in this way: I don't think that we would have embarked upon a recruitment exercise of that sort, and then expected those posts to come to an end almost as soon as they've been recruited.

Thank you. Finally, then, if I may, Chair, the Warm Homes programme, we're awaiting the consultation on the future of the programme, or its successor programme. The fuel poverty plan promised that consultation in June—that didn't happen. The 'Net Zero Wales' document promised a consultation, to begin by the end of this year; so we're in the dying days of that window, really. I'm just wondering whether—it might be an unfair question—you know when that intends to begin. But the more pertinent question really is, clearly, if that starts now, as we hope it will, it will be 2023 before there's a successor scheme. Nest and Arbed will have long come to an end by then, and there's a question as to whether the Government's intention is to continue with Nest in the interim, which, on the face of it, would seem sensible. But, of course, in light of Audit Wales's criticism, if you like, that Nest is very much a boiler replacement scheme now, which locks in fossil fuel to those homes, then maybe that might not be the best approach.

Llyr is quite right to point to some of the complexities here. The sorts of measures that we have used in the past, which were designed to improve fuel efficiency and to release money into the household budgets of people who were otherwise using inefficient and old-fashioned ways of heating their homes—they don't necessarily match up to what is needed in an era of a climate emergency.

So, I know that the Ministers who have an interest—and it's not just one Minister here; it is obviously Julie James in her housing and climate change capacity but it's Jane Hutt as well from a poverty perspective—are working hard together to try and make sure that the funds that we use in future, that those two ambitions are aligned, that we go on trying to improve the lives of people who live in fuel poverty, but that we do it in a way that makes a positive contribution to the net-zero carbon future that we need to create in Wales. Those things have not always been aligned in the past, because we weren’t always as aware of a need to do things in a different way 10 years ago. But we are aware of it now and a lot of work is going on to make sure that, when we are in a position to announce the successors to the Arbed and Nest programmes, a programme will be able to bring those two things together.

First Minister, in the sense of culture, the culture committee has very much looked for a cultural strategy from the Welsh Government and is asking for one to be put in place. Linked to that clearly is the question of the cultural recovery funding that was initially allocated. Now as we are going through—. You’ve identified yourself this afternoon that there are sectors that are facing some serious challenges, sometimes because of the way in which people are walking with their feet, but it’s not just hospitality—there are other cultural sectors as well. Are you looking at developing a cultural strategy, and how is that going to be impacted upon by the latest omicron variant to ensure that those sectors are also able to survive during this winter period?

Well, in the short run, Chair, I have seen advice that has gone to the Deputy Minister responsible for culture that looks to mobilise fresh support for the sector in the immediate future. That advice will have gone to the finance Minister as well. So, Ministers have got advice in front of them. It puts sums of money against different parts of the sector to help them through the weeks and months ahead. And as soon as Ministers have had a chance to consider that, and if they do approve it, then there will be an announcement imminently of that additional support.

And will that lead into the development of a culture strategy?

Well, it will do in the sense that we need to find a path for the cultural sector beyond coronavirus. That is not an easy path to plot because coronavirus is still very much with us and having a very direct impact on the sector. But the cultural sector in Wales is one of our great success stories. It employs lots of people—many more people than in the past; there is lots of investment from outside Wales coming into Wales. There are very high-profile results from that in terms of television series and film-making and so on. And so, it is a sector with some very, very significant long-term strengths, but some equally significant short-term challenges and the strategy has to balance up finding ways of keeping the sector going and on its feet and then finding ways in which we can capitalise on those strengths of recent times to go on growing the sector and to—. In many ways, one of the big challenges is to grow the workforce with the skills necessary to be able to go on attracting work into Wales. So, that is how the strategy is being considered.

Thank you, First Minister, and I think we’ve come to the end of the first section. James, a quick supplementary.

I was wondering who was unmuting me then. But, anyway, First Minister, just really quickly on culture with COVID passes—it’s a really quick question: what would the requirements need to be for COVID passes to be repealed in Wales? I have asked this question in the Chamber before, but I think it would—. I know we’re in the midst of a new rise of the omicron variant, but there must be some parameters that Government have where COVID passes will be repealed and I’d be very grateful if you could outline those today. Diolch, Cadeirydd.

Well, in very broad terms, Chair, I think what we’d need to do is we would need to look at that basket of indicators that we use in the coronavirus control plan, and see where those indicators were in the period before COVID passes were necessary. So, the basket of indicators are all the ones that Members will be familiar with: positivity rates, prevalence rates, hospitalisation rates, vaccination rates. Now, not that many weeks ago, we were in the happier position where those numbers were low enough that we didn’t need the extra protection that the COVID pass provides. We all look forward to the day when the numbers will return to those sorts of levels, and we can lift some of the things that have been necessary in more challenging times. But that’s what I would look for. I’d look at the indicators set out in the control plan, and then I’d broadly—this is broadly—look at where those indicators were in the period leading up to the need for the pass, and that’s where we’d like to return to.

And on that basis, obviously, since we’re talking about omicron, we understand, usually, there’s a two to three-week gap between cases arising and hospitalisation. So, with an expected peak at the end of January, we are looking towards the end of January, early February before we actually have an understanding of whether we see those decreasing or not.

Well, that is certainly true, Chair. I was being advised earlier today that the nature of the omicron wave will be, if the modelling is true, very intense over a relatively short period of time, that that gap that we’ve got used to—that two to three-week gap between community spread and hospitalisation—is likely to be highly compressed as well, and that we’re much more likely to see rapidly growing hospital numbers alongside rapidly growing community numbers, rather than there being the lag that we’ve got more used to. Now, all of this is modelling, and all of this is slightly speculative. But if you look at the hospitalisation rates in London and Manchester in the last couple of days—25 per cent up in London, more than that in Manchester—it does look much more like community transmission and hospital impacts are closer together than in previous waves.

Thank you.