Plenary

The next set of questions will be questions to the Cabinet Secretary for Health and Social Care, and the first question is from Delyth Jewell.

We remain firmly committed to reducing stillbirths and neonatal deaths by ensuring that all families receive safe, high-quality care. The quality statement for maternity and neonatal services sets clear national standards for consistent, evidence-based practice. Alongside this, the strategic maternity and neonatal network is driving system-wide improvements to reduce mortality and prevent avoidable harm through its safety support programme.

Thank you for that.

The stillbirth rates in Wales do remain stubbornly higher than the rate for rest of the UK, and baby loss charities like Sands highlight how more needs to be done, in their view, to bring down the numbers of babies who die shortly after birth as well. Losing a baby at full term must be one of the worst things any parent will face in their life. My heart goes out to anyone who’s been affected by such a cruel loss. I think everyone in this Chamber will be united in that.

A group of bereaved parents have launched a petition to call for action to save more babies' lives and for better care for parents following pregnancy or baby loss. They have drawn attention to how, in England, targets to reduce rates of stillbirth and neonatal deaths have helped hold focus, and although they may not be met, they believe firmly that this will have led to lives being saved. I appreciate all of the work that is evidently going on in the Welsh Government on this. I can appreciate how much of a focus this will be, but no such targets do exist at the moment. Is that something that you think should change, please?

Well, I would associate myself with the comments that the Member has made. The loss of a baby at any stage of pregnancy is an incredibly distressing experience for all those who are affected. Stillbirth rates in Wales have declined by around 17 per cent since 2010, but there has been a plateauing, effectively, since 2018. There’s been little change since then. The point that the Member puts to me in relation to a target is an important question. We’ve not set formal numerical targets to date, partly because of the small number of instances and the volatility that brings in terms of measuring performance against a particular target. But I’m grateful to her for acknowledging the other work that is going on in relation to tackling this challenge. All health boards are delivering targeted improvement work through the maternity and neonatal safety support programme, which I mentioned in my initial answer, including enhanced clinical reviews, adoption of national early warning surveillance systems, safer pre-term birth care bundles and better learning from incidents through structured case reviews.

The Member will know that I’ve commissioned a review of maternity and neonatal services across Wales, which is due to report early this year. That’s there to identify risks and make recommendations on how we can further strengthen services, and I will want to engage as quickly as possible with the recommendations that that review makes.

Thank you to Delyth for asking this very important question. I have mentioned on several occasions my two very special nephews, Steffan, who passed away soon after being born, and Emrys, who died at eight days of age, over the past four years. On both occasions, no-one was to blame, and targets would have made no difference at all.

What I’d like to raise, and this is also appropriate to the Minister for mental health, is the matter of counselling for parents after such an awful loss. In Steffan's case, there was no counselling available to the parents following their loss, because Steffan was not in the neonatal intensive care unit. He was in the maternity ward, and there was a waiting list of 24 weeks for counselling support for the parents through a charity. Just imagine going into hospital, into the maternity unit, expecting to go home with a healthy child, expecting to start a long period of maternity leave, and then suddenly everything shattering. You're expected to return to work without any professional counselling being available.

The experience for Emrys's parents was slightly better—there was a psychologist available at the hospital whilst Emrys was still with them. But, afterwards, they had to wait a long time for counselling through charitable provision, and the engagement with a bereavement nurse was only available over the phone, rather than face to face. How is the Cabinet Secretary working with the Minister for mental health and health boards to ensure that parents, at the worst possible time in their lives, receive the support that they deserve? Thank you.

I thank the Member for sharing his own experiences in his contribution.

He makes an important point about the approach to improvement in this area generally, and I think he makes an important point about the limits of targets as well. And our approach, certainly, has been an improvement-first approach, with national standards and independent assurance.

As I mentioned in my response to Delyth Jewell, the experience of parents and the wider family around baby loss is incredibly traumatic, in the way that he described in his question, and they may feel that their bereavement is not always acknowledged or supported, sometimes even hidden. The national framework for bereavement care seeks to ensure a consistent approach across Wales, and it has funding that is distributed both to health boards themselves and to third sector partners, who play a very important part in delivering some of these services.

He describes shortcomings, clearly, in the experience of the parents that he refers to. The maternity and neonatal network has been working with Sands, which Delyth Jewell referred to in her initial question as well, to support work on five bereavement pathways and we are hoping that the pathways will be scheduled for publication in March of this year, and I hope that they will contribute to solving some of the challenges that he set out in his question.

I just want to follow on from what Rhys ab Owen is saying, just to say that there is an excellent bereavement service at Betsi Cadwaladr University Health Board, which is served by at least two members of staff and ensures that, even if a death occurs in the middle of the night, it will be picked up during the day and then that individual does get support, and that means all individuals who suffer from bereavement. It seems to me that that is a very good model for all other health boards to follow.

I'm grateful to the Member for drawing attention to that positive experience in the service that she refers to in Betsi Cadwaladr health board. One of the approaches of the maternity and neonatal assurance assessment that is currently under way, which I mentioned a moment ago, is not simply to identify where there are shortcomings or areas that we need to focus better on, but also to identify good practice in the system, which can guide improvement elsewhere. So, I'm grateful to her for contributing to our understanding on that.

We have supported the health board to create a centre of excellence for orthopaedics. All elective orthopaedic surgery within the health board has now been centralised on the Princess of Wales hospital site, with three dedicated theatres and a ward of 28 beds for in-patient elective surgery.

Thank you for that answer, Cabinet Secretary, and I welcome the capital investment that has been put into the repairs at the hospital. That said, the hospital's orthopaedic service continues to face pressure to restore full operating capacity after that temporary suspension of elective procedures, which, in turn, then has contributed to extended wait times across the speciality.

A constituent of mine has now been waiting over a year for a knee operation, experiencing repeated hospital admissions, with no confirmed date, despite being prioritised as soon as theatre capacity allows. Now, if this situation continues, he will be forced to shut down his business entirely, leaving seven people, including himself, unemployed. I know there are many such cases, and I appreciate the difficulty of getting through the backlog with the same staffing complement and the resources available, as outlined there by the Cabinet Secretary, but I would be grateful if the Cabinet Secretary could set out what further support could be provided to the hospital to help manage this, and if a rough indication could be provided as to when we can expect those wait times to come down.

I'm happy to do that. I'm sorry to hear about his constituent's experience. We have taken specific action to support the health board to reduce orthopaedic waiting lists, which has historically been a challenge, in the way that the Member refers to. An additional £11 million has been allocated to the health board in relation to waiting time reduction specifically, and there has been work from the Getting It Right First Time team, and, of course, from the ministerial advisory group on productivity and performance.

There has actually been a 19.4 per cent reduction in the number of orthopaedic pathways waiting for more than two years. There is still a challenge, in the way the Member describes, but I expect those to be cleared by the end of this year. There has also been more than a 43 per cent reduction in the last year in the number of pathways over 52 weeks for the first out-patient appointment, which is probably more relevant to the point that he made in his question. I raised with the health board, as the Member may be aware, in the recent public accountability meeting, issues of waits and the plans to clear waits in a timely fashion. I had assurance in that meeting from the board that they intend to eliminate all two-year waits but also all eight-week diagnostic waits by the end of March this year.

Cabinet Secretary, I welcome the support for the Princess of Wales Hospital and the creation of a centre of excellence for orthopaedics, with its three theatres and a dedicated ward with 28 beds for in-patient elective surgery. The health board states that, at full capacity, they will be able to carry out 60 orthopaedic surgeries per week. My concern is whether we will have suitably qualified staff to utilise this increased capacity. For well over a year, no operations were conducted at PoW. What happened to the orthopaedic surgeons in that period? We surgeons have to carry out a range of operations during any calendar year in order to maintain our skills. Cabinet Secretary, are you satisfied that all those operating within this centre of excellence for orthopaedics have maintained their skill set?

Well, that's a matter for the health board to be satisfying itself about. I speak as a non-clinician addressing a question from a clinician, so I'm diffident in the confidence with which I approach my answer. But he makes an important point. In my visits to hospital sites in the Cwm Taf Morgannwg University Health Board area, I have been very pleased to hear the approaches that they have taken to rostering and to staffing more generally. By centralising services in the way that I'm sure he would welcome as well, that has provided a more robust, flexible model for staffing, both clinically and otherwise, to deliver the significant figures that he acknowledged in his question. It's that sort of adaptation of services, driven by GIRFT and other recognised standards, that will help us not simply to address the backlogs that we face, but to put the service on a sustainable footing, where those backlogs don't arise again in the future.

Questions now from the party spokespeople. Conservative spokesperson, Darren Millar.

Cabinet Secretary, just last month, a 90-year-old woman from Wyesham in Monmouthshire, Iris Morgan, waited for more than 32 hours for an ambulance after breaking her hip while at home. During that time, she became increasingly delirious, she developed a serious infection, and she was told by hospital consultants that that delay could have been a terminal event. Her family made repeated 999 calls, they were given estimated arrival times that didn't materialise, and they were advised not to move her themselves, leaving this vulnerable elderly woman in pain, on the floor, in distress, for more than a full day. When the paramedics finally arrived, they themselves were shocked at the length of time that Iris had to be on the floor, and they blamed this on ambulance transfer delays at the Grange hospital. Do you agree, health Secretary, that what happened to Iris Morgan was totally unacceptable? Will you apologise to her and her family and the others around Wales that are experiencing excessive ambulance delays? And do you accept that this is a symptom of an NHS that's in crisis?

I don't believe that her experience is acceptable, and I'm very sorry for the experience that she has had and those affected by it more broadly than her own personal experience. That is not an experience I want any patient in Wales to have, ever.

I think it is a symptom, as he says, of challenges right across the health service, and I think it goes beyond the ambulance service. My experience of working with the ambulance service is that they are innovative and flexible, and looking for new ways constantly of delivering the important service that they can.

We've sought to address this as a Government in a number of ways. Firstly, by reducing the incidents of ambulances waiting outside hospitals for prolonged periods right across Wales. Year on year, there have been significant reductions in the numbers of hours lost—patients waiting in the back of ambulances, ambulances not available, therefore, to be attending to patients like the one he described in his question. So, that is good progress. I want to see more of that happening in all hospital sites. There's too much variability. But what that tells me is that the system, when it focuses on that, is able to make rapid progress.

The Member will also know that we have introduced new arrangements to measure the performance of the ambulance service, and the ambulance service itself has introduced a clinical triage model that we know is making a difference for patients. I think those are positive developments. Obviously, some of those are recent, and we want to see those being embedded and delivering a better service for patients right across Wales.

Well, you didn't answer the question that I put to you, which was: is this symptomatic of an NHS that is in crisis? I believe that it is. I believe that the Welsh NHS isn't working properly. It certainly didn't work properly for Iris, and we all have examples in our constituency of people who contact us with unacceptable delays, and sometimes people die because they're waiting for an ambulance, and that can never be acceptable.

Let me give some other examples of why I believe the Welsh NHS is in a crisis. You don't have to look very far—just to the University Hospital of Wales here in Cardiff, the flagship hospital in our nation. But it's another example of the NHS in crisis and being broken. Wales Online has reported that a 77-year-old patient had a lung infection and was left shivering after the heating failed in that building, an 80-year-old wet from the dripping ceiling of a pigeon-infested catacomb—the daughter describing her loved one being transported via, and I quote, 'disgusting' tunnels, flooded in places, with discarded medical items and rubbish present, and bird faeces everywhere. Can I ask you: why isn't the Welsh Government stepping in? There was a letter signed by 300 consultants in the Cardiff and Vale hospital, directed to the bosses of the health board, describing staff morale, and I quote, at 'an all-time low'. That letter described persistent sewage leaks, causing water damage. and poor cleanliness. And here's the key line from that letter, Cabinet Secretary, and I urge you to listen very carefully to this and address it in your response:

'Years of insufficient maintenance and capital investment have compounded these problems, and no clear strategic plan has been shared to address or mitigate the associated risks.'

Now, there was a promise made to the people served by that hospital back in 2021 that you'd build a new facility. It's not been delivered. Do you have a plan to deal with dilapidated buildings like the one that we see just down the road here in Cardiff, and what action are you taking elsewhere to address problems in the NHS estate?

Well, on the Member's first point, I actually think that the public in Wales, and patients in Wales, are better served by a response to his question that engages with the substance of the challenge, rather than looks for a headline in a one-word descriptor of the NHS. And I think, for too long, we've allowed a debate to continue that does not have that level of transparency and honesty behind it. And I'm seeking to acknowledge the concerns that you're fairly describing, and to give you my understanding of why they're arising. I think that's a more helpful way of leading a discussion with the public than simply for looking for labels on the NHS that simplify the challenge.

On his second point, he is new to his new responsibilities, but he will know that I've addressed the question of that letter. And, again, it's been put to me perfectly fairly, by colleagues of his and others, on many occasions. One of the challenges that the NHS in Wales faces, as in other parts of the UK, is that it's had insufficient access to capital over the last 10 to 14 years as a consequence of policy choices made by a Government in Westminster that he consistently defends. The NHS and public services have not had access to the capital that they need. That has a consequence. What this Government has done is sought to prioritise within the constraints that his colleagues in Westminster have imposed on us for over a decade, and we have made maintenance commitments above and beyond that which other parts of the UK have made. As he will know, we are already funding the health board to undertake an estate survey of that hospital so that we can better target future funding.

So, can I just get this right? You refuse to acknowledge there's a crisis, right? If you don't think that something's broken, you're never going to come up with a plan to fix it. You blame this on money, so why make the promise in the first place if you say there's insufficient money? And can I remind you, Cabinet Secretary, that, for every £1 spent on a patient in England, the Welsh Government's budget gets £1.20 to spend on a patient here. That doesn't sound like deficient funding to me. The First Minister herself, in First Minister's questions yesterday, told this Senedd, and she seemed to be boastful about it, that the Welsh Government was spending £1.12 for every £1 spent on a patient in England. What are you doing with the other 8p? What are you doing with the other 8 per cent that you could be uplifting the Welsh Government's budget by? So, can I challenge you again? Can I challenge you again? Why on earth don't you make sure that every penny that comes to Wales for spending on the NHS goes on the NHS, so that we can fix this crisis once and for all?

The Member knows very well that there's a difference between the point that the First Minister made yesterday and the point that I'm making today. There is no credible commentator anywhere that believes that his party in Westminster properly provided capital to the health service in any part of the UK. That is not contested. It has consequences. He will also know very well—and some of his more nuanced Members will acknowledge this—that the funding the Welsh Government makes available to both health and social care is significantly in excess of that which is provided over the border. I'm not interested in making those comparisons, by the way. We want to make sure the service in Wales works to the best extent possible for the public in Wales. He makes a completely misleading point about the figures made available from the Westminster Government. Capital has been in very short supply, and this Government has prioritised that funding on the health service.

The Plaid Cymru spokesperson, Mabon ap Gwynfor.

Thank you very much, Llywydd. Last year, the Betsi Cadwaladr University Health Board pledged that waits of more than two years would be eradicated completely by the end of 2025. Following an independent inquiry into gaps in the data in the health board, we now know that the total pathways waiting over two years had reached 4,679 in October 2025. We've also received information that suggests that more than 100 patients had been waiting more than three years for treatment. What went wrong? Why are people in north Wales having to wait longer than anywhere else for treatment? Given that it's this Government that appointed the board, why has the Government failed so entirely in holding them to account?

I don't think we have failed to hold them to account. As you know, we've been very clear in terms of our expectations of the health board. It's not acceptable that people are waiting for the length of time that you mentioned in your question. I want to see people in every part of Wales receiving a prompt service, and that they receive the treatment that they need as swiftly as possible. It's not acceptable that that isn't happening in any part of Wales, including Betsi Cadwaladr health board, where we've seen that additional support is needed. We have taken direct action. Before Christmas, we ensured that a team of people were available to the board and the leadership there to support them in their work, to ensure that we see the improvements that we want to see. They have just started their job of work, and I hope we'll see progress in that regard too.

Long waiting lists and the chronic dysfunctionality of Betsi Cadwaladr are merely symptoms of a wider problem, namely Labour's failure over 27 years to redesign the foundations of the health system to reflect the population as it is today and as it will be, rather than as it was. The Government, and the First Minister in particular, often frames its performance on health in terms of the sheer number of NHS contacts that happen in Wales on a daily basis. But it bears repeating once again that this isn't a sign of success, it's a sign of managing sickness and of a system that isn't functioning as effectively as it should. For example, an FOI request by Plaid Cymru has revealed there were 17,994 attendances at Betsi's emergency departments in 2025. That's an average of almost 50 a day, which ultimately resulted in the patients self-discharging without clinical consent. In other words, they were either not treated at all or they didn't receive the level of care recommended by a clinician. Now, by the Government's metric, these attendances would presumably qualify as contact with the health system and thus something to be celebrated, even though it didn't improve their outcomes.

We all know why patients are resorting to these steps. It's because access to GP appointments is fast becoming a scarce luxury. It's because the process of expanding and reforming care in the community has been slow, and it's because there has been insufficient strategic focus on enabling people to live healthier lives. So, do you agree with me, therefore, that these figures I've just quoted illustrate the reality that talking about the total NHS contacts as a measure of performance is fundamentally flawed, and that it speaks to the prolonged failure of successive Welsh Governments to place our health system on a sustainable and resilient footing?

Well, I think the Member may have misunderstood the purpose of making that point clear. It isn't a point to celebrate; it's a point that indicates the scale of activity in the health service. I think that is something that is important to highlight. There are people working day in, day out to deliver a huge amount of support to people every single day, and most people's experience of the NHS, most of the time, is a positive thing. So, I think it is important to describe the scale of activity happening throughout the NHS. He makes an important point: that isn't something that is a celebration of success, it isn't, actually, a performance measure; it simply indicates the scale of activity, and I think he would pay tribute to all those contributing to that level of activity as well.

He makes an important point about the need to move services from secondary settings into primary settings and more broadly into community settings. I would say the Government has a good track record in doing that. There is much more that needs to happen and it needs to happen more quickly. But I think that he will, I'm sure, be encouraged by the fact that we've been able to reach an agreement with general practitioners that extends over more than one year, giving the system clarity and visibility of how services can move. Each health board has specified their current level of spend on primary care, has submitted plans for moving services over the next five years into primary and community settings. So, I think there has been a significant shift. Obviously, there is more to do.

Finally, I've raised the importance of our allied health professionals many times in this Chamber. They are integral if we are to develop a comprehensive preventative health service, key in ensuring that people re-enter the workforce, and essential in ensuring that many of our loved ones continue to live a fulfilling and dignified life. Yet, last September, I wrote to you asking why the post of chief allied health professional had not been advertised and you responded saying that the post would be re-advertised shortly. We are now in late January, and the post continues to be empty, leaving a gaping void in leadership and the voice of AHPs missing from the decision-making process. No date has been announced for the re-advertisement of the role, following the unsuccessful first round of recruitment in early summer, and no interim CAHPO has been appointed whilst a replacement was found. Does this Welsh Government consider AHPs as secondary service providers? And when will we see a new chief allied health professional appointed?

No. I can confirm that the Government does not see allied health professionals as a secondary part of the workforce. The strongest evidence for that is the increase in the numbers of recruitment and commissioning of training places across a range of AHP professional specialisms. He is right to say that without that diversification of the workforce, we will not be able to provide the kind of services that he and I both want to see, which is a strengthening of person-centred holistic care in community settings wherever that is possible. I would not take the indication of one post as being an indicator of the Government's broader approach. It is an important post. He is reminding me that from a sedentary position. I would assure him, though, that I've had numbers of conversations with Welsh Government officials in relation to the AHP workforce specifically, and so the voice of AHPs is certainly heard, both by Ministers and the civil service.

The Public Health Wales screening engagement team work closely with the voluntary sector, health board and the local authority, including through community connectors and hub officers within the Islwyn area, to increase awareness of screening through community education and training, and involvement in the screening engagement network.

Thank you for that response, Cabinet Secretary. According to the Western Mail, 15,000 women due to be screened for breast cancer in Wales have not been due to non-take-up of breast screening. The Senedd's Petitions Committee heard that only 69 per cent of women invited for screening attended those appointments in 2022-23, below that 70 per cent minimum and the 80 per cent target. So, Cabinet Secretary, as you were quoted in a letter to the Petitions Committee that uptake rates can vary across regions, age groups and socioeconomic backgrounds, and that's correct, due to the important impact of women self-selecting much too often to not be screened, what is, then, your assessment of the reasons, and what are the mitigations planned? And can you also, Cabinet Secretary, outline the breast screening uptake rate for Islwyn within Aneurin Bevan as compared to the national targets and the comparative uptakes across Wales?

Certainly. In relation to screening uptake in Islwyn, Public Health Wales monitor uptake rates by GP cluster, by local authority and health board area. So, the uptake for Caerphilly county borough is 71.2 per cent, and for the Aneurin Bevan University Health Board area 70.5 per cent. Both of those are slightly above the standard of 70 per cent. She's right to say there are many reasons women do not take up the offer of breast screening. This can include lack of awareness, sometimes misinformation, sometimes cultural and language barriers, anxiety about the process or results. It is, ultimately, a matter of personal choice, but it will be shaped by a number of those factors and others. Breast Test Wales constantly evaluates and implements strategies to promote participation in the programme. Each year, over 100,000 women take up the offer. The uptake is lowest in the most deprived communities. So, in order to address that, the screening programme provides targeted outreach in communities, including training community champions who are there to act as trusted voices to support people to take up their screening offer. Uptake is also lower in the younger age groups, which aligns with uptake being lower in those who are invited to screen for the first time. So, the programme has now produced video material to help people understand what breast screening is and why it is important.

Minister, I believe it's everyone's responsibility to ensure that the 80 per cent target for breast screening is achieved. To me, it was my second Petitions Committee, and I was shocked at the low figures in some constituencies. A significant barrier appears to be the static nature of mobile units. For example, I am told that the Ynys Môn unit is constantly in Holyhead, whilst in my own constituency it's constantly in the village of Ystrad Mynach. Minister, will you please review the deployment strategy for these 11 mobile units to ensure they rotate through the more rural and isolated communities and towns, and the poorer communities that you just mentioned, rather than remaining in the same fixed hubs every single cycle? We need to increase the hinterland of those mobile units. You mentioned that it's amongst the poorest communities. If it's too far away, people can't even afford to travel there. Thank you.

I agree that reducing those barriers to access is absolutely essential. There are currently 11 mobile units in Wales, and they rotate across more than 100 locations on a three-year cycle. The intent of the programme is that they're located within, as he says, easily accessible locations, and he will be aware of them being in supermarket car parks and other places. There is a strategy, which Public Health Wales is currently refreshing, which is the screening equity strategy, which is designed to ensure that screening is accessible to all communities and to all individuals who need it. That strategy is currently being refreshed through the course of this year, and there will be significant stakeholder engagement to inform the new strategy. I'll make sure that his comments are heard as part of that.

Cabinet Secretary, I too have been made aware of this petition, which I found quite shocking, that has now been signed by 4,000 people and rising. It is absolutely essential that we hit that 80 per cent target, and I'm sure that the Cabinet Secretary will agree with me, and the Members who have already spoken, that nearly 16,000 women having not been screened, and that 150 of those could have been detected with having early signs of cancer, is very concerning. So, my question to you is: why haven't these women taken up the screening? Why is it that take-up has been more successful in other parts of the UK? And will you be making an awareness campaign on this on social media and tv? Diolch.

Yes, as I've already answered to previous colleagues, there is a range of reasons why screening offers are not taken up, some of them are things that Government can act on, together with the health service, to address, others are more complex and are common in other parts of the UK as well. Breast Test Wales has a continuing programme of evaluating the strategies that we currently have to promote participation in the programme. She will have heard me say that some of the areas that we've been looking at specifically are targeting particular cohorts of women, where there is underrepresentation in the uptake, and I hope that we'll see better progress against those targets in the months and years ahead.

The average time spent by patients in emergency departments in November was 2 hours and 53 minutes. However, time spent by many patients in departments before admission or discharge is concerning. In response to this, we've escalated health boards for poor performance, we've invested £200 million to strengthen community care, and launched a national programme to support health boards to improve their performance.

Thank you. Well, it's all well and good for the First Minister to have stated yesterday that, after 27 years in power, they recognise that,

'more needs to be done to ensure that we do not see that corridor care that compromises patient privacy and dignity.'

Only this month, the Royal College of Emergency Medicine stated that clinicians across Wales are warning that emergency departments are under unprecedented and unsafe pressure, adding that, between January and November 2025, nearly 112,000 patients in Wales waited over 12 hours in emergency departments. They estimate that 936 excess deaths in 2024 were associated with long emergency department waits. In north Wales, the situation is particularly severe, with a fifth waiting 12 hours or more at Ysbyty Gwynedd emergency department, a quarter at Wrexham Maelor Hospital and nearly a third at Ysbyty Glan Clwyd.

Corridor care is becoming normalised, driven by a lack of available in-patient beds and delayed discharges linked to shortages in social care and community capacity. How do you therefore respond to the royal college's call for urgent action to improve whole-system patient flow, rather than a predominant focus on redirecting patients away from emergency departments?

Well, I think it's worth bearing in mind that, despite some of the figures that the Member has referred to in his question—it's also worth bearing in mind from a context point of view—the median time from arrival at an emergency department to triage was 16 minutes, which is, I think, the best performance in four or five years. And the median time from arrival to assessment by a senior clinician was 79 minutes. I've already mentioned the median waiting time to be admitted or discharged. So, it's important to bear that in mind as well as addressing the challenges that the Member fairly puts to me.

I wouldn't say that the focus has been on one part of the system. He's absolutely right to say that, where corridor care takes place—. And the Government's position is very clear: we do not endorse that as a routine measure, though recognising that, in certain circumstances where there is local escalation, that does obviously occur, as we can see at the moment. I think it's about a whole-system focus on better flow through the hospital. That is partly to do with delayed discharges, it's partly, also, about improving hospital performance on early discharges during the hospital day. We've seen a focus on that, particularly in the two-week sprint that we undertook before Christmas. We saw an improvement in that, which did lead to improvements in reduction in corridor care, and the second of those two-week sprints is starting today. I very much hope that we'll see an improvement over the next couple of weeks. Critically, though, we don't want to see these improvements during isolated two-week windows; we want to see this as a systemic improvement. But what it does tell us is that, with a focus on this issue from different parts of a hospital and services around the hospital, we can see improvements.

Public Health Wales is responsible for co-ordinating and delivering screening programmes in Wales. They are continuously assessing and implementing interventions to support uptake across all screening programmes, addressing inequities and working with communities through the screening engagement team to understand and overcome barriers to participation.

Diolch. As Chair of the Petitions Committee, I also wish to raise with you a recent petition submitted by Breast Cancer Now. We also heard, during the Petitions Committee—well, prior to the meeting—from Sheila from Ynys Môn. She said that, due to early detection, she just needed a lumpectomy and radiation, rather than the more debilitating chemotherapy. So, it's really important that we get women to screening, and, as you've just heard earlier, if the 80 per cent target was met, 15,871 more women would be screened and 156 cancer cases would be detected. There will be a report coming from the Petitions Committee, with recommendations to you, including having a publicity campaign regarding promoting the uptake. Cabinet Secretary, I hope this is something that you will help take forward with Public Health Wales on breast cancer screening. My question, I can't ask, because it's already been asked previously by the other Members there in the Chamber, so thank you.

I'm grateful to the committee for its work, and I will be very keen to see what recommendations and advice the committee provides. It is important that we make sure that women have access to screening and take up the offer in greater numbers. I would also say, if I may, as context, that this is an approach that we also want to see in relation to other forms of cancer as well, so the extension of the screening range for bowel cancer and the introduction of the new lung cancer screening programme in Wales are all manifestations of our commitment to making sure that we make screening as accessible as possible to as many people as possible in all parts of Wales.

The Welsh Government promotes pharmacy services through the national Help Us Help You campaign. This high-impact approach ensures strong public awareness of how community pharmacies provide timely advice, treatment and accessible care.

Thank you for that answer. I believe our pharmacies and our pharmacists provide an excellent service, but sometimes they're underutilised because people are not aware of the services and the information they can access from their pharmacist. Earlier this month, a local pharmacy ran a pilot and opened on a Sunday for six hours. What they did was they posted on social media advertising this fact to see what interest there would be and to encourage people just to go along, ask for advice and see what services were there. The feedback from individuals who did go—. It was a very busy pharmacy that day, I understand, but the feedback was just how surprised people were that so much was on offer there.

Of course, we both know that pharmacies can take a huge amount of pressure off other aspects of the NHS, particularly in the primary care sector. So, I wonder if you could expand a bit more on what advice and support Welsh Government is giving to pharmacies to make sure all constituents are aware.

Yes, certainly. So, the Help Us Help You campaign—this cycle of it launched on 1 November—is there to provide that information, so patients or the public can look first to go to their pharmacy for whenever that's appropriate. Of course, we have large numbers of independent prescribers in pharmacies now, and we will shortly be in a position where everybody qualifying as a pharmacist in Wales will be able to prescribe. And so there's a huge opportunity just ahead of us in order to ensure even more of a contribution, above and beyond the great work pharmacies already do.

So, the campaign itself focuses obviously on promoting pharmacies and it runs across tv, radio and social media as well, and we've developed stakeholder toolkits, which have been shared both with health boards and pharmacies themselves, to ensure what I think is important, which is consistent messaging about the offer, so that the public understand what's available and where. Since the launch of the campaign, we've had quite significant numbers of people accessing the information and I think we can also see an increase in the use of the common ailments service as a result of that. In 2023-24, there were over 340,000 common ailments service consultations in pharmacies, and in 2024-25, that had increased to over 0.5 million. So, there's a steady and significant increase, I think, in the availability of consultations in that way.

There is obviously more that we can do, and what I think is one of the strengths of the common ailments service is that it has built incrementally and has added extra functionality and extra services year on year, and we can see that making a real difference.

One of my top priorities is to ensure that waiting times across Wales fall and people can access treatments in a timely manner. To do this, we have supported health boards with additional investment, national and clinical support, and have prioritised regional working for specialities such as cataracts and diagnostics.

Thank you for your response, Cabinet Secretary. Despite a lot of warm words from the Government, the shamefully high NHS waiting lists remain, with residents across Wales, including my own constituents, forced to wait in pain. It's shocking, but perhaps not surprising, given Labour's shoddy mismanagement of our health service over the past 27 years. And let's not forget that Plaid Cymru are just as culpable, jumping into bed with the Government time and time again.

Cabinet Secretary, I want to highlight an appalling situation one of my constituents has been facing when it comes to healthcare here in Wales. My constituent was told in August 2024 that he would need surgery to repair a flap on the top of his stomach, with an expected wait of 52 weeks. In May 2025, my constituent sought an update on the waiting list and was at that point told that he now faced a wait of more than 80 weeks. In December 2025, he checked in for another update and was told that he faced a 76-week wait. In January this year, of 2026, he was told that he should face a wait between 105 to 110 weeks. Cabinet Secretary, how can it be that my constituent's original wait has more than doubled from the original 52-week wait to potentially 110 weeks? I thought that this Government was supposedly getting to grips with waiting lists, but clearly that's not the case.

I'm sorry to hear about her constituent's experience, and I'm obviously not able to comment on that particular situation, but I hope that she will write to whichever health board it is so that they can address the concerns that she is raising with me today.

Just as context, I think it is important to note that the additional investment and focus that the Government is bringing, and has brought for some time, on reducing long waits has meant that over the last 12 months, across health boards in the south-east region, the kind of long waits that she is referring to—waits over two years—have fallen significantly: a 76 per cent reduction over the course of a year. Over the same period, the number of patients—. Well, she's shaking her head, but these are indeed the facts, and I know that those are difficult sometimes for the Member to accept, but they are in fact the case. Over the same period, the number of patients waiting for a first out-patient appointment over two years has fallen by 95 per cent, and I expect that to be at zero at the end of this year.

Some of those figures remain far too high, but in the interests of having a transparent debate about what is happening in the health service, I think it is important to see that broader picture, as well as acknowledging the situation her constituent finds himself in.

Improving access to healthcare and reducing waiting times is a priority for this Government. We have taken direct action to support the health board to reduce its orthopaedic waiting lists. This includes support from NHS Wales Performance and Improvement, the clinical orthopaedic network and the Getting it Right First Time team.

Thank you, Cabinet Secretary. According to the most recent data, more than 1,500 patient pathways in Cardiff and the Vale are waiting over two years. But I was very pleased to read about the developments in Llantrisant Health Park. There, it is good to see collaboration between three health boards to tackle demand for orthopaedic care, by creating up to six theatres and 54 beds in phase 2 of that project. It is predicted that the total capital costs will be £123.6 million, with £1.93 million funded to date. According to the modelling, £1.54 of value will be delivered for every £1 invested. When does the Welsh Government intend to announce further investment in Llantrisant Health Park to tackle those orthopaedic waiting lists? Thank you.

I thank the Member for the welcome that he gave the health park in Llantrisant. I think that it will make a significant contribution in improving waiting times for diagnostics and surgery in the south-east. Just in the context of Cardiff and the Vale specifically, long waiting times are falling there too. Over the year to last October, there was a 69 per cent reduction in those waiting over two years. So, there are signs of progress already.

In terms of the timing of developments at Llantrisant, the full business case for the first phase—namely the diagnostic hub—and the outline business case for the second phase, which is the orthopaedic element, have been presented to the Government for a decision on investment. They are currently going through the system, and I expect advice very soon on that. I'm eager to ensure that we address this very quickly, so that we can see the impact of the progress in Llantrisant in the lives of people as soon as possible.

The hospital sterilisation unit at the Heath hospital came in last week for scathing criticism in a WalesOnline report, which revealed a secret report that was done by the health board that has not been made public, with damning accusations of bullying, contamination of surgical appliances, and just general meltdown in that department. Orthopaedic services rely on that sterilisation unit to provide key medical instruments to allow them to perform the functions that they do when people need procedures.

Will you commit today, health Minister, to insisting that the health board make available the report that was concluded in August 2024, following an earlier report in 2016 with similar revelations? Bear in mind that this report has come in light of the report on the operating theatres, and the mortuary potentially losing its licence to operate through poor practice. There are real issues going on at the Heath hospital. I have asked you numerous times to intervene directly. On this simple request, will you commit to making that report available?

As the Member will know from my previous responses to his questions—and it is a perfectly fair challenge—I have intervened directly. In fact, the health board is in higher escalation because of the themes emerging from a number of these reviews, including the one that he refers to in his question to me today.

The health board has confirmed that it has a detailed action plan and change programme in place in response to each of the reviews, and that work is under way against those action plans. I propose to discuss those in detail with the Chair of the health board at the next meeting that we have in the coming weeks. The plans cover individual behaviour, cultural transformation, leadership and management reforms as well, operational planning, infrastructure, quality governance, fairness and equity, and monitoring for continuous improvement.

He will know that the health board has responded to the point that he made specifically in relation to the review. The board has considered the reports. The reports, I understand from the health board, have been shared with staff representatives, and work has been under way, since the report was received by the health board, to implement the recommendations in that report.

I do agree with him that the kind of cultural and management challenges that that report, as we have seen in the coverage of it, sets out are not acceptable, and they are not isolated to that report. I spoke to the health board specifically at the most recent public accountability meeting. You will have heard what the Chair said to me in that meeting on these broader questions.

I thank the Cabinet Secretary.

The topical questions are next. The first question is to be answered by the Deputy First Minister and is to be asked by Mick Antoniw.

The Public Office (Accountability) Bill aims to strengthen conduct in public office, introducing a new duty of candour, making it an offence to mislead the public, and expands access to legal aid for bereaved families at inquests involving public authorities. Its application to Wales ensures that legal protections apply UK-wide.

Thank you for that answer. Of course, Hillsborough was a terrible tragedy. It followed on from another tragedy, an area waiting for an inquiry, which of course was the Orgreave events. The issue around the duty of candour is that had that existed at the time of Orgreave, then Hillsborough might never have occurred, and certainly not the cover-up of events and facts that had to be uncovered over several decades. I welcome very much that the UK Government is fulfilling its commitment in its manifesto to introduce a Hillsborough law, but that duty must be universal. I'm very pleased that certain amendments that were undermining that universality have been withdrawn, although I'm concerned about suggestions that they might be introduced at a later stage. Do you agree with me that the importance of this law across our particular Welsh interest means that universality must apply? There should not be exceptions to the concept of a duty of candour.

Mick, thank you very much for that. I acknowledge your campaigning on this issue and also for the Orgreave miners and their families over decades. We're looking at the application of a piece of legislation that will bring new duties that will respond to the concerns not only of those families affected by the Hillsborough tragedy, but by Grenfell Tower and all of those who feel that public authorities and those who provide public services have failed in the past in their ethical and moral duty of candour and assistance. It will put that ethical and moral duty on a statutory footing.

You rightly draw attention to the concerns of families, including those in the Hillsborough Law Now campaign group, who drew their concerns publicly to the attention of Government on an amendment that had been put forward focused on the security services. The Government have paused that and have sought now to work with those families affected and with campaigners to get this right. I think that's right, because the principle you speak of of universality is correct. I noted, in preparation for this topical question today, Llywydd, that the campaign group—and we should listen to their views—said:

'We welcome the government listening to the campaign, families, MPs and supporters by withdrawing their security services amendment. We shall engage further with government to ensure the bill fully applies to the security services whilst not jeopardising national security.'

Those families and campaigners recognise that there is indeed a national security issue, but want to work with the Government to get this right. We welcome this. We agree, by the way, Mick, with the points that you've made, but also those points that have been made by good colleagues of ours like Steve Rotheram of Liverpool, Andy Burnham and others, who have said that the previous amendment that has now been withdrawn risked not only undermining the spirit of the legislation, but actually being too broad on the opt-out for the security services. So, there's work to be done, but I welcome the fact that the Government has withdrawn it and will seek to work with them.

I repeat as well that part of the universality is the application of this to Wales. There will need to be a legislative consent motion that will be brought here. We will need to scrutinise that as a Government and then bring it forward for scrutiny here as well. But, of course, as part of those who have long campaigned in support of a Hillsborough law, we're supportive of this, we just need to get it absolutely right.

Clause 11 of the Bill creates a new criminal offence of misleading the public by Ministers and public authorities. As currently drafted, it doesn't apply to Welsh Ministers or public authorities in Wales as regards devolved functions. That's why, in your legislative consent memoranda, you haven't addressed clause 11. But since then, the UK Government has brought forward amendments 40 and 70, which would remove this exception for Welsh devolved functions. Clause 11, if it is passed, will now apply to Welsh Ministers.

Will you therefore be bringing a supplementary memorandum forward, and will that be reflected in a legislative consent motion, so that the Senedd can make its views known on this matter? Do you support the removal of this exception in relation to clause 11? And just on a particular matter that will be of interest to the former Counsel General, as currently drafted with respect to Welsh Ministers, it would apply to proceedings in the Senedd. This isn't the case at Westminster, of course, because absolute privilege applies there. Is that a matter that you have discussed with the UK Government in discussion of clause 11?

Again, Adam, thank you for your long-held support for the principles underpinning this legislation and getting this legislation right, and also, in concert with Mick Antoniw, seeking to make sure that this does apply universally across public bodies. In England and Wales, there are devolved areas of public bodies and public competence, and also reserved. I think it's right that it applies across that universe, so that no matter where an incident may take place, people know with absolute certainty that this legislation will apply to them. But we are, and always have been, very keen to be involved in this. It was taken forward at quite some pace—and credit to them—by the incoming UK Labour Government, which meant that they went at it at a rate of knots.

Since then, we've been engaging intently with them. I can confirm that, indeed, as you say, clause 11, referring to the offence of misleading the public, did not originally apply to Wales. It will now be extended. We agree, and we welcome that. That's been part of our discussion, in order to make sure that it does apply universally across Wales and England, regardless of borders. Amendments to this effect have been made, and this will be subject to, indeed, a supplementary LCM that we will bring forward. We continue to engage on all aspects of this, because we want to get this right for the entirety of England and Wales, because it is certainly about Hillsborough, Grenfell, Orgreave, and protecting against any future incidents where we should have offences of misleading the public, a duty of candour and a duty of assistance as well, to those who are affected by such incidents, or when there are inquiries as well.

Thank you to the Deputy First Minister. My father and a good friend of mine were at Hillsborough at the time of the disaster, and my friend says that his life has never been the same again since the disaster. Part of that trauma was the response of the authorities to the disaster.

There's a delay to the Westminster Bill, and I acknowledge that they have made progress, but that delay does present an opportunity for us to consider how suitable the Bill is. Does it meet our needs? We can see that a number of clauses in the Bill touch upon devolved matters. So, it is hugely disappointing, and perhaps there's time for us to deal with this, to read in the legislative consent memorandum, and I quote, that there has been

'limited engagement and involvement with the development of the Bill'.

I hope that this will change now, Deputy First Minister, because at the moment this is another example of a Bill being created for Wales instead of with us and in collaboration with us.

An important Welsh voice that needs to be heard, in my view, is that of Nadine Marshall, founder of VOICE, Victims Oversight in Criminal Enforcement. Her son, Conner, was killed—was murdered—at the age of 18 by a known offender, who was on probation at the time. In a year, 872 serious further offence reports were produced, which means that 872 families are still waiting for answers. Unfortunately, the Bill, as currently drafted, will offer precious little comfort and support to these families, and you know the views of the Hillsborough families about this part of the Bill—that the legislation is not applied retrospectively. Are you willing to have a conversation with the Westminster Government to ensure that this Bill is retrospective? Thank you very much.

We will indeed continue to engage now with the UK Government on this. You know that I am a considered person and that I try to be empathetic to others and to understand why there was limited engagement early on. But I do recognise that they wanted to move at pace and they were working with those campaign groups and families affected to introduce this legislation at an early period. But we are now continuing to engage with the families, and we shouldn't underestimate the fact that, in many of these instances, these have been injustices that have gone back decades upon decades—it's been continuing injustice. It's not only been the incident, not only been the way that those families and individuals were dealt with at that time, and the communities as well—the communities themselves—but we were in a situation where we had to bring this into a very human perspective: police officers or intelligence services lying, changing witness statements to protect reputations; inquest processes, where there was no funding for legal representation, so they had to stand on their own and protect their own interests; and the whole investigation was undermined by a lack of honesty, candour, transparency, the withholding of information, and so on.

This legislation is seeking to put in place, on a statutory footing, measures that will avoid that happening again, and will hold people to account for it. But I can give you assurances that we will continue—not only on behalf of the citizens of Wales, but on behalf of the citizens of Wales and England, because some of these matters know no borders either—to get this right, and we'll engage with the UK Government on it.

I thank the Deputy First Minister. The next topical question is to be answered by the Minister for Culture, Skills and Social Partnership, and is to be asked by Heledd Fychan.

Diolch yn fawr. The Welsh Government is working closely with stakeholders and partners to maximise the Tour de France's legacy, focused on boosting tourism, promoting Welsh culture and sport, improving mental health and well-being and ensuring lasting economic and community benefits across Cymru.

Thank you very much. I am pleased to hear that. I think that all of us are hugely excited, as are communities from Welshpool to Cardiff, that the Tour de France will be coming to Wales next year. I congratulate everyone who has been involved with the work. And as the Minister said, it is a huge opportunity for Wales to be seen by billions of people in countries across the globe. It is also a wonderful opportunity in terms of promoting cycling in Wales to the people of Wales, as well as to cyclists from abroad as a tourist destination.

It is, therefore, important that we take full advantage of this exciting opportunity and the legacy that it can create for our economy and the health of the people of Wales. You will know, Minister, that we have asked you many times about legacy issues, because we have had a number of major events here in Wales. When you and your officials appeared before the committee in November, there was recognition that the Welsh Government could perhaps have done more in terms of legacy. You used the example of where you had done more work with golf last year and ensured that that provided benefits, but one of your officials did say that this was a

'novel approach for us. Usually, we'll bid for an event, and then look at legacy post event'.

So, I do hope that those lessons have been learned for the Tour de France. So, what I would like to know is: can you provide us with more details? For example, how much funding has been allocated to looking at the legacy issues here? Is there a taskforce or a team leading this work? What will be the measures of success that you have agreed upon, or have you agreed upon those, in order for us to ensure that all of the things that you listed, and it is a list that I agree with, are actually delivered?

Diolch Heledd, for the question. I agree that this is hugely exciting for Wales, and I think that every Member of the Senedd will agree that it's great to bring this fantastic occasion to Wales. It really is great news that, for the first time, we will be hosts of the Tour de France route. And I'm very proud that we're bringing, again, another major sporting event to our nation—this one for the very first time. I'm sure Members from across the Chamber, like me, can't wait to see the yellow jersey, the iconic yellow jersey, cycling through the Welsh beautiful landscape—the best views in the world, no doubt, from a bike.

The Member points to a number of things when it comes to legacy. This is a passion of mine, as it is a passion of hers. We want to see a lasting legacy from hosting the Tour de France, both in tourism but also in improving sport, access to sport, and for other businesses as well. I'm sure the Member was very pleased to see the announcement on Geraint Thomas, who's going to be Cymru's cycling ambassador. He will work directly with Visit Wales to promote Wales as a nation that is a world-class cycling nation. So, I think that's a great step forward already. You can see the efforts being made by the Welsh Government in advance of the tournament to provide that lasting legacy, and then the benefits that will bring for the local economies through mid Wales, on the journey to south Wales.

The Member also points to other successes that we've seen. So, we've had great success with our legacy work with the Football Association of Wales, when Wales's national teams have reached major events, across the globe, and also, more recently, in the Wales golf legacy fund, when the Royal Porthcawl had the Women's Open. So, I have no doubt this will have the same opportunity for us, and inspire the next generation of Geraint Thomases and Emma Finucanes.

The Member pointed directly to what we can do in advance. Well, as part of the announcement, organisers of the Tour de France did also announce the Joy programme. It's a legacy impact, looking at social impact. We're very much involved in those conversations, but those conversations are ongoing. So, it will look at tackling those barriers to sport, it will look at improving mental health and well-being, and it will look at celebrating local community culture as well. So, they are ongoing conversations. I'll happily provide the Senedd with further updates, but I can assure the Member we're actively engaged in those conversations. This is a great news story for Wales, and it will once again put Wales on the global stage. It's a good day for Welsh cycling and Wales as a nation.

I share the sentiments made by the Member for South Wales Central—[Inaudible.] This is really exciting news for Wales, and I was delighted to read the announcement. With stage 3 of the race starting in Welshpool and finishing in Cardiff, the world's eyes will be on Wales. It's an honour for us to host the biggest and most prestigious cycling tournament in the world. For Wales to host the Tour de France for the very first time is huge, and the event is predicted to bring millions of pounds to Wales.

But I'm interested to hear from the Welsh Government how they'll make the most of this opportunity; you have raised part of that in your remarks, Minister. But with roads closing, it would be nice to see the Welsh Government and local authorities collaborate to see a vast expansion of bike schemes, to encourage sustainable commuting, and a large increase in public transport infrastructure, to manage both visitors and local commuters. So, how will the Welsh Government co-ordinate with councils to ensure the infrastructure is up to scratch for the event, and how will it fully take advantage of the event economically to maximise its impact at the time and, indeed, the legacy after that as well?

Can I thank Gareth Davies for those questions? Deputy Presiding Officer, this is the world's largest annual free-to-spectate sporting event in the world. It's fantastic, and Wales is going to be part of that for the first time. So, it absolutely is global eyes on Wales once again, and I agree with him about the opportunities that brings in front of us.

When I said earlier that we want to make Wales a world-class cycling nation, I meant it. It's why we brought Geraint Thomas in as a cycling ambassador for Wales. His work with Visit Wales will look at bringing people to the country to join in with Welsh culture and go on those routes themselves. But we want to see local people taking up the sport as well. I've already mentioned to the Member who raised the question this afternoon that we're in the planning process of legacy and what that looks like. We will want to remove barriers so people can enjoy cycling as a sport across the country, and I'll happily update the Senedd more once those plans progress.

I just want to give assurances to the Member that, with the particular engagement with local authorities who are on the route, we're already in discussions with them. We've been in discussions in the run-up to the announcement, and we'll continue those discussions with them, so they can maximise their opportunity of hosting, but then be a part of Wales as a world-class cycling nation.

I'm keen, Presiding Officer, to make sure all of Wales sees benefits from hosting this event, just as we've seen when Wales was home to women's golf and the Women's Open in the Royal Porthcawl. There was support for golf clubs right across the country, and we hope people from communities across the country will be able to take part and celebrate in this wonderful occasion that Wales will have in 2027.

It's absolutely wonderful news that the Tour de France is coming to Wales. I know that this is going to be a boost for people throughout Wales, but I'm particularly pleased that the race will be coming down through Cardiff, through Cardiff North, through my constituency, which is absolutely thrilling, and past the Maindy cycle track, of course, where Geraint Thomas trained, and also, of course, near the home of Geraint Thomas, who was brought up in Cardiff North and went to Whitchurch High School. And it's wonderful that he is going to be the ambassador for the Tour de France in Wales, and I congratulate those who are involved in making him that ambassador.

So, this will be a wonderful opportunity to ensure that young people in particular see the joy of cycling and take up their bikes, and a real chance to promote active travel. And so I do hope that the Minister will make—I know he will—every effort to ensure that we reach all the children throughout Wales, and particularly the girls as well, because the participants and the winners of the Tour de France have been men, on the whole, or, altogether, I think, have been men. So, I think that that is an important point, that we do try to reach out to the girls as well, and I think this is a huge opportunity. Thank you.

Can I thank Julie Morgan for those points? If I'm right as well, Presiding Officer, I think it also goes past Geraint Thomas's local, so I'm sure there'll be lots of people watching the race with a pint in hand during the summer, in July, and I might join him for that occasion.

It is a really great event, and hosting these major sporting events, or where our nation takes part in sporting events of this size, really does inspire the next generation, and has the opportunity to do that. I agree, I want to see young people get inspired and take part in cycling, as they see the Tour de France in action.

And absolutely to the point that Julie Morgan makes with regard to girls taking part in sport. It's part of the Joy initiative, the social impact programme that the organisers have announced, and the Welsh Government is engaged in that activity. I want to see the next Geraint Thomas, but I also want to see the next Emma Finucane, who's a Welsh Olympic champion in cycling. We're extremely proud of our history there, and I'm sure we'll see the future Emmas and Geraints because of the—[Inaudible.] I'm very, very proud that we are once again bringing a major sporting event to Wales, and hosting this type of event, and bringing the world's eyes to our wonderful country.

This is a great opportunity, especially for Welsh cycling. And perhaps the Minister might clarify—when he said he is joining Geraint Thomas, is he joining Geraint Thomas in the local or on the bike, or maybe both? [Laughter.] Maybe he could answer that for us later on.

Now, this is a chance to elevate all cycling centres and velodromes across our proud nation. Julie Morgan has already mentioned the Maindy velodrome. Now, the cultural significance of Maindy velodrome cannot be underestimated. Since the venue opened in 1951, this sport centre has developed Welsh sporting icons, including, as Julie has said, Geraint Thomas himself, whose impact on the sport of cycling is well documented, and it's good to see him being recognised here and internationally.

Now, this centre is the only venue left from the Commonwealth Games when it came to Cardiff in 1958, and is still the home of Maindy Flyers youth cycling club. And members of that club have gone on to win four Olympic gold medals—achievements earned by individuals who cycled around the track of Maindy. Now, despite all this, Maindy velodrome has been under threat. There's been a threat that a school is going to be built on Maindy velodrome. That has gone away now, but now we have an opportunity to recognise the contribution of Maindy velodrome, the contribution of the Maindy Flyers. Will the Minister use this opportunity to discuss with others, to formally acknowledge the importance of Maindy velodrome and of the Maindy Centre for cycling in Wales and internationally and look at granting Maindy velodrome heritage status? Diolch yn fawr.

I thank Rhys ab Owen for that, Presiding Officer. I think he knows the answer to the first question, and I'm sure he'll be there with me. When he points to Maindy velodrome, which Julie Morgan also brought up, he's absolutely right to point to the local history and the local legacy that it has brought, not just to this region, but Wales. I think there's real opportunity around hosting the Tour de France to celebrate Maindy velodrome and all of what that has offered and has to offer in the future as well. We've had an increase in capital funding by Sport Wales this year, and I'm sure Sport Wales would want to be part of the conversation about what the Tour de France means as a legacy point, and I'll ask them to consider all of the points the Member has made.

Thank you, Minister.

There are no 90-second statements this afternoon.

So, we'll move on to item 5, the Finance Committee debate, 'Post-legislative review of the Public Services Ombudsman (Wales) Act 2019'. I call on the Chair of the committee to move the motion—Peredur Owen Griffiths.

Thank you very much, Dirprwy Lywydd. I'm very pleased to be able to speak in this debate today. The Public Services Ombudsman (Wales) Act 2019 is a landmark piece of legislation. It came after calls to strengthen the independence and accessibility of the ombudsman’s office and to modernise the complaints process so that the ombudsman could better serve the public.

I was reminded that it was the first committee Bill of the Senedd, and it was taken through by the former Chair, Llyr Gruffydd. He wanted to ensure that he received a name check in this debate today—[Interruption.] Yes, exactly. But thank you to him and to the committee staff for taking the Bill through.

The Act introduced new powers designed to improve access to justice, enhance transparency, and to promote fairness across public services in Wales. For example, it allowed the ombudsman to accept oral complaints as a matter of course, and gave the power to undertake own-initiative investigations. These were significant steps forward.

The Act also included provision for a statutory review to be held, which enabled our committee to reflect on how this legislation has worked in practice. In particular it allowed us to focus on the following key questions: has the Act achieved its intended outcomes? Does the framework remain fit for purpose? Have there been any unintended consequences? And, importantly for us as a Finance Committee, has it delivered value for money?

As part of the review, we heard from a wide range of stakeholders and experts. Their insights have helped us to understand the impact of the Act and identify areas where further clarity, support or reform may be needed. We would like to thank everybody who took the time to share their views with the committee. We'd also like to thank the ombudsman and her office for their co-operation throughout the review, and welcome her commitment to build our recommendations into future strategies, plans and work programmes, as outlined in her response to our report.

Overall, the new powers have been positively received. They allow the ombudsman to adopt a more proactive and inclusive approach, while providing a robust statutory framework that underpins and strengthens the ombudsman’s crucial role in Welsh public life. Multiple stakeholders told us the 2019 Act still reflects best practice for ombudsman legislation internationally, six years since it came into effect. We are proud that this piece of Senedd legislation—introduced, as I said, by the Finance Committee in the fifth Senedd—remains a beacon of good practice and is revered amongst the ombudsman community.

The committee welcomes the progress made in strengthening public confidence in the office and in its targeted outreach work. We particularly commend the steps taken to not only provide resources in languages other than Welsh and English, but to also accept complaints in more languages, including BSL, to increase the ombudsman’s reach. But we believe there is scope to build on progress and recommend that the ombudsman continues to review her strategy to ensure it engages with hard-to-reach groups, ensuring everyone in Wales has equal access to the ombudsman’s services.

We also identified areas where refinement is needed to ensure the ombudsman continues to deliver for the Welsh public. These include reviewing the processes already in place with regard to oral complaints, own-initiative investigations and the Complaints Standards Authority.

We can’t comment on the new power to investigate matters relating to the private health related services of a complaint in a public/private pathway, as the threshold for such a complaint has yet to be met. As such, we believe that the power should be retained until sufficient evidence is received to suggest a change is required.

We also discussed the possibility of widening the ombudsman’s jurisdiction to include school complaints. We concluded that further work is needed in this area, and have recommended that the ombudsman undertakes a modelling exercise to determine the potential impact on existing services, as well as the practical implications of doing so. We asked that the findings be shared by autumn of this year. We also welcome the Cabinet Secretary for Education’s positive response to our recommendation and we are encouraged by the ongoing work in this area. Given the upcoming Senedd election, it will fall to our successor committee to monitor and review any work undertaken in these areas as part of its annual scrutiny of the ombudsman.

Dirprwy Lywydd, this work has reaffirmed a fundamental principle, namely that post-legislative scrutiny is vital. It ensures that laws that are passed by the Senedd continue to serve the public effectively, delivering on their intended objectives and providing value for money. We believe that the statutory provisions in the 2019 Act for a post-legislative review serve as a best practice model for all legislation laid before the Senedd. And this is why we have recommended that all relevant Bills introduced to the Senedd should include provisions for a post-implementation review. This review demonstrates the impact of post-legislative reviews. Scrutiny strengthens accountability and improves the quality of law making in Wales. I look forward to hearing the views of Members during today’s debate. Thank you very much.

I just want to echo the comments from the Chair of the committee as to the work of the committee, and also to add my thanks for the support from the clerks and the Senedd Commission staff in the compiling of this report. I think it's worth Members reflecting on the fact that, since 2019, complaints to the public services ombudsman have increased by 36 per cent, which is both a good thing and a bad thing, I suppose. So, it's a good thing that more people are perhaps feeling able to access the public services ombudsman and make sure that their complaints are being heard, but also that puts pressure on the public services ombudsman and her staff in managing that. But I can't help but think that the good work to include the ability to submit oral complaints could actually be promoted even further, and that's one of the recommendations, between recommendations 2 and 3 from the committee. Because, of course, being able to access the ability to complain should be as easy and straightforward as possible for people to do. Probably too many people still think that the only way to do that is through a written complaint. So, the committee did put recommendations in there to ensure that the ability for people to complain orally is as well known as possible. I think it's a really positive thing, both for accessibility, but also for the improvements to services that we all want to see, because complaints are there not just to satisfy the complainant in the moment, perhaps, but also to improve services in the long term as well. And, of course, the ability to complain as easily as possible creates reassurance for our taxpayers up and down Wales when they feel as though their needs have not been appropriately met.

I just want to make that point, and I think it would be interesting to hear from the Cabinet Secretary her views, and I am sure agreement, that the ability for people to complain as easily as possible, in as straightforward a way as possible, is a really important principle, and I'm sure she would agree with the recommendations from the committee for the ability to complain orally to be as well known as possible.

The other theme that I thought came through this, which the Chair pointed to as well, was the own-initiative powers that the ombudsman has. That came through quite powerfully in the evidence that we received. But I think what did come through clearly was that it's a long process and a very bureaucratic process for the ombudsman to complete those initiatives effectively. So, the committee, through recommendations 4 through to 9, have made a number of points as to how own-initiative investigations can be strengthened, improved, be made more efficient. And I hope—. Going back to those points around improving services and improving outcomes for people up and down Wales, having a smoother way of dealing with own-initiative investigations, I think, is a real positive on the back of this report.

I would like to thank the committee for its work. I think the report and the recommendations are very sensible. Clearly, the ombudsman's work is a key element in terms of citizens' rights in Wales in holding public services to account. In an age when deception, lies and misinformation are things we often hear people accused of, dragging standards in public life through the mud is something that we see time and time again, and it's more important now than ever that we have the work of the ombudsman in place and that people in Wales have a better understanding of their rights. In this regard, we welcome the conclusion in the report in terms of the effectiveness of the Act as a legal foundation, particularly as compared to the arrangements across the rest of the UK.

We also welcome the fact that public confidence in the ombudsman has increased since the introduction of the Act, which is testament to the committed work of the staff in the office. But, despite the successes, clearly this review does provide an opportunity to identify areas for improvement. We've heard some of those mentioned already. I agree entirely with what we heard from Sam Rowlands in terms of what we want to see in terms of oral complaints. With new technology, there are all sorts of different ways that people could make those complaints, and that would help in terms of staff capacity to deal with such complaints.

In terms of increasing the awareness of certain groups, particularly older people and minority ethnic communities, of their rights to make complaints, that is a theme that comes across very strongly in the report, and we welcome, therefore, the committee's recommendation on the need to review processes within the office to reach out to these groups.

One area where the Act falls short, as compared to models elsewhere in the UK, is the ombudsman's arrangements in terms of how they can carry out own-initiative investigations. So, we agree with the principle of simplifying the consultation process in order to accelerate the ombudsman's ability to carry out such investigations, and I would encourage the Government to consider how ombudsman offices in other countries, such as Ireland, have managed to retain that balance between transparency and efficiency.

The report also makes a strong case in terms of giving further consideration to extending the responsibilities of the ombudsman to include complaints related to schools, and this is particularly important, I think, as we consider the need to improve the consistency of standards across Wales. So, as the Cabinet Secretary responds, I would welcome an update from Government as to whether such a change is at least being considered, and to what extent the benefits of following the Irish example in this context have been assessed.

Thank you very much to the committee for their work. It is genuinely important that we review legislation, so I was very pleased to read the first conclusion, namely that every public Bill should include provisions for post-legislative review. That scrutiny is almost as important as the scrutiny before the legislation is passed, so thank you for including that.

Now, in looking specifically at the Public Services Ombudsman (Wales) Act 2019, although the scrutiny process came to the conclusion that the legislation had been implemented successfully, I do believe it's fair to note that there is scope and an ability for the ombudsman to change and improve.

We know that the increase in the case load has slowed since the legislation was introduced. According to the ombudsman, they've seen around 9,800 complaints over the past five years, rather than the 12,000 that they had predicted. That is a shame because the Act's policy objective was to be more accountable to the citizens of Wales.

Professor Naomi Creutzfeldt is of the view that the ombudsman could undertake more own-initiative investigations. I agree with that, so it is a shame that the ombudsman has only completed two such investigations since 2019. Clearly, there is scope to amend the legislation to simplify the process of initiating such investigations.

While the ombudsman takes pride in the fact that 79 per cent have confidence in the office's work, what about the remaining 21 per cent? Again, as Professor Creutzfeldt said,

'although you said everyone in Wales knows about the ombudsman, I'm not sure if people would then even approach them.'

The idea, therefore, that people perhaps don't have the confidence to turn to the ombudsman.

Professor Chris Gill also agreed that reaching a much wider demographic group is truly important for the ombudsman. Although work has been done in this area—and I understand that it isn't easy—the ombudsman acknowledges that the data continues to show that some groups are less likely to make a complaint, such as younger people; people from diverse ethnic backgrounds and nationalities; people who face socioeconomic disadvantage; and people who live with disabilities.

We all agree that the office of the ombudsman for Wales is for everyone in Wales, regardless of their circumstances. The fact that people are able to make a complaint orally is, for me, crucial. It's a shame, therefore, that only around 700 people have done so since 2019. Of course, the ability to make an oral complaint can simplify the process a great deal. But what would further simplify the process would be if those who had made a complaint to a public body, at the end of that body's investigation, if they had the right to ask that body to pass, to transfer the complaint straight to the ombudsman, directly to the ombudsman, so that they don't have to depend on the individual to do that, but that the body itself could do that on their behalf. That would greatly reduce the difficulty experienced by complainants—those who have to prepare a summary of the case and what has happened, and how the complaint has been dealt with to date, and so on. It would make things much easier for people.

I call on the Cabinet Secretary for Social Justice, Trefnydd and Chief Whip, Jane Hutt.

Diolch, Dirprwy Lywydd. The Welsh Government welcomes this report, and we're grateful to the Finance Committee for the thorough way in which you've approached the review and the comprehensive and balanced set of recommendations that you have produced. We were pleased to be asked to feed in views at the stage of the gathering of evidence, and I was glad to see that the committee has taken on board our views and incorporated quotes from my response in the report.

The Welsh Government believes that the Public Services Ombudsman for Wales plays a vital role on behalf of the citizens of Wales in helping to put things right when people haven't received the standard of service they're entitled to expect from a public body. Wales has a stronger story to tell here, but it's important that the role and activities of the ombudsman continue to develop and that we learn from what is working well elsewhere, as I hope that others are learning from us.

So, we welcomed and supported the 2019 legislation to expand the role of the ombudsman, and we were pleased to see that the committee has found that the Act has been a success overall. We think that the recommendations that the committee has put forward in its report are thoughtful, balanced and constructive, and we support all of them. And I'm grateful for the additional contributions made by Members today and reassure you that they are also helpful in terms of us moving forward and taking into account the review.

There is a role for the Welsh Government to play in implementing recommendation 16, which recommends that the ombudsman should work with the Welsh Government to understand the practical implications of widening the ombudsman's jurisdiction to cover school complaints, and share these findings by autumn 2026. And I am pleased to say that this work is being taken forward and discussions are under way to consider this proposal in more detail. Work is on course to complete the task by the autumn, as recommended by the committee.

The report also records, as a conclusion of the Finance Committee, that all public Bills introduced to the Senedd contain provisions for a post-legislative review. We support and welcome the important task of looking back at a piece of legislation to evaluate how well it has worked and what lessons need to be learned from implementation so far. And I'm pleased to update you that a post-legislative review is included in all new Bills laid by Welsh Government, and this requirement ensures that each Bill sets out its planned approach for monitoring, reviewing and evaluating the policy that underpins the Bill, and that these reviews are laid for the Senedd's consideration.

I call on Peredur Owen Griffiths to reply to the debate.

Thank you, Dirprwy Lywydd, and thank you to everyone who has participated in the debate this afternoon. Some themes have emerged from our three speakers, as well as the Cabinet Secretary, in terms of own-initiative powers and how those are used, and how we can make those more easy to use. I think that came through clearly in our recommendations, that it is disappointing that the powers have only been used twice, particularly when we spoke to ombudsmen from elsewhere, saying that they could use them, particularly in Ireland, where they have been used more broadly. So, I think that that is very important and is a theme that comes through in the recommendations, and, of course, I hope that the ombudsman will now look at the way that she uses her powers in that regard.

Also, better use of oral complaints and making it easier for people to use that mechanism. And the more fundamental point on the way that that process works, of course, is that people have to make a complaint to the public bodies first before approaching the ombudsman, and perhaps that process needs to be refined too. I think that the point that you made, Rhys, was very interesting about the end of the process, if people still aren't content: is there any way to send it directly to the ombudsman? I think that is something that we should consider with the ombudsman, in the scrutiny work will be undertaken.

I am aware of time, so I will draw my comments to a close. I was delighted that the Government is looking specifically at recommendation 16, and as I mentioned earlier, post-legislative scrutiny is extremely important in relation to legislation. So, that is something to be grateful for, that the Government is going to take that forward.

So, to draw my comments to a close, I am pleased that this work has been undertaken and I am proud of the work undertaken by our officials within the committee to complete this report. The comments made today will be taken forward and incorporated into our annual scrutiny with the ombudsman, and I'm sure that those comments will contribute to the legacy work of the committee and the work of the committee in the seventh Senedd. So, thank you, Dirprwy Lywydd, for your patience and forbearance.

The proposal is to note the committee's report. Does any Member object? There is no objection. Therefore, the motion is agreed in accordance with Standing Order 12.36.

Item 6 today is a debate on the Health and Social Care Committee's report, 'Prevention of ill health—obesity'. I call on the Chair of the committee to move the motion. Peter Fox.

Diolch, Dirprwy Lywydd. I'm really pleased to open this debate today on obesity, and I want to thank all those who gave evidence, and thanks to our clerks and researchers for the great work in pulling this really important report together.

Obesity is a significant public health issue with far-reaching consequences for individuals and society. It is complex and can be influenced by a number of factors. There are also links between obesity and mental health, as well as a range of other serious health conditions. No country in the world has yet reversed obesity, which shows the scale of the challenge facing us. However, this doesn't mean that we can afford to be complacent, especially as prevalence in Wales is rising.

The most recent figures from the national survey for Wales in 2024-25 show that 62 per cent of adults aged 16 plus in Wales are living with overweight or obesity. The cost to the NHS has previously been estimated at some £73 million a year. Alongside the rising trend in the number of people living with one or more chronic illnesses and an ageing population, the health and care system in Wales is under significant pressure.

'Healthy Weight: Healthy Wales' is the Welsh Government's long-term strategy to prevent and reduce obesity, but we heard it's having little impact on the ground. We also heard that there are long waiting times for adult weight-management services, while there is no provision for children and young people in a number of health boards. Whilst we must ensure that equitable services and support are in place for people living with overweight and obesity, we must not lose sight of the long-term prevention agenda of reversing the trend and minimising the number of people needing to access weight-management services. This is going to require clear oversight and direction, with cross-sector responsibility and accountability.

We chose to focus our attention on the effectiveness of the Welsh Government's strategy, regulations and associated actions to prevent and reduce obesity in Wales. As I said, we are very grateful to everyone who took the time to share their expertise and experience with us. Our report makes 18 recommendations to the Welsh Government, and I would like to thank the Cabinet Secretary for what is, generally, a positive response. In the time available to me this afternoon, I will focus on a small number of our recommendations, although I know there may be other committee members who will wish to cover some of the other recommendations in their contributions.

As a result of the evidence we received on the lack of impact of 'Healthy Weight: Healthy Wales', we believe that strong and clear leadership will be essential to ensure that this strategy is fully implemented. We therefore urge the Welsh Government to demonstrate that leadership and drive the changes needed to ensure services are in place to support people living with overweight and obesity.

We also called for clear lines of responsibility and accountability for delivering and monitoring the plan. This recommendation was accepted. In his response, the Cabinet Secretary said that the delivery plan for 2025-27 sets out new and clearer governance and accountability arrangements, and commitments that aim to strengthen and embed further whole-system approaches at both a community and national level. I thank the Cabinet Secretary for his positive response to this recommendation, and urge any future Welsh Government to continue to provide the leadership needed to drive forward this important agenda.

I'd now like to talk about children and young people. The increasing number of children who are overweight or obese in Wales is extremely concerning, with around 25 per cent of children living with overweight or obesity by the time they are starting school. This is a frightening statistic. A healthy relationship with food and nutrition starts at a young age. We therefore welcome the introduction of PIPYN, the children and family pilots in Anglesey, Cardiff and Merthyr, which are supporting families to achieve a healthy weight without stigma, through increased opportunities to eat healthily and be active. We believe that this type of intervention could have a positive impact on the numbers of children needed to be referred to weight management services, and look forward, subject to its satisfactory evaluation, to seeing it rolled out across Wales.

Where children and young people need the support of weight management services, it was concerning to learn that these were not available in every health board. Probably of greater concern, however, was that some of those health boards were the ones with the highest levels of children living with overweight and obesity in Wales. We recommended that the Welsh Government commission an audit of the provision of children's weight management services in each health board, to determine future provision across all health boards. We also recommended that this audit include details of the waiting times for weight management services, and the number of people waiting for weight management services in each health board.

The Welsh Government accepted both of these recommendations, and stated it will explore the development of a new clinical pathway for the treatment and management of obesity as a chronic condition, including the role of weight loss drugs. This will include the provision of services for children. I would be grateful if the Cabinet Secretary could provide further detail on the timescale for this work in his response to the debate.

I would like now to focus on one of the recommendations rejected by the Cabinet Secretary, and that was recommendation 14. We asked the Welsh Government to look at the changes made to the Healthy Start scheme in Scotland, which had increased the value of their vouchers in line with inflation and expanded eligibility to all families receiving universal credit. This recommendation was rejected on the basis that Healthy Start is not devolved to Wales.

I agree with nearly everything that Peter Fox has said, except that a healthy relationship with food starts at birth, not when they are very young. I’ll come on to breastfeeding in a minute.

I was pleased to take part in this inquiry when I was substituting for an absent colleague, but I obviously was not involved in the extensive work that you did. My sense is that your recommendations are not nearly strong enough, because I think you’re just tinkering at the edges. We have to realise that no country in the world has succeeded in reversing the rise and rise of obesity and overweight in adults. The pharmaceutical industry, no doubt working in collaboration with the food industry, have now come up with these drugs to suppress people's diets. That may change, on paper anyway, but we know that anyone who stops these injections will put on weight even quicker than those who have attempted weight-watching classes.

One of the real dangers of the popularity of these appetite-suppressing drugs, which are obviously disproportionately available to those who can afford to buy them, apart from the unknown consequences on the body's metabolism, is that people will eat even less nutritious food, because they are eating less food. If none of it is nutritious, we are going to see a spike in what is already a significant problem amongst children and adults. I am glad to see Altaf Hussain, who is a doctor, is agreeing with me. I think there are some very serious issues arising out of all this.

Equally, the banning of junk food products on television before the 9 o'clock watershed, which has been brought in by the UK Government, is not going to work, because unfortunately people don’t need to see the enticing, addictive, tasty but harmful products in order to have the chemical reaction of feeling hungry just by seeing the logo of the company that is promoting this crap, because they dominate completely our obesogenic environment. Merely seeing the logo, which is not going to be banned, will cause them to rush to the kitchen to try and pick up something that’s not going to be good for them. That is down to the research that has been done by a very excellent professor at the University of Liverpool, whose name I can provide you at another time.

We cannot afford to go on like this. The timidity of politicians to grasp the nettle in case they seem to be interfering on personal choices or nannying accusations is completely missing the size of the problem. The obesity crisis now extends to most parts of the industrialised world and is caused by the industrial adulteration of the raw ingredients of life into ultra-processed products, all in the name of profit. These people are not going to stop doing this unless we stop them poisoning us.

You need to conclude now, please.

Okay. Just to say that we know that this is the single most effective way of getting childhood obesity down, because Obesity Alliance Cymru tells us that it reduces the risk of overweight and obesity by 25 per cent and sets those good standards of healthy eating that we need to ensure that all those who support new families are helping them to do.

This was a very interesting inquiry and a very good one, and I'm very grateful to everyone who participated in this inquiry. It was an eye-opening one. I've used the term several times now that obesity is the rhinoceros that faces us on the road. We all see it. We all know the challenges that it poses, and the question here for us is what we're going to do to solve this and prevent it from causing the damage that it could cause. We heard in the evidence that the link between obesity and chronic conditions such as cancers and heart disease, amongst others, demonstrates the dangers of not tackling obesity.

Of course, when we talk about healthcare, it's easy to look at hospitals, at waiting lists or clinical outcomes, but to anyone who spends time visiting communities the length and breadth of Wales, it's clear that health is determined long before anyone reaches a surgery or A&E department. As we've heard from Jenny now, it's determined by the food that people can afford or the food that people receive following birth. It's determined by the homes that people live in, by the streets that they walk along and by the opportunities that they have to live a healthy life.

Nowhere is this clearer than in the story of obesity in Wales. Today, more than six in every 10 adults are overweight. This in itself is a cause of grave concern, but it's one part of the picture. People in the most disadvantaged parts of Wales are far more likely to be overweight or obese than those in the least disadvantaged areas, and the results of this inequality are gravely serious.

Over one in every six deaths from cardiovascular diseases in Wales are related to high body mass index figures. In 2024, the rate of premature cardiovascular deaths in Wales was 17 per cent higher than in England. Coronary heart disease continues to be the second most common cause of death in Wales, and indeed is the main cause of death worldwide. Obesity already costs the health service in Wales £73 million a year, but, by 2050, it's predicted that that figure will rise to almost £0.5 billion, with a wider cost to the Welsh economy of more than £2 billion. [Interruption.] Sorry, Jenny.

Seventy-three million pounds sounds like an interesting figure. Where did you get it from? Because I'm sure that that's an underestimate, just from a guess.

A research paper demonstrates £73 million at the moment, but I wouldn't be surprised to hear that it was an underestimate of what the main cost is when you consider all of the impact of obesity on the health service. That's a direct figure, according to the research paper that I saw, but it will increase significantly to over £2 billion, as I said, by 2050.

If we are serious about preventing obesity, we must start with children. Across Wales, thousands of children are growing up in poverty, and for many families a healthy diet is simply unaffordable. School meals offer one of the clearest opportunities that we have for early intervention. A nutritious hot school meal can support physical health, improve concentration, help to improve attendance and boost well-being in the long term. And although statutory school food standards do exist, they have dated and they are not regularly monitored. The scale of the challenge facing children is already clear. We know that over 10 per cent of children are living with obesity and are overweight, and children in the most disadvantaged areas are far more likely to be impacted.

Physical activity and sports are another vital part of prevention, but all too often, they're treated as optional extras. The committee’s inquiry drew specific attention to this. Despite this, this recognition has not led to an expansion of the effective programmes that we know work. The evidence is consistent: people who regularly participate in sporting activities are far less likely to be obese. Programmes such as daily active, the children and families programme and the 60-plus leisure active scheme demonstrate how social prescribing can support physical and mental health. Despite this, progress has slowed significantly on these methods, limiting the reach of interventions that are proven to work.

We must also face a difficult truth: a policy that depends primarily on individual will, information campaigns and encouragement has not worked. The environment in which people live matters. That’s why Nesta has recommended compulsory health targets for major food retailers, in order to encourage them to offer healthier foods and to challenge business models based on products that are high in fat and sugar. Modelling suggests that such targets could reduce calories purchased by around 80 calories per head per day, and could reduce obesity rates by around 23 per cent.

But I'm going to go back to the final point—at the heart of all this is poverty. Persistent poverty during early childhood increases the risk of obesity and long-term illness driven by chronic stress. If we don't tackle poverty, then we will never tackle this crisis. Thank you

As a member of the Health and Social Care Committee, I'm very pleased that we undertook this work, because, obviously, obesity is one of the very biggest health challenges that we face at the current time—an issue right across the globe and very significant here in Wales. I'm very pleased that the Welsh Government has accepted almost all of the committee's recommendations. I do believe that the report is very clear that obesity must be tackled through prevention and early intervention, and we must focus on everyday opportunities that help children in Wales grow up to be active, confident and healthy.

One of the recommendations, which, in fact, Welsh Government did not accept, was that Welsh Government should explore the feasibility of a directory of accessible community facilities to support physical activity at a local level. In rejecting that recommendation, Welsh Government has a view that, instead, local partners are best placed to signpost community facilities based on local knowledge and population need. Dirprwy Lywydd, one way or another, it is clear that inconsistent awareness and access remain key barriers, particularly in our more deprived communities, and we've already heard of that strong link between obesity and deprivation. For families—[Interruption.] Jenny.

I think that this is all true, but six out of 10 households never cook from scratch and they aren't all poor people. There would be people in this room, and who work on the estate, who are in that category, and obviously, they're doing huge harm to themselves. So, it is, unfortunately, as much a cultural problem about the weight of the propaganda that is imposed on people—'Buy this or that takeaway, buy this or that ready meal'—and not enough people who even know how to cook a simple meal.

I very much agree, Jenny. It is about lifestyle issues that are general across our communities, the way that the food industry operates and the lack of countervailing Government policy and action that's sufficiently robust. But nonetheless, it is a particular problem in deprived communities for a whole host of reasons and factors.

Many families face barriers—time, cost, transport—and if we were to rely on informal signposting to these community facilities that could lead to more active lifestyles, then we would risk reinforcing those inequalities, rather than reducing them. I do, therefore, think it's important to have formal facilitators that children and families can refer to for guidance to physical activity opportunities, whether these be through local authorities, as the children's commissioner suggests, or through schools, which many healthcare professionals in the report consider the best local facilitator. Because we do need to help and support our families, particularly in those deprived communities, to understand how their children and themselves can have more active lifestyles and the benefit that brings to general quality of life as well as tackling obesity and overweight.

For me, Dirprwy Lywydd, I'm very familiar with my local parkrun, which, along with several hundred others, I routinely take part in on a weekly basis on a Saturday morning. I'm also very familiar with our local junior parkrun, which my grandchildren occasionally take part in when other activities allow. As with parkrun generally, it's a free, weekly, inclusive, volunteer-led running event. It's launched a junior parkrun—this is across England and Wales—and has launched a new initiative to twin with 500 primary schools across England and Wales, linking schools directly with their local junior parkrun events. That is designed to embed free, inclusive physical activity into children's weekly routines, and I do believe that that's a very valuable initiative, Dirprwy Lywydd, to formalise links and to reach out in terms of deprivation and inequality to encourage those healthier lifestyle. Junior parkrun is about promoting movement in a non-clinical, non-judgmental way, avoiding stigma, which, of course, is another important theme in the report.

So, in conclusion, Dirprwy Lywydd, I would like the Government to think very hard as to how we can work for more formal connections between local sports community groups and our institutions, such as schools and local authorities, to improve participation in physical activity across Wales, because that's one important part of the response that we need to make in tackling obesity in Wales.

I would like to thank the Health and Social Care Committee for their report. My colleagues here, as always, are great, and it is so good to listen to them. As the committee rightly recognises, obesity is one of the greatest public health challenges facing Wales, and the threat is not a new one. Early in my NHS career, I was seeing an increased number of obese patients, and highlighted the impact this was having on joint health and the increasing need for surgery.

I welcome the committee's recommendation as a way to tackle the looming obesity crisis in Wales. As the committee rightly points out, if we apply the methodology used elsewhere in the UK, the true number of obese adults is one in three, not the one in four reported in official Welsh statistics. Research by Nesta predicts that unless we act, nearly two thirds of adults will be obese in the coming decades. The cost of treating obesity is expected to rise to almost £0.5 billion, and cost the wider economy nearly £2.5 billion. I fully support the committee's conclusion that much more emphasis needs to be placed upon prevention and early intervention. I therefore welcome recommendation 4, as well as the Welsh Government's acceptance of it.

I know from correspondence, as well as speaking to constituents directly, that those struggling with their weight find little support from their GPs. It is only when their BMA continues to rise, moving from overweight to obese, does anyone pay attention to them. This is the opposite of a preventative approach. We don't wait until a wound becomes septic before we treat it, so why do we wait until weight issues become life-threatening before offering help and support? Weight management support should be available to all who need it. This is one of the greatest public health interventions we can take, and by investing now we will not only save lives but save billions of pounds to boot.

Finally, Deputy Presiding Officer, it would be a remiss of me as the chair of the cross-party group on diabetes not to mention the link between obesity and type 2 diabetes. It is no coincidence that the drugs being used to drive weight loss were developed to tackle diabetes. Unhealthy diets leading to unhealthy weights has led to a dramatic increase in the number of young people developing type 2 diabetes.

Will you take an intervention?

Yes.

Are you aware that the food industry is now trying to get round the impact of these diet-suppressing drugs in order to raise the sales?

Exactly.

They are now suffering from less sales and try and beat the effects of the drugs.

Absolutely.

They are complete criminals.

Exactly, and I was pleased when you talked about sham feeding, when you are advertising food, and how it is affecting your body as a whole. We had this subject when I was a medical student, and we had to read it often.

So, this has prompted Diabetes UK Cymru to call for stronger 'Healthy Weight: Healthy Wales' policies as well as a dedicated health prevention budget. I hope the Cabinet Secretary will heed the calls by the health committee and groups like Diabetes UK Cymru and do more to eradicate obesity in Wales. Diolch yn fawr.

I want to start off by thanking everybody, all the organisations and individuals who contributed to this inquiry. The detail and the scope of the evidence received does reflect the complexity of the issue, and we've heard that today, but also the urgency of the situation that we are facing. In pure terms of financial costs, although they might be disputed, Public Health Wales estimates the cost of obesity to the NHS in Wales alone to be £73 million, rising to £465 million by 2050. Of course, there's a broader cost to society and the economy that that figure is estimated to rise to £2.4 billion, so it isn't really about whether these figures are accurate; the fact is that it is going to have a significant economic impact on dealing with this issue, and also dealing with the fact that many people then leave the workforce.

And what constitutes the NHS? Is it the mental health stresses that people feel from the exclusion as a consequence of morbid obesity? That, of course, is unsustainable. The cost to the individuals, to their quality of life, is also having to be taken into account. I want to focus today on children and young people. When it comes to public health, prevention is most definitely better and more cost effective than cure. So, while action targeted at adults is important—and Jenny raised this this afternoon—the fact is that the chances of remaining overweight as an adult are significantly higher if you were overweight as a child. Studies show that between 55 per cent and 80 per cent of obese children stay obese into adolescence and adulthood, with overweight pre-schoolers having double the risk of adult obesity.

At present, around 25 per cent of children in Wales are living with overweight and obesity by the time they start school, and that figure is increasing. That's an incredible figure, when you think about it. That's a quarter of all children. During the 2023-24 academic year, 13.7 per cent of children aged between four and five in reception class were overweight, and 11.8 per cent were living with obesity.

Given that we now have the highest childhood obesity rates in Europe, do you not think that we should be doing a great deal more to make more efforts to get more people breastfeeding, and to give them the support that they need? Because they simply cannot afford to buy those infant formula tins. We just don't seem to have grasped that, according to the evidence that you've received, just breastfeeding would reduce childhood obesity by 25 per cent. Certainly, not providing that support to poor families is likely to criminalise them, because they'll have to steal that infant formula.

I absolutely agree that people should be encouraged, and, where they can, should take breastfeeding very seriously to aid not only the weight of their children but the immunity that it provides to those children as well.

So, it is fairly obvious that the younger you are when you're overweight or obese, the higher the chance of your remaining that way as an adult. So, early intervention is, indeed, the best way to reduce long-term risks. All children should have the opportunity to be healthy, no matter where they live. Rates of overweight and obesity, as we have already heard, coexist with deprived areas. They also have lower levels of healthier behaviour, such as physical activity and healthy eating, although it is critical to recognise that, per calorie, healthy food is three times as expensive as unhealthy food—and that's another recognition that has been aired today. So, the food industry has to be held accountable for access to affordable, healthy food and the saturation of unhealthy food in society.

Food labelling and informative campaigns aimed at encouraging lifestyle changes are not the answer. I said at the top that overweight and obesity is a public health crisis. History tells us that the most effective approach to public health, from the sewage system of the nineteenth century to wearing seatbelts, is stringent, sweeping action. That means restricting access to and the promotion of unhealthy foods, and taxes that incentivise carrots and penalise ultra-processed food that sticks to the hips.

The Welsh Government's 'Healthy Weight: Healthy Wales' strategy is a central plank, and Welsh Labour's universal free school meals policy is a fantastic achievement.

You need to conclude now, please, Joyce.

I am. This is my last bit. And it is a vehicle best placed to drive that change. So, I am really delighted that the recommendation to review funding per head has been accepted in principle, following the uplift from £2.90 to £3.20 from January, along with the release of an additional £3.3 million of funding to support the delivery of free school meals. Thank you.

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

Diolch, Dirprwy Lywydd. I'd like to thank the committee for the report and for tabling the debate this afternoon. Living with overweight and obesity is one of the leading causes of ill health in Wales, and it's projected to overtake smoking as the biggest cause of preventable illness. Rates of obesity in Wales, as in many parts of the world, have risen steadily over many years. Today, more than 60 per cent of adults in Wales and almost a quarter of children starting school are living with overweight or obesity, and the impact on our population and on our NHS is both significant and startling. Obesity-related illnesses are estimated to cost the NHS in Wales £365 million a year. That's £1 million for every day of the year. And this, as we've heard, is expected to rise to £465 million a year by 2050 if current trends continue. When we consider the wider impact on individuals, communities and society, the total could reach £3 billion.

Our most deprived communities face the greatest barriers to healthy, affordable food, physical activity and supportive environments. As we've heard in the debate already, the causes of obesity are complex and are interlinked. Over many years, our food environment has evolved in ways that prioritise convenience over health. Energy-dense foods, often high in fat, sugar or both, have become more easily available; they’re more affordable and they're more heavily promoted than healthier options. At the same time, our daily routines have changed. We are, in many ways, the first generations for whom movement is no longer a natural part of our everyday lives. Instead, we have to make a conscious effort to be physically active.

There are things the Government can and must do to address obesity and support everyone to live healthier lives, but we all have a role to play. Just as the causes of obesity are complex and interlinked, so too are our responses. There is no single magic cure. I’ve provided almost £3 million each year to help health boards develop and expand weight-loss services, to help build a more consistent, effective offer across the country. We’re also developing a new service model to increase the capacity of weight-loss services closer to home in local communities and in primary care settings. We’ve also expanded access to weight loss drugs on the NHS, so that they’re available to people with certain conditions who are waiting for treatment that may be improved by weight loss, as well as via specialist services. But, as we’ve heard from, I think, all speakers, to really make a difference, we must strengthen our focus on prevention.

The new 'Healthy Weight: Healthy Wales' delivery plan, which was published in September, does just that. It adopts a whole-system approach, with action at both a national and a community level, and it directs support and resources towards children and young people specifically, where we have the greatest chance of making lifelong healthy changes. We have some reason to be optimistic. The levels of healthy weight amongst children in Wales are higher now than they were before the pandemic. [Interruption.] Certainly.

I just wanted to—. The 'Healthy Weight: Healthy Wales' document is an important one, but I don't think there's any mention of the role of ultra-processed ingredients in food, and I wondered if you've had any discussion with your Cabinet colleagues about banning, or taking steps to eliminate, ultra-processed ingredients from our children's primary school meals.

Well, the policy that we are advocating through the delivery plan has been discussed at Cabinet, for reasons the Member will be familiar with—the contribution that can be made right across the Cabinet table to reaching the objectives in the strategy. One of the areas in which I think there's a lot of potential, for example—and I know that the Member feels strongly about this—is in relation to using planning levers more proactively around the proximity of takeaways to schools, for example. Often, those are ultra-processed products. Wrexham County Borough Council has planning guidance that is very effective in this. So far, it's the only council in Wales, but this has been discussed at Cabinet for that reason.

The Member, in her contribution earlier, mentioned the importance of breastfeeding, and, to help maintain the emerging trend that we have started to see, and to support children and families, we plan to develop and deliver a new infant feeding action plan. This will build on the work laid out by the Wales—.

I wanted to say that there is a health warning that a generation of Welsh children will be outlived by their parents. That is very important to understand—that our children need good food.

Yes, indeed, and the focus in 'Healthy Weight: Healthy Wales' is consciously and deliberately on supporting children and young people to avoid obesity and overweight, for the reasons the Member sets out. The plan will broaden our approach to diet and nutrition in the earliest years of life, and I think crucial to that is engaging the whole family—because when parents adopt healthier habits, children are far more likely to follow their lead—and creating a supportive home environment, where positive lifestyle changes become part of everyday family life.

Members of the committee will have heard about our PIPYN and PIPYN Active children and family pilots, which are testing new and innovative approaches to doing just that. Using the learning from these pilots, we will roll out an updated model across Wales, prioritising areas with the greatest levels of childhood obesity. In bricks-and-mortar retail, and online, new regulations passed by the Senedd that restrict the promotion and display of products high in saturated fat, salt and sugar—those most linked to obesity levels in our children—will come into force in March, and I'm grateful to those Members who supported the regulations.

But we must also focus on the out-of-home sector. The number of hot food takeaways, as I mentioned earlier, in Wales has increased significantly, and there is a link between a high density of takeaways and areas of deprivation, making healthier food choices more difficult and exacerbating health inequalities. So, I'll be taking forward a public consultation to place limits on hot food takeaways, including around schools, to increase the availability of healthier food options on high streets, and to support local food businesses to develop healthier food choices.

We also know that children and adults living in more deprived areas are disproportionately targeted by outdoor advertising promoting food high in saturated fat, salt and sugar. And while local authorities and public bodies have some influence over the advertising that appears on spaces that they own or control, most of the infrastructure is privately owned. So, we're exploring what further measures are possible in public and private spaces to better protect children and families from the harmful impact of unhealthy food advertising in our outdoor spaces. We'll consult on options to strengthen the provision of healthier food in public sector settings, including across the Welsh Government estate and, importantly, NHS sites.

To deliver lasting change, we have to continue to ensure that movement is woven into the fabric of everyday life in communities across Wales. Movement is so important. From pickleball and climbing to swimming, yoga, tai chi, walking groups and strength training classes, our 60-plus active leisure scheme is helping older adults also to stay active, connected and well. Using the power of football to engage communities, our Fit Fans programme has helped people with complex health needs achieve significant improvements in their well-being. And our children and family pilots are supporting hundreds of families: real people whose lives are being slowly transformed for the better. By working across Government and alongside our communities, we can turn this plan into real, sustained change, giving every person in Wales the opportunity to live healthier, happier lives.

I call on Peter Fox to reply to the debate.

Thank you, Dirprwy Lywydd. Can I thank everybody who's contributed to the debate this afternoon, and thank my colleagues for also contributing and the work that they did in bringing forward this report?

Jenny, can I thank you for your continued passion around this subject? You're right to challenge the system, as you often do. It's very clear, and that's a very good point about the importance of breastfeeding. Indeed, it was on the radio this morning, the importance—if parents are able to breastfeed their children, how that likely stops them getting obese in later life. Not all can, we know that, but thank you for raising that.

Mabon, thank you for the sobering reminder of the fact that so many people in our communities are overweight—six in 10—and the premature deaths and things that occur due to related illnesses.

John pointed out the importance of signposting people to access and to find the places where they can follow a healthier lifestyle, and pointed out some of the things like the junior parkruns, and how that project, that pilot’s going to work with children and schools. It sounds really exciting.

Altaf, your experience in this is much welcomed and reminds us of the importance of the rise in type 2 diabetes, which is linked to obesity. We must not forget that, and especially when we see that rise in children especially.

Joyce, thank you for pointing out the very real costs of doing this, and the importance of prevention for children and young people, how we need to invest in our children and young people. They are our future. And that sobering message from Altaf, where a generation could end up outliving their children. That is a really, really moving point.

Cabinet Secretary, can I thank you for your engagement throughout, and for accepting many of our recommendations, and for clearly recognising the real issues we have here in Wales? But I think there is a need for us to put more pressure on our local health boards. It can't be right that many of our local health boards, those health boards with the biggest problems in areas, aren't providing child health weight-loss management. I think that is really a fundamental issue.

We welcome your focus on prevention. Prevention is something we’re hearing in every inquiry we do at the moment, and it's such an important step that we have to take to invest in prevention, so we can turn the tide on many areas—not just this area, but many areas. It's something that I hope the next Government really take forward.

Can I just finish by thanking everybody for participating? It is important, as the Cabinet Secretary said, for all of us to play our part in trying to drive a healthier agenda, so that our children have the real opportunities they deserve in life. Thank you.

The proposal is to note the committee's report. Does any Member object? There is no objection. Therefore, the motion is agreed in accordance with Standing Order 12.36.

Item 7 is the Welsh Conservatives' debate on hospices, and I call on Paul Davies to move the motion.

Diolch, Dirprwy Lywydd, and I'm pleased to move the motion tabled in my name.

Today's debate is an opportunity for us to recognise the importance of hospices in Wales and consider ways in which the Welsh Government can better support the sector. Hospices and palliative care providers across Wales are under more and more pressure as demand for their services increases. Providers are also facing serious workforce shortages and, of course, there are increased pressures as a result of cost-of-living rises, and because of policies like the increase in employers' national insurance contributions from the UK Government. As a result, without serious significant investment, more and more hospices will be considering reducing their services, and some may even be forced to close their doors in the coming years.

Unfortunately, it's too late for Shalom House, a hospice that was based in St Davids in my constituency. Shalom House closed its doors at the end of October last year, after almost two decades of supporting patients with life-limiting conditions, like motor neurone disease, chronic obstructive pulmonary disease and Parkinson's disease. I was very privileged to have had the opportunity to visit Shalom House several times as the local Senedd Member and, each time I visited, I was impressed with how dedicated, compassionate and committed the staff there were. And I wasn't the only one who was impressed. In Shalom House's final inspection report, Healthcare Inspectorate Wales found that the staff team were committed to providing patients with compassionate, safe and effective care. So, I believe it's a real shame that, despite all the amazing work that was being done to care for and support patients, Shalom House had to close its doors because of financial pressures rather than any shortcomings in the quality of the care that was provided.

In my view, the Welsh Government should be embarrassed that Shalom House has been forced to close, and it certainly should be embarrassed about some of the findings of the Hospices UK survey that our motion refers to. That survey found that nearly 30 per cent of Welsh hospices are reducing the number of in-patient beds or wider services as a result of increasing costs and workforce pressures. The fact that over 70 per cent of hospices with in-patient units agree that cost-of-living pressures are likely to result in one or more in-patient beds becoming temporarily or permanently unavailable is not acceptable. It's clear that the Welsh Government, as a matter of urgency, needs to develop a sustainable funding model, so that hospices are not forced to close because of financial pressures. According to Hospices UK, on average, 70 per cent of the care costs of delivering hospice services are funded by charitable donations, with the remaining 30 per cent provided by the Welsh Government and local health boards. It's very sad that hospices are having to rely so heavily on the generosity of the public in order to be able to run services, and as more and more people are requiring palliative and end-of-life care, their future is unsustainable.

And this is not a new issue. There have been long-standing concerns about the sustainability of the sector, and if we don't see meaningful investment and action now, then more hospices will end up reducing services, and that ripple will be felt in our communities and by the NHS. Evidence of reducing services can be seen in north Wales, where St David's Hospice beds at Ysbyty Penrhos Stanley in Holyhead have been temporarily closed because of the impact of rising running costs and reduced income. And there is a genuine fear that we could see more of this happening across Wales, if a permanent, sustainable solution is not found.

Of course, the situation was further inflamed when the UK Government announced increases in the national minimum wage and employers' national insurance contributions. And you don't need to take my word for it. In October, the chief executive of St David's Hospice Care Newport, Emma Saysell, made it clear that these rising costs, coupled with a lack of sustainable funding, has made the hospice's financial situation tenuous. She said, and I quote,

'This is the worst time financially that I think we've ever faced. The national minimum wage increase has cost the hospice over £100,000. Couple that with the increase in national insurance, that was another £180,000.'

And providers like St David's Hospice Care are having to find additional funding just to keep their doors open. Charitable donations are just not enough to run a hospice. There needs to be adequate, consistent, statutory funding.

Now, of course, it's a programme for government commitment of the Welsh Government to review voluntary hospice funding, and to give credit where credit's due, some work has already been done. Back in July 2021, the Welsh Government asked the end-of-life care board to review hospice funding. That review identified some important considerations around including hospice-at-home care and the role of children's hospices in providing respite care, and as a result, an increase in recurrent funding was made to the sector. And whilst additional allocations of funding to the sector are, of course, welcome, until a clear decision is made on how the sector will be supported in the medium and long term, we will not make meaningful progress in addressing these systemic challenges.

So, let's consider some of the things that we need to see from a sustainable funding model. Firstly, there needs to be far greater parity between the services delivered by hospices and the NHS, and a clearer recognition of the vital role they play within the wider health and social care system. Hospice care is delivered in the community and in a range of settings, from in-patient facilities to hospice-at-home care, and it relieves significant pressure on the NHS by reducing the number of hospital admissions and enabling patients to stay at home, and that needs to be recognised.

I have selected the amendment to the motion. I call on the Cabinet Secretary for Health and Social Care to move amendment 1, tabled in the name of Jane Hutt.

Formally.

We welcome this motion because it looks at the long term. That level of forward planning is admirable. And given recent events on the benches opposite, it's not always a given. And thinking about Reform: Reform will bang on about the need to look after our own, about the need to stop funding certain programmes. But when it comes to a motion that actually looks at a positive proposal to increase funding to the most vulnerable people in our communities, where are they? Nowhere to be seen.

But putting all of that to one side, the hospice sector deserves the full and serious attention of this Senedd. Hospices provide care; not just at the end of life, but at the most human moments, supporting families, carers and communities when they're at their greatest strain. The motion rightly recognises that work and it also confronts an uncomfortable truth, that the current funding model is no longer sustainable.

The message of the motion is as true today as it was when I introduced a debate on the same subject exactly two years ago. And it's worth reminding ourselves of what I said two years ago.

Hospices are a crucial part of our health and care system, providing specialist support that tens of thousands of people depend on every year, from newborns to older people. They provide a wide range of services: care in the home, emergency out-of-hours support and support for the bereaved. They ensure that a patient's end of life is treated with the utmost dignity, sensitivity and comfort. I’d like to pay tribute here to the ceaseless commitment of staff who go far above and beyond to provide this care.

Hospices are also a crucial part of community care, keeping people out of hospitals and alleviating pressure on the front line. But, as this motion rightly acknowledges, the hospice sector’s financial situation has now become unsustainable. By now, two thirds of hospice funding comes from charitable donations, a ratio that increases to around three quarters for children’s hospices. And with the additional cost of employer national insurance contributions, rising energy bills and a shrinking workforce, we are swiftly reaching a point that is totally unsustainable. This has already led to the closure of hospice beds, as was seen in Penrhos Stanley in Holyhead.

In my debate two years ago, I outlined three possible outcomes of this crisis. Two of those options are completely unacceptable: either leaving people to suffer in pain, or shifting the entire burden onto health boards that are already under huge pressure. So, the only sensible solution is to respond to the Government’s warm words on end-of-life care with the necessary funding that reflects the reality on the ground, thereby providing the assurance and stability needed by hospices to do what they do best.

As well as the clear moral case for action, the economic rationale is also robust. We are all aware of the fact that we have an ageing population, and that the cost of supporting health in the final years of life are, on average, significantly higher. According to an assessment by Marie Curie, the demand for end-of-life care services will grow significantly in coming decades. By the 2040s, 37,000 people in Wales will require end-of-life care every year, which is an increase of 5,000 on the current position. So, the call for a new financial settlement for the sector is not just a matter of filling gaps in funding, but one of long-term investment in the health needs of our population.

There is also a job of work to be done to refine governance arrangements. I've mentioned often the need to reform regional partnership boards to improve collaboration between health boards and local authorities, and our plans in this area would include appointing a designated lead for end-of-life care in every board.

I'm very pleased to contribute to this debate on hospices and palliative care today. These are issues that I've always felt are so important to us as politicians. I have a long-standing relationship with City Hospice in my constituency, where I was vice-president for many years. I've also had close contact with Tŷ Hafan, one of the only two children's hospices in Wales. The last time I visited Tŷ Hafan, I was shown around by Tom, the inspirational young man who is a member of Tŷ Hafan's 'the squad', a group of young people who, thanks to modern medicine and excellent care, have lived into adulthood.

City Hospice, in my constituency of Cardiff North, is based in the grounds of the old Whitchurch Hospital, and it provides its care to people in their own homes. There's no residential provision, but they use their base to provide day services, counselling groups, bereavement services, holistic therapies, money advice, and the use of their beautiful garden, which backs onto the Forest Farm nature reserve.

Hospices are charities, and they're made possible by the huge generosity of the public and volunteers. I believe very strongly that using the voluntary sector in the way that we do is the right model for delivering palliative care. Historically, palliative care has developed in this way in this country, and I think we have some of the most excellent examples of palliative care here, because the voluntary sector can concentrate on this area of work without the overwhelming demands that the NHS experiences.

We do know that many people do die in hospitals, where it's often impossible to deliver the individual care that hospices are able to provide. So, I believe the model is right. However, the demand on hospices is growing; that's been raised here today already. I've been told by City Hospice that there has been an increase in patient numbers over the last three years, an average of 5 per cent per year, and around 1,800 patients are now being served by City Hospice. And, of course, that is their families and the carers as well.

Hospices are providing essential statutory services, and I think this point has been well made by the hospices. I think it is essential that they are fully reimbursed by the NHS so that the essential statutory services are fully funded. Then, the voluntary income of the hospices is used to deliver all those extras that are essential as well. The generalist palliative care in City Hospice is entirely funded through donations and the community.

I don't think it's a bad thing to say that some of our hospice care and palliative care is supported by a public that wants to donate. I think that is a model that is acceptable. But the essential care—the statutory services—should be funded by the NHS. I also think there should be more consistent arrangements in place and that there should be pay parity with the NHS, as I know the hospice movement is calling for. But I am very glad that the Welsh Government and the hospice sector are working together to develop a sustainable funding model, because I think we do need a sustainable funding model.

The value of hospice care in Wales cannot be overstated. It is a necessity. Across Wales, 15 charitable hospices operate with unwavering dedication, supporting more than 20,000 adults and children living with terminal illness each year. Their work goes far beyond clinical treatment, helping people live well as they approach the end of life, enabling them to make lasting memories, express their wishes and experience peace and dignity in their final days, and providing vital support to caregivers and families, helping them navigate emotional strain, uncertainty and grief. Their support is holistic, compassionate and tailored to the needs of each individual.

Hospice services extend beyond institutional settings, allowing people to remain at home surrounded by familiarity and love. They also offer access to in-patient beds within local communities, ensuring that essential care remains close to home, reducing unnecessary hospital admissions, supporting timely discharges and easing pressure on GPs, district nurses and social care teams. However, this immense contribution relies heavily, as we've heard, on charitable fundraising, with nearly 70 per cent of hospice care costs met through donations.

Wales's hospices invest around £30 million of charitable funding into the health and care system every year. Looking forward, demand for hospice and palliative care is projected to increase by around 25 per cent over the next 25 years, driven by an ageing population, increasingly complex medical conditions and widening health inequalities. Despite being promised a share of the £3 million allocated in the Welsh Government's budget, Wales's two children's hospices, Tŷ Hafan and Tŷ Gobaith, were still waiting to receive confirmation of their allocation, or when they would receive it, in November. To meet growing need, they are calling for sustainable ring-fenced funding, rising to 30 per cent of care costs by 2030, still below the average for adult hospices.

The UK Government has announced additional funding for adult and children's hospices in England, dwarfing the Welsh Government's hospice funding here in Wales, where healthcare is being shifted out of the community into hospitals, in direct contradiction of stated Welsh Government policy. Lower spending on hospice funding in Wales will cost the Welsh Government more. By the 2040s, an estimated 37,000 people in Wales will require palliative or end-of-life care annually, with demand rising substantially, yet hospices continue to face serious sustainability challenges, with rising staffing costs imposed through ‘Agenda for Change’ and national insurance increases, combined with the rising cost of living, leaving hospices forecasting deficits for 2025-26. As they warned, many are now facing difficult decisions, drawing on reserves, reducing inpatient beds, scaling back services, delaying recruitment, reducing existing services, postponing plans to expand or introduce new services, or even closing.

You need to conclude now, please, Mark.

Although hospices remain committed to raising charitable funds, this disparity must be addressed if their essential clinical care is to continue. Diolch yn fawr.

I've been privileged over the years to work with the St David's hospice in Newport. They are an absolutely amazing organisation. The quality of the care that they provide at the hospice, with their in-bed facilities and a range of supportive activities and therapies, as well as, crucially, in people's homes, allows so many people to die with dignity surrounded by the love and comfort of familiar surroundings and family. It’s an incredibly impressive organisation in every way. They raise an amazing amount of funds every year through a wide variety of activities and events, including Newport's half marathon, which I have taken part in almost every year that it’s been run.

I must say I do recognise the pressures that others have mentioned. I know Emma Saysell very well, and their current funding pressures are enormous. In fact, they set a deficit budget for this year of £250,000, and they will be setting another deficit budget for the 2026-27 financial year. They have a very widespread range of retail shops, not just in Newport but in the surrounding area, because they do serve a wider geographical area, and that retail trade has suffered. Those shops are not performing as well due to increased costs and the impact of lessening footfall in the high street, and also, of course, many members of the public now sell their items online, with various new online platforms encouraging and allowing that.

They are mindful also, Dirprwy Lywydd, that they will see an increase in patient numbers, creating additional demand for their vital services, because of the ageing population that we have, which is set to increase markedly in the years to come. So, it is a massive challenge for the sector, including St David's Hospice, to meet that increasing demand while they have those increased costs that are placing such a demand on their model of delivery.

And, of course, it's also the case for Tŷ Hafan, which I'm also very familiar with. In fact, I have a family at the moment who've contacted me to say just how vital the services that Tŷ Hafan provide are for their family. Their son Patrick, who is eight years old, has a rare genetic condition, has to use a wheelchair, is tube fed and has severe learning difficulties and sensory issues. Sometimes his behaviour is challenging and he often sleeps for only two hours per night. This means that Patrick's parents, Collette and Matt, and, indeed, his brothers, Vincent and Sam, need support as a family. It's much wider than Patrick's own personal needs in terms of the support that the family themself need, and they found that Tŷ Hafan very much recognise that and do provide that support for the whole family. In fact, Collette tells me that every few months, they are offered a short-notice cancellation bed at Tŷ Hafan. They will get a phone call asking if Patrick would like to come in tomorrow for a couple of days, and that's an absolute lifeline for their family. They have full confidence in the medical services available there at Tŷ Hafan, and it then allows them to spend some time with their other sons, Sam and Vincent, to enable the family to do the simple things that other families take for granted and that make all the difference. Patrick's father Matt tells us that it's critically important that Welsh Government properly funds hospice care in Wales, including Tŷ Hafan, because it's an absolute lifeline for families who are facing the absolute worst. It's important to show Wales is a compassionate country, and having the support of Tŷ Hafan makes all the difference and keeps so many families from not being able to cope at all.

I'm pleased to be part of this debate. No doubt we will mention several of the statistics that will be repeated, because it's such an important area. Of course, many of us have already been touched by the service that is provided by hospices across Wales, so it's such an important area to look at. Can I thank all of those charities who do so much outstanding work in the field—charities in my area, such as St David's Hospice, the Hospice of the Valleys, Helping Hands, Tŷ Hafan and others operating in the constituency, providing that invaluable support to patients and their families during that most difficult time of people's lives?

I want to draw particular attention to Tŷ Hafan, as Julie Morgan and John Griffiths have already highlighted—that hospice and charity that cares for children and the families of children. Last year the charity supported 477 families, with a further 437 families receiving bereavement support. It supported over 1,000 respite nights and delivered 280 nights of end-of-life care and symptom management support. Dirprwy Lywydd, the simple truth is that as medical technologies advance, we are all living longer and this will inevitably increase the demand for palliative care at the end of life. Yet, as Hospice UK estimates, one in four people do not receive the specialist palliative care they need, often as a result of marginalisation and exclusion, made worse by patchy and uneven services and funding.

Furthermore, this vital sector has been hit with increasing costs, as we've heard, such as the employers' national insurance rise and the workforce shortage. We cannot allow inadequate care to be the reason people feel driven to consider ending their lives, out of desperation, and the reality is that for too many, this is already the case. A survey of Wales's 14 voluntary hospices found that 30 per cent are already reducing beds or cutting services, while over 70 per cent of those with in-patient units expect at least one bed to close, either temporarily or permanently.

I'm not here today to make a judgment on the assisted dying Bill, which is a debate for another time and another place, however, the conversation around assisted dying must shine a light on how we as a society care for those at the end of life and those most in need of support. What we urgently need is better financial policy making to sustain our hospices. We need a long-term sustainable funding model for hospices in Wales to address this crisis with the urgency it deserves. The Welsh Conservatives, as we've said, have already pledged to implement this, as well as an additional £40 million over the next Senedd term, and I encourage every party here to do the same.

Dirprwy Lywydd, this should not be a political matter, and I certainly do not want to make it one. We are all talking about care at a time when people are at their most vulnerable. This vital sector provides that essential care and support for both patients and their families and we cannot underestimate how important that work is. I hope that colleagues across the Chamber will support this motion and provide our hospices with the long-term support they so desperately need. Diolch.

I had the privilege of visiting the St Kentigern Hospice in my region a little before Christmas. It serves areas in Denbighshire, Flintshire and Conwy, and that visit truly did highlight, beyond any doubt in my mind, the significant difference that such hospices make to the lives of so many people. It was so worrying to hear staff saying quite clearly during that visit that the model of hospice provision, to all intents and purposes, is broken. That isn't something new to many people who are familiar with the hospice provision here in Wales, but, as we know, they have had to work so very hard over a number of years just to survive. But now, of course, more recently, with the increasing significant cost pressures that they face, along with the ongoing battle to fundraise—to do that now in the midst of a cost-of-living crisis leaves the sector in an extremely difficult position.

And let's be clear, hospices are essential, as we've heard, to our wider health service. They take the pressure off our NHS in so many ways, and I'm sure if you were to ask the health boards themselves to describe the importance of the hospice sector, then they would leave us in no doubt about what they contribute.

Now, statistics don't always tell us the human story, do they, but they clearly do tell a story. We know that more than 35,000 people die every year in Wales, and up to 90 per cent of those could actually benefit from palliative care that hospices excel at providing; 20,000 children and adults are supported by hospices each year; 800 clinical care staff are employed by hospice care organisations. Now, imagine if those services weren't available. That's one way of underlining how important they are. Imagine that they weren't there, and the additional pressures that their disappearance, effectively, would place on our hospitals, on our GP practices and other associated services, and that's why it's hugely concerning that a third of them, according to Hospices Cymru, have had to reduce services.

Now, three quarters of costs, of course, are staff and wages, and the UK Government's national insurance hike last year has left St Kentigern, for example, with an additional £65,000 bill, with no support to claw that back. That's a huge concern. Well, that's the reality, and those are the consequences of political decisions. They've had to rely on the community to raise funds; just 30 per cent of their funding comes from Government. And I personally have been involved with Tŷ Gobaith-Hope House as well, volunteering and raising funds on a few occasions. St Kentigern, particularly, have 10 shops, and they rely on 300 volunteers to support the fundraising work that they do. It really defies logic that a service of such importance effectively relies on coffee mornings and raffles. We know that goodwill doesn't pay the bills.

But we also know that St Kentigern isn't just a hospice, it's a hub. The cafe that they run there is a key hub for the wider community. There are also outreach visits to patients, to enable them to stay in their home rather than to become hospitalised. There are so many intangible impacts that these community-based organisations make to thousands of people's lives on a daily basis.

Now, the ask from the hospices is that they have that sustainable funding scheme, and I mentioned the ongoing cost-of-living crisis is having a real impact on their income streams. I have real concerns that some of these vital services, and they are vital, aren't they, they're not nice to have—. The danger is that they will diminish and eventually disappear. Our NHS is already under huge strain, and hospices are key to easing that burden.

It was the former Vice-president Hubert Humphrey who said,

'the moral test of government is how that government treats those who are in the dawn of life...in the twilight of life...in the shadows of life'.

It's our hospices who are supporting those in the twilight of life and in the shadows of life. It's in light of quotes like this that we have brought forward this debate today on hospices.

I want to recognise the exceptional work that hospices and palliative care providers do across Wales, and particularly in my region in north Wales. Every day these dedicated staff and volunteers provide high-quality care to those at the end of their lives, offering comfort, dignity and vital support to their families. Their work is often unseen, yet as we've heard already today, it is invaluable.

We cannot talk about celebrating their work without acknowledging the unprecedented pressures that they face. We've already heard that hospices are struggling under the weight of rising costs, workforce shortages and increasing demand for their services. We've heard about the employers' national insurance increases, rising energy bills and other operating costs that are forcing organisations that primarily exist to care for the vulnerable into financial crisis.

I've heard this first-hand from Nightingale House Hospice in Wrexham, who recently celebrated their thirtieth anniversary of excellent work in Wrexham, supporting the town and its surrounding communities. Like all Welsh hospices, they are experiencing financial pressures, and are now having to budget a deficit for this coming year. We heard from Peter Fox, and I read the same survey by Hospice UK in regard to the fact that so many hospices are having to reduce those beds and cut services. But in addition to what Peter Fox said, that same survey shows that three quarters of hospices fear they'll be forced to withdraw support they currently provide to hospitals and to care homes as well.

It's important to stress that these pressures are not caused by the sector itself. They're the direct result of decisions being made in this place, and by politicians in Westminster as well, decisions that are being made to increase the cost of employment without providing support to go along with it, leaving these organisations to bear the brunt of rising demand without that adequate funding. That's why we believe the Welsh Government must act responsibly and urgently to ensure that those at the end of life receive the care and dignity they deserve.

Going back to Nightingale House Hospice in Wrexham, when they opened 30 years ago, they had running costs of around £1 million a year, of which 80 per cent was statutory funding, and they had to raise an additional 20 per cent. Today, that same hospice has running costs of around £5.6 million, and it's completely flipped. It now raises 80 per cent of its funds, with only 20 per cent coming from statutory sources. This shows the shift in that 30-year time between how hospices were funded and how they're not being funded adequately today.

Many thanks to the Welsh Conservatives for bringing this motion, probably very close to Paul Davies's heart, because last week I spoke to somebody from north Pembrokeshire who said how awful it was that Shalom hospice had closed, and the impact that would have on individuals and their families. Now, we all know that many people wish to die at home, but of course that's not always possible. Studies have shown that home-based palliative care is the least costly model, with hospital care being the most costly model, and then hospice care being a vitally necessary middle ground. Despite this, almost a fifth of hospital beds in Wales are occupied by people in the last 12 months of their lives, according to Marie Curie, and, unfortunately, I was at such a bed only a fortnight ago.

The body of evidence and policy suggestions are already here when it comes to hospice care. A report on the state funding of hospices in England was published by the House of Lords in 2024, where many of the issues we face in Wales were raised and solutions offered. At that time, Hospice UK called for a strategy for the next five years that involved all four nations. That would involve statutory funding, a national bequest campaign, which Hospice UK have already started, and other ideas for a long-term funding stream for hospices, to avoid the closure of hospices like Shalom in Paul Davies's constituency. This would prevent also the postcode lottery we are now seeing, which means wealthier areas end up with better care.

When hospice and palliative care is provided, it is of high quality, and life-changing for individuals and their families. I have seen that with my own eyes in Holme Tower in Penarth and City Hospice in Whitchurch. I've also seen how fantastic Tŷ Hafan is when they supported my brother and sister-in-law in the final days of my nephew's life, and for years afterwards.

Supporting what Julie Morgan has already said, evidence presented to the Westminster Health and Social Care Committee on assisted dying shows that the UK has been a world leader in palliative and end-of-life care. Evidence even showed that specialist palliative care is so effective at symptom relief that many who enter hospices—and I've seen this—thinking that they were going there to die were stabilised and then lived fulfilling lives for many months to come. There is an incredible 50 per cent discharge rate from hospices. They aren't necessarily a place where you go to die; it's often a place where you go to stabilise, and to stabilise the medication.

I appreciate the Welsh Government amendment, and I know that hospices welcome the increase in funding and the ongoing work by the Welsh Government to develop a sustainable funding model. But, even at the time of that funding uplift in 2024, we all remember that Hospice UK made it clear that the funding did not address the immediate funding challenges that Welsh hospices are facing. Marie Curie said the same thing. If what Welsh Government was doing was enough, Hospice UK would not be asking them for urgent action.

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

Diolch, Dirprwy Lywydd. We have had today an opportunity to discuss and to agree on the important role that hospices play, following the short debate again in September. I want to set out today the Welsh Government's position on the future of hospice and palliative care in Wales.

But I want to begin by reaffirming the principle on which this Senedd is united. Hospices make an exceptional and irreplaceable contribution to end-of-life care. They provide compassionate specialist support at the most difficult moments in people's lives, delivered with dignity, professionalism and humanity. We recognise their importance and are working closely with the sector, as many Members have acknowledged, to understand and to support the pressures that they are facing.

Recent developments underline the seriousness of those challenges. The closure of Shalom House Hospice and the temporary closure of in-patient beds at St David's Hospice in Holyhead have caused real and understandable concern for patients, families, for staff and communities. These events, as we have heard in the debate, highlight the need for a sustainable long-term approach to hospice funding and commissioning that protects essential services and ensures stability for the future. This debate today is focused on a stable funding framework for hospices.

Dirprwy Lywydd, over this Senedd term, the Welsh Government has increased hospice funding by £21 million. This includes an additional £5.2 million every year, alongside more than £9.5 million in one-off grants to help the sector manage rising costs. Most recently, as we've heard in the debate, we have provided £3 million in recurring funding to support hospices with inflationary and workforce pressures. This sits alongside significant investment from health boards, which, of course, play a central role in commissioning and supporting hospice care.

However, in a period when public finances are under real pressure, it is even more important for us, together, to ensure that the resources that we have are used as effectively as we possibly can. Our shared aim with the sector must be to direct funding towards care that makes the greatest difference to people's comfort, dignity and quality of life. This means supporting services to work efficiently and ensuring that people receive the right care in the right place, including, importantly, as we've heard, reducing avoidable hospital admissions. Health boards and hospices each play a vital role in achieving this. By exploring innovative approaches, improving co-ordination and embedding the best practice that we've heard referred to today, we can ensure that the resources that we do have can go as far as possible to support the work of the sector. Working together in this way will strengthen palliative and end-of-life care within the budgets we have available to us, while maintaining the compassion, expertise and person-centred support that patients and families rightly expect.

I call on Gareth Davies to reply to the debate.

Diolch yn fawr iawn, Deputy Llywydd, and I'm grateful to all the Members who've contributed to this debate this evening. I want to begin by paying tribute to the extraordinary staff, volunteers and families who support hospices and palliative care services across Wales. We all applaud their compassion and commitment, but compassion alone cannot sustain a system that is so clearly under strain. Today's debate has laid bare that palliative and end-of-life care in Wales is at a very critical juncture. Almost one in five beds in Wales are occupied by someone in the last year of their life, as quoted during the debate, and one in 14 emergency department attendances relates to someone at the end of life. And yet, despite many people expressing a wish to die at or close to home, too many are spending their final days in hospital without the appropriate end-of-life support they need. That's not because hospices are failing; it's because the system around them is. Hospices support around 20,000 adults and children in Wales every year, providing in-patient care, care at home, bereavement support and vital services in the community.

In the Vale of Clwyd, in my constituency, we are lucky to have the fantastic St Kentigern, located in St Asaph, as Llyr Gruffydd mentioned during the debate, whose work in the community and support provided to families goes way beyond in-patient care, and I have met with them many times to discuss the concerning dire financial situation hospices across Wales face, with Welsh Conservative colleagues, Darren Millar and Mark Isherwood, earlier on in this Senedd.

As others have mentioned during this debate, adult hospices are forced to raise, on average, 70 per cent of their running costs from charitable donations, equating to around £30 million per year raised through coffee mornings, charity shops and community events simply to keep essential services running. This model is unsustainable in the long run. Inflation, workforce pressures and rising demand are pushing services to the brink. We've already seen the consequences: beds being closed, services reduced and, tragically, hospices like Shalom House in Paul Davies's constituency closing altogether. Against that backdrop, the Welsh Government's £3 million commitment to 2025-26 simply does not meet the scale of the challenge, and it's not even close.

That is why the Welsh Conservatives have been clear, and we've been ambitious. We have committed that a Welsh Conservative Government will invest an additional £40 million over the next Senedd term in hospices and palliative care, providing the biggest boost in end-of-life care in Welsh history. We've pledged to ring-fence funding so that Wales's children's hospices receive 50 per cent of their operating costs. The Welsh Government's own quality statement promised care that's safe, timely, effective, person centred, efficient and equitable. Those aspirations are commendable, but aspirations alone do not fund beds and retain staff. Marie Curie and Hospice UK have been unequivocal that, without urgent action, more services will close, specialist staff will be lost, and families will be left without the care they desperately need. This is an issue that affects every single family in Wales, and how we care for people at the end of their lives is a measure of our values as a nation. Demand for palliative care is estimated to increase by 25 per cent over the next 25 years, so investment in palliative care is essential.

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

The next item is the additional topical question, which will be asked by Rhun ap Iorwerth.

Today, I released a written statement providing an update on the Menai suspension bridge phase 2 works to this historic 200-year-old landmark. It is critical infrastructure and an iconic feature of north Wales's built environment, but, of course, ensuring its safety and structural integrity must always come first.

I thank the Cabinet Secretary for that response. Now, I did have to check with my staff today, asking them, 'Can you check exactly when the bridge had to close? Are we sure that it was the end of 2022?' And, yes, it was the end of 2022, and today's announcement about further delays to these works is going to be received with great frustration by the local community. It is unacceptable that the work of repairing a bridge that closed in 2022 is now being extended until 2027. It is a not insubstantial percentage of this bridge's 200-year history. But what's been experienced locally has had a real impact on people's lives: people's businesses have suffered, of course; community groups had hoped to celebrate the two-hundredth anniversary next week, with an assurance given that that would be possible—it won't be; and the concerns will continue about the ability of public services to cross the Menai, and so on.

I will say that I welcome the fact that our arguments on the need to limit the inconvenience caused by the closure of the bridge for certain periods or to have traffic management measures in place for certain periods have been heard. And whilst the timetable is being extended now, I do understand that the periods of traffic control will be as little as a few days every now and again, and that is a step that we can welcome, I think. But, of course, we had been given an assurance that the works would have been long finished by this point, and people constantly feel that we have a Government that doesn't understand and appreciate the impact that this work has had.

So, to my questions. The Cabinet Secretary has said that he is pushing for an assurance that there should be no further delay. I'm almost afraid to ask, but how confident is he that this won't be a date that is changed again? Secondly, I have been disappointed that the Government, over a period of time, has failed to provide financial support to the businesses affected when they needed that. But let me ask this: what work will the Government do or what plans are in place to provide support for businesses to re-establish themselves and to recover from the difficulties that they faced, and to promote the economy of Menai Bridge and nearby areas. And thirdly, I would truly like to know when we are likely to receive the findings of the Government investigation into the work to maintain the bridge. The questions are still intensifying, I'm afraid. People want answers about why they have to suffer all of this inconvenience for so long and how this was allowed to happen, and it's important that that work is shared publicly as soon as possible.

Well, can I thank Rhun for his further questions? Reprofiling the work means that there will be no closures, and that's in the interest of the business community. We listened very carefully to them, and the choice was: do we want road closure, bridge closure or do we want to keep the bridge open and have that work carried out in a safe way but also keep traffic moving? We went for the latter. So, whilst it won't be completed until 2027, there will be no road closures. That will benefit the community, that will benefit businesses, it will benefit the freight sector that rely on the crossings over the Menai. And I think it's worth putting into the context that this is a 200-year-old bridge. When it was built, it was built with a view of only ever carrying horses and carts. And, in reality, if you look around the world, bridges everywhere right now are having to be replaced, maintained, repaired. The George Washington bridge, for example, in New York, one of the richest cities in the world—that was closed in 2025 for maintenance work. The Mont Blanc tunnel as well, as a critical piece of infrastructure between France and Italy, was completely closed—completely closed between September and December of last year. And in Scotland, in Aberdeenshire, the BBC reported just yesterday that 200 bridges—200 bridges—in Aberdeenshire require maintenance and repair work or replacement. There are communities that are cut off because bridges have been closed completely since 2023. This is a challenge for communities and Governments around the world, particularly when it concerns bridge infrastructure that has to be maintained to the highest standard.

So, I'm going to be meeting with Equitix on Friday, again—they are managing agents for this bridge—to seek assurance that the highest quality work will be taken in the months to come and that there will be no delays. I'm very confident that there will be no further delays. Why? Because we're investing as never before in road maintenance. We are fixing our roads. As a result of the extra financial support for councils this year, we're going to be achieving a historic milestone: 200,000 potholes repaired or prevented; 500 km of road maintained and repaired as a result of Welsh Labour Government investment. That shows how serious we are about making sure that we fix our roads. And in terms of bridges specifically, of course, the River Dee bridge is a critical piece of infrastructure. That's going to be the next big project to be taken forward, replacing that. Without that, the Port of Holyhead would not exist in all likelihood, because it would cut us off from the rest of Great Britain. That shows how seriously we take road infrastructure in north Wales.

Cabinet Secretary, this is ridiculous. People on Ynys Môn and across the Menai have been waiting five years for these repairs to be dealt with. You've got to be embarrassed at the very least at the state of what's going on here. I think there's a growing feeling from people on the island and on the mainland that you just don't get it. I think the 'around the bridges in 80 days' tour we had from you just then kind of points to that fact. I was waiting for the Golden Gate bridge to be mentioned, which happens to be twinned with Foryd bridge in Rhyl, actually, but you didn't mention that. But there's a growing consensus that you just don't get it. It's not just a minor inconvenience. It's not just something for an old bridge, that you've just got to get used to it. It's a failure of project management, to say the least. It's having a real impact on communities in the area and across the wider region as well. Those bridges keep our communities connected, support local jobs, enable tourism to take place successfully. We've rehearsed it time and time again in this place about the issues when there are high winds and the nervousness that it causes to people on the island, and in terms of dealing with the fact that this is just not being taken seriously at all, it seems.

So, the questions that people are asking are basic questions: what's going on, why is it taking so long, why are the shifting timelines taking place, it feels like, all the time, why such vague reassurances, and where's the transparency on this as well? The warm words about having strong conversations with those, perhaps, responsible on the ground just aren't cutting it at the moment. Local businesses are telling us that they can't plan ahead as they wish to do so.

So, in terms of questions I would like to hear answered today, what lessons are you learning now from failures on this project that will be immediately rectified? When will we finally receive a clear, credible timetable that we can rely on and not be in this place again hearing about another failure of timing? What are the delay costs? How much is this costing taxpayers in Wales, these continuous delays? We need this dealt with quickly. It needs to be sorted soon. People need to know that you're taking it seriously.

I'm afraid what the Tories don't get is the need to make sure that health and safety is put first. We constantly hear from Tories about the need to rip up health and safety standards. We will never do that. We will never do that in the workplace. We will never do that with transport infrastructure either, so it's vitally important that we properly maintain our bridges and our roads. It's really rather rich, coming from the Conservatives, who imposed austerity on us, to be lecturing us on the maintenance schedule of our assets.

I mentioned Aberdeenshire. It's because of austerity that Aberdeenshire now have 200 bridges that need urgent repairs and maintenance work on them. So, I won't take any lectures from the Conservatives over how to maintain infrastructure, given their historic underinvestment in all forms of transport infrastructure in the UK. But we will ensure that this iconic piece of built environment in north Wales is completed, that it is provided with a full repainting to celebrate its two-hundredth anniversary, and we will be celebrating that key, historic moment in this bridge's history. It is something that we richly celebrate, and we are proud of, and we will be continuing with those celebrations.

Thank you, Cabinet Secretary.

That brings us to voting time. Unless three Members wish for the bell to be rung, I will move directly to voting time.

The only vote this evening is on item 7, the Welsh Conservatives' debate on hospices. And I call for a vote on the motion, tabled in the name of Paul Davies. If the proposal is not agreed, we will vote on the amendment tabled to the motion. Open the vote. Close the vote. In favour 22, two abstentions and 24 against. Therefore, the motion is not agreed.

I now call for a vote on amendment 1, tabled in the name of Jane Hutt. Open the vote. Close the vote. In favour 24, two abstentions and 22 against. Therefore, amendment 1 is agreed.

I now call for a vote on the motion as amended.

Open the vote. Close the vote. In favour 25, two abstentions and 21 against. Therefore, the motion as amended is agreed.

That concludes voting for this afternoon.

We will now move to the short debate.

If you're leaving, please do so quietly.

I call on Lee Waters to speak.

Diolch, Dirprwy Lywydd. I've agreed to give John Griffiths, Carolyn Thomas, Mabon ap Gwynfor and Mark Isherwood a minute of time.

Tourette's is a complex and misunderstood condition, and yet it's a common one. It's a brain order that affects one in 100 people. That's a similar prevalence to autism or childhood epilepsy, but it doesn't get the same recognition, either from the general public or from the health service.

If most people know anything about Tourette's at all, it's that it makes people swear and shout in public. And the excellent new British Academy of Film and Television Arts-nominated film, I Swear—which I would recommend to everyone—to some degree reinforces that stereotype. In fact, the vast majority of people with Tourette's do not have a compulsion to swear, but, as the film also captures, they do suffer pain, anxiety and isolation. And yet people think Tourette's is funny and it's not. It causes great distress and pain.

Tourette's is not in itself a psychological condition, nor a behavioural one, nor is it caused by poor parenting. It's a complex neurodevelopmental condition that causes significant psychological impact. But it's faulty brain wiring, and it presents through tics, sudden body movements or sounds that are difficult to control: urges to blink or twitch, to jerk or to jump, to sniff or to cough, or to shriek or make noises.

Tics can come and go, they wax and wane. Twirling in circles or throwing your head back this month may be replaced by touching the floor every few seconds next month. And those who suffer it say the feeling is a bit like a sneeze. You can feel it coming on and you just have to let it out. Most will try and suppress their tics for short periods when they're in public settings, like school or work or meetings, but it's really hard. Try suppressing a sneeze. It's really uncomfortable and exhausting. And very often, when the pent-up feelings are released, they can be even more intense. Many people with Tourette's describe living with constant exhaustion and physical discomfort, tired from holding everything in throughout the day, and sore from the relentless tics that emerge when they're finally in the safety of their own home.

Parents of children with Tourette's will often tell you that when their kids come home from school, they will experience meltdowns—outbursts of rage and violence are not uncommon. 'But they were fine all day', a teacher or relative may say, but little do they know, and little do they understand. That leaves parents feeling disbelieved and a failure, and the children often consumed by shame and guilt for hurting their loved ones and their feelings.

In about 10 or so per cent of cases—it's not fully known—people have the irresistible urge to swear and say socially inappropriate things. Imagine living with that: the stigma, the shame and the judgment. Studies published by the British Medical Journal show that having a tic disorder brings significant distress and pain. And, obviously, this has negative effects on what they describe—in language you would only find in a medical journal—as academic, social and occupational function. But put it another way: it's annoying, it's exhausting, it hurts, and it comes across as really weird, which causes stigma and isolation.

And tics don't come alone. People with Tourette's typically have co-occurring conditions that can affect daily life just as much, or more, than the tics: attention deficit hyperactivity disorder, very common; obsessive compulsive disorder; anxiety and depression. And it can be hard to bear. Studies show a fourfold increase in risk of death by suicide by people with Tourette's.

Symptoms usually start to emerge during early childhood, and when you seek help, sometimes the despair deepens. You can really feel misunderstood, because you are. You can really feel alone, because you are. The child that you love more than anything is in deep distress, and your family and relationships are under enormous strain. You face turmoil and there's no help, nowhere to turn.

The level of understanding amongst teachers, GPs and health professionals is generally quite low. And to be fair to them, they don't know where to turn either. There is no clinical pathway for Tourette's to follow. There are no National Institute for Health and Care Excellence guidelines, nor any plans to create any, and no consistent service provision. There is no diagnostic or treatment pathway in any Welsh health board. And remember, this is a disorder that affects as many people as have autism or childhood epilepsy.

Children with significant tics are funnelled into child and adolescent mental health services, with the long waits we're all familiar with. But Tourette's is not in itself a mental health condition, though it is often accompanied by one. If there are not severe mental health conditions presenting, CAMHS will be reluctant to support. And neither CAMHS nor paediatric services have the expertise to support tic disorders. So, very often, families will be told their child cannot be supported, leaving them with nowhere to turn. They may eventually get prescribed medication, and then the focus becomes on monitoring the effect of the drugs, but with little emphasis on the talking therapies that evidence shows need to accompany them. Therapy, which should be the first line of treatment, is very rarely, if ever, offered.

Tourette syndrome, attention deficit hyperactivity disorder and autism are distinct lifelong neurodevelopmental conditions that can co-occur, sharing some overlapping symptoms and characteristics. Tourette syndrome, as we've heard, is widely misunderstood, mischaracterised by one of the most persistent myths that Tourette's is simply about unintentional bad language. In reality, only a small minority of people with Tourette's experience coprolalia, involuntary swearing, with estimates placing it at around 10 per cent of those with the condition. Most people experience a combination of motor and vocal tics, such as blinking, throat clearing or repeating sounds.

In Wales, Tourette's is far from rare. It affects around one in 100 children, yet families continue to face long waits for diagnosis and a lack of consistent specialist support across health boards. Without proper pathways, many children are left to struggle with anxiety, social isolation and additional neurodevelopmental conditions. By challenging misconceptions and improving awareness, we can ensure that children and adults with Tourette's in Wales receive the understanding, dignity and support they deserve.

[Inaudible.]—this important debate today. I've been assisting a constituent who has been seeking a Tourette's diagnosis and support for her son, but has been passed between professionals with little progress made. He stretches his neck, clicks his tongue, blinks a lot, scratches and bites himself, lots of word repeats, never keeps still, no sense of danger, wears clothes inside out and back to front, and obsesses about people. It's exhausting for him and his family. And through correspondence with the Minister for Mental Health and Well-being and the health board, I was shocked to find out that there is no consistent route to receiving a Tourette's diagnosis across health boards, as Lee highlights. Families across Wales are left frustrated and isolated, and my constituent has had to fight every step of the way, and still her child is not receiving the support he needs.

I would like to see a clear and consistent pathway, along with education providers given the assistance they need to properly support children living with Tourette's. There is a useful e-learning continuing professional development-accredited free course called ‘Understanding Tourette Syndrome’, with a test at the end. It can be found on the Tourettes Action website. I would like to encourage everyone to take part, and suggest this could be part of mandatory training for education and health professionals. Thank you.

I would like to mention the case of eight-year-old Harry from Rogiet in Newport East, who was diagnosed with Tourette's syndrome at the age of five. Ahead of this debate today, Harry's mum, Katie, wrote to me about the need for improved NHS services. Harry has had little or no NHS help, Katie tells me, since his diagnosis, because, in her view, healthcare does not seem to exist for conditions such as this. She also cited a general lack of interest from health professionals. Unfortunately, the family felt they had to find a private paediatric neurologist, ultimately, because they just couldn't see a clear pathway in the NHS, as we've heard from Lee and other contributors to this debate. Harry struggles with his tics, which has also impacted his mental health, and his family rightly say it just isn't fair that he is left to manage without adequate support or help. Of course, that recourse to a private paediatric neurologist is not a realistic option for many of our hard-pressed families in this cost-of-living crisis, and we really need to do better in terms of NHS provision.

Thank you to Lee for bringing forward this debate. It's certainly an issue that we don't discuss often enough. There was a debate, I believe, on the floor of the Senedd back in 2022. There was a petition before the Petitions Committee calling for a pathway for these conditions, and it's just disappointing to see that there hasn't been any development in terms of that pathway. But I would like to refer very briefly to what Lee said:

'those who suffer it say the feeling is a bit like a sneeze. You can feel it coming on and you just have to let it out.'

As far as I understand, there is scientific support for that feeling and sense, and there is support in place for people who do live with tics and Tourette's, and it's support for managing behaviour. I want to see whether this Government has considered introducing this support for people with Tourette's so that they receive lifelong support so that they can manage that need to undertake that activity, whatever it might be, when it comes upon them. So, I look forward to the Minister's response in that regard.

I call on the Minister for Mental Health and Well-being to reply to the debate. Sarah Murphy.

Thank you very much for the opportunity to respond to this debate. I would like to thank Lee, of course, for tabling this short debate, and all Members—Carolyn, Mabon, John and Mark—for bringing their support for those with Tourette's syndrome to the Siambr this evening.

As the Member said, Tourette's syndrome is a condition affecting around one in every 100 children in Wales, and it is more common in boys and men. I echo Lee Waters again in stating that it is important to note that Tourette's syndrome is not a rare condition. Its prevalence is comparable to that of autism. I know the condition is frequently misunderstood, as we've heard this evening, and for many people, the reality is that tics are distressing and exhausting. That's why we must ensure that our approach to Tourette's syndrome, tics and all neurodevelopmental services reflects the true scale of need in our communities.

But as we have heard this evening, the level of support available to families is simply not where it needs to be. Not all health boards are providing a specific Tourette's diagnostic and treatment pathway, which unfortunately means there is significant variation in service provision, and the level of care can come down to where people live. This is not acceptable.

At the heart of this is the lack of guidance from the National Institute for Health and Care Excellence about either Tourette's syndrome or tics. NICE does, however, recommend, as we've heard this evening, an online remote behavioural intervention for tics, also known as ORBIT, and Neupulse, which is aimed at improving treatment options for people with chronic tic disorders. But this lack of overarching guidance from NICE means that families are too often required to battle for a referral through CAMHS, and in many cases must rely on specialist centres outside Wales simply to secure a diagnosis. The situation has been described quite rightly as needing to improve.

Members will know that the Welsh Government introduced the statutory code of practice on the delivery of autism services, which sets out clear legal duties for local authorities and health boards to improve assessment pathways, access to health and social care and then post-diagnostic support for people with autism. Within the code, we recognise the importance of supporting people who have co-occurring conditions.

Tourette syndrome frequently presents alongside other neurodevelopmental differences, including autism and ADHD, although I agree with Mark this evening that they can be very distinct. That code has strengthened the expectation that services must respond appropriately to the needs of autistic people with additional conditions. This includes duties related to mental health support, multi-agency planning and the provision of equitable access to health and social care. The principles underpinning the current autism code, such as that equal access, early identification, clear routes to support and recognition of co-occurring needs are principles that will guide the way we improve services for those living with Tourette syndrome.

I thank the Minister.

Thanks to Lee for bringing forward such an important topic this evening.

That brings today's proceedings to a close.

Have a safe journey home, everyone.