Contributions

Diolch, Ddirprwy Lywydd. Dwi'n croesawu'r cyfle i gyfrannu i'r ddadl yma ac ymateb i'r cynnig sydd o'n blaenau ni. Dwi hefyd am ddiolch i'r Aelod dan sylw am fod yn eiriolwr diflino dros ein gwasanaeth iechyd, a dwi'n gwybod ei fod yn dod â phrofiad proffesiynol gwerthfawr iawn i'r ddadl hon heddiw. Mae yna lawer iawn yn y cynnig y gall y rhan fwyaf o Aelodau ar draws y Siambr ei gefnogi, fel rydyn ni wedi ei glywed. Rydyn ni oll eisiau gwasanaeth iechyd gwladol cryfach yng Nghymru, gyda mwy o ofal yn cael ei ddarparu mewn lleoliadau NHS lle bynnag y bo modd, a chleifion yn cael gofal amserol, diogel ac o safon uchel. Fel Llywodraeth, rydyn ni'n gadarn yn ein cred bod y gwasanaeth iechyd yn perthyn i bobl Cymru, ac er y byddai rhai cymeriadau gwleidyddol a'u noddwyr cyfoethog amheus ac anatebol yn hoffi meddwl fel arall, dyw ein gwasanaeth iechyd gwerthfawr ni ddim ar werth a fydd o byth ar werth tra byddwn ni wrth y llyw. Fe wnaethon ni etifeddu ôl-groniad sylweddol o gleifion sydd wedi aros yn rhy hir am driniaeth. Ein blaenoriaeth ni felly yw adeiladu capasiti'r NHS, cynyddu gweithgarwch a rhoi'r gefnogaeth sydd ei hangen ar dimau clinigol i drin mwy o gleifion yn ddiogel o fewn NHS Cymru. Mae'r Llywodraeth yn cytuno â'r egwyddorion canolog y tu ôl i'r cynnig. Mi ddylai capasiti'r NHS gael ei ddatblygu a'i ddefnyddio bryd bynnag y bo modd. Dylai penderfyniadau gael eu harwain gan ystyriaethau clinigol. Mae'n rhaid rhoi diogelwch cleifion yn gyntaf a rhaid i gapasiti ychwanegol bod yn dryloyw efo mesurau llywodraethiant priodol ar waith. Y cwestiwn yw: beth yw'r ffordd orau o gyflawni'r ymrwymiadau rydyn ni wedi'u gwneud i bobl Cymru, yn enwedig ein hymrwymiad i leihau amseroedd aros a chael gwared ar yr arosiadau hiraf?

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Thank you, Dirprwy Lywydd. I welcome the opportunity to contribute to this debate and to respond to the motion before us. I would also like to thank the Member in question for being a tireless advocate for our health service, and I know that he brings very valuable professional experience to this debate. There is a great deal in the motion that the majority of Members across the Chamber can support, as we've already heard. We all want a stronger national health service in Wales, with more care provided in NHS settings wherever possible, and patients receiving timely, safe and high-quality care. As a Government, we firmly believe that the health service belongs to the people of Wales, and although certain political figures, along with their wealthy, questionable and unaccountable backers, might think otherwise, our precious health service is not for sale and never will be while we are at the helm. We inherited a significant backlog of patients who have waited far too long for treatment. Our priority, therefore, is to build NHS capacity, increase activity and provide the support that clinical teams need to treat more patients safely within NHS Wales. The Government agrees with the core principles underpinning the motion. NHS capacity should be developed and utilised wherever possible. Decisions should be guided by clinical considerations. Patient safety must be prioritised and any additional capacity must be transparent with appropriate governance measures in place. The question is: what is the best way to deliver on the commitments that we have made to the people of Wales, particularly our commitment to reduce waiting times and to eliminate the longest waits?

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Our planned care reset and delivery plan is firmly focused on that objective. The plan was developed with national clinical leaders, speciality leaders and NHS operational experts. It is increasing NHS capacity and productivity, redesigning pathways and exploring dedicated surgical and diagnostic hubs. Our aim isn't simply to purchase short-term activity, but to build a stronger and more sustainable NHS service. We're already seeing this approach support progress in tackling waits of more than 104 weeks, with most additional activity being delivered within NHS Wales itself. By drawing on the expertise of our clinical and operational teams, strengthening weekly planning and making better use of existing capacity, we are supporting more patients to receive care within the NHS, with independent capacity used selectively where needed. Clinical leadership runs throughout the plan. Clinical leaders are identifying opportunities to increase productivity, redesign pathways and safely increase activity, keeping decisions focused on what is best for patients. Dirprwy Lywydd, our overriding responsibility as a Government is to deliver the programme for government. That means reducing waiting times, eliminating excessive waits and ensuring that patients receive treatment when they need it. People waiting for surgery, diagnostics or out-patient appointments are not concerned with organisational boundaries. They are concerned with receiving safe and timely care. Health boards are expected to maximise NHS capacity by improving productivity, by using their workforce effectively and strengthening clinical pathways. But health boards must also make responsible choices. They're expected to consider how NHS capacity can be maximised before commissioning additional provision. This isn't a new approach; the NHS has long commissioned services from external providers where necessary to supplement its own capacity. Where patients would otherwise face excessive delays, health boards must retain the ability to plan services around clinical need, local capacity and the responsibility to reduce harmful waits. Importantly, there are already robust arrangements in place to ensure accountability and transparency. Health boards publish planned care performance monthly, including progress against delivery trajectories, waiting times, activity and recovery plans. The Welsh Government scrutinises delivery weekly so that emerging issues can be addressed promptly. Dirprwy Lywydd, patient safety must remain at the heart of every decision we take. Where additional capacity is used, established arrangements must ensure care is safe, clinically appropriate and properly monitored, including quality, outcomes, follow-up and continuity of care. Clinical leaders must be able to raise concerns where proposed arrangements do not provide safe treatment, effective governance or appropriate follow-up, and those concerns must be acted upon. The motion also raises important questions about the future sustainability of planned care services. Alongside tackling waiting times, we must build a stronger and more resilient system through more day-care surgery, higher productivity, fewer unnecessary follow-ups and better use of diagnostics and theatres. The expert group considering surgical and diagnostic hubs is central to that work. Dedicated elective facilities could protect planned care from emergency pressures, improve access and support a more sustainable NHS-led model.

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Mi rydym ni'n cefnogi egwyddorion y cynnig, sef gwneud y mwyaf o gapasiti'r NHS a chryfhau darpariaeth gynaliadwy oddi mewn iddo lle bynnag mae hynny'n briodol yn glinigol. Mae'r gyfraith bresennol, gan gynnwys Deddf Caffael y Gwasanaeth Iechyd (Cymru) 2024, eisoes yn cefnogi darparu cydweithredol a chomisiynu hyblyg. Trwy ddisgwyliadau cenedlaethol clir, llywodraethiant cryf a rheoli perfformiad tryloyw, gellir cyflawni'r nodau hyn gan ganiatáu i'r byrddau iechyd sicrhau gofal diogel ac amserol. Felly, does dim rheidrwydd, fel y saif pethau, i gyflwyno Deddf newydd eto. Mae yna le i edrych ar gryfhau llywodraethiant, ac mi ydyn ni'n gwneud hynny, a sicrhau tryloywder, sydd yn rhywbeth rydym ni hefyd yn ei wneud. Os ydym ni'n gweld nad yw hyn yn cael y canlyniadau rydym ni'n eu dymuno, efallai y gellir dod yn ôl ac edrych eto ar Ddeddf newydd. Ond mae yna bethau y gellir eu gwneud ar hyn o bryd, ac yr ydym ni fel Llywodraeth newydd yn eu gwneud, sydd ddim yn golygu bod angen deddfu—ac wrth gwrs, does dim angen deddfu yn ddiangen chwaith. Mae Cymru hefyd wedi dilyn dull gwahanol o fuddsoddi mewn seilwaith, gan wneud llai o ddefnydd o PFI na Lloegr yn y gorffennol. Mae Cymru hefyd wedi datblygu modelau eraill i gryfhau rôl y sector cyhoeddus, gwella tryloywder a sicrhau mwy o fudd i gymunedau. All cleifion ddim aros os oes camau gweithredu y gellir eu cymryd rŵan. Maen nhw'n dyheu am weld newid positif rŵan, ac mae eu galwadau nhw'n gwbl gyfiawn. Y prawf yw a yw'r gofal yn ddiogel, yn amserol, yn rhad ac am ddim ar y pwynt o ddefnyddio, ac yn sicrhau'r canlyniadau gorau lle bynnag mae'n cael ei gomisiynu. Mi fyddwn ni bob amser yn ceisio cryfhau darpariaeth yr NHS, gan gydnabod hefyd bod rhaid i fyrddau iechyd allu gweithredu'n gyfrifol pan fydd angen capasiti ychwanegol i atal niwed y gellir ei osgoi. Am y rhesymau hynny, rydym ni'n cefnogi'r cynnig. Rydym ni'n gwneud hynny ar y sail bod modd cyflawni ei egwyddorion o gryfhau capasiti'r NHS, gwarchod diogelwch cleifion, sicrhau arweinyddiaeth glinigol a gwella tryloywder, a hynny heb ddefnyddio deddfwriaeth o reidrwydd eto. Mi fyddwn ni'n parhau i ganolbwyntio ar gyflawni, sef cynyddu capasiti'r NHS, lleihau'r ôl-groniad yr ydym ni wedi'i etifeddu, a galluogi penderfyniadau diogel sy'n cael eu llywio gan farn glinigol ac sydd er budd gorau cleifion. Diolch.

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We do support the principles behind the motion, namely maximising NHS capacity and strengthening sustainable provision within it, wherever this is clinically appropriate. The existing legislation, including the Health Service Procurement (Wales) Act 2024, already supports collaborative delivery and flexible commissioning. Through clear national expectations, robust governance and transparent performance management, these goals can be achieved, enabling health boards to ensure safe and timely care. Therefore, there is no necessity as things currently stand to introduce further new legislation. There is scope to look at strengthening governance, and we are doing so, and ensuring transparency, which is also something that we are doing. If it becomes apparent that these measures have not yielded the desired results, then we may need to revisit the possibility of new legislation. But there are things that can be done, and that we as a new Government are doing, that do not require new legislation—and, of course, there is no need to legislate unnecessarily either. Wales has also adopted a different approach to infrastructure investment, having made less use of PFI than England in the past. Furthermore, Wales has developed alternative models designed to strengthen the role of the public sector, enhance transparency and deliver greater benefits to communities. Patients cannot afford to wait if there are actions that can be taken now. They want to see positive change now, and their demands are entirely justified. The ultimate test is whether the care provided is safe, timely, free at the point of use, and delivers the best possible outcomes, wherever it is commissioned. We will always seek to strengthen NHS provision, while also acknowledging that health boards must be able to act responsibly when additional capacity is required to prevent avoidable harm. For these reasons, we can support the motion, and we do so on the basis that its principles, namely strengthening NHS capacity, safeguarding patient safety, ensuring clinical leadership, and improving transparency, can be achieved without necessarily resorting to additional legislation. We will continue to focus on delivery, namely increasing NHS capacity, reducing the backlog we have inherited, and enabling safe decisions that are informed by clinical judgment and in the best interests of patients. Thank you.

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Diolch, Lywydd. Dwi'n croesawu'r cyfle i ymateb i'r ddadl yma ac i gydnabod pwysigrwydd canser y prostad i'r nifer fawr o ddynion, teuluoedd a chymunedau ledled Cymru y mae e'n effeithio arnyn nhw. Canser yw prif achos marwolaethau yng Nghymru, ac mae canser y prostad bellach yn un o'r canserau mwyaf cyffredin y mae dynion yn cael diagnosis ohonyn nhw. Mae gormod o ddynion yn dal i wynebu oedi cyn cael diagnosis, triniaeth a gofal, ac mae gormod o deuluoedd yn dal i brofi ansicrwydd a phryder wrth aros am atebion. Mae'n rhaid i ni wneud yn well. Gaf i fod yn glir? Dwi'n deall y pryderon sydd wedi ysgogi'r ddadl hon. Bydd yr Aelodau'n gwybod bod gwasanaethau canser yng Nghymru yn flaenoriaeth fawr i mi. Ym maes canser, mae'r perfformiad o ran amseroedd aros yn parhau i fod yn is na'r safonau rydyn ni'n eu disgwyl, ac mae hynny'n cynnwys rhannau o'r llwybr wroleg. Er bod staff yr NHS yn parhau i weithio'n ddiflino o dan bwysau sylweddol, dwi ddim yn fodlon efo ble rydyn ni heddiw a dylai neb arall yn y Siambr yma fod yn fodlon chwaith. Mae gwellau canlyniadau a phrofiadau i bawb sy'n cael eu heffeithio gan ganser yn parhau i fod yn flaenoriaeth allweddol i'r Llywodraeth yma. Dyna'n union pam rydyn ni'n datblygu strategaeth ganser genedlaethol 10 mlynedd newydd, y cyntaf o'i bath ers 2006. Bydd y gwaith hwn yn gosod gweledigaeth strategol, hirdymor a blaenoriaethau cenedlaethol i lywio gwaith cynllunio'r NHS a thrawsnewid gofal canser dros y ddegawd nesaf. Mae'r nod yn syml ond yn arwyddocaol: bod mwy o bobl yn goroesi canser, bod mwy o ganserau yn cael diagnosis yn gynharach, nad yw mynediad at ofal yn dibynnu ar ble mae rhywun yn byw, a bod pobl yn cael cymorth amserol wedi'i bersonoli drwy gydol eu taith canser. Rhaid i'r un nod gael ei wireddu ar gyfer dynion sy'n cael diagnosis o ganser y prostad ag i bawb sy'n cael eu heffeithio gan ganser yng Nghymru.

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Thank you, Llywydd. I welcome the opportunity to respond to this debate and to recognise the significance of prostate cancer for the large number of men, families and communities across Wales that it affects. Cancer is the leading cause of death in Wales, and prostate cancer is now one of the most common cancers diagnosed in men. Too many men still face delays in receiving a diagnosis, treatment and care, and too many families continue to experience uncertainty and anxiety whilst waiting for answers. We must do better. Let me be clear. I understand the concerns that have prompted this debate. Members will be aware that cancer services in Wales are a major priority for me. In the field of cancer, performance regarding waiting times remains below the standards that we expect, and this includes parts of the urology pathway. Although NHS staff continue to work tirelessly under significant pressures, I am not satisfied with the current situation and no-one else in this Chamber should be satisfied either. Improving outcomes and experiences for everyone affected by cancer remains a key priority for this Government. That is exactly why we are developing a new 10-year cancer strategy, the first of its kind since 2006. This work will set out a long-term strategic vision as well as national priorities to guide NHS planning and the transformation of cancer care over the next decade. Our objective is simple, but significant: that more people survive cancer, that more cancers are diagnosed early, that access to care does not depend on where one lives, and that people receive timely, personalised support throughout their cancer journey. This same objective must be delivered for men diagnosed with prostate cancer, just as it must for everyone affected by cancer in Wales.

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We intend to publish this strategy on World Cancer Day 2027, alongside a national cancer conference bringing together NHS leaders, clinicians, planners, partners, stakeholders and the third sector to share best practice and explore how our national priorities will be delivered across the next decade. Improving outcomes and experience to match the top quartile in Europe will require sustained effort, long-term commitment and honest recognition of the challenges we face. It's an ambition worthy of the people of Wales. Cancer doesn't discriminate, and nor should we. Our intention is to support improvements across all cancer types and for people of all ages, backgrounds and communities. Importantly, the strategy will cover the entire cancer pathway, from prevention and screening through to diagnosis, treatment, recovery, survivorship and living well with and beyond cancer. The strategy will address the key challenges facing cancer services, while putting in place the enablers needed to deliver sustained improvement. That means looking at workforce, leadership, research, innovation, digital systems, infrastructure and service design alongside the quality and effectiveness of care itself. We also want to accelerate the adoption of new validated tests, technologies and recommended treatments, while strengthening accountability and transparency to drive improvement across Wales. The strategy is being informed by one of the most extensive engagement exercises undertaken in cancer policy in Wales. A national call for evidence is currently gathering insights from stakeholders and the public, and I encourage all those with an interest in cancer services to contribute by the 31 October deadline. Alongside this, we are undertaking structured engagement with NHS organisations, professional bodies, key partners and the Wales Cancer Alliance. To Paul's point on consultation, we are listening directly to people affected by cancer through patient engagement forums across Wales, co-ordinated by the Wales Cancer Alliance, to ensure that lived experience helps shape the priorities and actions needed to improve outcomes and experiences for the future. It's important that this process is allowed to conclude before decisions are taken on the final content of the strategy. The programme of engagement is still under way and the final priorities should be shaped by the views, expertise and lived experiences that we are gathering, rather than by predetermined conclusions. The challenges facing the urology cancer pathway are not unique, but they bring into sharp focus the changes we must make if we are to improve cancer outcomes in Wales. These ambitions sit at the heart of the strategy. While the Welsh Government doesn't directly fund individual diagnostic tests, the strategy will set out how the NHS and its partners will work together to evaluate and introduce new diagnostic investigations for suspected cancer, including for prostate cancer.

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Dwi'n cydnabod y pryder y mae canser y prostad yn achosi i ddynion a'u teuluoedd a pham y byddai llawer yn croesawu sgrinio. Mae Llywodraeth Cymru yn dilyn cyngor Pwyllgor Sgrinio Cenedlaethol y Deyrnas Gyfunol ac, ar hyn o bryd, dyw'r pwyllgor ddim yn argymell sgrinio poblogaeth ar gyfer canser y prostad. Er hynny, mae wedi argymell sgrinio wedi ei dargedu ar gyfer dynion rhwng 45 a 61 oed gyda'r gennyn BRCA2 a hanes teuluol gradd gyntaf o ganser y fron, yr ofari, y pancreas neu'r prostad. Rydyn ni wedi gofyn i Iechyd Cyhoeddus Cymru i ystyried sut y gallai hyn gael ei gyflawni yng Nghymru. Mae'n arfer clinigol sefydledig eisoes i gleifion â chanser prostad lleol risg isel gael cynnig gwyliadwriaeth weithredol, ac rydyn ni'n monitro cyfraddau triniaeth radical drwy archwiliad cenedlaethol canser y prostad, i gefnogi gwelliannau mewn gofal. Mae meddygon teulu yn cefnogi gwneud penderfyniadau a rennir gydag unrhyw ddyn sy'n pryderu am ei risg o ddatblygu canser y prostad. Mi fyddwn ni'n gweithio gyda'r NHS i ystyried a oes angen canllawiau ychwanegol i gefnogi meddygon teulu i gynnal y trafodaethau hyn. Dwi am roi sicrwydd i'r Aelodau nad ydyn ni'n aros i'r strategaeth i wella'r data canser. Gan weithio gyda sefydliadau'r NHS, rydyn ni eisoes yn cryfhau argaeledd, ansawdd a defnydd o'r data i osod amodau llwyddiant ar gyfer pan fydd y strategaeth yn cael ei chyhoeddi. Mae Llywodraeth Cymru wedi gweithredu a bydd yn parhau i weithredu ar ganfyddiadau adroddiad Archwilio Cymru, gyda cham nesaf y gwaith hwn yn cael ei yrru gan y strategaeth. Lywydd, mae pawb yn y Siambr yn rhannu'r un amcan eang: canlyniadau gwell, profiadau gwell a gwasanaethau gwell i bobl sy'n cael eu heffeithio gan ganser yng Nghymru. Mae'r strategaeth ganser genedlaethol yn darparu cyfle unwaith mewn cenhedlaeth i sicrhau'r gwelliant hwnnw, nid yn unig i ddynion sydd wedi cael diagnosis o ganser y prostad, ond i bawb y mae canser yn effeithio arnyn nhw yng Nghymru. Dyna'r ymrwymiad sy'n gyrru'r gwaith yma, a dwi'n edrych ymlaen at barhau â'r daith honno gyda chleifion, clinigwyr, elusennau ac Aelodau ar draws y Siambr hon. Diolch.

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I recognise the anxiety that prostate cancer causes men and their families and why many would welcome screening. The Welsh Government follows the advice of the UK National Screening Committee and, at present, the committee does not recommend population screening for prostate cancer. However, it has recommended targeted screening for men between the ages of 45 and 61 who carry the BRCA2 gene and have a first-degree family history of breast, ovarian, pancreatic or prostate cancer. We have asked Public Health Wales to consider how this could be implemented in Wales. It is already established clinical practice to offer active surveillance to patients with low-risk, localised prostate cancer, and we are monitoring rates of radical treatment through the national prostate cancer audit, to support improvements in care. GPs support shared decision-making with any man who is concerned about his risk of developing prostate cancer. We will work with the NHS to consider whether additional guidance is needed to support GPs in conducting these discussions. I want to reassure Members that we are not waiting for the strategy to improve cancer data. Working with NHS organisations, we are already strengthening the availability, quality and use of data to lay the groundwork for success once the strategy is published. The Welsh Government has taken action and will continue to take action on the findings of the Audit Wales report, with the next phase of this work being driven by the strategy. Llywydd, everyone in this Chamber shares the same broad objective: better outcomes, better experiences and better services for people affected by cancer in Wales. The national cancer strategy provides a once-in-a-generation opportunity to secure that improvement, not only for men diagnosed with prostate cancer, but for everyone affected by cancer in Wales. That is the commitment driving this work, and I look forward to continuing that journey alongside patients, clinicians, charities and Members from across this Chamber. Thank you.

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Diolch yn fawr iawn, Lywydd, a dwi'n croesawu'r cyfle i ymateb i'r ddadl bwysig hon. Dwi hefyd yn ddiolchgar i Ken Skates am ddod â hi gerbron y Senedd yma heddiw. Hoffwn ddiolch hefyd i'r holl Aelodau am eu cyfraniadau dirdynnol yn ystod y ddadl. Mae hwn yn faes lle mae cryn dipyn o dir cyffredin ar draws y Siambr. Mae llawer yn y cynnig heddiw y gallwn ni gytuno ag o. Mae gofal lliniarol a gofal diwedd oes o safon uchel yn hynod bwysig. Mae'n golygu bod pobl yn cael eu trin efo urddas, tosturi a gofal. Mae hynny'n bwysig i'r unigolyn. Mae'n bwysig i deuluoedd ac i ofalwyr hefyd, ac mae yr un mor bwysig i'r bobl sy'n eu cefnogi drwy rai o'r adegau mwyaf anodd y byddan nhw byth yn eu hwynebu. Mae hosbisau yn rhan hanfodol o'r gofal hwnnw. Maen nhw'n darparu arbenigedd clinigol gwerthfawr. Maen nhw'n helpu pobl i fyw cystal ag y gallan nhw. Maen nhw'n gweithio law yn llaw efo'r NHS a gwasanaethau cymunedol i ddarparu gofal sy'n dosturiol ac yn canolbwyntio ar yr unigolyn. Dwi wedi ymweld â nifer o hosbisau fy hun, yn gyntaf fel gwleidydd yr wrthblaid, ac erbyn hyn fel Gweinidog yn y Llywodraeth, a bob tro dwi'n cael fy nharo gan ymroddiad y staff, y gwirfoddolwyr a phawb sy'n rhan o'r gwaith. Dwi'n siŵr fy mod i'n siarad ar ran y Siambr gyfan wrth ddweud bod arnom ni ddyled enfawr o ddiolch iddyn nhw. Dwi'n deall yn iawn y pryderon sydd wedi codi heddiw am y pwysau sy'n wynebu'r sector, a dwi'n cydymdeimlo'n llwyr gyda nhw. Yn wir, mi oedd llawer o'r materion sydd wedi cael eu hamlygu heddiw yn faterion y gwnes i eu codi fy hun pan oeddwn i ar feinciau'r gwrthbleidiau, fel yr ydyn ni wedi clywed. Mi oedden nhw'n bwysig bryd hynny, ac maen nhw'n parhau yn bwysig heddiw. Mae'r sefyllfa ariannol yn un heriol, a dydw i ddim am esgus fel arall. Mae hosbisau wedi bod yn glir ynglŷn â'r pwysau sy'n wynebu'r sector: costau ynni uwch, cynnydd mewn cyfraniadau yswiriant gwladol, galw cynyddol am wasanaethau ac ansicrwydd ynghylch trefniadau comisiynu. Mi wnes i glywed y pryderon hynny'n uniongyrchol pan wnes i gyfarfod gyda Hosbisau Cymru yn ddiweddar. Mi wnaethom ni drafod y pwysau sy'n wynebu'r sector ar hyn o bryd. Mi wnaethom ni hefyd drafod y tymor hwy a'r hyn sydd angen ei wneud i roi gwasanaethau hosbis ar sail fwy cynaliadwy.

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Thank you very much, Llywydd, and I welcome the opportunity to respond to this important debate. I'm also grateful to Ken Skates for bringing it before the Senedd today. I'd also like to thank all Members for their poignant contributions during this debate. This is an issue on which there is a great deal of common ground across the Chamber. There is much in today's motion that we could all agree with. High-quality palliative and end-of-life care is exceptionally important. It means that people are treated with dignity, compassion and care. That's important to the individual. It's important to families and to carers as well, and it is just as important to the people who support them through some of the most difficult times that they will ever face. Hospices are a crucial part of that care. They provide valuable clinical expertise. They help people to live as well as they can. They work hand in hand with the NHS and community services to provide care that is compassionate and focused on the individual. I have visited a number of hospices myself, first as an opposition politician, and now as a Minister in Government, and on every occasion, I've been struck by the dedication of the staff, the volunteers and everyone else who is part of their work. I'm sure that I speak on behalf of the whole Chamber when I say that we owe a great debt of gratitude to them. I fully understand the concerns that have been raised today regarding the pressures that face the sector, and I sympathise entirely with them. Indeed, many of the matters that have been highlighted today were matters that I myself raised when I was on the opposition benches, as we have heard. They were important then, and they remain important today. The financial situation is challenging, and I will not pretend otherwise. Hospices have been clear about the pressures that face the sector: higher energy costs, increases in national insurance contributions, increased demand for services, and uncertainty regarding commissioning arrangements. I heard those concerns directly when I met with Hospices Cymru recently. We discussed the pressures currently facing the sector. We also discussed the longer term and what needs to be done to place hospice services on a more sustainable footing.

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However, recognising the constraints doesn't mean accepting that nothing can be done. There are practical steps that we can and must take to improve services and strengthen planning. Our programme for government contains a clear commitment to address the key challenges facing palliative and end-of-life care. My officials are already working with colleagues across health, social care, regional partnerships and the unpaid carers agenda, to turn that commitment into practical action. The national service specification supports more consistent planning and delivery. The national competency framework supports workforce development, while the hospice commissioning approach establishes principles for more consistent and sustainable arrangements. The workforce point in the motion is particularly important. The national competency framework provides an important foundation for ensuring staff across health and care have the skills and confidence needed to deliver high-quality palliative and end-of-life care. Palliative care must also be recognised earlier and embedded across the pathways through which people receive care. Through the development of our national cancer strategy and acute and emergency care framework, we are looking at how specialist palliative support can be better integrated across services, supporting earlier access to care, stronger advanced care planning, and more joined-up support for patients and families. Llywydd, I also want to address the call for fair and sustainable hospice funding. Current arrangements have developed differently across Wales. Hospices have told us that inconsistency and uncertainty make it more difficult to plan services, retain their workforce and invest for the future. Too often, access to palliative and end-of-life care can still be influenced by where people live or how services have developed historically. That variation is not in the interests of patients, families or the wider system. The hospice commissioning guidance gives us a common direction, but its publication was not the end of the process. The next phase must be about implementation. This includes a national population needs assessment, and work on future commissioning and funding models. The national palliative and end-of-life care programme is working to build a clearer understanding of need across Wales, so that decisions reflect what people require rather than simply reflecting historical patterns of provision. We want to make meaningful progress towards more consistent and sustainable arrangements during this Senedd term. I recognise the sector wants greater certainty and I share that goal. Our focus now is on implementing the commissioning approach and ensuring funding decisions are informed by evidence, agreed service expectations and clearer accountability. But our attention isn't limited to the longer term. We will continue to pursue practical opportunities to support hospices with immediate pressures, while continuing this wider reform programme. A recent example is the agreement of £800,000 through the all-Wales capital programme to support the redevelopment of City Hospice. Whilst investment in one project can't resolve the pressures facing the sector as a whole, it demonstrates that we are supporting services now while developing more sustainable arrangements for the future. It's also vital that we set a clear, shared policy direction bringing together services, workforce, commissioning, funding, and support for families and carers. And we're not starting from a blank page, although we recognise there is always room to improve. The quality statement for palliative and end-of-life care, which sets the strategic expectations across health, social care and the third sector, is currently being refreshed and, alongside the existing suite of supporting documents, will help provide the strategic framework for the next phase of improvement.

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Ond yn y pen draw, rhaid i fframweithiau cenedlaethol droi'n weithredu ymarferol ar lawr gwlad. Drwy fy sgyrsiau diweddar gyda'r sector, gan gynnwys mewn digwyddiad gan Marie Curie a Hospice UK, dwi wedi clywed y neges yn glir. Mae awydd gwirioneddol i gydweithio, awydd i wella'r gofal a'r cymorth sydd ar gael i bobl wrth iddyn nhw nesáu at ddiwedd eu hoes. Dyna pam dwi wedi gofyn i swyddogion ddechrau'r gwaith o baratoi ar gyfer uwchgynhadledd genedlaethol ar ofal lliniarol a gofal diwedd oes. Rŷn ni'n bwriadu ei chynnal mis Mawrth nesaf. Dwi am i'r uwchgynhadledd honno ddod â'r NHS, hosbisau a rhanddeiliad eraill ynghyd. Dwi am iddi helpu i siapio blaenoriaethau'r dyfodol ar gyfer gofal lliniarol a gofal diwedd oes yng Nghymru. Nid y bwriad ydy comisiynu adroddiad arall nac ailadrodd heriau rŷn ni eisoes yn eu deall. Y bwriad ydy dod â phobl at ei gilydd o amgylch rhaglen glir o weithredu a chyflawni yn ystod tymor y Senedd hon. Lywydd, dydw i ddim yn tanamcangyfrif maint yr heriau sy'n wynebu'r sector. Dwi hefyd yn deall yn iawn y pryder sy'n deillio o'r ansicrwydd ynghylch cyllid a'r gweithlu. Ond, ar yr un pryd, mae'n bwysig cydnabod y cynnydd sydd eisoes wedi bod. Mae'n bwysig hefyd ein bod ni'n manteisio ar y cyfleoedd sydd o'n blaenau ni. Y tu ôl i bob trafodaeth am gyllid, comisiynu a'r gweithlu, mae pobl go iawn a theuluoedd go iawn—pobl sy'n wynebu rhai o'r amgylchiadau mwyaf anodd y gall unrhyw un ohonon ni ddychmygu. Maen nhw'n haeddu gofal sy'n dosturiol, gofal sydd yn deg, a gofal sydd ar gael pan fo'i angen fwyaf. Mae gennym ni gyfle yn ystod tymor y Senedd yma i wneud gwahaniaeth gwirioneddol trwy gydweithio ar draws yr NHS, hosbisau, llywodraeth leol a'r trydydd sector. Trwy wneud hynny, mi allwn ni greu system sy'n fwy cynaliadwy ac yn fwy cyson—system sy'n rhoi pobl wrth ganol y gofal sy'n cael ei ddarparu. Dyna'r gwaith rŷn ni wedi ymrwymo iddo fel Llywodraeth, a dyna'r gwaith y byddwn ni'n bwrw ymlaen ag o mewn partneriaeth efo pawb sy'n chwarae rhan mor bwysig wrth ddarparu gofal lliniarol a gofal diwedd oes ledled Cymru. Diolch, Lywydd.

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However, ultimately, national frameworks must become practical action on the ground. Through my recent discussions with the sector, including at an event hosted by Marie Curie and Hospice UK, I have heard a very clear message. There is a genuine appetite for collaboration and an appetite to improve the care and support available to people as they approach the end of their lives. That's why I have asked officials to start the work of preparing for a national summit on palliative and end-of-life care. We intend to hold it next March. I want that summit to bring together the NHS, hospices and other stakeholders. I want it to help to shape future priorities for palliative and end-of-life care in Wales. The intention is not to commission another report, nor to rehearse the challenges that we already understand. The intention is to bring people together around a clear programme of action and delivery during this Senedd term. Llywydd, I do not underestimate the scale of the challenges that face the sector. I also understand full well the concerns stemming from uncertainty on funding and the workforce. But, at the same time, it is important to recognise the progress that has already been made. It is also important that we maximise the opportunities ahead of us. Behind every discussion on funding, commissioning and the workforce are real people and real families—people who face some of the most difficult circumstances that any one of us could imagine. They deserve compassionate care, fair care, and care that is available when it is needed most. We have an opportunity during this Senedd term to make a genuine difference by working together across the NHS, hospices, local government and the third sector. By doing that, we can create a more sustainable and more consistent system—a system that puts people at the heart of the care provided. That is the task that we have committed to as a Government, and that's the task that we will be taking forward in partnership with everyone who plays such an important part in providing palliative and end-of-life care the length and breadth of Wales. Thank you, Llywydd.

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Diolch yn fawr iawn, Lywydd. Heddiw, dwi'n nodi'r camau pendant y mae'r Llywodraeth yma yn eu cymryd i amddiffyn pobl, cefnogi staff a chryfhau gwasanaethau iechyd a gofal ar draws Cymru y gaeaf hwn. Mi fydd y gaeaf yn heriol. Mi fydd y galw'n cynyddu, mi fydd salwch anadlol yn rhoi pwysau ychwanegol ar wasanaethau, ac mi fydd y cyfyngiadau o ran y gweithlu, cyllid a gofal cymdeithasol yn parhau i fod yn sylweddol. Allwn ni ddim cael gwared ar bob risg, ond mi allwn ni baratoi'n gynharach, ymyrryd yn gyflymach a gofyn i bob rhan o'r system weithio gyda'i gilydd. Dyna pam rydyn ni wedi gweithredu'n gynt nag unrhyw Lywodraeth flaenorol yng Nghymru, gan ddangos arweinyddiaeth genedlaethol gryfach, disgwyliadau cliriach a ffocws di-baid ar gyflawni. Mae pob bwrdd iechyd wedi cyflwyno fersiwn ddrafft o'u cynllun parodrwydd ar gyfer y gaeaf erbyn 1 Medi. Am y tro cyntaf, mae'r cynlluniau hynny'n cael eu profi'n drylwyr yn ystod mis Medi a mis Hydref fel bod risgiau, rhagdybiaethau a dibyniaethau yn cael eu herio, a chamau'n cael eu cymryd, cyn i'r pwysau gyrraedd y brig. Mae hyn yn cryfhau ein dull o weithredu yn sylweddol. Nid dim ond gofyn i sefydliadau a oes ganddyn nhw gynlluniau ydyn ni, rydyn ni'n profi a ydy'r cynlluniau hynny'n gredadwy, yn gweithio mewn ffordd gysylltiedig ar draws y system gyfan ac yn gallu sicrhau gofal diogel o dan bwysau. Mae ein gwaith cynllunio'n cael ei lywio gan adroddiad modelu anadlol y gaeaf 2026-27, sy'n edrych ar senarios o ran y ffliw, COVID-19, firws syncytiol anadlol a chyfuniad o heintiau. Mae dangosfwrdd ategol yn galluogi Llywodraeth Cymru a NHS Cymru i fonitro pwysau cenedlaethol a lleol ac addasu'r ymateb wrth i'r amodau newid. Mae ein nod yn glir: dylai pobl gael y gofal iawn yn y lle iawn heb oedi y gellir ei osgoi. Dylid cefnogi mwy o bobl i aros yn iach gartref. Dylai'r rhai sydd angen gofal brys, gofal mewn argyfwng neu ofal acíwt gael y gofal hwnnw yn gyflym ac yn ddiogel, a ddylai neb aros yn yr ysbyty yn hirach nag sy'n angenrheidiol yn glinigol oherwydd nad ydy cymorth ar gael mewn mannau eraill. Mae cyflawni'r addewid hwnnw yn gofyn am fwy na chapasiti ychwanegol mewn ysbytai. Mae gwydnwch y gaeaf yn dibynnu ar gael gwasanaethau sylfaenol, cymunedol a gofal cymdeithasol cryf, gweithredu'n gyflym pan fydd pobl yn mynd yn sâl, llif effeithiol drwy ysbytai a chefnogaeth amserol i bobl wella adref.

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Thank you very much, Llywydd. Today I am setting out the decisive actions that this Government is taking to protect people, to support staff, and to strengthen health and care services across Wales this winter. The winter will be challenging. Demand will rise, respiratory illness will place additional pressure on services, and the constraints in terms of the workforce, finance and social care will remain significant. We cannot remove every risk, but we can prepare earlier, intervene faster, and require every part of the system to act together. That's why we've acted earlier than any previous Welsh Government, demonstrating stronger national leadership, clearer expectations, and a relentless focus on delivery. Every health board has submitted its draft winter preparedness plan by 1 September. For the first time, those plans are being stress-tested during September and October so that risks, assumptions and dependencies are challenged, and that action is taken before pressure peaks. This is a material strengthening of our approach. We're not simply asking organisations whether they have plans, we are testing whether those plans are credible, connected across the whole system and capable of protecting safe care under pressure. Our planning is informed by the 2026-27 winter respiratory modelling report, which covers scenarios in terms of flu, COVID-19, respiratory syncytial virus and combined infection scenarios. A supporting dashboard enables Welsh Government and NHS Wales to monitor national and local pressures and adapt the response as conditions change. Our objective is clear: people should receive the right care in the right place without avoidable delay. More people should be supported to remain well at home. Those who need urgent, emergency or acute care should receive it quickly and safely, and nobody should remain in hospital longer than clinically necessary because support elsewhere is unavailable. Delivering that promise requires more than additional hospital capacity. Winter resilience depends on strong primary, community and social care services, rapid action when people become unwell, effective flow through hospitals and timely support for people to recover at home.

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That is why cross-cutting and cross-sector action is at the centre of our approach. Health boards, local authorities, ambulance services, primary care, housing, social care and voluntary organisations must plan and act as one system around the needs of individuals and communities. Community nursing, frailty services, single points of access, community response teams, hospital at home, rehabilitation and reablement all have a critical role. When these services work well, people are supported earlier, avoidable admissions are prevented and those leaving hospital can recover safely and independently at or close to home. This must include people who face the greatest barriers to care, including those experiencing homelessness, housing insecurity or social exclusion. Their needs don't fit neatly within organisational boundaries and neither should our response. This work is aligned with delivering health together and our ambition for an integrated community care system—a more sustainable model built on prevention, early intervention, community-based care and better integration. For this winter, I'm setting three immediate priorities. First: protect people through vaccination, which continues to be the best safeguard against the transition of disease. Eligibility for the RSV vaccination has been expanded and health boards are working with Public Health Wales to improve the uptake of influenza vaccination among eligible people and staff. It is also vital that we continue to robustly counter at all times the dangerous anti-vax narratives pedalled by people who should know better. Second: make every day count for patient flow. Health boards and local authorities are expected to apply 'home first', discharge to recover and assess, criteria-led discharge and trusted assessment consistently, seven days a week, so that people can leave hospital as soon as they are clinically ready. Third: strengthen urgent care in the community. Single points of access, community response teams, hospital at home, same-day services and rapid clinical advice must help people receive earlier care and protect hospital capacity for those with the most urgent and complex needs. These aren't optional aspirations, they are delivery expectations. We'll monitor progress against clear operational evidence, including access to urgent care, ambulance handovers, hospital flow, discharge and community capacity. Where assurance is insufficient, organisations will be required to strengthen their response and take corrective action. To support delivery, NHS Wales Performance and Improvement is making an additional £2 million available through the national urgent and emergency care improvement programme. It will be targeted at practical action before, during and after winter to improve acute hospital flow, accelerate safe discharge, reduce avoidable delay and strengthen patient safety at the points of greatest pressure. We'll expect health boards to demonstrate how that investment has improved delivery. A national winter planning session this month will bring together health boards' chief operating officers and local authority partners to resolve shared risks, reinforce joint accountability and maintain co-ordinated delivery throughout the winter. Workforce availability remains a serious risk. Health boards must maintain safe, flexible and credible contingency arrangements, and national support will be targeted where it can make the greatest difference. But our responsibility goes beyond one winter. As a result of climate change, pressure no longer follows a predictable seasonal pattern. The record-breaking heatwaves of the summer months placed immense strains on our staff and estate alike, and it is essential that the lessons of adaptation from this year inform our approach to future years where hazardous heat levels will become the norm. I'm therefore announcing that Wales will move to a comprehensive, continuous cycle of planning and preparedness, so that risks are assessed, learning is acted upon and resilience is strengthened throughout the year.

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Dydy'r camau rydyn ni'n eu cymryd y gaeaf hwn ddim ar wahân i'n huchelgeisiau ehangach ar gyfer iechyd a gofal yng Nghymru. Maen nhw'n arwydd cynnar o’r cyfeiriad sy’n cael ei nodi drwy 'cyflawni iechyd gyda'n gilydd', ein huchelgais hirdymor i wella canlyniadau, lleihau anghydraddoldebau a sicrhau system iechyd a gofal gynaliadwy ar gyfer y dyfodol. Fel y nodir yn ein rhaglen lywodraethu, yr hyn sydd wrth galon ein huchelgeisiau ydy newid i ganolbwyntio mwy ar atal, ymyrraeth gynharach a gofal mwy cydgysylltiedig. Allwn ni ddim cwrdd â'r galw yn y dyfodol drwy ofal mewn ysbytai yn unig. Mae'n rhaid inni wneud mwy i gadw pobl yn iach, cefnogi annibyniaeth, ymyrryd yn gynharach pan fydd anghenion yn codi a darparu mwy o ofal mewn lleoliadau cymunedol. Er mwyn cyflawni'r uchelgais honno, bydd angen inni weithio gyda phartneriaid ar draws y sector iechyd, y sector gofal cymdeithasol a’r sector cyhoeddus ehangach. Yn y tymor byr, mae hyn yn golygu adfer gafael lle bo angen, gwella perfformiad a chryfhau atebolrwydd. Ar yr un pryd, mae’n rhaid inni wneud yn siŵr bod ein gweithlu, ein gwasanaethau, ein seilwaith digidol a’n hystadau mewn sefyllfa i allu cwrdd â heriau’r dyfodol. Yn fwy na dim, mae’n rhaid inni fynd ar drywydd y newidiadau hirdymor sydd eu hangen i wella iechyd y boblogaeth, lleihau anghydraddoldeb a symud ein ffocws tuag at atal, ymyrraeth gynnar a gofal yn agosach at y cartref. Lywydd, dwi am gloi drwy ddiolch i’r holl staff mewn ysbytai, gwasanaethau ambiwlans, gofal sylfaenol, timau cymunedol, awdurdodau lleol, cartrefi gofal a sefydliadau gwirfoddol sydd eisoes yn paratoi ar gyfer y misoedd i ddod. Mae eu proffesiynoldeb a'u hymroddiad nhw yn anhygoel. Maen nhw'n haeddu cynlluniau sy'n gredadwy, penderfyniadau sy'n amserol ac arweinyddiaeth sy'n glir. Bydd y Llywodraeth hon yn darparu'r arweinyddiaeth gryf a rhagweithiol honno. Mi fyddwn ni'n sicrhau goruchwyliaeth genedlaethol drylwyr, yn gweithio ar draws y Llywodraeth, ac yn gweithio efo partneriaid i fynd i'r afael â risgiau a chynnal gwelliant. Mi fyddwn ni'n barnu llwyddiant nid yn ôl ansawdd y cynlluniau ar bapur, ond yn ôl yr hyn y mae pobl yn ei brofi: gofal mwy diogel a chyflymach, llai o oedi y gellir ei osgoi, gwell gefnogaeth gartref a gwasanaethau sy'n parhau i fod yn wydn pan fydd pwysau'n cynyddu. Nid dim ond mynd drwy'r gaeaf ydy ein huchelgais ni. Ein huchelgais ni ydy adeiladu system iechyd a gofal sy'n wydn, yn rhagweld pwysau, yn gweithredu'n gynt, yn gweithio fel un ac yn cryfhau gyda phob tymor. Diolch.

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The actions we are taking this winter are not separate from our wider ambitions for health and care in Wales. They are an early demonstration of the direction set out through 'delivering health together', our long-term ambition to improve outcomes, reduce inequalities and secure a sustainable health and care system for the future. As set out in our programme for government, at the heart of our ambitions is a shift towards prevention, earlier intervention and more joined-up care. We cannot meet future demand through hospital care alone. We must do more to keep people healthy, support independence, intervene earlier when needs arise and provide more care in community settings. Achieving that ambition will require us to work closely with our partners across health, the social care sector and the wider public sector. In the immediate term, this means restoring grip where needed, improving performance and strengthening accountability. At the same time, we must ensure that our workforce, our services, our digital infrastructure and our estates are equipped to meet the challenges of the future. Above all, we must pursue the longer term changes necessary to improve population health, reduce inequalities and shift our focus towards prevention, early intervention and care closer to home. Llywydd, I want to conclude by thanking staff across hospitals, ambulance services, primary care, community teams, local authorities, care homes and voluntary organisations who are already preparing for the months ahead. Their professionalism and dedication are extraordinary. They deserve plans that are credible, decisions that are timely and leadership that is clear. This Government will provide that strong and proactive leadership. We will maintain rigorous national oversight, we'll work across Government and we'll act with partners to address risks and sustain improvement. We will judge success not by the quality of plans on paper, but by what people experience: safer and faster care, fewer avoidable delays, better support at home and services that remain resilient when pressure increases. Our ambition is not simply to get through winter. It is, rather, to build a health and care system that is resilient, anticipates pressure, acts earlier, works as one and becomes stronger with every season. Thank you.

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Lywydd, diolch i'r Aelod am y sylwadau hynny.

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Llywydd, I thank the Member for those comments.

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Thank you for those comments, and thanks for your opening remarks welcoming the fact that we have started the preparations earlier. In fact, I remember when I was asked to take this position, one of the first actions I did was ask for planning around winter preparedness, because, as you said right at the start of your contribution, this is something that happens annually, it's something that we should be prepared for. So, we've started earlier than ever before, which means that we are in a better position now than ever before to tackle the challenges that winter brings, and we know that those challenges and that winter is getting harder. I've also asked the NHS in Wales to look at the impact of the El Niño event as well, which is likely to have a significant detrimental impact on communities across Wales, and that needs to be taken into consideration. But to your further points about the modelling and testing, yes, we are modelling those plans put forward by the health boards now. As I said, we're modelling them and testing them during September and October to see how robust they are. NHSPI is doing that work with the health boards, and, if we find weaknesses in the system, that gives us time then to correct course and find resolutions so that those weaknesses aren't highlighted when winter hits hard. You asked about the limited capacity and the access to clinics with vaccination, for instance, and what other workforce or funding might be made available in the case of Swansea bay. As you said right at the beginning, this is an event that happens every year. So, this is part of their annual preparing. They should be budgeting for this. It's part of the budgets that they have and part of the work that they are preparing for year-round. So, I expect, the same as every other year, for them to deliver within budget. They're aware that this is happening. They are preparing for it. And finally, you asked about the health board's need to prepare within the budgets and what assessment I've made of Swansea's plan. Now, I'm glad you finished right at the end there mentioning other health boards, because there's more than just Swansea in Wales. My assurance is moderate at the moment that they will be able to achieve the plans that they have set themselves—moderate currently, and we're just in early October now, based on the plans that I received in early September. Now that we're testing the plans that they've put forward—all the health boards and the trusts as well have put forward plans. We're testing them this month; we did a little bit last month. Having the learnings and the lessons from that testing, that assessment will increase over time, and I'm confident that we will be in a better position when winter comes and they will be in a better position to tackle the issues that winter brings to our communities.

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Thank you for those questions. Llywydd, it's true that we've started earlier than ever before in planning for winter pressures. Now, the Member does point to other pressures within the health system: two-year waits, you've mentioned before, and I've responded to those issues numerous times, and we've made it clear that we will tackle those two-year waits. The money is now going into the system, with plans designed by clinicians and the health board, and we'll be seeing the result of that when we see the numbers coming through in the November period. But those pressures, while they're there—. The winter pressures add further to the already current pressures that we've got in the NHS. That's why we are looking at frailty as an issue, making sure that we tackle frailty in the community. So, when you asked about GPs, it's making sure that GPs are supported in the community with district nurses so that we identify those issues earlier on, and, if frail patients do enter the front door of an A&E, that they're seen sooner, so that frailty is identified sooner, rather than people having to wait in the A&E for a longer time. So, that'll take pressure off the acute settings. You asked about GP recruitment; you'll know that our target is to recruit an extra 100 GPs before the end of this Senedd term, which we will achieve when we reach that point. That will take pressure off in some communities where, currently, there's not enough resource in that primary care setting. So, that's a target that is clear; it's in our programme for government.  And with vaccinations, currently, we've seen some improvement in the uptake of vaccinations in some of the most vulnerable parts of the community, especially in children, but it's very early, at this stage, to be able to monitor exactly if we're going to achieve an increase in the vaccination uptake. But, at the moment, it's looking promising. I am asking professionals in the health sector to make sure that they also take up the offer of a vaccination as well, because it's important in those acute settings especially, and with people who are mingling and working with people who are already ill, that they are vaccinated so that they don't share the illness when the time comes.

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Llywydd, there were a number of questions there and a lot of statements as well. I agree with a number of the statements that you made. Regarding capacity, workforce, beds and flow, flow was a theme of your contribution, which I'll get on to in a minute, but, of course, the number of beds, whether we've got enough or not, is dependent on whether or not we can make sure that people don't enter that acute setting in the first place, tackling issues earlier on, which is why we are looking at that whole-system approach, making sure that we are shifting resources into the community, making sure that the primary care setting is resourced and has the support it needs in order to stop people from going there. It would be remiss of me not to point out that community pharmacies play an important role here, especially with the common ailments scheme. Back in 2024-25, they gave 462,000 consultations. That's a massive amount of work that's done in our community pharmacies, and they play a crucial role also with vaccination as well. Getting those community-based services in place is crucial, and we're getting co-operation from those organisations, community pharmacies, GPs and others. What's changed since July? Well, we've got plans now. The health boards have designed these plans, have presented them to us, we're testing them and making sure that we learn the lessons. So, we're going to be in a better position than ever before to face the pressures that inevitably will hit us when winter arrives. You asked about the ambulances. Ambulance handovers are always a concern, and we need to see improvement in that space. We've seen some improvement over the last few months, which is a real positive, and we need to see that sustained over the coming few months, because as you say, winter is going to present a different challenge, but I am glad that we're seeing those improvements in the ambulance service. Finally, you mentioned social services, and I'm really glad that you did. It's forgotten far too often in the discussions around the impact on the health service, but more importantly on individuals. And, yes, the social care sector, social services, are crucial in this. We're making sure that the COOs, the chief operating officers of health boards, are meeting up with leaders of social services in local authorities to develop that plan, making sure that they're aligned and that we can have improved discharges. We're looking at improved patient flow—which is the theme, as I said, you looked at in your contribution—and the transition home, starting the planning for the discharge process earlier, making sure that we've got a seven-day approach to that, with expected discharge dates and regular senior clinical reviews of those discharges, so that people can go home sooner than they are currently doing.

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Diolch i Elyn Stephens am y cwestiwn pwysig yna.

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I thank Elyn Stephens for that important question.

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Absolutely, people will want assurances and to understand that the ambulance will arrive on time. I don't know how many of you saw the film Effi o Blaenau, which showed how an ambulance during winter didn't arrive on time and the cataclysmic consequences of that. Now, we're not in that position; that was a film. But, yes, people will want to be assured that those ambulances can reach them. And, yes, we've got four local resilience forums operating along the police boundaries here in Wales, and they ensure that the emergency services, the NHS and local authorities develop those contingency plans in the event of road closures or catastrophic incidents around the weather. So, they'll have control and grip on that, which makes sure that ambulances will be able to find and reach their destination. The Welsh Ambulance Services University NHS Trust is also preparing for what we call the predictable winter risks, especially for rural mountainous areas, including severe weather and the pressures that rural areas provide. So, WAST is preparing for that, and people can be assured that they will be there.

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Diolch i Claire Archibald am y cwestiwn yna.

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I thank Claire Archibald for that question

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Thanks for your recognition of the fantastic work done by a number of healthcare workers, third sector organisations and others in ensuring that the preventative measures are taken. You referenced specifically Bronglais, Glangwili, Withybush and others in your constituency, and they are under severe pressure, and it's now early October. So, that's why we're taking a year-round approach to this, because it's not a one-off event or, even just when the summer heats come, a two-time event for the year. We have to prepare for pressures on the health system throughout the year. Those are the steps that we're taking. If pressure does become more than expected, then we will respond to that. We've got some of the best staff in the health system and the care system anywhere in the world here. We're so lucky to have them, and they will respond as needed, as they've always done, year after year after year, if pressures arise. But I will finish by saying that when it comes to flu—and flu is one of the biggest challenges, and frailty, but the big challenge in winter—we monitor what's going on in the southern hemisphere. Currently, the flu season hasn't been as bad as we would have feared in Australia, but they're seeing a very late surge and very late spike in numbers as they come into their spring. So, we're monitoring that, and we will be following what's going on in Australia with interest and preparing for that.

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Llywydd, the Member makes really important points there around people who are homeless, primarily rough-sleeping, I think, is what you were referring to in this instance. Nevertheless, people who are sofa surfing and having to depend on friends and others for a bed are also vulnerable in this situation. That's why we're making sure that people in those kinds of situations are a priority group for us when it comes to ensuring that we identify them in order for them to get treated on time, get vaccinated, and get the support they need. However, the questions, Llywydd, that the Member raised are more appropriate for the Cabinet Minister for housing. She will have heard what you have to say and she will take note of what you've said. I will have conversations with her, as I regularly do because of the link between housing and health, and make sure that the Minister is aware of your concerns and the points that you raised.

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Llywydd, I agree with the Member that those providing healthcare in our communities are under significant pressure. And again, let's recognise the work that nurses, community nurses, GPs, allied health professionals and others do in this field. We owe a debt of gratitude to them. We know that pressures in our emergency departments are often a symptom of the pressures elsewhere in the system, which is why we've set in place a programme to shift resources into the community, making sure that primary care is properly resourced. We've got the Community by Design transformation programme, ensuring that we have a community and home first approach. District nursing, for instance, remains at the heart of the approach that we're taking. Across Wales, there are 167 neighbourhood district nursing teams providing a 24/7 service, and undertaking more than 230,000 visits every month. So, that's the work that we've got in place; that's why we're making sure, and how we're making sure, that people are seen closer to home. If we are to make sure that the acute settings are protected, that hospital spaces and intensive care units are protected, then we have to make sure that we've got those services in the community, treating people at home.

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Llywydd, the Member makes an incredibly important point there about the accessibility of services for the most vulnerable and disabled people in our communities. We discussed non-emergency transport last week, and so there are discussions with WAST about accessibility, making sure that steps are being taken between WAST and health boards, so that disabled people and others who can't easily access, via private transport or other means, treatment, that they are prioritised. It is a point that I will pick up with them in my next discussions, and I'm happy to give you an update on that when I do. But making sure that there are remote consultations and flexible visits is something that should be considered, absolutely.

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Llywydd, I'd like to thank the Member for the contributions that he made when he was spokesperson. This is the first opportunity I've had from here to say that and express my gratitude for his work in that field. But on to the points that he raised, yes, we need confidence that the system will work over the winter period. That's why we're stress-testing them. So, there are issues that we need greater assurances on. I mentioned earlier that currently we've got moderate assurance. Some of the parts we need to make sure that they work and function better are around protecting the acute hospital capacity. That goes without saying, I'd imagine. We know of the pressures that are on acute settings at the moment. On the discharges without delay, as I mentioned, we've got steps that we expect the health boards to ensure they deliver. That is something at the moment that we want them to work on, which is what we're stress testing and making sure that they will have improved outcomes when it comes to the winter itself. You can measure the success or otherwise of the plan that we've put in place by the number of people who attend or otherwise hospital and put pressure on the acute settings during the winter period.

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Diolch am y cwestiwn. Yn unol â'n hymrwymiad ni yn y rhaglen lywodraethu, mae ein fframwaith system gofal cymunedol integredig yn dod â phartneriaid o'r sectorau iechyd, gofal cymdeithasol, tai a'r trydydd sector ynghyd i edrych ar anghenion lleol. Drwy'r gronfa integreiddio rhanbarthol a'r gronfa gyfalaf integreiddio ac ailgydbwyso, rydyn ni’n cefnogi gwasanaethau ataliol, gofal yn agosach at y cartref a chanolfannau lles integredig, gan gynnwys mewn cymunedau gwledig.

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In line with our programme for government commitment, our integrated community care system framework brings health, social care, housing and third-sector partners together around local needs. Through the regional integration fund and integration and rebalancing capital fund, we are supporting preventative services, care closer to home and integrated well-being hubs, including in rural communities.

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Diolch. Ddirprwy Lywydd, mae'r Aelod yn gwneud pwynt pwysig yn fanna o ran rôl gofal integredig yn agosach i gartref ac, wrth gwrs, dyna rydym ni'n trio ei wneud ar hyn o bryd. Mi rydyn ni wedi delifro ar yr ymrwymiad a wnaethom ni yn ystod y 100 diwrnod cyntaf er mwyn cael y byrddau iechyd i ddatblygu cynlluniau er mwyn sifftio'r adnoddau i'r gymuned—0.5 y cant o'r ariannu blynyddol yna ydy'r gofyniad, ac maen nhw'n dod â chynlluniau ger fy mron i cyn bo hir. Dwi wedi ei wneud yn glir mai'r disgwyliad ydy eu bod nhw'n gwneud hynny yn fuan. Un o'r ymrwymiadau wnaethom ni yn y rhaglen lywodraethu, os ydych chi'n cofio, Ddirprwy Lywydd, ydy sicrhau bod mwy o ofal integredig yn cael ei ddelifro yn agosach i gartref er mwyn sicrhau gofal yn agosach i gartref, gofal ataliol yna, mwy o gefnogaeth diagnosis cynt, ac atal pobl rhag mynd i'r ysbyty. Felly, mae hynna'n rhan ganolog o'r hyn rydym ni'n ei wneud. Mi ydyn ni wedi sicrhau bod yna ddatblygiad yn mynd i fod yn sir Benfro, yn ardal yr Aelod, gydag arian cyfalaf o £1.6 miliwn yn cael ei roi i Fwrdd Iechyd Prifysgol Hywel Dda er mwyn datblygu cynllun busnes ar gyfer canolfan o'r fath yn Abergwaun, a dwi'n edrych ymlaen at weld y cynlluniau yn dod ger fy mron. Byddwn i'n hapus i gadw'r Aelod yn wybyddus o beth sy'n digwydd os ydy hi'n dymuno. Diolch.

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Thank you. Dirprwy Lywydd, the Member makes an important point there in terms of the role of integrated care closer to home, and, of course, that's what we're trying to do at the moment. We have delivered on the commitment that we made during our first 100 days in order to get the health boards to develop plans to shift resources into the community—0.5 per cent of that annual funding is the requirement, and they are bringing plans before me soon. I have made it clear that the expectation is that they should do that soon. One of the commitments that we made in the programme for government, if you recall, Dirprwy Lywydd, was to ensure that more integrated care is delivered closer to home in order to ensure care closer to home, preventative services, increasing earlier diagnostic services, and to prevent people from having to go to hospital. So, that's a central part of what we are doing. We have ensured that there will be development in Pembrokeshire, in the area covered by the Member, with capital investment of £1.6 million provided to Hywel Dda University Health Board in order to develop a business case for such a centre in Fishguard, and I look forward to seeing those plans come before me. I would be happy to keep the Member informed of developments if she wishes. Thank you.

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Thanks for that. You do make a very important point about accessibility in rural communities, or the lack of accessibility. That's why this Government has put forward the rural-proofing plan, so that, whenever a policy is developed or whenever anything is initiated from this Government, it is rural-proofed—we ensure that rurality is considered when rolling that out. And that applies to discussions around mobile coverage as well as everything else. When it comes to digital connectivity, Hywel Dda is ahead of the game in many respects when it comes to ensuring that we have improved digital connectivity and digital systems in the health board. What we need to see is that the digital systems that we've got in Hywel Dda are linked with social care as well and linked with other national health services. That is a weakness in the system. That's something we're looking at as part of the 10-year digital health programme.

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Thanks for the question, and we do appreciate and understand that a lot of people, organisations and businesses across Wales will be feeling the squeeze over the coming months as energy costs increase. My officials are continuously monitoring the situation. At the moment, it doesn't look like we've got any price spikes coming through from the health sector, or demands coming through. But, as I said, we are monitoring that, and if the issue should arise, then I will be immediately dealing with the case and talking to my colleagues here in Government.

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Thank you for the question. The NHS Wales Joint Commissioning Committee holds the Welsh Ambulance Services University NHS Trust to account through routine performance scrutiny, including cancellation trends, causes and geographical patterns. WAST’s improvement programme is strengthening reporting and action to reduce late cancellations, improve communication and provide a more reliable service for patients in Monmouthshire Torfaen and across Wales.

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You're absolutely right to highlight the impact that cancellations can have on some of the most vulnerable people in our communities. Access to healthcare isn't just about the appointment itself, as you rightly say; it's also about ensuring that people can travel to and from that appointment safely and reliably. This is precisely why the NHS Wales Joint Commissioning Committee, and the Welsh ambulance services NHS trust have accepted the need for further improvement in non-emergency patient transport services. For many people, reliable transport is not a convenience; it's what makes access to healthcare possible. The focus of the trust's improvement programme is therefore on improving reliability, reducing avoidable cancellations, and ensuring those with the greatest need and who meet the eligibility criteria for transport are able to get to appointments and back home safely, and with dignity. This programme includes a public engagement exercise that is currently live, and I encourage service users to contribute to ensure all voices are heard.

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Thank you for that supplementary question, which makes a crucial point about the access to public transport and the links of public transport to our health organisations. I was at Llantrisant Health Park recently—you might have seen the new development there—and one of the first questions I asked was about access on public transport in order for people to attend appointments at the new Llantrisant Health Park once it's up and running. This applies equally to district general hospitals across Wales, and when you think about the area that you represent and the people there served by the Grange, Nevill Hall, the Royal Gwent, and, in fact, Nevill Hall serves others as well, in Powys. So, it is crucial that we get this right. That's why consideration of access to healthcare is part of the new franchising model that's being rolled out for buses here in Wales. My colleagues and I work closely with the Deputy Minister for Transport, Mark Hooper, and are discussing this regularly.

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Thank you. You make an important point there about the fact that, if people can't access their healthcare, then they have to pay, and it's not exactly free at the point of delivery then. As I said, this is an issue where WAST is conducting a current review, and I would encourage the Member and others to contribute to the review of the non-emergency patient transport service so that we can assess the situation and improve the situation, moving forward.

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Thanks to the Member for giving me the opportunity to once again respond to questions around waiting lists, which I have exercised quite often over the last few months, so whatever I say won't be new. You are quite right that the numbers are going up currently. That is part of the legacy of what we are dealing with from the previous Government. So, what we did over the summer period was announce the £145 million that is going into tackling the waiting lists—£45 million in capital and £100 million of revenue funds. Then, during the recess period, we had conversations with the health boards and clinicians to draw up the plans for how that funding was going to go into the system, what the plans were going to look like. Health boards provided the final plans to me at the beginning of this month, and that's when the money started to be pumped into the system. Health boards will be paid on delivery of outcomes, not paid upfront. So, yes, while we can expect to see the waiting lists go up when they are announced again this month, for the month of August, once the money is going into the system we can expect to see those waiting lists come down. And, yes, I am confident that we will be hitting the target on the two-year waits.

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Because we're taking action on this. I've spoken to the BMA several times before being in this position and since about the importance of primary care and GPs and their roles. They are crucial, you're quite right. If we are going to tackle your first question around the waiting lists, we need to get things right in the GP setting. That's why we've committed to recruiting 100 GPs before the end of this term, making sure that they are deployed to the areas where they are needed most. We have a programme where we will be supporting GPs and ensuring that we build on the current structures that we've got in order to have more co-operative models so that we can help take the back-room costs away from them and allow them to invest in the medical services that they want to provide. So, yes, I'm happy to work with the BMA and others on this. It's one of our priorities, and that's why you'll see us deliver on this and things improve by the end of our term.

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The Member is right; it is frustrating that the planning process can hold things up. That's why we will be working with the Minister for planning, Siân Gwenllian, here, on identifying how we can improve that planning process for essential infrastructure. But I think, more importantly, when we talk about up to 10 surgical hubs, it's not necessarily about building new ones all of the time, it's about better utilisation of the theatre spaces that we've got, utilising some of the spaces that are in the hospitals at the moment that could be used for theatre space. I was in Nevill Hall recently, and there was one theatre there that was used as a waiting room for patients. Now, that can't be right. So, you could add something on to that hospital as a waiting room and then reutilise that as a theatre space to bring down the waiting lists. So, there's a mix and match of things we can do in this space, which is what we're looking at and why we set up the expert group to identify how best we roll out those surgical hubs across Wales.

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Not that I am aware of, Ken, but if you are aware of any issues that you think should be brought to my attention then please do so.

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That's an interesting question, because the structure that we have around the accountability framework is a legacy of your Government, something that my predecessor, Edwina Hart, had set up originally back in 2009. I'm not happy with the current accountability framework. I don't think it allows for transparent accountability, hence why we brought in the new framework for escalation last week. I think we do need to look at the accountability structure within the NHS so that people can have confidence. The fact that, as a Minister, I can only appoint the chair of a health board means that I don't have many sticks when it comes to holding them to account. So, I'd be more than happy to look at that structure. In fact, I've asked officials to look at the accountability framework, and I'm happy to work with you, should you want to do so.

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Dirprwy Lywydd, I'd like to thank the Member for that line of questioning. Now, the programme for government is an excellent piece of work—many here would agree. But the job of the programme for government isn't to set out the absolute detail of every piece of legislation or every part of work that we'll be doing; it's to set the direction. And the same applies to the announcements that we as Ministers have made. Now, this question lies in the portfolio of my colleague the Deputy Minister. She has set out the priorities that she has in her portfolio, and she did mention and talk about the importance of unpaid carers. In fact, a lot of what we've been doing with unpaid carers is based on the brilliant report by the health committee—health and care committee, I should say—in the last Senedd, of which I was a member. And we are now actively working on those recommendations in order to ensure that unpaid carers here have the dignity and respect that they deserve. But I would suggest that you raise it with my Deputy Minister in order to push the agenda forward on this.

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Thank you. I think you're right, the programme for government did list a non-exhaustive list of a number of health issues that are related to people in Wales. When I say 'non-exhaustive', it means that there are others out there that we will be tackling and looking at. Lung disease is clearly one of them, and we know that, when it comes to lung cancer, it is one of the biggest killers in Wales still. That's why one of the priorities of our Government is in that preventative field, so that we stop people reaching that stage of living with or suffering from lung cancer. And that's why one of our ambitions is to roll out lung screening in Wales.

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Our programme for government commits to prioritising the prevention of ill health through a cross-Government approach and development of a public health strategy. It also includes a commitment to strengthen national clinical pathways for cardiovascular care, ensuring equitable access to high-quality, person-centred services, reducing unwarranted variation and improving outcomes and experiences.

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Diolch. Dirprwy Lywydd, I'm not sure if I should declare an interest: I used to be a staff member for the British Heart Foundation many years ago, since the Member referenced the British Heart Foundation in his question. But, on to the substantive point, I recognise the important contribution that national clinical networks make in supporting NHS service improvement. NHS Wales Performance and Improvement is reviewing the clinical leadership model for all national clinical networks, including the cardiac implementation network. The review is focused on determining the most effective clinical leadership arrangements to support the transformation of clinical services in Wales and is due to complete in December of this year. While this review is under way, NHSPI sought to make temporary appointments to clinical leadership roles in the cardiac network, but was, sadly, unable to make an appointment. In the meantime, NHSPI is providing support from its senior executive team, including the medical director, in relation to the work plan of the cardiac implementation network.

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It's probably important to set out that I don't set, as Minister, targets for each individual health board; it's the health boards themselves that deliver clinically in their areas, so it's up to them to deliver based on their ability to do so. But you do make a very important point about the regional differences that we've got in Wales; that someone can live in one part of Wales and expect a different service and, indeed, a different outcome to someone in another part of Wales. That's why one of our ambitions and one of our priorities in this Government is to tear down those regional barriers that are stopping organisations from working together. I and my colleagues—both Deputy Ministers—attended a Welsh NHS Confederation meeting yesterday with the chairs and chief executives of the health boards and trusts across Wales, and we were discussing this exact point of how we can make sure that they work together better, so that they serve the people of Wales and have a one-Wales approach to delivering services.

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Patients deserve clear, timely and compassionate communication throughout their care. We are strengthening accountability for patient experience, improving how NHS bodies share information and expanding the NHS Wales app and joined-up records so that people can access appointments, waiting list information and care details more easily.

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Dirprwy Lywydd, I agree that this is more than just a simple inconvenience. When patients are awaiting a diagnosis or a treatment, poor communication can add significant distress and uncertainty. Patients shouldn't be passed between organisations to obtain information about their own care. Where services are shared, NHS organisations must take collective responsibility for keeping patients informed and ensuring that communication is clear, timely and joined up. That's why we are improving information sharing, expanding digital access through the NHS Wales app, and holding NHS organisations accountable for the experience that patients receive throughout their care journey. On cancer, we are developing a new cancer strategy that is looking exactly at this, and I was speaking about this point earlier today with Macmillan, looking at ways of improving the communication between the acute setting, the primary care setting and the patient, in ensuring an improved whole-cancer-pathway experience.

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We are taking clear action to decarbonise the health and care system and strengthen climate resilience. The 'NHS Wales decarbonisation strategic delivery plan' and 'Decarbonising Social Care in Wales' set out how the sector will contribute to Wales's statutory net zero 2050 target, while protecting services and improving population health.

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Thank you for the question. I'm afraid looking at it from that lens is overly simplistic. That's tantamount to saying, 'Let's stop development in the estates, because we need to put more money into nursing, or more money into the clinical sector.' It's not that simple. When we look at decarbonising the NHS, first of all, we have to accept that climate change is happening, and we have a duty to respond to that massive challenge. Climate change alone is leading to—we've seen it over the last summer—worse health outcomes for people in Wales. But decarbonising the NHS isn't just a matter of putting things on paper, or changing some ways of working; it's about improving the services. It's about making sure that we have services fit for the twenty-first century, that we have an estate fit for the twenty-first century, that we have equipment that is suitable for the modern challenges ahead. So, we won't stop the decarbonising project. It is part of ensuring that we have an NHS that is capable of answering the needs of modern times.

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Dirprwy Lywydd, surgical hubs are central to our plans to reduce waiting times and improve access to planned care. We have committed £25 million capital funding to support the development of elective care, surgical and diagnostic hubs across Wales. An expert group will advise on future hub configuration and report later this year.

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The elective care expert group has started its work and is developing a delivery plan for up to 10 elective care hubs across Wales, with recommendations due by the end of 2026. The group is clinically led and brings together senior surgeons, nurses, anaesthetists and operational leaders. It will determine how many hubs are needed, where they should be based and how they can add the greatest capacity. We're backing the programme with a £25 million capital investment. By separating planned surgery and diagnostics from emergency pressures, the hubs will increase capacity, reduce cancellations and help patients receive care sooner. We're already putting this approach into practice. The £121 million regional orthopaedic hub at Llantrisant will provide six theatres and 54 beds and is expected to deliver around 3,000 operations a year. Aneurin Bevan University Health Board is one of the three health boards working together on the project.

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The Welsh Government works with Digital Health and Care Wales and all NHS bodies to protect digital infrastructure and patient data. National monitoring, independent assurance, clear legal duties, incident response and improvement plans support a defend-as-one approach, while continued investment strengthens resilience, workforce capability and accountability across NHS Wales.

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Dirprwy Lywydd—. Oh, Llywydd, sorry. I put my head down for two minutes and everything changes. Llywydd, the national data resource, managed by Digital Health and Care Wales, uses the Google Cloud platform to store data, following an open-market procurement exercise. This arrangement takes place under strict contractual arrangements where the NHS remains the owner of the data. The overarching development, deployment and delivery of the NDR platform doesn't inherently lock organisations into Google as a cloud provider. Standards used to manage data such as Fast Healthcare Interoperability Resources, FHIR, are open standards, not Google proprietary formats, so data stored are portable by definition. However, the Member's example of what's done with open-source solutions in Europe is interesting, and I'd be interested to keep this conversation going as we look to develop our plans and resources.

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