Gwyn Williams

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1. 6. Members' Legislative Debate under Standing Order 11.21(iv): An NHS first Bill en

   Diolch yn fawr, Ddirprwy Lywydd. This debate, in a nutshell, is, essentially, about putting the NHS first when deciding how to reduce waiting lists, and I'm grateful for the cross-party support on this matter. I should declare an obvious interest, which you're all expecting me to say anyway, that I'm a consultant eye doctor at Singleton Hospital in Swansea. I've worked in the NHS for 23 years as a doctor and 10 as a consultant. I believe in the NHS, work in the NHS, and I've seen the problems and opportunities first-hand. Our clinicians know their patients, they know the hospitals and, more importantly, they know the systems that they work in. We should give them the opportunity to put forward plans for reducing waiting lists before asking private providers if they can do so. And this is not party political, or at least it shouldn't be. I believe we all want people across Wales to receive safe, timely care. We want waiting lists to fall and we want public money to deliver the greatest possible benefits for our patients. So, what does this proposal ask for? Three things: to favour NHS-led provision; to give clinical leads the power to reject unsafe private proposals or inadequate follow-up arrangements; and to demand transparent publication of data on private provision from every health board. And why? Because I believe that putting the NHS first can help us deliver safer care, work more efficiently and make better use of NHS money. And I will take each one of these things in turn. Deliver safer care. One appointment or a surgery is only one part of the process in a patient's diagnosis and treatment journey. It isn't, and, indeed, can't be, a stand-alone thing. Likewise, an operation also. What happens afterwards matters too, and, indeed, before, with listing and pre assessment. It's obviously not hugely safe to send one link of this chain to an unfamiliar provider and then the patient is returned. Clinicians all over Wales can speak about experiences, for example, with patients returning to the NHS with some form of complication following a cataract operation, for example, privately via outsourcing. These complications can and should require urgent treatment, which then takes priority over elective cases, such as macula hole repairs. The proposed legislation would give clinical leads the authority to refuse private arrangements they consider unsafe or which lack appropriate follow-up care. The people responsible for patients' care must have a say in how that care is provided—the people who mop up the mess. Secondly, to work more efficiently. Local NHS teams know the patients, the department and the systems, yet decisions to outsource or insource work to companies can be taken several levels above them, before they have the opportunity to offer an in-house solution. Oftentimes, if the patients are not known to the company clinicians, who also can't access records and are not responsible for follow-up—we don't have an electronic patient record all around Wales, for example—decisions are deferred, as it is merely an exercise in kicking the can down the road to make the figures look temporarily better. But it always catches up worse than before. I'm a fan of the HBO miniseries Chernobyl, where Professor Valery Legasov says, 'Every lie we tell incurs a debt to the truth. Sooner or later that debt is paid.' And when is that? When the contract ends in this case. This proposal would require health boards to seek the development of those solutions first: additional waiting list initiative clinics and operating lists within the NHS, planned by the teams who understand the service. And we also need to consider the effect on our workforce. When clinicians cut their NHS hours to do more private-provider work, which does remunerate better, it has to be said, the private sector grows and the NHS capacity atrophies. We become more dependent on the very provision that is drawing our staff away, and we're, in fact, paying to drain the very service we need to strengthen. If an NHS team cannot undertake all the additional work, private provision would remain an option. This proposed Bill would merely establish a presumption in favour of NHS-led plans. Thirdly, to make better use of public money, if indeed we do put the NHS first. Private contracts use public money. I think Mabon recently quoted £1.5 million that was spent over the past few years on outsourcing. That money used in an NHS setting would have helped develop services and make a permanent improvement to departments all over Wales. We need to appreciate and understand the full cost of the contracts, including follow-up, complications and any work that then returns to NHS services. Cataracts, for example—obviously, I'm biased towards cataracts—[Laughter.]—are not undertaken and simply sent back. Complications are needing extra surgery, appointments in eye casualty, as well as administrative problems caused by one eye being operated on privately via outsourcing and the other eye falling through the cracks, which is a terrible image. [Laughter.] Health boards should publish transparent data on their use of private provision so we can see what has been purchased and assess what it delivers. And why does this matter to constituents across Wales? Because behind every waiting list figure is a person waiting for treatment. They need safe care, timely treatment, and confidence that someone will take responsibility for their follow-up. The decision we make today affects the NHS's ability to treat patients tomorrow. We need to reduce waiting lists while strengthening the service people will continue to depend on. And why does this matter to me personally? Because this is why I'm here. This is why I came into this job and why I sit in this chair: to give the clinicians delivering care the opportunity to put forward solutions. We have an opportunity to put NHS capacity, clinical judgment and accountability at the centre of decisions about waiting lists—not an expensive, unsafe, can-kicking, sticking-plaster exercise that erodes the health service upon which we depend. Let's stand up for the NHS. Let's put the NHS first. Let's show the people of Wales that we take their safety, their waiting times and their public money seriously, by giving the people who know the patients and deliver their care the opportunity to lead. Diolch yn fawr.

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2. 6. Members' Legislative Debate under Standing Order 11.21(iv): An NHS first Bill cy

   Diolch, Lywydd. Diolch, Weinidog Cabinet. Faint o amser sydd gen i ar ôl? Munud a hanner. Ocê.

   Official English translation

   Thank you, Llywydd. Thank you, Cabinet Minister. How much time do I have left? A minute and a half. Okay.

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3. 6. Members' Legislative Debate under Standing Order 11.21(iv): An NHS first Bill en

   First of all, I thank everyone who took part in the debate from all sides. Before I come on to the specifics, just to reassure Benjamin and Natasha that this is absolutely not about discriminating against the private sector at all, it's just about doing what we can in-house and what we can't outside of the house. Because there are risks—safety risks, but also continuity-of-care risks, follow-up risks—all kinds of things that make it more desirable to do the work in-house. I myself have been in a strange position, for example, whereby our waiting lists for seeing patients—out-patient appointments—have been going behind. And I want to see more, but I'm told that, because of outsourcing and because there's a lack of money for doing the work in-house, the only way I would have been able to see my own patients is by joining the company and seeing them in a whole different environment, which is very odd. That's why I wanted to bring this to all of your attention, specifically so that we just put the horse before the cart and we try to do things in a sensible, cheaper and safer way beforehand. So, just to reassure you, we're not going to ban the private companies altogether. This is absolutely not the aim of this. It's just about there being a presumption to do the work in-house first.  I agree with Shav: this is not an ideological argument at all, it's more of a scientific and commonsense argument. I'm grateful to all the people who spoke. I was going to list them all, but there are too many and time is running out. But also the people who wanted to speak but there was no time as well: Leticia, Sarah Rees and Cristiana Emsley. I'm very grateful to her, again, not that she did speak, but that she wanted to speak, and I'm grateful for that. Thank you.  And lastly, just to say that this is all just about creating the conditions for allowing the national health service to survive. Aneurin Bevan—who has been quoted already, but I've got a different quote, thankfully—famously said that 'The NHS will last as long as there's folk with faith left to fight for it.' We're fighting for it. Diolch yn fawr.

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1. 8. Legislative Consent Motion: The Armed Forces Bill en

   I welcome this legislative consent memorandum for the Armed Forces Bill. My son, Emyr, serves in the 1st Regiment Royal Horse Artillery, so I value the opportunity to speak on this matter today. This Bill recognises a range of items, from the issue of defence housing and property, the armed forces covenant, as well as protecting victims of service offences. These issues directly impact thousands of Welsh armed forces personnel who serve. This LCM seeks consent on defence housing and other property, which makes provisions for a 10-year plan to build new homes across a third of the Ministry of Defence estate. I welcome this, as veteran homelessness is a serious issue not just in Wales, but across the United Kingdom as a whole. I strongly believe that armed forces personnel and veterans must be provided with clear signposting and support on issues such as housing, in order to make a transition back to civilian life when that time eventually comes. The armed forces covenant aims to provide further support to current armed forces personnel and veterans. I would hope that my son Emyr, as well as all other military personnel, are supported and that they receive access to essential services and are treated fairly. Robust reforms are also needed to modernise the investigation, charging and disciplining procedures for victims of service offences. A protection towards armed forces personnel is seen here, with improvements of support for protecting the victims of the most serious offences from further harm. For these reasons, I am in support of granting consent to this LCM. We owe it to our troops and our veterans. Diolch yn fawr.

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1. 2. Questions to the Cabinet Minister for Government Effectiveness and the Constitution cy

   Diolch, Weinidog Cabinet. O ofal plant i gyfraddau busnes a chymorth efo costau byw, mae'r Llywodraeth yn mynd i'r afael â'r problemau sy'n effeithio ar bobl hyd a lled Cymru. Dwi'n falch o'n gweld ni'n cydweithio ar draws gwahanol bortffolios a lleihau'r gweithio sy'n cymryd lle mewn seilos llywodraethol—rhywbeth dŷn ni wedi'i eisiau ers blynyddoedd maith. Nawr, fel y nodwyd ar ôl y 100 diwrnod, mae'r Llywodraeth yn buddsoddi £100 miliwn i daclo rhestrau aros y GIG. Mae'n hynod o bwysig i bobl ar draws Cymru, ac, wrth gwrs, yng Ngŵyr Abertawe, fod y Llywodraeth yn llwyddo i fynd i'r afael â'r broblem fawr hon, sydd wedi wynebu Cymru ers llawer rhy hir. Sut bydd y Llywodraeth yn sicrhau bod buddsoddiadau fel hyn yn darparu'r budd mwyaf effeithiol, ac, yn fwy pwysig, parhaol, wrth gyflwyno'r rhaglen lywodraethu? Diolch yn fawr.

   Official English translation

   Thank you, Cabinet Minister. From childcare to business rates and support with the cost of living, this Government is already tackling the issues affecting people across Wales. I'm pleased to see us collaborating across different portfolios and reducing the work carried out in Government silos, which is something that has been needed for many years. Now, as noted after the first 100 days, the Government is investing £100 million in tackling waiting lists in the NHS. It's vital for people across Wales, and, of course, in Gŵyr Abertawe, that the Government succeeds in tackling this huge problem, which has faced Wales for far too long. How will the Government ensure that these investments will provide the most effective, and, more importantly, continuous benefit, while delivering the programme for government? Thank you.

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1. 3. Topical Questions en

   Thanks to Huw for bringing this important issue up, and for Kiera for mentioning Gŵyr Abertawe. Thank you, both. Admiral's announcement that they were cutting 500 jobs has been devastating for our own communities in Gŵyr Abertawe, as Kiera mentioned as well, and we've had many e-mails about this. In fact, one came just in the time that we've been sitting here in Plenary. It's an important issue for the people of Swansea, because almost 2,000 people are employed by Admiral in the Swansea area. Admiral, of course, being Wales's only FTSE 100 company, recorded a £958 million profit last year, and it is my view, and the view of my fellow MSs, that these lay-offs are completely optional. This is causing concern, as we can imagine, because the economic situation of our own constituency is fragile, to say the most favourable thing, really. So, can the Minister, please, after his engagement with the company, update both us from Plaid Cymru, but also people from other parties as well, on the situation, so that we can properly communicate with our constituents, because they are very, very concerned, and it has a disproportionate hit on the economy of Gŵyr Abertawe? Diolch yn fawr.

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2. 6. Reform UK Debate: Default 20 mph speed limit en

   I have to say, as well, I recognise that this is an important issue to debate, and I think it is good that we've got this out in the open so we can discuss these things, for I also, as with Janet Finch-Saunders, have come across residents that have said to me that they are very much against this, and I've come across many residents—though I tend to meet them in meetings rather than going round houses, funnily enough—who say that they support it. But I recognise that there is opposition, and where there is opposition, for this Chamber to be democratic, we have to have a debate about it. So, I welcome this. [Interruption.] Thank you. So, first of all, I also agree, could it have been rolled out in a better manner? Yes, I think it could have. And I think if I introduced any of the people on this side, or that far side over there, to my own father, he would have much to say as well with that. But, when it comes down to the actual blanket—. I shouldn't say that, sorry.

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3. 6. Reform UK Debate: Default 20 mph speed limit en

   I apologise for using the word 'blanket'. When it comes down to the policy itself, generally, which is not a blanket policy in any way, it's a good thing. And I will use data to illustrate this. As a lecturer in Swansea University, I'm very used to PowerPoint presentations, and I think it is very strange to discuss data, especially graph-based data, where you can do with lines on graphs, and not have that luxury. I was going to ask Louise, as she had a very nice paper-based graph, and I thought about adopting that, but then I thought I would never be able to draw the graphs or the pictures in anywhere near your style, for my writing is terrible. So, I'll use the actual figures instead, although they are more tedious to read out like this. First of all, they come from Senedd research, because I thought everybody would respect that, and the UK Government's STATS19 road safety data, and I was going to separate this into four parts: collisions, injuries, economics, and the culture of it. First of all, collisions. There's been a 22.5 per cent fall in collisions after the 20 mph limit was introduced in September 2023 and, on other roads, a 0.2 per cent fall. In England, this fell by 4.7 per cent, and in Scotland it went up by 1.5 per cent. That's collisions. And then we come to injuries. Casualties: there have been 630 fewer casualties of all kinds. Deaths went down from over 100 to 84, but you're quite right in saying it went from 84 to 91, but this is still down from where it was before. An 11 per cent decrease in those killed or seriously injured. And then there is the economics of it. Can you put a price on life? Well, yes, you can. That's the basis of healthcare economics as well in medicine, when you put a price on lives saved versus cost to the economy. And there is projected cost to the economy. You're quite right in saying that as well. Do they balance up? There's not enough data to come to a conclusion yet. But, and I won't read out these tedious figures, but, there are: pounds for everybody killed, measured in the millions, mainly because of the way the road is closed, traffic is diverted and such; hundreds of thousands of pounds for somebody seriously injured; and some £20,000 for somebody slightly injured. And there have been many estimates as to what this adds up to, but, again, without the use of PowerPoint or a graph-based phenomenon, I won't read out a very long number that doesn't mean anything in itself—

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4. 6. Reform UK Debate: Default 20 mph speed limit en

   I will take a leaf out of your book, and I'll say, 'Yes, I will welcome the intervention.'

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5. 6. Reform UK Debate: Default 20 mph speed limit en

   It's an interesting one, and I think it's a very legitimate point, opportunity costs. I would answer that by saying that we're in a situation now whereby I am told by the scientists that it will take until 2029 for them to have properly understood both the economic and the lives-saved cost of this, and we can't come to a proper decision as to what those costs would be, pro and con, until 2029. We have the option of finishing the experiment early and not knowing whether it would have made a difference one way or the other, or waiting until 2029. It might well be that, when that comes to an end, they say the drift upwards in casualties or lives might have continued, it might come back down again, but until we've reached that date—and that's a date chosen by people who are more intelligent than I—we can't know. So, the answer is, as a scientist, I will say that we can't know the answer to that question, because the time hasn't elapsed yet for us to properly compare the data. I'm aware the clock has gone red, but also I'm aware of the culture of this place—that if you accept an intervention, you get a little bit of grace.

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6. 6. Reform UK Debate: Default 20 mph speed limit en

   Thank you. With regard to culture, to come back to that aspect, people used to play outside more. I went to Sketty Primary School in our constituency this week. One of the greatest problems is people being addicted to social media—not playing outside, but indoors. Max Boyce, when he used to sing about this four-hours-each-way match, 'When I Played for Wales'—Wales against England, it was something like 400-odd against 12—he played in Llewellyn Street in Glynneath. I've never been been to Llewellyn Street in Glynneath, but I encourage people, for preventative health, mental health, all that kind of thing, to be outside. Let's play outside more. Less social media. Less in the house. So, for multiple reasons, I think this is a good thing. Thank you. Diolch yn fawr.

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1. 4. Statement by the Cabinet Minister for Health and Care: Review of the Escalation and Intervention Framework cy

   Croesawaf gyhoeddiad y fframwaith cyfrifoldeb a chefnogaeth genedlaethol newydd, yn enwedig y pwyslais ar ganfod ymyrraeth gynnar ac ymyrraeth bwrpasol. Fel dywedodd Benjamin Hodge Mckenna, dyw'r fframwaith presennol ddim yn gweithio. Mae atal a'i gwneud hi'n haws i fynd i'r afael â heriau cyn iddynt ddod yn argyfwng yn agwedd rwy'n cytuno â hi, a dwi'n meddwl y bydd pawb yn y Siambr yn cytuno gyda hwnna hefyd. Dwi'n falch ei fod e'n cael ei ddefnyddio ym maes iechyd a'r gwasanaeth iechyd, ond hefyd yn fwy eang, fel egwyddor arweiniol cyffredinol.  Gobeithiaf y bydd y fframwaith newydd yn cryfhau cyfrifoldeb ac yn gwella gwasanaethau, ond o ystyried y gwahaniaethau mawr yn rhanbarthol mewn gwasanaethau a pherfformiad—rhywbeth dwi fy hun yn siarad yn aml amdano—sut byddwch chi'n sicrhau bod y fframwaith yn cael ei gymhwyso'n gyson ar draws pob bwrdd iechyd yng Nghymru, lle mae cymaint o amrywiaeth? Diolch yn fawr.

   Official English translation

   I welcome the publication of the new accountability and support framework, in particular its emphasis on early identification and purposeful intervention. As Benjamin Hodge Mckenna said, the current framework isn't working. Preventing and making it easier to tackle challenges before they become crises is an approach that I agree with, and I think that everyone in the Chamber would agree with that too. I'm pleased that it's being used in the area of health and our NHS, but also more broadly, as a general guiding principle.  I hope that the new framework will strengthen accountability and improve services, but given such regional variation in services and performance—something I myself regularly talk about—how will you ensure that the framework is applied consistently across all health boards in Wales, where there is so much variation at present? Thank you.

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1. 3. Questions to the Senedd Commission cy

   10. A wnaiff y Comisiwn ystyried llwybrau amgen sy'n cysylltu Tŷ Hywel â'r Siambr i helpu i leihau tagfeydd yn ystod y Cyfarfod Llawn? OQ64548

   Official English translation

   10. Will the Commission consider alternative routes linking Tŷ Hywel to the Siambr to help alleviate bottlenecks during Plenary? OQ64548

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2. 3. Questions to the Senedd Commission en

   Diolch yn fawr. I would humbly suggest, as a new Member, as many of the people here are—. The level of the canteen, which is marked M, and the first floor and the stairwell on the other side, as you said in your answer, can only be connected via a lift. It does seem to be, at busy periods, a bottleneck of people. I have lost count of the number of long-serving staff, including a very nice lady called Sam, who works in the tea room here—. She has said that she has lost count of the number of times that she has suggested a flight of steps connecting that level with the stairwell on the other side. And there is some space to the side. So, would the Commission agree that this is a bottleneck and that a simple addition of a flight of steps would ease congestion? Would you look into it further so that I can report back to Sam in the tea room?

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1. 1. Questions to the Trefnydd, Chief Whip and Cabinet Minister for Culture and Sport cy

   3. Pa drafodaethau y mae Llywodraeth Cymru wedi'u cael gydag Undeb Rygbi Cymru ynghylch ei gynlluniau i gwtogi nifer y rhanbarthau? OQ64440

   Official English translation

   3. What discussions has the Welsh Government had with the Welsh Rugby Union regarding its plans to reduce the number of regions? OQ64440

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2. 1. Questions to the Trefnydd, Chief Whip and Cabinet Minister for Culture and Sport en

   Grass-roots clubs should be at the heart of the Welsh Rugby Union's decision making. The decision to drop either the Ospreys or the Scarlets will be devastating for communities across south-west Wales. As someone from Ystradgynlais, for example, I would say that, if you were to tell me that there was no longer to be a local derby between Ystradgynlais and Ystalyfera, there might be some form of civil disorder, even. This is a decision of much graver consequences, as it used to be said, in the Swansea valley at least, that there were two places of worship for the Welsh people and it was debatable whether it was chapel or the rugby pitch that was the most culturally significant. The Ospreys' and Scarlets' success is known across Europe, with both teams also heavily contributing to Wales's international success. The people demand, rightfully, and deserve transparent answers, as you say, from the Welsh Rugby Union, which they've not been given. As we've seen too frequently in south Wales, when industry leaves—and this is a form of industry—nothing takes its place. Does the Minister agree that the Welsh Rugby Union should provide the transparency, accountability and collaboration on how they got to their decision to drop either the Ospreys or the Scarlets? Thank you.

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1. 1. Questions to the First Minister cy

   1. Pa fudd ddaw i drigolion Abertawe yn sgil sefydlu cwmni ynni cyhoeddus cymunedol i Gymru? OQ64441

   Official English translation

   1. What benefits will come to the residents of Swansea following the establishment of a community public energy company for Wales? OQ64441

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2. 1. Questions to the First Minister en

   A publicly owned energy company based in Swansea, with a focus on supporting community and local ownership would not just positively impact communities across Gŵyr Abertawe, but also across the wider Swansea bay area. The cost-of-living crisis has impacted many thousands of people in my constituency, made worse, of course, by the closure of the furnaces over in Port Talbot, which is not so far away. Swansea has the second biggest tidal range in the world, and the city's proximity to the electric arc furnace across the bay will be an integral part of our transition to net zero. So, if it is based in Swansea, it would also provide a tangible future of sustainable careers that future generations can look forward to. With these exciting points in mind, will Swansea be considered for the potential headquarters of a community public energy company for Wales? Diolch yn fawr.

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1. 1. Questions to the Cabinet Minister for Health and Care en

   I'm sorry to be a type of Job's comforter, as my dear mother would say, but I'm going to add to your woes—your already considerable pile of woes—sorry. The situation isn't just nurses and midwives, but it actually involves medical trainees as well, speaking, again, from an ophthalmic perspective, which takes seven to 10 years of training in blood, sweat, tears and vitreous, as well as the actual cost of it as well. And we lose a third of our trainees to England because there's a lack of centralised planning for consultant vacancies for when people leave the system. So, then what we end up with in Wales is—and we already have the lowest number of specialist consultant ophthalmologists in Britain per head—we recruit from abroad to fill up the gaps. Whereas if only we could have a centralised authority to match trainees with their jobs, we would solve the problem. So, do you agree that you need central planning on a specialty basis to stop the brain drain from our country?

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1. 2. Questions to the Cabinet Minister for Government Effectiveness and the Constitution cy

   4. Sut mae'r Gweinidog Cabinet yn gweithio gyda'r Gweinidog Cabinet dros Iechyd a Gofal i gyflwyno'r adolygiad annibynnol o berfformiad y GIG, yn unol â blaenoriaethau'r Llywodraeth? OQ64388

   Official English translation

   4. How is the Cabinet Minister working with the Cabinet Minister for Health and Care to deliver the independent review of the performance of the NHS, in line with the Government's priorities? OQ64388

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2. 2. Questions to the Cabinet Minister for Government Effectiveness and the Constitution en

   Diolch yn fawr. As a consultant myself, I'm well aware of the inefficiency of the NHS, and clinicians and consultants have been calling for change—meaningful change—for years now. We need a fundamental change in culture, one that promotes accountability, performance and continuous improvement, while moving away from the previous blame culture and the toxicity that can too often hinder progress and, in fact, has hindered progress. Above all, the focus must be on patients and on ensuring that their voices are heard throughout the system. We need a far more joined-up approach across the health boards in particular, which we spoke about last week, and organisations such as Digital Health and Care Wales. Despite spending millions of pounds on digital transformation, progress on different electronic patient records has been slow, with work most often delayed due to health boards not collaborating or working with each other. We are already lagging behind countries with integrated national systems, remaining reliant on fragmented digital infrastructure, which is cost inefficient and unable to communicate effectively. Can the Cabinet Secretary outline how he will work with the Minister for Health and Care to deliver the hard reset that is needed across our health boards to deliver this meaningful change? Diolch yn fawr.

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3. 6. Statement by the Deputy Minister for Public and Preventative Health: Priorities for Public and Preventative Health cy

   Diolch yn fawr, Ddirprwy Lywydd. Mae cael mynediad at ofal deintyddol yn hollbwysig er mwyn atal problemau deintyddol ac iechyd yn gyffredinol, a dwi'n croesawu ein hymrwymiad i adolygu contract deintyddol y GIG er mwyn datrys materion hollbwysig sy'n effeithio ar y proffesiwn yng Nghymru ac ar brofiad ein cleifion. Fe wnaethom gyfarfod ag arweinwyr ym maes deintyddiaeth yng Nghymru yr wythnos diwethaf i wrando ar eu pryderon, ac mae adolygu'r contract, fel a nodir yn ein maniffesto, yn un o'u prif flaenoriaethau. Hoffwn dalu teyrnged i Mike Hedges o'r Blaid Lafur, achos roedd e yn y cyfarfod hefyd. A fydd y Dirprwy Weinidog yn ymrwymo i wneud hyn cyn gynted â phosib, yn ogystal â chysylltu ag arweinwyr ym maes deintyddiaeth yng Nghymru i geisio atebion clou i sefydlogi gwasanaethau deintyddol yn y cyfamser. Diolch yn fawr.

   Official English translation

   Thank you very much, Dirprwy Lywydd. Gaining access to dental care is vital to prevent dental and health problems more generally in the future, and I welcome our commitment to review the NHS dental contract to resolve vital issues affecting the profession in Wales and the experience of our patients. We met with leaders in the field of dentistry in Wales last week to listen to their concerns, and reviewing the contract, as set out in our manifesto, is one of their main priorities. I'd like to pay tribute to Mike Hedges from the Labour Party, because he was in the meeting as well. Will the Deputy Minister commit to undertaking this task as soon as possible, as well as contacting leaders in the field of dentistry in Wales to seek short-term solutions to stabilise dental services in the meantime? Thank you.

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1. 6. Member Debate under Standing Order 11.21(iv): Ophthalmology services en

   Diolch yn fawr iawn, Ddirprwy Lywydd. And I, first of all, have to declare a very obvious interest in this, which you can all can guess anyway, but, for the record, I myself am a consultant ophthalmic surgeon at Singleton Hospital, as is Safa, who is a co-submitter. And I have to thank as well, not just Safa, but Jane Dodds, who also is a co-submitter, although, to the best of my knowledge, she does not have any formal ophthalmic surgical training. [Laughter.] I want to thank, though, everyone around this Siambr, from all parties, who supported the motion and allowed it to get to this debate. Thank you, everyone. I don't see this as a party-political thing at all really, but something for everyone who wants our people to see better. Because eye care affects everyone. Individual people from this Chamber have come up to speak to me—though I will not mention their names, patient confidentiality and all—who have had surgery for sight-threatening eye conditions. Perhaps you'll hear from them later.  I wanted to break this down into three sections: what the problem is and why I've brought this, the background to the possible solution, and then the actual solution itself.  First of all, as we've heard before, medicine evolves. The system we have now is perfectly set up for the 1980s and 1990s, when ophthalmic surgeons pretty much could do all the operations, apart from extremely rare complex ones, and high technology didn't really exist for things such as advanced tube surgeries for glaucoma. Injectable agents for age-related macular degeneration didn't exist. Services weren't needed anywhere near to the scale they are now, but now we have sub-specialisation, expensive equipment, and it isn't possible any more for every health board to do everything in every hospital. If they could, it wouldn't be very efficient, it wouldn't be very safe, because the systems are too small. So, in Wales, we have too many small hospitals and small health boards attempting to do everything, and not enough tertiary hospitals, unfortunately. The health boards are not joined up to each other at all. There is a great wall separating the flow of patients and staff between health boards, and I know, because I've attempted to break the walls down, and they are insurmountable barriers of bureaucratic Sovietness in the worst kind of way. So, people go blind because of this. This is the problem. I was going to illustrate an example of a patient of mine who came to see me in Swansea and had the misfortune of living just the other side of the bridge in the Hywel Dda area, just over the bridge in a place called Bynea. A very nice place, but the fact that it is the other side of that river caused a huge problem, because I couldn't order any scans in my hospital, properly, without filling out an IPFR, as it's called—an independent patient finance form—for every single interaction. If I wrote to Hywel Dda, the people there rightly would say, 'Who are you, working in a whole other health board to tell us what to do?' And everything is delayed by 100,000 per cent, that's the problem. Another thing: retinal detachments. Because the health boards are all siloed—and we heard of the evil of silos just now—because the health boards are siloed, vitreoretinal surgeons, who are the only people who can treat retinal detachments, can't work properly together. So, say you have a retinal detachment, it's just random serendipity if you can have your operation that day, and you need to be operated on urgently for this, otherwise it's a long journey to Bristol, to Oxford, to Moorfields in London. And if you have a retinal tear in need of surgery, you have to posture for that time, which usually involves lying flat with where the tear is lying at the most inferior part. Otherwise the retina slowly peels away as you reach help. And if you have to travel to Oxford, you obviously cannot drive in an upside-down position in the back seat of your car. And it is stressful for people as well, having to put up with such awful long journeys, whereas if the system was joined up within Wales itself, they wouldn't have to do that.

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2. 6. Member Debate under Standing Order 11.21(iv): Ophthalmology services en

   Uveitis: I tried for a long time to set up a tertiary referral centre within Wales for uveitis, and I've been to many, many NHS-style meetings, as I know other people have as well. And the NHS loves meetings to discuss things; it does meetings very well indeed, but rarely do actual solutions come from simply meetings, because I've been to many regional meetings about the health boards working closer together, and the end result? Uveitis patients still go to Bristol as a tertiary referral centre, which is far away. Photodynamic therapy for a condition that is called central serous chorioretinopathy: there's only one laser that does that in south Wales, which is in Cardiff. We can't get access to it from Swansea, and we can't buy our own laser, the lasers are very expensive, and the drug is very expensive. It makes sense to join everything together. Corneal transplants: not every health board has a corneal surgeon. Cross-linking for a condition called keratoconus. It's completely a postcode lottery as to whether you can get to it. Even cataracts—. We do 500,000 cataracts a year in Britain. Cataracts, the commonest operation. Everyone in this room will end up having cataract surgery. Wouldn't it be a wonderful thing if they could have it done in a timely way? If we could do it, one day when I need cataract surgery, in a timely way within Wales itself, rather than having to pay out of my own pocket to have it done privately, or wait 100,000 years to have it done in my local hospital. We need to adapt with the times, and we need surgical hubs, efficient surgical hubs, but also we need the free flow of patients. It's a wonderful thing, for example, having a wonderful surgical hub in Swansea, but if you live in Carmarthen, you can't get to it because it's in a whole different health board. We have to have the free flow of patients. And this, what we've ended up with, is from decades, decades, decades of neglect of the NHS in general, and including ophthalmology. A part of this is due to the lack of an electronic patient record. If there's no light shone on anything, bad things fester. If proper numbers aren't being collected as to the delays in surgery, the delays in transplants, the delays in injections, the delays in treatment for diabetic eye disease, the commonest cause of blindness in working-age people; if it's not recorded, it goes unanswered, unchallenged, untested. It's been terrible trying to set this up, because I've been, again, to 100 billion NHS meetings trying to get this organised. Whereas Digital Health and Care Wales mandate OpenEyes, which is what they unimaginatively called the electronic patient record, it has to go through every single health board separately. And even though the same risks would be present everywhere, every single health board has onion-like layers of accountability and different forms of managers and people who say, 'Well, this isn't right, that isn't right, we need to adjust this, adjust that.' And the curious thing is, whereas the problems should be the same everywhere, each health board comes up with a whole different list of problems that need to be addressed independently, which is inefficient, expensive, and sadly leads to blindness. That is the thing. So, the health board system is letting us down on multiple different fronts. So, that's the background to it. People going blind in Wales because of a lack of access, because of artificial boundaries, and an out-of-date system. But then comes the background, and this is where another conflict of interest comes in, because the current llywydd of the Royal College of Ophthalmologists in Wales, the inestimable Rhianon Reynolds, has called for just this very solution: an EPR, joined-up ophthalmology, the breaking down of the health board barriers and the implementation of the national clinical strategy for ophthalmology. All of which, really, were suggested by another inestimable person who chaired the Health and Social Care Committee report, which was published last year, into the failings of Welsh ophthalmology. But now comes the time to put all this into action, because people out there are relying on us, and I also feel very guilty myself, of course, because I've caused direct harm to my own patients by being in this place. There are many skills required of a person being in here, but an advanced knowledge of ophthalmic surgery isn't really one of them. [Laughter.] So, that aspect of my training is—[Interruption.] Perhaps for this debate alone. So, I feel guilty for that as well. So, I want to show, on multiple levels, that our being here—not just me, but Safa as well—is making some sort of difference to things. We need joined-up working, and if we can't—. If it was up to me, I would take all of ophthalmology out of all the health boards and merge it together, cull the hideous levels of managerial excess and overlap, and grow the system again. This is what I would do. This is the best thing. And many people would say, 'Ah, but this would apply to other specialties in medicine as well', and I'd say, 'yes'. There's a whole issue with the health board system duplicating things everywhere. If it is not possible, for whatever reason, to break down the health board barriers, let's just think of some way of squashing them together, so that we don't have these hard and fast blocks to patient and staff flow. Otherwise, we will repeat the mistakes of the past. And I trust Mabon ap Gwynfor to deliver the goods, to see the thing through. So, we need three things, in summary, because my 10 minutes is coming to an end: the implementation of the national clinical strategy for ophthalmology; to break down the health board barriers; and, in my view, merge all of ophthalmology into one single health board to escape from those barriers altogether and to get rid of expensive, duplicative administrative work that isn't really administrating anything because we don't have an electronic patient record, which we need to track things. Thank you very much.

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3. 6. Member Debate under Standing Order 11.21(iv): Ophthalmology services cy

   Diolch yn fawr iawn, a diolch yn fawr iawn, Weinidog, hefyd.

   Official English translation

   Thank you very much, and thank you very much, Minister.

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4. 6. Member Debate under Standing Order 11.21(iv): Ophthalmology services en

   I'm very grateful, and I don't think there are any words in English or Welsh to express how happy I am to see the unity in this Chamber today over this purpose. I'm grateful to everyone. Thank you. I'm especially grateful to those who spoke of their personal experience. Thank you so much. And to hear of NHS toast being described like caviar—I've never heard that before, and I don't think I will again, but it was a very beautiful description. Thank you, all. I wanted to come to a few very important things that Jane Dodds said earlier. First of all, she said about the optometry side, which is something that was echoed, of course, by the Minister himself. And I hope that she will be gratified to know that I have bored David O'Sullivan, the chief optometric officer, to death over multiple hours over my rumination as to how things should run in Wales, and he is exactly in line with everything. And I hope perhaps, for he asked me what time this would be on, that he might be even watching now, to say, 'David, there's work to be done.' Because primary care, as you well know and rightly pointed out, is absolutely a key element of fixing secondary care. They're two sides of the same coin; you can't fix one without the other. And the other thing you said was around—. Although you didn't say the word 'Datix', you implied Datix forms. They're forms that people fill out when bad things happen. And I completely concede that Welsh people, people living in Wales, are too stoical for their own good. They don't complain, and a common phrase, in fact, said amongst the ophthalmic community here is that, 'This wouldn't happen in Surrey.' I don't know much about people who live in Surrey—I imagine they complain at a more regular basis—but we don't complain very much at all, and it is to our detriment. Stoicism is good in some ways, but bad in others, and I wanted, lastly, to thank the Minister for his hard work in putting together the report last year. And I look forward, and I offer myself—and Safa as well; I'm sure she'd agree—[Laughter.]—to help you as much as possible to do what needs to be done to fix ophthalmology in Wales. And I'll end by saying, for I'm wearing the tie of the Royal College of Ophthalmologists here, whose motto is 'ut omnes videant'—and if I was in teaching mode, I would ask, 'What does that mean?' to those who speak Latin—'so that all may see'. Diolch yn fawr. Thank you.

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1. 1. Questions to the First Minister cy

   5. A wnaiff y Prif Weinidog roi diweddariad ar gynllunio'r gweithlu ym Mwrdd Iechyd Prifysgol Bae Abertawe? OQ64339

   Official English translation

   5. Will the First Minister provide an update on workforce planning in Swansea Bay University Health Board? OQ64339

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2. 1. Questions to the First Minister en

   Diolch yn fawr. The people of Swansea are deeply concerned by this week's announcement that the health board is proposing the loss of around 800 posts. Whilst I do recognise that these proposals are intended to provide greater financial stability and reduce reliance on expensive agency staff, in fact, workforce planning in the long term is an issue not just in Swansea but across the entire Welsh NHS. But these changes come at a particularly challenging time, when we are also seeing reductions in training places for future healthcare professionals despite the clear need to recruit and retain more NHS staff. There is undoubtedly a need to rebalance the way our health service manages its finances, but patient care must remain the overriding priority. Therefore, will the First Minister outline what discussion is taking place to ensure that these workforce changes do not negatively impact patient outcomes or the quality of care that patients receive in Gŵyr Abertawe? Diolch.

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3. 3. Statement by the Cabinet Minister for Enterprise, Connectivity and Energy: New Development Agency for Wales cy

   Diolch yn fawr. Jest i ddweud yn rhwydd—

   Official English translation

   Thank you very much. Just to say quickly—

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4. 3. Statement by the Cabinet Minister for Enterprise, Connectivity and Energy: New Development Agency for Wales en

   Just to say very quickly that I spoke earlier about Swansea Bay University Health Board. Although I've mentioned before and will again in the eye care debate, I am myself also an employee of Swansea Bay University Health Board. Diolch yn fawr.

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1. 3. Questions to the Senedd Commission cy

   3. Pa ystyriaeth mae'r Comisiwn wedi'i rhoi i agor swyddfa yn Abertawe? OQ64281

   Official English translation

   3. What consideration has the Commission given to opening an office in Swansea? OQ64281

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2. 3. Questions to the Senedd Commission en

   Diolch yn fawr. Whilst the Government itself has an office in Penllergaer, which we in Swansea are very much hoping will move to the city centre in order to boost its flagging economy, the Senedd Commission, as you rightly say, does not. And it's important, as you say, that people across the country feel engaged with our politics, and therefore it's important that the Senedd boosts its engagement in different parts. I've long believed, as Swansea voted for devolution and this city has not, that this fancy building, which we now reside in, should have been located in Swansea. But due to the cost, it's too late to do that now, it would be impossible to build another one. But as John Davies mentioned last week, the economy of Swansea is slipping further and further behind that of Cardiff, and anything, anything at all, that you can throw the way of Swansea would be broadly welcomed. Swansea would support very much the opening of an office, and please, please, please, will you consider, again, doing so? Thank you.

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3. 5. 90-second Statements en

   Diolch yn fawr, Ddirprwy Lywydd. Safa, Peredur and I were lucky to attend the fiftieth anniversary of the organisations that make up Adferiad last week, at Norton House in Swansea. Peredur, of course, chaired the cross-party group on substance abuse, so is the most experienced person in this Chamber with this subject. This is one of Wales's largest and most important mental health and substance abuse organisations, and was formed by a merger of Cyngor Alcohol Information Service, Hafal and the Welsh Centre for Addiction and Dependency. It's important as well to recognise the coming together of mental health issues and substance abuse, as the crossover, we found out, was quite substantial and stark. We listened to many harrowing stories from people who'd been helped by this all-important charity, which employs 750 expert staff and volunteers across Wales—a national voice grounded in local communities. To our shame as a society, our veterans disproportionately suffer from both substance abuse and mental health disorders, and a combination of both. They are helped through Adferiad via the Change Step programme. We also heard from Elin Jones, life president, and we were very much inspired by their work. So, I would like to say, on the record, happy fiftieth birthday—pen-blwydd hapus—Adferiad, and may the next 50 years be equally good. Thank you.

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4. 7. Reform UK Debate: Nation of Sanctuary en

   I'm going to have to adapt slightly what I say because Lindsay and Shav said many of the points that I was going to say, but I'm an adaptable soul and I'll work around that. First of all, I'm the kind of person who likes to try and understand why a situation is as it is—a clinician scientist, if you will—and I'm not really prone, myself, to any divisive rhetoric at all, I'm sure you'll be happy to know, for I do not intend to use any. From a simple perspective, the nation of sanctuary, as we've heard, helps refugees who are already here to settle in, and from a benevolent perspective, it is a kindly and good thing, and from even a cynical perspective, it would reduce the chances of any problems occurring. But it is for refugees who are here anyway. So, then the question comes: why would people be against it? Firstly, we have to recognise the fact that many people are. And I would even say that, on this side of the circle as well, we have friends, family and even colleagues at work—well, technically we have colleagues, because all on this side of the circle are against it—but even in our various workplaces, we have colleagues who are against it as well, people who are otherwise good people, well-meaning people. And are they the kind of people who are tub-thumping, Tommy Robinson-supporting racists or Voice of Wales subscribers? No, they're ordinary people, kind people, nice people, decent people, as are people in the Reform ranks as well, I'm sure. John Clark. The first time I came across him, he offered to bring me a glass of water. That's not the action of a rabidly racist man. And many of you are good people, for I've come to know several of them. So then the question is, 'Why?' I'm glad that you used the Senedd research department, for I did also. And I asked them five questions, and I chose them specifically because I thought that the evidence would not be disputed. And now that you've used them as well, Mr Thomas, I'm glad. Great. So, the first question is: how many asylum seekers are in Gŵyr Abertawe? And the answer came back: 677, although 18 are not in any accommodation, which is down from 844. And as you said, in all of Wales, there are 3,391. The second question I asked was: how many of them are Ukrainians? And the answer is: in Swansea, 353, which is slightly more than half. And I asked, although you've answered that question already: how many are in hotels? They said 'none'. The only place where they're in hotels is in Cardiff, and the number is less than 100, roughly the same number as are in this circle as we speak, if you include the Llywydd and the bench over there. So, with the numbers relatively small and falling, why would people be so rabidly against it, if we're all using the same data set? And the answer is, 'We're not.' And this is why we're so privileged to be politicians, because we do canvassing and we go round the houses. A not insignificant number of people in Swansea are against the nation of sanctuary, and they come in various forms. If they weren't of the form that would chase me down the garden and I feared for my own safety, I would ask them and try to reason with them. And I'd say, 'Why? Why are you against the nation of sanctuary?' And they said, 'The numbers are too high.' And what I should have done, because I made a note of so many of these numbers, but I did not obtain any ethical approval for running a study and publishing it, but it would have been very interesting, because the numbers varied quite wildly, and none of them were accurate. The highest was 177,000 in Swansea alone, which is more than half the number of people in the city itself. And many people would mention local hotels. I won't mention the names of the hotels just in case I get into trouble, but I took the trouble to call the hotels to say, 'Do you have migrants?' Because they were so convincing. And the answer was, 'No, it's on social media. No, we'll put out something in the press.' But in the news, you come across people who are worried, who go to the beach to be wary of migrants coming in, and they take binoculars so that they can make note of it, without realising that the other side of the sea in Swansea is England. But no-one has come ashore. So, then, why would this be the case? Because if you believed all these numbers, you might very well change your mind. So then there is that, quote, 'There are lies, there are damn lies, and then there's Facebook.' Although, to quote Richard Dawkins, 'Good people will do good things, bad people will do bad things, but in order for good people to do bad things, it takes Facebook.' That's another thing. Because there's not so much a misinformation, but a disinformation campaign. And the fourth question I asked was: does the nation of sanctuary policy encourage illegal migration? There are many references here. The answer is 'no'. I'm running out of time, so I'll say the fifth quickly: what is the cause of the disinformation? Yada yada yada. Many, many references. Russia. Don't support Russia. Fight for our country, for Welsh valleys, for British valleys—for this side as well—and reject, vote against this Bill. Vote against it, please. Thank you. [Applause.]

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1. 1. Questions to the First Minister cy

   Mae ysgolion yn Ngŵyr Abertawe yn nodi cynnydd mewn absenoldeb, sy'n arwain at gynnydd mewn pryderon ynghylch anxiety—pryder—a iechyd meddwl sy'n gysylltiedig. Mae clod mawr i John Davies fan hyn, achos ei synied ef oedd e ein bod ni'n mynd rownd ysgolion Gŵyr Abertawe i weld beth oedd y problemau, so ein bod ni'n gallu gweld beth rydyn ni'n gallu gwneud amdanyn nhw. Mae'r absenoldebau yn achosi problemau dysgu, problemau i rieni a phroblemau i athrawon. Yn amlwg, mae'r rhain i gyd yn gwneud dysgu yn anoddach fyth, ac yn effeithio ar nid dim ond recriwtio ond ar gadw athrawon yn y swydd hefyd. Pa gamau fydd y Llywodraeth yn eu cymryd i gefnogi athrawon gyda hyn a’u helpu i aros mewn swyddi? Diolch.

   Official English translation

   Schools in Gŵyr Abertawe are reporting an increase in school absences, leading to increasing concerns regarding anxiety and related mental health issues. A great deal of praise is due to John Davies, because it was his idea that we go around the schools in the constituency to see what the problems are, to see what we can do about them. These absences lead to problems in terms of learning, problems for parents and problems for teachers. Clearly, all of these things make teaching even more difficult, impacting on not only recruitment, but teacher retention as well. What steps will the Government take to support teachers and to help them to remain in their posts? Thank you.

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2. 6. Statement by the Cabinet Minister for Health and Care: Health and care winter 2026-27 preparedness en

   I congratulate you, Minister, for doing this at the height of summer, only one week after we all almost baked to death in this very same Chamber. [Laughter.] But, bed numbers. This is not so much the elephant in the room, but the mammoth in the Chamber. We have one of the lowest bed numbers in Europe, only 3.4 per 1,000 compared to an EU average of 4.3 to 4.7, which makes the physiological reserve of the system so fragile. And because of this, every winter, which again has a habit of coming once a year, we are then almost pushed over the edge because of that. And that elephant in the room is tied to social care. I despise the term 'bedblockers', because it implies some fault on patients for being in there, but people—. We hear also from the Reform side about delayed discharges, and the ultimate delayed discharge is to do with being stuck in hospital not so much for days, but for weeks and months, because of a lack of placement. In light of this, what assurances can I have from the Cabinet Minister that work is being undertaken towards a Welsh national care system? Thank you.

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1. 6. Welsh Conservatives Debate: Hospital services and hospital closures en

   Cabinet Minister, everyone, we all, other than the career politicians, walk into this Chamber carrying the ghosts of our past experiences and previous professions, and I am no different here. The devil is in the detail of this thing, and it says, 'any and all hospital and unit closures'. And I now don my previous llywydd—a far less powerful llywydd position—of the Royal College of Ophthalmologists in Wales's hat to try to answer this question as to why I respectfully—and it is with respect—disagree with the motion.  First of all, we need more than ever to improve efficiency within the national health service, and I don't think myself that this is a party political issue, because it involves everyone across this Chamber, their friends, their families, their constituents—everyone—and themselves. They want to have their healthcare provided, and the motion didn't specifically say about emergency care, for which there is a different case, but for 'all', as an examiner, any question with 'all' is always wrong, as any question with 'always' is always also wrong.  There are demographic challenges coming in the coming decades as well: the ageing population. In my own profession, for example, in ophthalmology—I'm a medical retina specialist dealing with age-related macular degeneration—there's no surprise that there is an epidemic of age-related macular degeneration, mainly because it has 'age' in the actual name of the disease itself, and providing services for neovascular age-related macular degeneration is one of the greatest strains affecting ophthalmology in Wales. And we have to strike the right balance between improving efficiency and ensuring people can access the care they need. When I was llywydd of the royal college, I had the privilege of travelling all over Wales to see the different eye units, to see how things could be improved. GIRFT—I don't know if you're all aware of that organisation. It stands for Getting It Right First Time. It's similar to NICE, the National Institute for Health and Care Excellence. It tried to get health economics involved to try to make the national health service more efficient. And I've been to north Wales; I went to Abergele. I saw the cracks on the wall of the Stanley eye unit, and there's a nice measuring device, so that a graph can be drawn as to how rapidly the wall seems to be expanding and how close it comes to collapse. But yet, the cracks are still there. And I've been to many units. GIRFT says you have to do eight or more cataracts on a list. I'm proud to say that my own hospital in Swansea does so, but there are some units in Wales that do not do so and will never do so. I spoke to a person, a consultant colleague in a neighbouring health board, before coming in here today, and I asked if I could use his name; he said 'no', because he didn't want to be sacked, mainly. But, essentially, he said that even if eight patients came to his unit, and he didn't do any operation but laid a hand upon their head and they went back to the ward, he would not be able to get through eight patients because of the infrastructure problems in the hospital. There are some units in Wales that will never be able to provide eight cataracts on a list. And this is just a microcosm. Cataracts are not an emergency. People only have two eyes. I think it is perfectly reasonable to ask people to travel a little distance to get their eyes done within a few weeks or a few months, rather than wait 100,000 years to have them done locally and die of old age, and all the disability of not being able to see in the meantime whilst waiting for that to be the case. Maintaining services purely for economic or political reasons can be harmful, and I completely understand when constituents come and say, 'We don't want this service moved, or that service moved.' There are some good cases to maintain them, and many cases I would support, but then keeping everything open always takes away being able to actually fix the system. The proposal to keep every unit open regardless of efficiency is unrealistic and it is not what we need for twenty-first century medicine. James, over on the Reform side, said very sensible things, actually. He said that—[Interruption.] Sometimes this occurs. He said, for example, that medical technology changes and therefore medicine has to change. The equipment used in ophthalmology costs hundreds of thousands of pounds. The theatre spaces cost £100,000. It isn't just the scoopy device that they used to use back in the 1970s to get rid of cataracts without any intraocular lenses being injected. It is not feasible that every health board provides every single service the whole time. I think of Mabon there. Already, because of the strictures, his feet are fettered, he's got one hand tied behind his back, and, if this were passed, he'd have the second hand tied behind his back. What an awful image that would be. He would be completely unable to change things, to do what we need.  To sum up, I say that keeping open every unit is inefficient, wasteful and costly. More importantly, it would lead to patient harm. I will say lastly that, as soon as the Table Office taught me how to put in a statement of opinion, my first statement was on the postcode lottery in Wales. That was before I realised that the statements of opinion don't really lead to any actual change. But I do feel strongly on this issue. Diolch, Lywydd.

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1. 6. Statement by the Cabinet Minister for Health and Care: Delivering on our priorities: Reducing waiting times and strengthening primary care en

   Diolch yn fawr, Lywydd. Diolch, Cabinet Minister. I welcome the statement today and the strong commitment to reducing waiting times. Seven hundred thousand people are on a waiting list for the NHS, and to expand on an analogy put forward by Mr Millar, the national health service in Wales is covered in so many layers of sticking plasters that at present, it resembles some form of Egyptian mummy. People across Wales desperately need a change in the way that we do things and I'm glad that a Plaid Cymru Government will deliver this. This work needs to be done correctly, guided by those with a deep understanding of the structures and the issues that are faced. Obviously, there's a pretty big declaration of interest here, in that I believe that clinicians, doctors, front-line staff are best placed to make these decisions. They know what the problems are and they know how to solve them. I am one, of course. I therefore welcome the establishment of your task and finish group, but does the Cabinet Minister agree with me that the implementation of the surgical hub programme has to be led by front-line clinical staff, by doctors, and clinically and expertly led? Thank you. Diolch.

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1. 6. Reform UK Debate: Government international spending en

   I am cognisant of the fact that I am quite hugely outnumbered now, but there are two aspects to this: first is how it looks, and second an example of how it is. First of all, Wales has long been a country that looks beyond our own horizons, looking to make a difference in the world and help where we can, but also we rely on help coming in to us as well. I speak as a person who works in the NHS and many, many healthcare workers, of course, come from abroad, especially here in Wales, and every hospital in the country would crumble if all the international workers went home. Twenty-two per cent of our workers in Wales are non-EU nationals, 6 per cent come from the EU itself. In Singleton Hospital in Swansea, in the eye department, I am the only Welsh-speaking, Welsh-origin consultant there, and much as I like to convince myself that I can do the work of 10 people, I cannot, especially now because I am here. [Laughter.] Chronic shortages in these sectors increase hospital discharge delays, reduce bed availability and create bottlenecks across the healthcare system. At a time when the NHS is struggling, we need the support from abroad as well, though we also, of course, need to grow our own ability. And now an example—everybody likes an example. And Huw over there, he kindly mentioned the Wales for Africa programme, which was a wondrous programme and I myself have been a part of it. Our global health partnerships are things we should be proud of. I took part in Vision 2020, which was, in fact, part of the London School of Hygiene and Tropical Medicine with the World Health Organization and the Royal College of Ophthalmologists, to prevent avoidable blindness on a worldwide basis. This was an all-UK thing, but within Wales it was funded in large part from the Wales for Africa programme, for which our eye department in Swansea was very grateful. We took part in the Sheikh Zayed regional eye care centre in the Gambia before we had this Vision 2020 link, and through that programme we supported better ophthalmological practice there, we cured blindness, but more importantly perhaps—if you are all thinking, 'What do we get back from this?'—is the fact that we set up that unit with a diabetic retinopathy clinical research network, so that they could provide clinical data into a worldwide network of how to treat diabetic eye disease, what you do in macular oedema, for example. Proliferative diabetic retinopathy and cases of advanced diabetes are infinitely, unfortunately, more common in the Gambia than they are here, so we have much to learn from this, and the international community of researchers has much to learn from this. For the benefit of people here in Wales with diabetes and for all mankind, for we are all—we heard John Donne quoted a few times— 'a piece of the continent, a part of the main', and, 'any man’s death diminishes me, / because I am involved in mankind.' Anyway, this whole debate tries to position international investment and domestic investment as a zero-sum game. It isn't. Looking outwards does not come at the expense of looking inwards. I suggest that such a simplistic outlook condescends to the people of Wales and stymies science. I urge all Members, remaining Members, to reject the motion put forward today and to show that Wales has ambition.

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1. 5. Statement by the Cabinet Minister for Health and Care: Health and Care Priorities cy

   Rydyn ni'n gwybod bod rhestrau aros y GIG yng Nghymru o dan Lafur wedi bod yn llawer rhy hir ac yn llawer rhy uchel, gyda'r data mwyaf diweddar yn dangos 666,000 o gleifion yn dal i aros cyn dechrau eu triniaeth. O'r rheini, mae bron i 25 y cant yn aros dros 36 wythnos. Yn fy mhrofiad i fel offthalmolegydd, mae gormod o bobl yn sefyll yn llawer rhy hir am driniaeth am gyflyrau fel macular degeneration, ac yn mynd yn ddall o ganlyniad i hyn. Mae'n amlwg bod angen newid sylfaenol i'r ffordd y mae'r GIG yn gweithredu, a dwi'n falch na fydd y Llywodraeth Plaid Cymru newydd yn parhau gyda'r drefn arferol.  Felly, Weinidog Cabinet, a allwch chi amlinellu pa gamau pellach fydd yn cael eu cymryd i ostwng y rhestrau aros, a sut bydd y Llywodraeth yn sicrhau gwelliant cynaliadwy, yn hytrach na dibynnu ar fesurau byrdymor fel allanoli—outsourcing—i gwmnïau preifat? Diolch

   Official English translation

   We know that NHS waiting lists in Wales under Labour have been far too big and far too long, with the latest figures showing that a little over 666,000 patients are still waiting for their treatment to start. Of those, almost 25 per cent are now waiting over 36 weeks. In my experience as an ophthalmologist, too many people are waiting far too long for treatment for conditions like macular degeneration, and are becoming blind as a result. It's clear that we need fundamental change to the way that the NHS operates, and I'm pleased that the new Plaid Cymru Government will not continue with business as usual.  So, Cabinet Minister, will you outline what further steps will be taken to decrease waiting lists, and how will the Government ensure sustainable improvement, rather than depending on short-term measures like outsourcing to private corporations? Thank you.

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