 Prynharodd, sy'n ffordd. I'n Andrew Goodall, yng nghymru yng Nghymru Cymraeg o NHS Wales. O'r hoffi'r rhagliadau mor cwestiynau a'r rhagliadau, y cyfnodd Cymru yn cael ei gwybod痴ol. Over the last month, we've seen a noticeable impact on NHS capacity and services. We have four levels of escalation in the NHS, which reflect pressures in the system. Today, there are 11 hospitals reporting levels three or four, which shows the increased pressure across the NHS. The NHS continues to balance normal winter and emergency pressures with the demands of looking after people, seriously ill with coronavirus symptoms. There are currently 1,275 COVID-related patients in Welsh hospitals. This is 18% higher than last week and the highest number since late April. One in six people in hospital beds are there because of coronavirus. This is now only 9% lower than the peak we saw in April. When I spoke to you last, I said I was concerned about this rising trend. I continue to be concerned. We expect demand for hospital treatment for people with coronavirus to continue to increase in the days and weeks ahead. It will take time to see the full impact of the national firebreak to work its way through the NHS. There are currently 57 people being treated in critical care for coronavirus, 12% higher than last week. About a third of our critical care capacity is now being used for coronavirus patients. Our normal critical care capacity of 152 beds is full, mainly with people who do not have coronavirus. We currently have 163 people in critical care at the moment. We do have plans to expand critical care capacity if it's required. We estimate nearly 16,000 people have been discharged from hospital after being treated for coronavirus since the pandemic started. People admitted to hospital with coronavirus will typically stay twice as long as other emergency admissions, which has a knock-on impact on available bed capacity. I want to turn now to coronavirus and transmission in healthcare settings. The evidence shows that when COVID is spreading quickly and widely in a community, it can rapidly and easily enter a closed setting like a hospital where it can be quickly spread. We regret every case of hospital-acquired COVID, but I want to be clear, this is not as simple as a failure of hand-washing or poor infection control procedures. This virus is highly infectious and it can be passed on in the asymptomatic, pre-symptomatic and symptomatic phases of the infection. It is incredibly difficult to prevent its spread in busy healthcare environments, especially with around 90 people with COVID currently admitted each day. Hospital transmission rates in Wales have increased over the last two to three weeks. Last week there were 192 cases of probable or definite cases of hospital transmission in Wales. This is equivalent to one in 40 of the confirmed cases reported nationally. Everyone admitted to hospital is tested and 6% currently have COVID on admission. The rate has been highest in Cwmtaff Morganog University Health Board, where community transmission is also at its highest. But even here, hospital transmissions account for just 3% of the total cases in the area. Despite hospital transmissions, over 85% of our available beds do not have coronavirus patients, so care remains safe for the vast majority needing to access hospital. All health boards have detailed plans for the prevention and the control of COVID infections in hospital. I want to say a few words about NHS activity. You will remember that at the start of the pandemic, we postponed planned operations and appointments to help the NHS. But essential services, including cancer and mental health and emergency services, continued. We have been restarting and restoring activity across the NHS since lockdown ended. This means that the NHS is now busier. It has more than twice the number of non-coronavirus patients in hospital beds than April, because we have been able to admit more emergency and planned patients over recent months. While the number of people with coronavirus is moving towards the April peak, our information shows the NHS is doing more planned activity than it was in the spring. Planned inpatient and day case admissions in September have increased by more than 160% compared to April. Cancer referrals have returned to expected levels and treatment activity was higher in August than in April. The number of new outpatients seen, whether face-to-face or remotely, was 75% higher in September than in April. Primary care services in GP practices and pharmacies have been open and available all year round. We have also now restored other activities in primary care. The flu vaccination programme has had a successful start with a larger uptake already than last year. In dentistry, more than 300,000 people have been treated since March. Just last week, around 22,000 people were seen in person, in practices, and a further 6,000 received remote advice and follow-up advice. Community optometry activity continues to increase. 38% more patients were seen in September compared with July. But not all of our services have returned to their normal levels. Delivering normal NHS services in an environment where coronavirus is widespread in our communities makes this very difficult. Providing safe care is always our first priority. The protections we have put in place to respond to coronavirus take more time and slow down the number of patients who can be seen and treated. This means that across the UK the NHS is seeing waiting times increase and the waiting lists grow, and this is our pattern in Wales too. We will continue to do all we can to see and treat patients, but this will need a much longer-term response. For this reason, we continue to focus on clinical priority and the urgency of patients needing to access our services. I am very grateful to all our health and care staff for their commitment and for everything that they are doing to respond to people's needs in the most challenging of circumstances. They have had little or no respite from pressures over recent months, yet have continued to maintain our health and care services, and I would like to pass on my personal thanks to them all and for their commitment to patients. Our plan is to continue to respond to coronavirus pressures in the NHS, maintain emergency services, and as much NHS activity as possible for as long as is possible. We want to ensure that the NHS can balance its emergency response alongside services we have gradually restored. But the higher the level of coronavirus in the community, the more difficult this is to achieve. This will be a difficult winter and we will continue to support the NHS to prepare and respond. It's important that we all play our part and do everything we can to look after ourselves and each other. It's important we all follow the rules, we keep our distance from each other, practice good hand hygiene, work from home where we can, and wear a face mask in indoor public places. By doing this, we can support each other and our NHS and care services in the weeks and months ahead, and we can protect the broader range of activities we have reintroduced. Together, we will keep Wales safe. Thank you, Jochafari Al. In the normal way, I'm going to go to questions from the journalists, and starting today with Owen Clarke. Owen, Pranhamdar. Pranhamdar, Dr Goodall. To justify the lockdown in England, the UK government pointed to some worrying stark analysis, even suggesting hospitals in England could be overwhelmed in a matter of weeks, despite extra capacity. What are your projections in Wales, whether it be worst case scenario or mitigated by the firebreak lockdown, and we also hear of GPs talking about being under unbearable pressure, so do you agree this simply isn't the case of hospitals feeling the strain? Jochafari, thank you, Owen. I hope that in describing NHS activity today, I've tried to demonstrate that this is about how we support patients through our whole system, and it's really important to recognise the volume of cases and patients who are being seen in community settings alongside the hospital setting. And it's absolutely right that we should acknowledge the extraordinary efforts of GPs and other primary care professionals for the way in which they have supported the care and treatment needed for our Welsh patients. If I was looking at recent activity levels for GP activity, it's in line with what our normal levels would be compared with last year, and they have adopted and adapted a range of different approaches and technologies to actually make that happen and to support staff, so I would absolutely agree with you that it's really important to make sure that we are supporting all elements of our system in an appropriate manner. My response on the pressure that the NHS is under at the moment, I'm obviously in daily contact, if not more frequently, with the NHS right across Wales. I was talking to chief executives yesterday, for example. One of our concerns, Owen, is of course that we are having to respond to modelling that still says that if we're unable to break the chain of transmission, there could well be very significant increases in both hospital admissions and deaths right through the whole winter period of time, and clearly the actions that were taken by Welsh Government with a national firebreak are in line with needing to do something very different from a society and a community perspective to protect the NHS. As we look at our current numbers, you'll have seen in my overview, as I was speaking, that we're getting now very close to the peak levels that we saw in April. I don't think that the peak that we saw in April represents the NHS being overwhelmed, but I think it's a very visible milestone to demonstrate the significance of the impact that we're going to see across the NHS system. But the NHS is more prepared. We have got plans in place, and that does include our ability to expand additional capacity working with the plans from the individual health boards across Wales. Based on where we are at the moment, we are obviously tracking the data on a daily basis. I think it's inevitable that over this next week we will see our figures get to the levels that we saw in April. Having said that, there are still available beds within our system to be used today, and we still have the ability to expand into additional beds. I think that the next two to three weeks are pretty important for us, and we need to review the data that is telling us about the impact of the firebreak and also the potential impact of the earlier local restrictions. We are hoping that we will see some evidence of some stabilisation. On the numbers, if things carried on going as they are, inevitably the NHS in Wales would get to a point where it does become overwhelmed. My discussions with the chief executives in Wales and also with other professional bodies is a wish to make sure that, as far as possible, we can maintain the range of NHS activities rather than just revert to where we were in March when we stepped away from routine activities. Thank you very much. You mentioned hospital infections in your opening statement. Hospital acquired infections, people catching COVID in hospitals. We know of the situation in Cwm Tawf Morgannog being a problem for many weeks, but we also see rates rising dramatically in the Narem Bevan health board in South East Wales and Swansea Bay health board as well. What prospect have you got of getting this under control? You say it's not a failure, really, of infection control measures, but surely that is part of the problem. Clearly there is a connection point between just seeing growth and prevalence across Wales and the number of cases in our communities, because inevitably that will affect patients who are being admitted at this stage. Looking at the Cwm Tawf Morgannog experience, whilst the number of patients admitted into hospital with coronavirus is around 6% for the whole of Wales, it's actually 15% for Cwm Tawf Morgannog. So there is a connecting point, but it's really important that we can ensure that we are discharging all of the appropriate practices in place, that we are enhancing that, that we are learning from experiences across the UK, indeed internationally and ourselves in Wales, which is why Public Health Wales have been supporting health boards across Wales with a 16-point set of actions, which are there to ensure that we can reduce the level of transmission that is occurring. In normal circumstances, in our infection control practices, we normally can see that if we're able to get about 90% compliance on the range of areas, we will see some of the normal winter bugs, for example, at breakout coming under control. Coronavirus almost needs the system for people, for staff, to be 100% complying 100% of the time. So whatever good infection control policies and procedures are in place, we need to make sure that we can continue to respond to this. I think my general message, Owain, is of course I would have an expectation to look to contain and control these areas. We have had evidence of that across Wales with other hospital areas that have been able to do so over the course of these recent weeks, but we need to make sure that we can continue to focus on the links that happen in terms of what is happening generally with our communities. That's why we are asking our communities to work with us and to understand that they can help the NHS by actually undertaking their own activities and practices like hand hygiene and social distancing. Finally, Dr Goodall, and many thanks. Are you considering scenarios where you would have to postpone on an all Wales level some of the essential services of the NHS as happened in the spring? Are you considering that scenario where you would have to do that centrally across Wales? Owain, we have to consider a range of scenarios. One of the reasons for introducing the particular action back in March was because we needed to give time to the NHS to prepare to train staff and actually to be able to ensure we had available capacity if it was needed. I think we are in a different situation at the moment, which is why the general feeling from the NHS in Wales is a wish to look to protect the range of activities happening as much as possible. But if the numbers continued and we continue to see an increase in activity in coronavirus patients coming through our system then inevitably there is a point when we have to focus on safety and emergency response. I don't feel that we have reached that point yet and certainly in my discussions over recent days with the NHS we are aware that there may be a need for future national actions. Most importantly at the moment, however, is still to focus on things that can make a difference because the national fire break has been welcomed by the NHS in Wales to help us with the level of spread within our communities. Thank you, Owain. Just moving next to James Crichton-Smith from ITV Wales. Good afternoon, James. Good afternoon, Dr Goodall. Thank you. Why are you confident that lockdowns like fire breaks work when the likes of Caerphilly and RCT who went into renewed measures first both have still among the highest COVID rates in Wales? Well, two comments I would make, James. I mean firstly, obviously from a government perspective we're looking at how the fire break generally can have an impact by bringing together different sectors in response rather than just relying only on an NHS response and clearly the fire break is there to make sure that there is a contribution from society more broadly. The level of the national fire break is different and enhanced from the local restrictions but you're right to make the point that there would have been restrictions in those areas that perhaps haven't had the impact that we wanted but from our perspective we can see that it did help to actually slow down some of the potential transmission that was occurring within those communities at this stage. What we do know is that in terms of actions that made a difference and our ability to respond that the national set of actions that occurred back in March had a very significant impact on the trend that was happening for the NHS across the UK and in Wales itself so as well as us trying to prepare and professionally respond to the pressures that were facing at that time and I have always through these press conferences just tried to recognise that a lot of the impact came from actually the behaviours of people, individuals, communities and society so the reintroduction of a fire break under that kind of level similar to what we experienced in March we would hope and expect has the same kind of impact and that's been the basis of the professional advice that has been provided across Welsh Government. Thank you for that. What measures then are being used to determine whether this fire break has worked and what do those measures what levels do those measures need to get to in order to be able to turn around and say we've been a success here is it the R8, is it the percentage positive can you give us some clarity on that? Thank you James so the intentions of the fire break have been to focus on various areas if I can tie them to my own sector and my own level of experience they are a package of measures intended to get the reproduction rate below one and we of course are tracking whether we can see that to convert in that way we are looking to make sure that we are able to ensure the NHS is not overwhelmed but more than that we've been looking to ensure that the NHS can carry on this range of activities that I've been describing so if I talk generally we have been tracking at a Welsh Government perspective examples of whether mobility seems to have changed, the travel arrangements of members of our community over the last couple of weeks can that act to translate but my greater interest is finding and looking at the impact on the NHS and what we're seeing at this stage so clearly tracking the level of positive cases in our community and the general level of prevalence alongside the reproduction rate is quite important I have an interest in tracking what is happening on the NHS side in respect of hospital admissions are they stabilizing, are they reducing I have an interest in seeing how long patients are staying as a length of stay within the hospital environment is that shortening, does that mean that we have more capacity available but two particular areas which are more difficult but represent the more seriously ill patients are actually the impact on our critical care services and also of course sadly when individuals die within our services and are unable to be supported in the appropriate manner so the mortality rates within our areas are quite important now if I'm looking at our current figures we are seeing some early evidence that perhaps hospital admissions whilst still at a higher level than we would wish have started to stabilize particularly over this last week or so but I worry that we will still have to wait another couple of weeks or so before we really see the impact on NHS services more generally and perhaps as an aside I could just explain to you that we are seeing some changes perhaps around our experience in critical care and the nature of patients being cared for in there it does seem to be the case that there is some success in the second wave of patients earlier with some of the interventions that we have learnt work using the evidence that is around and available and both for ourselves but also across the UK we are actually seeing a lower mortality rate at this phase but again I am concerned that perhaps critical care is not quite yet experiencing the numbers that we would expect because there is always a 2-3 week lag behind the admission of patients Thank you One more if I may Would you like to see mass testing in Wales like that in Liverpool and if so what moves are being made to make that happen First of all really important that we are able to ensure that we have the testing capacity available that we can process in a range of different areas whether that's for the broader community whether it's what we need to do for our clinical services or indeed what we need to apply in vulnerable areas like care homes we are currently working our way through some choices about how we can continue to develop a test-trace-protect mechanism across Wales we've been using the firebreak period to review and revisit that and certainly in respect of areas that have higher levels of prevalence one of the issues that is under consideration at the moment is actually whether there would be an ability to do some more targeted mass testing of individual areas and you are right James the announcement about Liverpool acting as a city area that is going to go through that we may well have some opportunities to do similar in Wales so we haven't resolved that quite yet but we are involved in a number of discussions about choices that may allow us to support some of the targeted actions in our communities in Wales James thank you very much just moving next to Anna Lewis from Wales online good afternoon Anna good afternoon I just wanted to touch on what you just mentioned to James just there we've seen that you've mentioned that hospital number of people in hospital with coronavirus is now only 9% lower than it was at the peak but looking at the numbers of people in ICU in critical care that's only half of what it was at the peak you've touched on that bit we're wondering could you explain it a bit fully but why there is that difference now it's always difficult to Anna with our numbers to ensure that we give ourselves a bit of time to work it through but by now at this stage I would have expected if it was the first wave experience to have seen more coronavirus patients in our critical care areas at the moment we are at about 60% lower than the peak that we saw in April at this time I think that's a good sign of course because we don't want patients to be in critical care with coronavirus we want them to be supported and to be able to be discharged home safely and back to their family arrangements but there is clearly evidence from our clinicians about people having been put on earlier intervention so with the high level of testing that is going on across Wales at the moment it does mean that we're identifying people with coronavirus earlier that means that if an intervention is required we're able to do that earlier and provide the treatment that's necessary and when patients are coming into the hospital environment one of the things that we've also learnt is the ability to put particular patients on oxygen therapies it's part of a respiratory pathway that we have patients on as well and that is seeming also to be a more effective way rather than perhaps some of the use of ventilators in ICU which was the experience during the first wave as well but certainly although the numbers in Wales are smaller if I look at some of the UK numbers this seems to be a shared experience across the UK that hospital admissions may be going up but critical care seems to have been much more successful in the way in which it is caring for patients and the mortality rates currently seem to be lower and perhaps if I could add we are currently seeing a smaller proportion of our hospital admissions going into that critical care environment as you said Great thank you I wanted to ask you mentioned that now is going on NHS to carry on critical routine work and care how is this affecting the workforce who are also dealing with rising hospital admissions for coronavirus and if those ICU numbers and hospital admissions due to Covid continue to increase how will that how will the staff do all that dealing with both factors at the same time? Thank you Anna so first of all if I could just reiterate my thanks to all of our NHS and care staff across Wales they are very tired at the moment Anna they have been affected by this personally as well as professionally as all of us have been and I think we just need to recognise the extraordinary efforts that they are taking to make sure that we have services available in Wales and that we are trying to ensure that we are able to increase that range of services as well we have got support in place for our staff so they can access that and we have been enhancing that as we learn more about how traumatic the experiences can be for some of our areas but you are absolutely right when I said in my introduction that we now have twice as many non-coronavirus patients in our beds as back in April I think it just shows you how much busier the NHS in Wales is at that time which obviously affects the capacity and the workforce that we have available and whilst we do have plans for expanding activity and expanding capacity like into the field hospitals ultimately even with some increases in our staff we still have the same workforce that needs to respond to all of these pressures as we see things potentially continue to increase so I am concerned to make sure that whatever arrangements we put in place are done on a staged basis that there may well be local decisions that are needing to be taken at the moment by individual health boards to balance between planned activities and emergencies because they have to prioritise what is coming in through the front door but we hope that we are finding ways to support staff appropriately just at the moment our sickness and absent rate is actually lower than it was at the same point last year which may be a bit of surprise with everything we have experienced but we are definitely seeing an increase over the last couple of weeks of more members of staff needing to be off because of coronavirus and also a higher increase in a percentage of staff who are now isolating because of the impact of test trace protect and the testing approaches as well but it is really fantastic the way in which the staff have responded over these recent months they honestly are tired, Anna and I think that is why we want to make sure that the public can continue to work alongside us Thank you and if I could just ask the last question if I may we have been receiving messages from people who have had their care postponed or have not been able to get appointments due to the coronavirus pandemic what would be your message to the people who are facing that position right now So first of all I would like to apologise to patients who have been unable to access services that they need but I hope that they will understand the extraordinary circumstances in which we continue to respond the NHS has remained busy throughout all of these recent weeks and months and it is why Anna that I wanted to ensure that the public understood that we are trying to increase the activities that we are undertaking, we are not just staying static we are trying to make sure that that can continue to increase week on week we have mechanisms in place to ensure that we are able to look at urgency and clinical priorities for patients and we hope that we can see patients actually in a very different way perhaps how we would have last year because there has been so much change and use of technology that there are different approaches that we can take to manage that The one thing that I would say is that whilst we can't say when we will be through this pandemic we will have to develop a plan and I am afraid it will be a long term plan for how we are able to deal with patients on our waiting lists and we will need to ensure that we are able to invest in extra capacity and support to ensure that the NHS is able to get those patients sorted appropriately in the right kind of setting but we are still in the middle of a pandemic and despite all of our good intentions we are still not at the point when I am afraid coronavirus has been ended at this stage and I hope with a balance between vaccines that may emerge over the forthcoming months and also more successful treatment that we may be able to get in a better place but I would hope that they can and that our clinical staff are trying to do everything possible to get them into our system Thank you Anna Moving next to Steve Bagnell from The Daily Post Good afternoon Steve Good afternoon, thank you Dr Goodall You've just touched on this The First Minister has said the early vaccines won't be a get out of jail free card How long do you think it will be before the first ones are available and do you share the First Minister's view on how effective they will be and that people shouldn't be holding up for them to solve COVID-19 Thank you very much Steve It may sound a difficult comment but I think we have to try to balance the need to bring forward vaccines as they become available alongside being realistic that we are going to continue to have a society that is working in the context of COVID-19 There are some now good examples both in the UK and internationally of vaccines that we do expect to be available shortly We as a minimum need to ensure that we have preparations that are able to take place so that should the moment come when somebody says the vaccine is available we know we can roll it out pretty quickly There will be an order of priority for how we target that vaccine to the population and as you would expect it would start with the most vulnerable in our society it will start with trying to ensure that we are able to support our health and care staff and then it will actually move more generally into the population and I'm afraid that whenever it starts from and however quickly we look to expedite this on the basis of the available vaccines it's going to take us some months even to get through what would be the first cycle at this stage I think the first minister is right to say that we can't just assume that the vaccine does everything there will always be issues of effectiveness with any of our vaccination programs that take place but our hope is and certainly with some of the potential that is being shown through the trials that are happening, not least in the UK that there will be sufficient effectiveness that what it helps us to do is to break the chain of transmission that we are seeing across Wales so I personally feel that we should have hope about this the availability of effective vaccine would be a game changer for us in terms of the way both we and internationally people are responding to this coronavirus but I'm afraid it won't be an overnight solution for us Thank you and the first minister also said yesterday further consideration was needed how the hospitality sector would operate following the New England was having its own forward lockdown have any decisions been made yet and what factors specifically was the Welsh Government having to consider following the Prime Minister's announcements So Steve, obviously I'm speaking from an NHS perspective about the sector and the process that is going through for hospitality will be with the first minister and the cabinet and as you would expect there will be other officials who are involved in that not least with their liaison with the sector I would expect that the first minister will be able to build on his announcements yesterday and actually give some of the further detail and guidance that is necessary for that sector I think the underpinning concern however to help with the understanding of this is clearly the more we introduce times when there can be much high levels of social interaction the more potential there is for the virus actually to transmit and there is a need I think to balance access and for people to be able to see loved ones, friends and family but recognising that the virus just simply will transmit so I look forward to the first minister making clear some of the final announcements that will look to apply, not least for the hospitality sector from next Monday A final question please it's just to whether you can just clarify where the R rate is in Wales at the moment and which direction it appears to be going in The R rate at the moment we're still on a range that says it's somewhere between 1.1 and 4 we continue to have keep a close eye on that at this stage clearly with the higher numbers of cases that are being reported in Wales it does mean that the reproduction rate is much more meaningful at this stage than perhaps it was during the summer with very small numbers of cases we will have the latest weekly assessment come through later on this week we have to hope that there will be some indication of some changes around the reproduction rate but that might still in itself take another couple of weeks is that we've lived through as part of the firebreak arrangements in Wales Thank you very much Steve moving next to Dan Bevan from LBC Thank you Doctor good afternoon this statistic that you've given one in 40 cases of coronavirus nationally in Wales are hospital transmissions that sounds like quite a worrying statistic is it something that concerns you and as you've already alluded to this is a very highly infectious virus is that a number that you'd expect to be about this level for this type of virus I mean Dan thank you for the question obviously I've focused on hospital transmission as part of my introduction here today and I think that would recognise that this is a very serious issue for the way in which our system responds there are actions here that we need to take ourselves in overseeing the NHS about looking for our professional teams and our infection control teams across Wales to respond to the need to emphasise how all of us still have a contribution to make here in respect of how we approach social distancing and hand hygiene I mean those numbers are smaller perhaps than people may have expected given the overall numbers as I said that's around 3% of patients coming into our system at the moment who are reported to have coronavirus but I think it's enough of a concern at this stage to make sure that we are targeting actions on this so that's why Public Health Wales are using their own expertise to make sure that we have a focus on infection control actions it's why you've got areas being segregated you've got cubicles being introduced you've got red and amber and green zones being created we're trying to minimise the level of contact and transmission happening we're able to enhance the use of PPE all of these things that are that can make a difference but as I said earlier Dan this virus seems to require 100% compliance 100% of the time and our daily lives I would ask members of our community to do so and of course that also means that we need to make sure we're able to comply in terms of our NHS staff as well Thank you and one of the key features of the fight against coronavirus has also been the effect that it's had on people's mental health and particularly I want to focus on the people who have been on the front line of the fight against coronavirus how many NHS workers are currently off sick because of mental health problems and what does your worry for these people, for the people who work in the NHS and their mental health in the medium to long term? So Dan to answer your figures within the 0.7% who were off the reasons of coronavirus I have to say those figures are more related to individuals with symptoms rather than a knock-on effect of mental health if I was looking more generally at our sickness and absence figures probably around one in four of our staff off our mental health reasons I can't really tell you this afternoon that that would all be to do with coronavirus but what I would say is that the impact of what NHS colleagues have seen in their professional lives in a work environment and some of the real difficulties that they will have experienced in services whether you're a paramedic responding to a case or in an emergency department or in a GP surgery or certainly in a critical care environment some of our staff have seen some very difficult things over recent months including seeing their inability to be able to intervene to care for patients as they would have wished and positively at this stage at least there is more that we can do with patients manoeuvring through it's why we do have support available we have a health professional scheme that's in place that's hosted by Cardiff University originally that would have been targeted on medical staff but we've enhanced it during the period of the pandemic to actually ensure that that's available for all of our staff and we're also working with Social Care Wales on mechanisms that would allow us to support of course care home staff and those working in Social Care as well so I might just see whether offline we can be a bit more explicit for you on some of your mental health figures but typically one in four of our staff would probably be off for some kind of emotional health or mental health problems Thank you very much for answering that I just want a final question if I may as well one of the reasons for the fire break was to make sure that the NHS could prepare itself for this potential second peak that as you say might get to around the same level as the first I wonder what have you been doing within the NHS over the last week or so and continue to until the end of the fire break in order to minimise the risk of needing a third lockdown First of all the NHS in Wales was very supportive of the fire break actions taken it was felt that was necessary particularly looking at the trends that we were seeing ourselves on our own numbers and figures and the NHS had an opportunity to be part of the broader discussions that were happening across all sectors and of course we've had the data available to support it and beyond the NHS as well speaking to a number of representatives around Wales of health professionals they were also very supportive of the mechanisms that were undertaken by Welsh Government as well but yes we've been using the time to ensure that we can commission some of the additional capacity that's necessary and that we can focus on areas like a testing but from an NHS perspective Dan we were already responding we were already seeing an increase in patients so a number of our plans had already been put in place good news is that we're seeing areas like flu vaccination already increasing beyond levels that we saw last year so the public have seen that that is an opportunity for them to look after themselves particularly of their vulnerable the NHS I asked two weeks ago to be ready to be able to commission field hospital capacity if it was needed to manage some of the pressures within our system and service we have today got 32 patients in one of our field hospitals in Wales in the Cwntaf Morganog area but I can say also that the other health boards have also been looking at their own plans and I would actually expect probably over this next week at least two or three other health boards to start to bring forward their plans for additional capacity in field hospitals as well and then also the NHS has been contributing to the discussions on test, trace and protect and the ability to make sure that we're able to maintain the contact tracing mechanisms in place and I'm still really pleased to report that despite a doubling in the number of tests taking place and an enormous increase in the number of people who are now to be contacted and to be followed up that we're still seeing 94% of the index cases actually tracked down and 95% and I think it's been over 70,000 follow-ups who have been tracked to date 95% of those actually been followed up as well so I think we've got good foundations to build on in our TTP process in Wales working with local authorities and local stakeholders and again there's been an opportunity to see whether we can do anything different on that as well okay, thank you very much Dan now moving to Daniel Barnes from the South Wales Argus Thanks very much can I ask, are you worried that if pubs and cafes for example are open in Wales but not in England people might travel across the border in places like Monmouthshire to visit Welsh pubs potentially spreading the virus so my comment on that would be it probably goes a little bit above my NHS role and if I comment generally on it England will have its own regulations about the way in which individuals can move outside their communities and the guidance in England is clear that they should not be coming across the border or across areas at this stage because of the national mechanisms that will be introduced on Thursday require that I think that we need to work with stakeholders across Wales and clearly the police have done a fantastic job over recent months ensuring that people understand the regulations but where necessary needing to make sure that they can actually apply the regulations appropriately so but I would hope that given the seriousness of the suggested arrangements in England that the population there would also understand that the more they are able to limit their contacts and more they are able to stay close to their home environment the more likely it is that we are going to see this chain of transmission break not just in Wales through any fire break arrangements but actually more broadly across the UK is very much, staying on that point we have had reports of people being turned back at the border in places like Chapstow by the police do you think that roadblocks like this are going to become commonplace for the time being well again it goes a little outside my NHS role to comment on these areas but I know the police obviously have a role alongside all of the arrangements that are being put in place for public services across Wales to ensure that if regulations are there that they are followed by their own choices to do I think the approach that we've broadly tried to take in Wales this would be true of the way in which I've tried to describe some of the pressures for the NHS we want to work with our population we want to work alongside it and we do feel that we have an opportunity to have an impact on this virus by actually working together and whilst there is always an ability to fall back on what the regulations say I think as the First Minister has tried to outline over this last week or so what we're really doing at the moment is peeling to a wave and how we just need to understand that our day-to-day lives have an impact on the spread and transmission of this virus so I would prefer to maintain an ongoing conversation with the Welsh population and hopefully that can be supported then by our other stakeholders including the police of course okay thank you very much Daniel I'm moving finally to Andrew Andrew Nuttall from the leader good afternoon Andrew thank you figures released yesterday by Public Health Wales there was a stark and apparent jump in the figures locally here in our area of Wrexham in the Bacti Cadwaladr region compared to which neighbours say in Flintshire and Bishir and the likes there's worry that we've heard amongst the community itself there was over 100 cases in Wrexham alone yesterday we obviously don't know what that will be like today's figures they won't come out until 2 o'clock but there's worry amongst the community about people that still aren't following the rules would you be able to comment on those sort of figures and sort of those concerns just looking at our figures generally so Public Health Wales figures that were out yesterday afternoon were showing that the Welsh incidence rate was now 256.5 for the population ratio that we look at and you're right to say that however we are seeing other examples of that so there are currently two areas who are above 500 on that population ratio and we have 10 200 and obviously that is a concern the more areas of Wales that we see seeing some of those higher numbers at this phase I mean your comments on local experiences reflect our concern for the whole of Wales it's really important that we are all need to recognise the need to adapt the way in which we are interacting the population may be getting frustrated that some of our call messages remain the same but honestly out of the things that make a difference being really clear about social distancing and that 2m rule and being really clear about your ongoing hand hygiene and of course the use of face masks in those indoor areas these are all significant contributions to the way in which we are trying to manage this public health emergency so I would appeal to everyone to realise that rather than not being able to help us here they all have a very individual experience and if we can do that for the whole of Wales this is a virus that we can hope that we can contain and get under control thank you and secondly with a new virus itself in circulation are you worried that because this is just a general sort of extra pressure on the NHS regardless of how big or small it is and are you worried that a virus that wasn't around last year is going to cause a knock on effect to the NHS anyway regardless of what sort of impact people do have on it with these new measures yeah this is a difficult time of year and I've commented on how challenging the period is going to be and I particularly focused on that in the last press conference that I did as well because we've got a number of different factors coming together here we've got the normal winter pressures we've got the coronavirus impact we have to make sure we have plans in place in respect of arrangements for EU exit at this stage and there are as you said the normal winter experiences the other difference at the moment is of course that our NHS is much busier generally as I've tried to describe here so one of my worries is that some of the resilience that we would have had in March and April because beds were available because we stopped activities is now less available to us because we are trying to maintain our general approach to activity but I am worried about it if I was to be hopeful I would say that it looks like that some of the southern hemisphere experience has had less flu this season all of the hand hygiene things and the social distancing things that are being done actually stopped the spread of flu as well but I think we will need to keep a very careful eye on this and the one thing that is very different at this time last year during the winter despite all of our pressures and any delays that we have experienced we didn't have one in six patients with coronavirus in our beds ok thank you very much Andrew I think at that point I'll thank you all for your questions thank you very much