 Dweud amgylchedd, Bryn and Dda. I'm Dr Frank Atherton. I'm the Chief Medical Officer for Wales. And I'm Andrew Goodall, Chief Executive of the NHS in Wales. Today, just like last week, we will give you an overview of the pandemic in Wales and its impact on the NHS. Frank, over to you. Yes, thanks Andrew. So I wanted to start today with just some very cautious note, a very cautious note of optimism because there are some encouraging signs over the last few days that coronavirus is beginning to stabilise in Wales. We need to be very careful about how we interpret that because the situation certainly remains very serious and we're still dealing with the added factor of the new variant, the highly contagious strain of the virus that we talked about last week. We also need to be very cautious because we know that even when things do stabilise in Wales and in the rest of the UK, they can take off very quickly. We've seen that recently in London, the south-east of England and the east of England. So we need to be quite cautious, but there has been some positive movement over the last few days. With a small fall in the overall rate of coronavirus infection for Wales, it's down to about 410 per 100,000, 410 cases per 100,000 at the moment. And if we think back to mid-December, the rates were about 650 per 100,000. So there has been an increase. One of a note of caution, of course, is that it's not evenly spread across Wales. So we are seeing, particularly in north-east Wales, particularly high rates in areas of flincher and rexham in particular. And those are probably being driven to some degree by the new variant that we've talked about before. So this strain of virus is very infectious. It spreads quickly from person to person. That's why it's really important that we all continue to follow those stay-at-home rules and the other guidance that Wales Government has put out. When we mix, when people mix, the virus will spread. Another slightly positive thing is that the rate of positive tests in people who are tested for coronavirus has dropped slightly. It used to be one in five. In fact, last week when we spoke, it was about one in four that were positive. It's now about one in five. 20% of tests are positive. So that's heading in the right direction, but it's still way too high. And again, there's variation across Wales with rexham positivity rates being about 30%. The other cautious notion is that we have started as people will realise our vaccination programme here in Wales. We're continuing to make progress on that. And the latest figures as of today show that just over 100, in fact 101,000 people in Wales have had their first dose of vaccine. So we're well on the way to that first milestone that the minister set out in the vaccination strategy, which was published just on Monday. And that's an enormous effort for which we have to be grateful to the many thousands of people across Wales from the NHS health and care system who are working so hard to get the clinic set up to protect the people who are at greatest risk. Now, I say, you know, I caveat the good news. There's always a sting in the tail with coronavirus and we still don't know to the extent to which the new variant has fully run its course. We know pretty well that it's become firmly established in North Wales. In South Wales, it is probably still spreading. And so we don't know how much further spread there will be of the variant in South Wales. And we're currently looking into that. We had some really bad news yesterday. It wasn't on it was not unsurprising, but it emerged from ONS that this pandemic has caused an excess death across the UK, the highest since the Second World War. And that's a really sobering thought. And another somber milestone is that Wales yesterday reached the sad milestone of passing 5,000 deaths here in Wales. And, you know, it's easy to look at those numbers and see them just as numbers. But of course, behind each of those numbers, each of those deaths is a family left grieving. And our thoughts should be with them at this time. I think what I'll do is hand over to Andrew and we'll just talk about what it means for the health service. And then I'll perhaps just kind of wind up with what does it mean for us as communities, as individuals? Thanks Andrew. Thank you Frank, Joach. As I've said before, these first few weeks of January are traditionally the most challenging weeks of the year for the NHS. But this will be the most challenging winter I and other NHS staff will have experienced in our careers as we balance winter and emergency pressures with the demands of looking after thousands of people who are seriously ill with coronavirus. Over the last few months, we have seen a steady rise in the number of people who have been admitted to hospital with coronavirus. And despite the tentative and encouraging signs of cases stabilizing in the community, we continue to have significant concerns about the ability of the NHS to deliver services. The impact of the restrictions, including the lockdown measures, will take some weeks to be felt by the NHS. And it will be a while yet before we see the number of admissions to hospital or the number of people needing critical care starting to fall. Today, there are 14 hospitals at level three or four, the two highest levels of pressure and three hospitals are at level four. Many frontline staff have spoken about their experiences at the centre of the response to this terrible and unforgiving virus. I'm very grateful to them for being prepared to speak about delivering care in the NHS at the moment. Please listen to what they are saying. They are telling you that this is very real and the pandemic is having a significant impact on patients and on staff. The number of people admitted to hospital with coronavirus symptoms has continued to rise over the last two weeks. There are now around 2,870 COVID-related patients in Welsh hospitals. This is the highest on record. We have now exceeded double the peak we experienced during the first wave in April. At that level, the NHS will have to make some very difficult decisions about the balance of services it can provide. More than a third of hospital beds are occupied by COVID-related patients. We would not normally start the very busy winter period with a third of our beds unavailable for normal NHS pressures. This is simply unprecedented. I've been talking about the impact coronavirus has on our hospitals, but its effect is felt across all of our health and care settings. Nearly two-thirds of critical care patients currently have coronavirus. 15% of ambulance calls offer coronavirus and we are receiving 10% more 111 calls because of the pandemic. My greatest concern at the moment is the impact on critical care. Units are under enormous pressure as we continue to see people who are very sick with coronavirus admitted to critical care across Wales. There are now 150 people in critical care units with coronavirus. This is the highest level that we have seen during the second wave. This is almost our entire non-pandemic critical care capacity in use. The average age of people in critical care is 59 and almost twice as many men are admitted as women. We are currently operating at 152% of critical care normal capacity and have opened many more beds as we have seen the number of people who need this highly specialised support reach record levels. It is only possible to care for these people by stopping other NHS activities and opening more critical care beds in other clinical areas, such as theatres and specialist clinical environments, and by using other staff to support specialist critical care staff. Very sadly, about 38% of people with coronavirus who have needed critical care did not survive. And because we have seen higher numbers of admissions in the second wave, we have seen a higher number of deaths therefore in critical care. The last few weeks have been sobering and extremely difficult for staff throughout the NHS. High levels of positive cases in the community leads to more hospital admissions, more seriously ill patients, including in critical care, and ultimately to more deaths. The commitment of our health and care workforce under such extraordinary circumstances is incredible, and I would like to simply say thank you to you all, Diolch. Our NHS staff have also been at the heart of the vaccination programme, setting up clinics from a standing start to create a service vaccinating thousands of people every day. Before I hand back to Frank, I would urge anyone who needs emergency care to call 999, and if you need non-urgent help, please contact your GP or call NHS 111. Frank. Yes, thanks Andrew. So, you know, to summarise, you know, we may, may be seeing some early positive signs of progress in terms of our community transmission, but as Andrew has really outlined very clearly, the NHS is still under very real pressure from the pandemic. That's why Wales is still in lockdown, and we have been since the 20th of December. If we look at our mobility data, the latest data shows that we have about similar levels of movement of people around as we did during the firebreak, and that's good. And I want to thank everybody in Wales who is complying fully with the guidance and the rules that are in place. It's really important. Unfortunately, with this virus, most is not enough. We all absolutely have to comply with those rules. We have to keep ourselves as separate as possible, because the virus likes people mixing and that's how it spreads. And we know that this new variant is present in Wales, it's expanding in Wales. So it's even more important that we all stay at home and follow the rules. We absolutely have to work at home wherever we can. We've all been through a great deal together, you know, during this pandemic, but there's a long way to go yet. The vaccination does give us some prospects for recovery, but we need everybody's help to make that to work. So the message still is stay at home, keep yourself safe, protect the NHS and save lives. And if we do need to go out, we should only really be going out for essential purposes. And it's really important that we maintain our physical distance from each other to stop the virus from spreading, that we wash our hands frequently, follow those respiratory guidance that we use a face covering where that's needed indoors. And finally, and this is so important, you know, people who do develop symptoms of coronavirus, if they do develop symptoms, it's really important that they isolate and get a test. So Diolch yn fawr, and we'll now take questions from the journalists. All answers, as usual, will be broadcast on social media channels. Thanks. Diolch, Frank. Thank you. I'm going to start today's questions with Catherine Harve-Jones from BBC Wales. Prynhandau, Catherine. Prynhandau i'r ddau honno chi. Firstly, we heard earlier that there are some encouraging signs that cases of coronavirus are beginning to stabilise in Wales. But Dr Goodall, a question for you. You said in your opening remarks that it will be a while yet before we see the number of admissions to hospital or the number of people needing critical care starting to fall. There have been warnings in England that the next couple of weeks could be the worst of the whole pandemic for the NHS there. Do you have similar concerns for the next couple of weeks for the NHS here in Wales? Diolch, Catherine. Thank you. As I've outlined, I think this winter will be the most challenging that I and other NHS staff will have experienced inevitably. Particularly so when you have a third of your beds taken up by patients who need care beyond just the normal pressures of the NHS. Obviously Welsh Government has put in place a number of interventions through December and pre-Christmas, which have perhaps allowed for us to have some impact and some evidence that these are starting to improve, as Frank was saying, the outlook on community prevalence. But inevitably with the NHS system that there is a lag that will occur. If however I just look at our figures over the last seven to ten days in comparison to where we were in early December, for example, we were seeing a weekly growth of hospital cases that was anywhere up to about 25%. If I just look back just on the last seven to ten days, both in terms of our total numbers of COVID-related patients in beds and also the confirmed cases, which is a bit like a surveillance measure that we're using within our hospital beds. Total cases have shown a slowing down in that growth. Just yesterday, same point last week, we were about 7% higher than we were last Tuesday. If I look at the confirmed cases, actually they have both stabilised and perhaps even reduced a little bit at the moment. So, as Frank was saying, we may have some early evidence and some encouraging signs that those measures have started to translate through into the system. But it still remains very challenging and very busy. And I think one of our worries for January, and this will fit with a commentary from elsewhere in the UK, is wherever we are, if the new variant has traction, we will potentially see further increases happening. It's why in particular I think we need to keep an eye on North Wales. We have seen a growth of cases there. For example, just since the 26th of December, we have seen a doubling of the number of hospital cases in North Wales. Just from the beginning of December, we have actually seen a number of patients with COVID-19 in critical care increasing fourfold. So, I can see some evidence that some of our preparations and actions are working at this stage, but things can change very quickly capturing just in a matter of days, as this virus has demonstrated throughout the pandemic response. Diolch. Dr Arthur Tyn, if I can turn to you, and it's about vaccinations and the second dose in particular. Looking at the most recent figures that we have across the UK, other UK nations seem to be providing far more of the second dose to people than here in Wales. In England, for example, over 19,000 people received this second dose in England between the 10th and 11th of January, compared to just 18 people here in Wales. Are we following the same policy on second vaccination in the UK? And if so, why are the numbers of second doses increasing so much elsewhere while not here in Wales? We are following the same policy. The chief medical officers were very clear about the second dose policy. A delay in giving the second dose up to 12 weeks would lead to better population outcomes because we're getting more vaccine into more people. It's as simple as that. I think there's been an issue in England. You have to kind of ask people in England why there are some cases where people have had second doses. There are a few in Wales, but by and large, I'm really pleased that everybody in Wales is understanding that a second dose given now is a first dose denied to somebody else and that they need that protection. I think there are a number of cases where the second dose is given to avoid wastage. If a pack of vaccine is open, it obviously has to be given. There have been some issues around that in Wales, and that's quite important. We don't want to waste vaccine. We just can't afford to waste it. In fact, our vaccine wastage here in Wales is less than 1%, which is really, really good news. Thanks, Catherine. Thank you, Diolch. Good to move for the second question from James Crichton Smith from ITV Wales. Good afternoon, James. Good afternoon. Thank you very much. I'm happy for either of you to field these. I don't mind who have the best place. The first question is, as of this morning, when you look at those numbers of how many people have been vaccinated, how many of those people who have been vaccinated are over 80? James, on the numbers that we're tracking through at the moment, we will be reporting on those numbers to show the coverage across Wales at this time. So, of the different categories that we are seeing working through, they are being fed in by individual areas. We have started off with a focus in Wales around healthcare staff just because of the dynamics of how we administer the Pfizer vaccine. So, there would have been a disproportionate focus because clearly we need to make sure that we're able to discharge the vaccine as close to communities as possible, which is what's happened. But you will see health boards and health organisations across Wales, as well as what we'll do through our national data, show some of the progress that's been taken. So, alongside over 80s, for example, and Aaron Bevan, I know, have reported on some of their own figures talking about the fact that about a third of their care homes have been done. That would include some over 80s, and around two-thirds of care home staff have been achieved at this stage. But we are tracking those, and we will be reporting those and feeding into those reports at the moment. But we will have put a particular focus around healthcare staff in order to protect staff and the patients in front of them at this stage. But we will see very quickly the over 80s numbers increase, and that has been happening on a daily basis through this week in particular. Okay, so obviously you can't give me a specific number on over 80s, as indeed we can find out in England. My second question then, Boris Johnson says he wants to move to 24-7 vaccination as soon as possible. Do you share that ambition, and when do you think we'll see it here? Well, if I start off, James, on that question. First of all, we need to continue to ensure that the activity and the administration of vaccines continues to increase. So, as an example, when Frank and I were sat here last week, the numbers that have been reported has doubled just simply in one week. So we are now over 100,000 at this stage. In terms of our planning judgments at this time, we have to align ourselves to the supplies that will become available. But certainly from next week there is a step up in terms of the supplies available, particularly of the Oxford AstraZeneca vaccine. We have already expanded locations, we have also expanded hours, and we've also expanded the days in which they are being discharged. But I don't think anything is off at all in terms of the choices that we need to make. So I think firstly we need to just extend the hours and make them available. But if we, at some point during this response, particularly as we go over the next four to six weeks, we feel that there is an opportunity to do things on a 24-7 basis, then we would do so if that's the way in which we deliver the activity. But I hope that you will have seen through the plan this week and some of the expansion activities. One of our real areas of focus is the extent to which, alongside mass vaccination centres, we can revert the vaccine process to our primary care structures. So our local GP practices are cluster arrangements and we would expect that to really make a very significant difference in the volume. But frankly you may have a comment. Well I would just add that I would expect local health boards to be flexible in their approach and to really look at the demand. And if there is a demand, a real demand for further hours of opening, then I would expect them to meet those. But it depends partly on the supply, the supply is really important. And we also have to remember that the same people who are working so hard to deliver vaccines are the people from the NHS and the social care staff who are busy as Andrew has said on other duties. So we need to kind of make sure that we don't destabilise the NHS by increasing activity elsewhere. So we'll go as fast as we can but we will go as safely as we can and we will go in a way which avoids wastage as much as we possibly can. Those three things are really important to us James. James thank you very much. I'm going to move next to Mark Smith from Wales Online. Good afternoon Mark. Good afternoon to you both. This is more of a question directed at you Dr Goodall. In parts of England including London patients are being discharged early from hospitals and taken to hotels to free up beds for critically ill COVID-19 patients. Given the fact critical care capacity has reached as you say 152% of cupency in recent days in Wales. Has the Welsh NHS given any thought to moving some patients perhaps recovering from the virus into hotels to ease the pressure on our hospitals? So I would respond in a couple of ways Mark. Firstly, as well as patients who are recovering from coronavirus we obviously have patients who are waiting to be discharged from normal activities which the NHS is offering. I think we need to look at the overall system and perhaps not only at coronavirus but we continue with our normal discharge practices at this stage. What I would say secondly is that the model that we put in place in respect of field hospitals for Wales was deliberately about supporting a sort of a post discharge from acute hospital site but pre returning to home environment. So actually the model that we established in Wales was deliberately to make sure that it wasn't about critical care patients being cared for off hospital sites. Latest numbers are for our field hospitals across Wales although some of them are being used as mass vaccination centres as a judgement at this stage. Is that we have 186 patients in our field hospitals across Wales and that volume is increasing at this stage. And certainly I do think that subject to workforce and staffing arrangements the field hospitals will continue to offer some opportunity for patients to move on in the system. But in respect of recovering patients that we have again I would emphasise that whilst a typical emergency patient will come in and perhaps be discharged within five to seven days, coronavirus patients for many of them may well still be in hospital beds after two weeks and even thereafter three weeks as well. So whilst they have a label of recovering on them that does include some patients who are still very seriously ill and requiring a lot of additional clinical support. And I don't think that would be appropriate for either a field hospital environment and certainly wouldn't be appropriate for a hotel environment. But you know we need to continue to look at these models but I would really emphasise that I think our field hospital description would be better mechanism for supporting that kind of flow of patients out closer to their home environment. Okay, thank you very much for that. And secondly once again hospitals in England are reporting shortages of oxygen because of the huge pressure of treating the rising number of people left seriously ill with COVID. Would you be able to tell us then what oxygen supply levels are like in the Welsh NHS at present given the fact there are so many patients in invasive ventilated beds at present? Yes, so we put a lot of preparation into the availability of oxygen during the first wave preparations and response including sometimes where actually the balance between having oxygen available and the number of patients coming to the system were actually some real concerns and we put in various contingency at that stage and we have liaised across the UK because of course oxygen will be in great need everywhere. At the moment in terms of our operational pressures in Wales and because of some of the ongoing treatment of patients there are no reports of any hospital sites unable to cope with patients who require oxygen. There is provision being made. We obviously have seen perhaps some different treatments emerge during this phase you know seeing patients who are being supported on respiratory pathways and having oxygen off general wards rather than needed to be cared for in a critical care environment. And you know just as an aside you know I know as part of an operational response through this week but we were approached ourselves about whether we could offer some support for oxygen supply elsewhere in the UK. And of course we want to continue to be able to offer mutual support and reciprocity across the whole of the UK. So at this stage from an operational level even with the numbers that I've outlined in hospital beds no reports of shortages but I think a lot of that comes down to the planning and preparation that we put in place while we were going through the first wave mark. OK, thank you very much Mark. Going to move next to Dan Bevan from LBC. Good afternoon Dan. Good afternoon Dr Goodall and yourself Dr Appleton. This question is for yourself Dr Goodall if you don't mind. A study in England has found that nearly half of ICU staff are currently suffering likely from problem drinking, severe anxiety or PTSD. Is that something that's being replicated in the Welsh NHS and at the moment how many staff are off not because of coronavirus or self isolation but because of stress and mental health problems? Dan I saw the same report myself and obviously we all want to work through it and I think it just really brings home the experience that our staff across the UK and in Wales have been through in caring for patients over these recent weeks and months. It's really important that we're able to identify those concerns and problems and provide well-being as well but having gone through a first wave experience which itself was very difficult to actually see the numbers continuing to increase. I reported today that we have now passed double the peak of the first wave at this stage and you can imagine what that means. Our NHS staff report understandably so that they are exhausted at the moment because this has been a constant treadmill and one of my worries for ICU alongside some other of our areas is it's been a constant right through from the first wave and irrespective of COVID-19 driving a lot of our care and treatment requirements in critical care when COVID numbers are lower they are simply caring for other patients who are coming in for normal activities. I think we need to recognise the pressures that are on our staff in the system. We have wrapped well-being support around individuals. We expect that to be triggered at a local basis for clinical managers, for clinical teams to be able to openly talk about these areas as well at this stage. On the numbers side of it in terms of sickness and absence rates at the moment I'm not able to pull out specific reasons on mental health within our overall numbers but as I know you've asked before Dan I'll see what I can do outside of the press conference. We are currently running at 9% staff in sickness absence. That would usually be about 5-6% at the moment this time of year. About 4.5% of that is for COVID reasons. 2.5% of that is simply because of self-isolation of staff based on current guidance and tracing and about less than 2% associated with sickness associated with COVID as well. But I do think within our sickness and absence numbers we do track about mental health issues and emotional health problems and we'll see what we can do. But I'm not sure I'll be able to define that all of those are because of COVID-19 I'm afraid. I appreciate those numbers. Thank you very much Dr Goodall. This question for yourself Dr Afton. This morning on LBC's breakfast show with Nick Ferrari Professor Jonathan Bantam said that coronavirus will likely never be fully eradicated but of course is vaccine. Do you think that a vaccine programme similar to the one we've got this year will have to be repeated next year and how often subsequently? Thanks Dan. There's only one disease which has ever been eradicated in human history and that's smallpox of course. Eradication completely removing a virus from the planet is an impossibility pretty much except for that exception I've just mentioned. So it is likely that we will have to well it's a pretty much a certainty that we're going to have to learn to live with coronavirus. Now we just don't know what will happen to the virus it is you know it does mutate like all viruses do and some of those mutations we've talked about recently the new variant the South African variant it's quite possible that it may mutate to a milder form and become a more of a seasonal issue that we have to deal with on a yearly basis if that is the case then it's entirely likely that we may have to move to a situation rather like flu vaccination where we have to give a seasonal vaccine against coronavirus every year but it's really too early to say that I would you know to knowing for sure Dan we will have to wait and see but for sure coronavirus will be on the planet for some time to come here. Dan thank you very much. Going to move next to Tom Magna from Carersworld Live. Good afternoon Tom. Good afternoon Doctor Aston Doctor Goodall thank you both for your time and please feel free to chip in as appropriate I've got two questions one short one long so let's start with the short one on vaccination. What is the exact process by which the priority list from the JCVI is communicated to the Welsh Government to public health Wales and to the public to generate their appointments. So I start on that so JCVI is an independent scientific body it produces its guidance it's a panel of experts they produce that guidance they submit it to chief medical officers we looked at that advice and it agreed entirely with it so that's the kind of process that it comes through to Government I then take it to our first minister and our minister and they are in full agreement that is the right approach to do because that is the best way to save. The most the most lives. In terms of communicating with the public well hopefully people understand that there are now nine immediate priority groups that we're going to try to work our way through the first four of those by the middle of February and then all nine groups by by the spring. There are letters that are being prepared and going out this week in fact from health boards and local authorities working together to advise people about how they will be and when they will be likely to be receiving invites and the message to everybody is to wait until you hear from people don't just turn up to a vaccine centre or to your GP you should wait to hear everybody will be called for vaccination in due course. Thank you for that very helpful answer. Can I now turn to a more complex subject of shielding? Our viewers are telling us there are differences between lockdown one and the latest lockdown and I sent through the background of our viewer Sylvia from Vale of Glamorgan hopefully you've had a chance to look at it but just for everybody else let me summarise what she says. She'd basically like to know how the shielding list did drawn up she says when I inquired about GP about my son who is a chronic asthmatic that's two pumps plus control medication he has autism plus many other serious physical and learning disabilities for shielding he was told that he meets two out of the three criteria. Perhaps you could explain the criteria when it comes to your answer. Sylvia says this helps neither of us as you can imagine he cannot socially distance he doesn't know what distancing is. We have therefore not let the house since March other than for GP and hospital appointments which are she says an absolute nightmare because of the danger her son put both himself and her in and the danger he poses to other members of the public her words. So the substantive question is should certain groups of people with autism, i.e. those who can't leave their home without a carer with them, be shielding for their and other members of the public safety given the high figures of COVID-19 at present? Thanks very much Tom. It's a really important question and the question of shielding has been one that we've really had to think very long and hard about because of course there are benefits to shielding but also potential harms as well. In terms of the criteria, really the shielding group was drawn up across a fornation basis on thinking around who are the most vulnerable, who are the most clinically extremely vulnerable. Everybody is vulnerable to some degree but some people are more vulnerable because of age or because of their preconditions, heart disease, lung disease etc. And so it was really those lists of significant comorbidities, significant other health issues which led to the definition of who was and was not in the shielding group. Now we always recognised of course Tom that that's an imprecise science and when you're dealing with a population it's hard to kind of capture everybody. So there has always been licence for healthcare professionals to add people to that group if they feel they have a particular vulnerability for whatever reason. In terms of what shielding people or the clinically extremely vulnerable should be doing now, I mean clearly they've been advised by the minister, they've received a letter just before Christmas advising them not to work, not to go to school for the time being. There will be a further communication out to that group in the very near future to tell them what to do. But really anybody, and I think this speaks to your correspondent and her son, needs to think long and hard about we are in lockdown in Wales so really we shouldn't be mixing with anybody. Now that doesn't mean the same as shielding but it does mean that we shouldn't be going out and mixing at all really. So my advice really would be to follow the general rules if there's a specific concern that somebody has and they feel they, for whatever reason they need to be in that shielding group then they could have a discussion with their healthcare professionals. Thanks Tom. Tom, thank you very much. Going to move next to Nathan Shoesmith from the speaker. Good afternoon Nathan. Good afternoon to you both. I have questions for either of you. Given the current pressures, are you confident that those that need mental health support and other types of treatment, and Dan has already asked you about mental health for ICU staff, people that need treatment, are you confident that they can get non-COVID related treatment? If you fear that people may look at the current situation and put off going to get treated because they feel they won't be able to access it. Nathan, it will be an ongoing concern of mine and I commented at various stages during the first wave at the point where seeing lower numbers of patients accessing our services, particularly at a point of lockdown will cause concerns, particularly where they are for essential reasons. First need to confirm again that our frameworks that are in place in Wales are about ensuring that essential services remain available, but inevitably there will be a focus on coronavirus, on emergency care and also on urgent patients into our system, whether that is through a hospital environment or via a GP referral mechanism. We need to keep an eye on it. There is a choices framework that has been put in place nationally, which is being used by individual organisations because what they need to do is to balance their particular circumstances and pressures based on the number of patients they have in their facilities and services who have coronavirus. We have validated them making decisions through December and I do feel that is part of why at this stage hospitals and organisations in Wales are continuing to be able to respond to services. I do keep a very close eye alongside other colleagues about the level of activity that is going on in our system. As an example, through December and January based on our operational data we have seen a reduction of about a third in our A&E attendances. On the one hand that might be that people are able to access other services. It may simply be related to lockdown because, as an example, less people on the roads, less road traffic accidents for example, but we have to have a constant focus on whether there is other harm that has been done in the system. I'm afraid there are implications at the moment for our waiting lists and our waiting times because we are trying to ensure that we are prioritising and protecting emergencies but we also need to make sure that we will have future plans for that. But I think Frank, this takes us back to our whole focus in Wales about focusing on different harms and whilst we need to focus on coronavirus to make sure that we are accommodating other patients in our system. We've always used that framing in Wales that it's not just about the immediate deaths and disability and disease caused by coronavirus. There are effects from the economic lockdown we are in and there are social effects that we are very conscious of. You are right to flag mental health issues particularly, Nathan, because that is a very significant concern. We are working with health boards to think about how we can provide those services sometimes in a different way through online services, through other modalities rather than the traditional face-to-face, but it's a really important point that we need to not lose sight of so thanks for raising that. Mental health services is registered as one of the essential services within our framework and also the World Health Organisation's framework, Nathan. There is answers and looking forward to the future a bit more. In the vaccination strategy there are plans for COVID-19 1-9 to be offered the first dose of vaccine by the spring, so about two months time or so. Is there any new thinking on research going on behind the scenes in terms of if that's achieved, that amount of people vaccinated and the risk that those people would have them be somewhat eliminated? Do you know what that could mean for NHS demand pressures and also is there any thinking on what restrictions may look like in the future once people are vaccinated? There is a really current and vital question, so yes, there is a lot of thinking going on around both those issues. First of all, in terms of the impact on NHS capacity and services, when we get through those first nine high priority groups, from those groups, about well over 90% of disease that comes into hospitals comes from those groups, so we should see some benefit from that because we have to remember that the vaccines we know are pretty good at preventing serious disease and preventing hospitalisation and ultimately preventing deaths. So we would expect and we would be very hopeful that there would be a positive benefit for that into the spring and then into the summer. On your second point, it's a really important distinction that we don't really know enough yet about the way that vaccines stop transmission. We don't know if they can stop transmission in the community. So we will learn more about that as the vaccine programme is rolled out, but we can't assume that just because a significant slice of the population is vaccinated that we can relax our guard, that we can let our systems for what we call non-pharmaceutical interventions, the social distancing, the respiratory hygiene and all of that. We can't let our guard down on that just yet, so we will learn more about that as the vaccine programme is rolled out. Okay, thank you Nathan, and lastly and finally to move to Joe Strong from Atrium News. Good afternoon Joe. Good afternoon to you both, and this is a question for either of you. Medical and nursing students brought in to help hospitals cope with the virus. Are they being vaccinated and are they being supplied with the correct personal protective equipment? Thank you. I'll go first and Andrew may want to add to this, but absolutely I would expect every health board to be treating medical students and nursing students and allied health professionals students as frontline healthcare workers and treating them in exactly the same way as they treat other healthcare staff. So they certainly are eligible for vaccination, and they should certainly be receiving the levels of PPE that are needed. Just to add to it, we would expect PPE to always be appropriate to the environment. The one distinction would be that clearly the PPE that you would wear in a critical care environment may be different from what you would wear within an outpatient clinic environment for example or a community pharmacy. So the PPE will always be about the environment in which people are working rather than perhaps the specific roles that they have, but I agree with Frank's comments. We would absolutely accept that they are just simply members of our staff and we would treat them accordingly. Thank you, and my second question is, you touched on this briefly earlier, but it's been announced that all over 50s will receive the vaccine by spring and most adults by the autumn. Is there a rough estimation as to when students and younger people will get the vaccine so we can return to face to face classes on a permanent basis? Thank you. I think the reality and the good news for young people is that they tend to have less serious infections. So the intention is to go through the cohorts who are most at risk in the first instance, and that will take place over the coming months. Further discussion with JCVI, the Joint Committee on Vaccination and Immunisation, who makes these prioritisation lists will be happening as we get through those cohorts. So there will be a lot of thought given to how we cover off the rest of the population, the rest of our communities, after the initial priority groups are met. Joe, thank you very much. That's the end of our questions for this afternoon. Thank you for the questions and also thank you for listening. Joachim Arianne.