 Bwydda bawb o ddiogelch chi am y mynd o'r gyda fi a Judith Padgett, prif weithred rhaig y gosannaeth iachid enhymru. Am y Llynedd Morgan, health and social services minister in the Welsh Government, and I'd like to thank you for joining me and Judith Padgett, who is the chief executive of the Wales NHS. Now today is the second day of the junior doctor's strike in Wales, but before we talk about that and the plans we've put in place to help support the NHS, I want to start by thanking everyone who works in the NHS in social care and all the unpaid carers for everything they've done this winter to look after us all. This is an incredibly busy time of the year for our health and care services. Tens of thousands of people have sought help from the NHS over the Christmas and New Year period. And while health and care services have been very, very busy, the vast majority of people have received timely and high quality care. That's in large part because we've spent the year planning for winter and we've invested in more NHS staff and new services to support the health service. More people than ever are working in the NHS in Wales. More doctors, more nurses, more ambulance workers and support workers are delivering quality care on a daily basis. The NHS 111 Press 2 service for mental health, urgent primary care centres and same day care centres are successfully and safely providing care and support to thousands of people every month, taking the pressure away from emergency departments. More people are getting advice via NHS 111 online and phone services. And we've seen a 50% increase in people using the common ailment services in their local pharmacy to get free treatment for a wide range of common illnesses without the need for a GP appointment. So I'm pleased at the steps we've taken so far this winter and over the last year through our National Six Goals programme have already proved to have helped the situation. When comparing the Christmas and New Year period from this year compared to last despite the continued high demand, feedback back from the NHS suggests improved ambulance performance and reduced handover delays compared to the last festive period. We're also seeing improvements in delayed discharges of care. Our provision of new detailed data is helping health boards identify the areas in which they need to target resources in order to help more people leave hospital when they're ready to do so. I want to turn now to the junior doctor strike which started yesterday. This is the first time junior doctors have taken strike action in Wales. A lot of planning has gone into ensuring emergency and life-saving treatment continues but there will inevitably be significant disruption to services. Judith is now going to explain how we've prepared and the measures that have been put in place. Thanks Minister. I'd like to echo what the Minister has said about thanking all our health and social care staff for their amazing efforts this winter. Of course we plan all year round for the winter period but this year we've also been preparing for industrial action by junior doctors that's taking place this week. We've worked with NHS Wales employers and the BMA to ensure emergency departments can continue to provide life-saving care and the most time critical operations like those for cancer and also our maternity care services have continued. These will be delivered over the three days but with thousands of junior doctors on strike over those three days there is obviously a significant impact on our NHS services. Health boards have planned new rotors and consultants and specialist doctors have helped to provide cover. The focus is on emergency and life-saving services. While some planned treatment schedule to take place over this three day period has been proposed, postponed, health boards have also not arranged appointments or procedures during this time. We will have a fuller more accurate picture of the disruption by the end of the week but so far I can tell you that our hospitals have been busy as expected but they are coping and they're keeping essential services running. Yesterday we estimated that more than 30% of planned procedures or operations were postponed and more than 45% of outpatient appointments had to be rearranged. As of yesterday afternoon 13 of our 19 hospitals across Wales were reporting being in level red which is the busiest level for normal NHS services but I'm pleased to report there have been no adverse impact reported on urgent and emergency care services because of the industrial action. I would like to thank the staff of the NHS and also the BMA for the constructive way in which we and the NHS have been able to work together. To develop an agree a process for derogations and I hope we can continue to work together in social partnership. Thank you Minister. Diolch yn fawr Judith. We fully understand the strength of feeling behind the strike action but our funding settlement which comes largely from the UK government in the form of a block grant is simply not sufficient to recognise the demands junior doctors are making. Dwi'n diall yn iawn crefder y tŷmlaes y tŷol i'r weithred ystryc yma. Ond nid yw'n setlyod cyllido sy'n dod yn benaf o lŵo dreth yden os yn edrych ar fer grant bloc yn ddigon i gynnab o'r dygofynion mwy modd y gynhau yn ei wneud. The offer we've made, a 5% increase which has already been paid into junior doctor pay packages is equal to that that has been made unaccepted by other NHS workers. This is at the limits of the finances available to us and whilst we have not been able to meet the recommendations of the pay review body this year during the last financial year we offered a significantly higher sum than was given in England. The UK government has failed to properly fund public services as a result of persistently high inflation, Wales's overall budget is worth 1.3 billion less in real terms than when it was set in 2021. We are facing incredibly difficult decisions about next year's spending plans. The UK government has also failed to provide clarity to the Welsh government about funding available to Wales as a result of NHS pay deals made in England. The autumn statement provided some detail but with just a few months of the financial year left we still don't know the full position regarding consequential funding resulting from the NHS pay increases in England which were announced nine months ago. We also don't have any clarity about how the pay offer for NHS consultants in England will be funded. This piecemeal approach is severely impacting our ability to plan and illustrates how the current funding arrangements don't work for devolved governments. I want to make it clear that we're always open to continuing talks with the BMA and NHS Wales employers to find a solution. Diolch yn fawr iawn a'w nawr, Teg, sy'n cwestiynau cwestiynau. Owen Clarke. Diolch yn fawr iawn. Thank you very much to both of you. Could I start with asking Judith to answer first and then maybe the minister to pick up as well. I just wanted to drill down a bit into the figures of the scale of disruption. You mentioned 30 per cent of pan procedure is 40 per cent of outpatients. Does that include things that would not have been booked in in the first instance? So are we comparing what is usual with what happened there? And you mentioned 13 out of 19 being on red. Do you expect that figure to increase as day two and day three go ahead? Ac ar y pwynt yna, nid ddwy iaith os ymbosib y gweinidog, allwch chi rhoi eich asesiad chi, could you give your assessment of how the NHS is coping? So to clarify the figures, on an average day in NHS Wales we would see 14.5,000 outpatients, split between new outpatients and follow-ups, and on an average day we would see 1,300 planned operations yesterday. We postponed 6,500 outpatient appointments and 400 operations. So the figures I give you take account of things that were postponed or cancelled on the day. Yeah, they were some cancelled on the day, yes. They're all in those figures, yeah. Canceled on the day? Yes, yeah. Diolch yn fawr. Wel, chi'n i clwyd yr ysafdegau o ddiwrth ddiwydd Padgetyn a fally yng Nghyffredinol ma tia unig pedon mil o apwyntiad o'n cael ei wneud yn allanol yn ddiddio. O'r reini o ti achwych mil a hanner wedi cael apwyntiad o'r llanol y ddau, felly arfer ma tia 1.3 mil o operations y cael ei wneud yn ddiddiool yn NHS pedor cant o ddweud y cael ei wneud ddaw, felly o'r tona lot yn llain ar arfer. Felly dwi'n meddwl bod lot o bobl o'r toed yw eri cael ei wneud. O'r lot o bobl hef cael ei apwyntiad yw yn y llai cyntain oes yn un gwybod bod ystraicymnidig wedi gweithdoedd reynu ddim wedi cael ei roi nawr plen. Yn eich cwestiynau, rydw i, yn obiwso'n ffyrdd minister. A gael lechiadau byn oedd eto yn y ddweud aeth yn hyn o'r sgwyl o'ch nhw. Pam yn ei ddod. Mae'n penodd, chi'n ddweud, oedd y cwestiynau. Felly ddweud fyddod fel hyd o'r ddweud? Mae'n meddwl bydda ni'n meddwl o'r ddim podeidio, ond y cyfrifiadau allaniad yn ei ddweud? Mae'n meddwl i'ch ddweud, mae'n meddwl hynny ddweud? Mae'n meddwl i'ch ddweud ystod a oedd ein bod hyn sy'n meddwl i mi yw'r gwaith y dyfodol. Wel, dioghwarae. We all want to avert strike our action if at all possible, this is not a situation that either party really wanted to be in, but I think people who have been watching closely the very difficult decisions the Welsh Government have had to make in recent weeks have seen the challenges that we are facing from a financial perspective. And in fact, we've gone around the whole of the Cabinet table and they have cut their budgets elsewhere in order to shore up the existing situation in the NHS, which doesn't take account of the needs and the wants of the unions who want to see an increase in pay. So it would be very, very challenging to do that. We are obviously always open to further discussions with the BMA. I met them last Thursday for a discussion on the situation. We are obviously interested in negotiating a new contract. We went quite a long way down that path and I think there are some opportunities there for us to reopen those discussions, but it obviously is very difficult with the financial constraints that we are under at the moment. Yn amlwg, sy'n mynd o hwn o'n i eisiau bod mae'n sefyllfa lly i'n gweld ymartho strike action i'n gweld ar hyn o bryd. Mi gwrdd eisiau gyda'r BMA dydd iaid dweitha. Yn amlwg, i'n i wostod yn agored i trafodaethau pelach a dwi'n meddwl bod yna sy'n ffasol lle gallai'n iweithio mewn partneriaeth i edrych ar cytundeb newydd ac mi eto'n i'n beth iawn lawr o trwedd yn a gyda'n nhw cyn i'n i fod yn y sylfa yma lle i'n i wedi derbyn bod yna problem ariannol yn gweinabynu. Hello, good morning. The counterparts in Scotland and England have obviously seen those higher pay offers there in Wales, as you said. Not even that six percent has been measured is that that five percent, a'r sgwrdd o'r dŵr yn ymddangod, o'r bwysig yn ychydig ar gyfer ar gyfer y ddweud, rydyn nhw'n fawr yn fawr i'r ddweud. Wrth gael i'r ddweud o'n hyn o'r ddweud? Felly, rydyn ni'n rhoi i'r ddweud eich mynd i'r ddweud, rydyn ni'n rhaid o wcfydol ymddangodd yn ddweud yng nghaelog rhan o'r LNHS yn Wales, Rwy'n dechrau at ychydig o'r boblau eich cerddur yn oed yn gwybodd yn ffasgfaith. Rydyn ni yn y rhywbeth o wahanol i gyd yn rhan i ddefnyddio'r bwysig. Roeddwn ni'n gwybod bod yn amlwg o'r ddechrau, rydyn ni'n gwybod bod y ddau, yn ymgyrchaf y 6% perhau a'r 1.5% yn ddechrau, where in England the offer was significantly lower than that. So I do think it's important to look over not just one year but several years. Thank you and of course talking about the funding settlement here and the huge constraints that you are facing. If there's no more money there then what do you truly see the end of this being? Ydw i ddweud beth am y cwrdd ffordd hwn ac yna'n gallu ar rhai o'r gyllidebun dros y gwenylol a ddweud rwy'n gweithio gumud ar gyfer'r munud o ran a'r arfer. Rydyn ni'n roi gwneud o'r cyfrifiad hwn i'n daerhau'i cyfrifiad ar y gyfrifiad hwn. Gwyd someplace ar y gallai y cyfrifiad hwn i ddechrau'r gyfrifiad hwn o ran anodig ar bod y gweithio'r Gwyd-Eustin. Mae'r fact yn ni, ac mae'n wneud i'r exploit ychydig, mae'n rhai i'r exploit i'r exploit i'r jutyn, gyda'r bwysig o gydag ymwneud o'r ffordd o'r ffordd i gael wneud, a'r ffordd oes yn deall, fel rhai gwybod ydym yn fwy o'r bwysig o'r bwysig yn ymwneud o'r ffordd o'r ffordd o'r bwysig o'r ffordd o'r ffordd i gael ymwneud, felly rwy'n edrych ynogi'r gweithio cyhoedd. Rydym yn ogymell ymwneud yn cynnig, rydym yn cymdeithasol o'r bwysig o'r bwysig, ond mae'n gweithio'n gwybod. Dan Wilson, global. Thank you minister, good morning. Given what Marina was saying there about the different offers that have been made across the UK, and the fact that the Prime Minister has said his offer last year was full and final, is there a concern that this will simply drag on until the next election? And if so, how confident are you if Labour were to win the UK election that this could be resolved fairly quickly? Well none of us want this to drag on for a second longer than necessary, which is why we're very keen to speak not just to the junior doctors, but obviously there's a potential for action by consultants and essayist doctors as well in future. So discussion is the way forward, but it is difficult, I think, for us to do that in the financial context that we have at the moment. Obviously I'm very interested in seeing a Labour government, a Labour government that I hope would look at the record of past Labour governments, where we've got very close to paying the European average for the NHS as they do in other countries in the EU. It's very difficult because obviously they are facing severe financial constraints as well, but the commitment, if you look at former Labour governments, you will see that the commitment to the NHS has been absolute. Thank you, and just a question to Judith, if I may. When junior doctors in England walked out on strike earlier this month, there was a plea within a day for them from NHS bosses to return to work. Given the pressures already on the NHS and what you outlined a moment ago, are you envisaging a scenario before Thursday morning where a similar call is made here? So our experience over the last 24 hours has been that that hasn't been required. Clearly the NHS deals with crises and really difficult situations, and this is absolutely a challenging situation, but we've got good lines of communication open with the BMA, constructive conversations are continuing. If that becomes necessary, we have the agreed process in place to do that, but at the moment I'm hopeful that we will get through the next two days in a reasonable way, but as I said some of this is unpredictable as to what demands come in on the NHS and what might happen to put us off course. Can I just add to that, if you don't mind, my thanks to the senior doctors who have stepped in to help us out in this situation, but the pressure on the NHS remains very, very intense, and I would appeal to the public in particular in the cold snap that we're expecting in the next few days to pay particular attention and to be careful in what they are doing, and if they can use those alternatives that we have in place, the pharmacies, the 111 service, the same day emergency care centres, the early primary care centres, all of those are available as alternatives because the pressure is intense and we need to get through the next few days. Lydia Stevens. My first question would be for Judith. Are you able to give any sort of cost estimation relating to how much consultants are being paid to cover these shifts? I've been contacted by several people who have sort of suggested this within the sort of £150 per hour range and you know what sort of impact is that going to have on obviously the costs of running the NHS over the next few days? So I'm not able to give you accurate costs about how much the industrial action is going to cost us. Clearly the consultant contract does make provisions for additional financial remuneration where consultants are working on days that they would not normally work or doing tasks that they would not normally do, but clearly there is a broader calculation to be made that is obviously that we will won't be paying junior doctors during this time and also the activity in the NHS, the planned activity will be less. So by the end of the week we should be able to give a reasonable estimate of what that is but as of today not able to do so I'm sorry. And the next question for Minister relating to this issue then that you know the money needs to come from some way and it's clear that that money needs to come from a budget. A bigger budget that needs to come from the UK Government then. Have any discussions been made or has talks started with the UK Government because this is obviously an issue they're also facing relating to junior doctors different situation in Scotland where they've also been given quite a substantial offer of the. Are they talks about how the UK Government and the Welsh Government can come together to address this situation which is a problem for both governments? Well it's not helpful the fact that we haven't got any clarity in terms of how they've paid and how they've made that offer to doctors in England. Our finance teams have been pressing the finance teams in the UK Government to give us some clarity around that so that we can know whether there is going to be a consequential element to that funding which would come to Wales which may help us out. But if they can't give us any clarity for what they've already paid out then it's very difficult for us to make plans not just for this year but also clearly there's absolutely no clarity at all in terms of next year. So you know the system doesn't work well it certainly works to the disadvantage of our ability to plan and to make those offers that we may like to make if we knew that there was more money coming. Jess Payne. Thank you, good morning. I spoke to a lot of junior doctors yesterday and one thing that they kept mentioning was the pandemic and how they received a lot of applause and words of thanks but that those actions seem a little bit hollow. I don't know if you have any response to that. Well I think we're all incredibly grateful to the incredible work that they did during the pandemic but it's not just during the pandemic these people are on the front line day in, day out, week in, week out and I think if we can we should show our appreciation and it's not just through applause. We are in this very difficult situation. Five percent is the offer that everybody else in the NHS in Wales has been offered and that has been accepted by people on agenda for change. So you know we're not giving any lesser offer to junior doctors in Wales and five percent is not an insignificant offer either. Thank you. David Nicholson. Morning Minister. On the strike yesterday one of the Welsh BMA leaders talked about that it might be possible to resolve this without putting money up front. I perhaps jam promised for tomorrow when finances permit might be a way of resolving the dispute. Is that something you would be considering and as a brief supplementary will you be popping down to see the junior doctors at their demonstration outside the same today? Thanks very much. We've got to be really careful because the pressures on the NHS are so intense you aware that we have waiting lists that we're very keen to get through. We're open to any negotiations on this in particular those which don't require additional funding this financial year and possibly next financial year because of the financial limitations that we're under but we have committed to pay restoration over the longer term already so obviously we are more than happy to get into some of the detail of what that could look like going forward. I haven't been invited to go to the demonstration today but I'll see if my diary permits that. Thanks Minister and just briefly you talked about the reasons why you didn't put yourself in the ring for Welsh Labour leader this time around because of the pressures of the job as health minister. Does that mean once the new leader is elected you'll be standing down as health minister? Well that's very much out of my control that my hands that will be the decision for the next Labour leader in Wales. But you could resign couldn't you? I could thank you very much.