 Prydyn hwnnw, wrth gwrs. I'm Andrew Goodall, chief executive of NHS Wales. Since I last spoke to you in the summer, we've seen an increase in coronavirus cases across Wales. We are now beginning to see the impact of this on our NHS and care services. I want to update you about how the virus is affecting the NHS across Wales and individual services. Yesterday, Public Health Wales reported 764 new cases of coronavirus. In some health board areas, the levels of coronavirus are now higher than those we were seeing at the peak in April. This is because testing is more widely available. Very sadly, we are seeing an increase in the number of people dying from coronavirus. Every day this week, Public Health Wales has reported deaths. The Office for National Statistics yesterday said deaths involving coronavirus are at the highest level since the start of July. Behind every figure is a person and I want to pass on my personal condolences to all the families who have lost a loved one to coronavirus. We have four levels of escalation in the NHS which reflect pressures in the system. In July I was reporting that most of our sites were green or level one status. Today there are 12 hospitals reporting either levels three or four which show the increased pressure across the NHS as we balance emergency activity with rising numbers of people needing treatment for coronavirus. Today there are just over 700 COVID-related patients in Welsh hospitals. This is 49% more than last week. This is the highest number since late June. The number of confirmed coronavirus patients in Welsh hospitals is currently 326, 70% higher than two weeks ago. This is about half the number when we were at the peak in April, but I am concerned at the rising trend. The demand for beds for people with coronavirus will continue to increase in the days and weeks ahead. About 15% of our acute and community hospital beds are vacant, but some hospitals already have limited capacity in those parts of Wales where there are high levels of coronavirus. There are currently 25 people being treated in critical care for coronavirus. This has been stable over the last two weeks, but we expect to see this increase. Our normal critical care capacity of 152 beds is full mainly with people who do not have coronavirus. Health boards are already implementing plans to expand critical care, which will have a knock-on effect on other NHS services, including unfortunately planned surgery. We know a lot more about the spread of the virus than we did earlier in the year. We know that an increase in community cases leads to an increase in hospital admissions, an increase in critical care admissions and sadly an increase in deaths. Inevitably, as we see increasing numbers of hospital admissions, it will impact on the NHS's ability to maintain and deliver all aspects of service. A range of services will need to change to manage coronavirus. I will give you two examples of this. Around 10% of current 999 ambulance calls relate to COVID symptoms. It can take a paramedic up to six minutes to put on the necessary PPE they have to wear when responding to somebody with COVID symptoms. This has consequences for the speed of response to red 999 calls where time is of the essence. It also has an impact on ambulance response time performance. Each ambulance must be thoroughly cleaned between calls taking that vehicle off the road. The number of operations and procedures we can carry out is also affected by coronavirus. Every operating theatre must be safe for patients and staff, which means a wide range of preventative measures must be put in place. From enhanced infection control and decontamination between operations to PPE, which must be changed between patients. Even for the most routine of operations, the time needed for each surgery has increased by 50%, significantly reducing the number of operations which can take place. I want to give you some insight into how NHS activity has been affected by the pandemic. In March we took the decision to postpone planned operations and appointments to enable the NHS to respond to coronavirus while maintaining essential services including cancer, mental health and emergency services. Restarting the NHS is a complex process, especially when there is still so much we don't know about coronavirus. We continue to provide essential and emergency care. We have seen a gradual return to normal levels of activity in our emergency departments across Wales since June. The most recent operational data for September shows a small reduction in 999 calls and A&E attendances, which perhaps reflects the higher levels of coronavirus we are now seeing across Wales. We have seen the number of people referred into the NHS for cancer treatment recover to expected levels, but treatment activity levels are 10% lower than normal. Demand for mental health support reduced significantly at the start of the pandemic, but they are close to what we would expect now for this time of year. We are expecting that demand will increase for mental health services. We have seen the biggest impact on waiting times. The total waiting list has increased by around 10% over the last six months, but there has been a five-fold increase in people waiting more than 36 weeks because of the limited activity taking place. It will take time to address these waits, but we will do so using all means possible. About a third of outpatient consultations are taking place remotely by call or video consultation, and we have agreements in place to use independence sector capacity in Wales. As I said earlier, based on the current trends, I'm concerned about the impact of the current growth in coronaviruses on our NHS and care services and the speed at which it is spreading across Wales. The impact on our hospitals at the moment is similar to what we saw in March. 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 possible. We want to balance essential services alongside the delivery of planned and routine services which have been reintroduced over the summer, but the higher the level of coronavirus in the community, the more difficult this becomes. I anticipate that this winter will be more challenging than any I have known in my professional career. We have commissioned plans for an extra 5,000 beds. This is ten times the number of our usual winter plans. The flu vaccination programme is another important part of our winter protection plan. It's been extended this year to protect more health and care workers and members of the public. I would urge everyone to have a flu jab to protect themselves and others. Demand is likely to be high this season, and you will be called at the appropriate time for your risk group well ahead of the arrival of the flu virus to the UK. We have also introduced Covid-like zones or green zones in hospitals for emergency and planned admissions, and we are implementing enhanced infection control policies and practices, building on what we have learnt from the first wave earlier this year. This is a virus which is easily transmitted in hospitals and can be invisible if people do not have symptoms when they pass through our services. Unfortunately, where there are high levels of community transmission, it's highly likely we will see cases in hospitals and other care settings, despite taking all possible steps to prevent it. We are facing a difficult winter ahead of us. We have seen an extraordinary response from our NHS and care staff over these recent months. They have been busy right through with little respite. It is a lot to ask more of them, but I know they will continue to respond professionally and with care. It's important 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. Together, we will keep Wales safe. Thank you. I'm now going to move in the usual way to questions from journalists. Starting with Owen Clarke from the BBC. Yn amdad, Dr Goodall, can I ask you if the trajectory of spread of coronavirus in Wales continues as now? When do you expect to see the same level of patients in Welsh hospitals as we saw in the spring peak? Is it true that the pressure will be even more difficult now, given the commitment to maintain essential services? Are you genuinely worried about the impact this is having already on staff? I am concerned about the trend that we see at the moment. We are at half the peak of patients who we saw in hospital beds when we had the peak back in April at this stage. Obviously, Owen, we've learned about how we can respond to the virus and we are looking to ensure that we have appropriate plans in place. We have a different level of preparation than perhaps when we were at the first peak. We do have a responsibility to make sure that we are able to balance the care and treatment that patients need to access across Wales. It's really important to perhaps understand some of the scenarios that we're planning for at the moment. You may have seen Swansea University putting their own analysis in respect of some of the work we've been doing around scenarios in Wales. That says that if we don't put in mitigating actions from both the response from the NHS and also from the government, that we would expect to see a significant more number of deaths in Wales, possibly as many as over 6,000, that we could expect as many as 18,000 additional hospital admissions. So wherever we are at the moment, we need to ensure that we are able to respond to those kind of exceptional peaks at this stage. But on the trend that we have, I think we still have plans in place that will allow us to balance the care and treatment that we need to have over the next two or three weeks or so in particular. But if we see a doubling of capacity, as was the case back in March and April, it doesn't take much with the maths involved to work out that we could see a system that is under pressure. But at the moment, I think that there is a professional response that is ready and waiting, but we all need to work together. Owen, you mentioned about staff. I think we just need to again acknowledge the extraordinary efforts and contribution from our staff in the NHS and care system. I am worried, however, that whilst the virus itself had reduced during the summer months, for the NHS, of course, we've carried on with many of our routine activities and reintroduced care. And perhaps it's telling that in an area like critical care, which is full today, it has actually been full throughout the response at this stage. It has just switched its care between coronavirus patients and patients coming in for planned surgery. So maybe that just gives a little bit of insight into the way in which the NHS has carried on with its duties and responsibilities. Thank you for that. You talk about mitigating actions, and I know decisions about imposing any kind of restrictions are one for ministers. But in your professional opinion, would a so-called circuit break lockdown or measures help the NHS in any way? Does the data you look at suggest that could work? When we were preparing the NHS back in March and April, of course we wanted to ensure that the NHS was going to be in a position to respond to any of the peaks that we were expecting at that time. And as you know, the changes that we put in place really in matters of days were unprecedented at that time. I have the opportunity within any process that's under review by ministers to make sure that the pressures on the NHS are understood and they are considered. It is obviously a more rounded assessment of the way in which coronavirus affects all sorts of sectors and society in general in Wales. But our learning is that there is a need to try to keep ahead of the curve at this stage. So those will be, as you said, Owen, kept under review by ministers, by the First Minister and by the Cabinet, and there are assessments that are in place even during the course of this week. I think the most important thing is to make sure that if we are concerned about our ability to maintain care and services that as back in March and April we need to ensure that we are able to protect those on behalf of the population in Wales. And I'm sure we'll see some emerging decisions over the course of the forthcoming days. Thank you, Owen. Just to move on to Owen Phillips from ITV Wales. Can I continue with what Owen Clarke asked there in terms of pressures? If admissions continue to rise at the current rate, at what point would the NHS be unable to cope? Are we talking a couple of weeks or are we talking months? So, again, we all need to just keep an eye on the data that evolves. I'm obviously looking at this on a daily basis and able to make some judgments. It's clear that the system is already describing pressures, and whilst we have capacity available across Wales, you will see the impact of some individual health boards needing to make some decisions on behalf of their populations. So, as I said earlier, Owen, the fact that critical care is already needing to expand out into some of the additional clinical areas like the need to use theatres in some areas of Wales, inevitably has a knock-on effect where we see areas like across Cwntaf Morganog where some very exceptional decisions have had to be taken in order to protect patients and care within the hospital environment, inevitably that has a knock-on effect on the other routine activities. But at the same time, there are other areas of Wales with low community prevalence who are still able to get on with pressures. So, it's always very difficult to call when the moment is, but if I say that we are currently half the level we were at the peak and this virus in terms of some of the international experience can be seen to be doubling every couple of weeks or so, then it's quite possible without seeing some mitigating actions so that within the next month we would see the NHS in Wales under pressure. Having said that, do you remember that our level of preparation is very different from where we were back in March and April? We have commissioned 5,000 additional beds that can be provided, both in terms of NHS capacity, but also field hospitals. I have just this week mobilised the NHS in Wales to make sure that any plans or proposals for field hospitals could be used perhaps earlier than was expected given the current way in which this virus is developing. Can I ask, we have seen some COVID outbreaks within hospitals as well in several hospitals in Wales. What changes have you made in terms of policy in light of those outbreaks to protect staff and patients? Indeed. I mean, your emphasis on the protection of staff and patients is the key one in this and any actions being taken forward for any individual hospital need to reflect the seriousness of the situation here. The fact that these are visibly being described in the public domain is important. There has to be transparency about the pressures that are being experienced in these areas. As I said earlier, one of my concerns that is inevitably areas that have a very high level of community transmission is going to see some impact and implications for the way in which hospital services are provided. We have obviously learnt about the virus over recent months. We have used other experiences around outbreak management both in Wales and across the UK to ensure that we can put in extra actions. There is an action plan that we are able to bring in through the outbreak control teams where Public Health Wales have given the evidence base for the kind of actions that need to be introduced. Now, that is about stricter infection control mechanisms. As you will be aware, the NHS already has a very strong infection control process. We have to tighten the environment within the hospital environment particularly to make sure that social distancing is being maintained. That will be true across both staff and patients. We have to enhance our cleaning procedures and also it may lead to some suspension of services and hospital admissions. But we build on an experience over many years of dealing with infection control. But this is still a virus that surprises us in terms of its ability, particularly in closed settings, to find an ability to transmit across to other parts of hospital and healthcare environments. Diolch. Thank you, Owen. I am going to move next to Adam Hale from PEA. On the Dr Gozel, will a travel ban on people entering part of Wales, not lockdown currently, who are coming from areas of the UK with their own problems with COVID, have any effect on the ability of the Welsh NHS to operate? Well, as you know, any approach to how we would limit travel would be a consideration for ministers, Adam, and the First Minister has been clear on his views over these recent days and requests that have been made. We are very clear in Wales that as part of our management of concerns about high levels of community transmission, that we are putting in place local restrictions so that if a local area is put into those restrictions, people should not be travelling out of area other than when they have reasonable excuses. And I think that probably emphasises what the Welsh Government policy is on this, is looking to limit some of those travel arrangements. We know that when there is social interaction, that is where this virus is most likely to develop and it is trying to limit those opportunities and for people to think really carefully about the times that they do need to carry out some of those activities. The First Minister will continue to review that process alongside the Cabinet, and if there are mechanisms that need to be introduced in Wales, I'm sure that will be taken forward. From my perspective, I would welcome any actions that help us to have a control over the levels of community transmission and particularly help us to make sure that we are able to protect and support the NHS in Wales. Thank you. When did you first hear that a circuit break was being advised for Wales and the UK? Is that something that you want to see happen? We have professional advisers within Welsh Government and also across our system in Wales, including expertise in areas like public health Wales. The circuit breaker concept has been part of thinking over some time in terms of if there was a resurgence of the virus, how would actions take place? So it's not a new concept, but obviously over the last few days we have heard a lot more discussion about it in terms of whether these steps were necessary. Now, we would all hope that those types of extra steps would be not necessary to take at this stage. Again, I would revert to say that that will be part of the political process in Wales with Welsh Government through the First Minister and Cabinet needing to consider the balance of evidence that's available. But certainly, as you'll be aware, there are a range of professional views that would both support that approach, but equally there are professional views that may feel that that is the wrong step to be taken. And I'm sure at the moment that the First Minister will be taking active consideration of this and I know that he'll be using the professional advisers that we have both in Welsh Government and out within our system more broadly. Okay, thank you. Adam, I'm going to move next to Mark Smith from Wales Online. Good afternoon, Mark. Good afternoon, Dr Grisall. First, would you be able to give us an update on the current testing turnaround times for NHS Wales staff? And have there been any problems in getting, particularly frontline staff, timely results to allow them back on the ward's treatment patients? There's a mixture of results that we work away through from some of the mass testing arrangements right through to how the public can have more rapid access in some of our outbreak areas. I'm going to be a bit limited about what I can probably speak to you about, but maybe we could pick that up outside on some of the numbers. But in terms of some areas of control that we have on the NHS side, for example, I do know that over the last week of over 8,000 tests that have been undertaken in hospitals, and that can relate to both patients and staff. About 82% of those were turned around within 24 hours or so. I also know that with some of the community and the mass testing that's taking place, again, that feeds into our figures, that I think over 75% of those have been turned around within 24 hours. But that would not give you a complete picture, so perhaps we can offline just provide you with some of that information. But it is actually published on a weekly basis, Mark. Okay, thank you very much indeed. And secondly then, based on many of the sobering statistics you've given us, coupled with the growing waiting lists and the ongoing pressure to continue with normal activity for as long as possible, do you believe this second wave is going to be more challenging for the NHS to manage on the first? Well, Mark, you've been at these press conferences and asked me questions before, and I know you and your colleagues will have asked earlier on this year whether I thought that there would be a second wave. And I think I was quite consistent in believing that unfortunately that was very likely to be the case, and certainly that has driven our planning from the NHS system on the things that we've learnt about and that we can do better on, but also on the level of capacity that we need to have available should it be needed. I think I've already said in my introduction that I think this is going to be the most personally challenging period that I would have seen in my own career, and I'm sure that that will be duplicated across all of our fantastic staff in the NHS and the care system. We will be focused on wanting to respond professionally and focusing on the needs of the Welsh population. I think there's a combination at the moment of things that we need to understand and work our way through. We know that the winter is in any case a very challenging period for all sorts of different reasons. We see different types of patients coming in, often driven by age and underlying health conditions, and we have to accommodate and respond to that. We clearly have the impact of coronavirus at whatever stage it is, but even if it is at a more residual level, inevitably it has some impact on our services. We also have to look at the upcoming flu season, and obviously we have an annual vaccination programme to protect the Welsh population as much as possible from that, and we don't know yet how difficult that will be in adding on to additional pressures. The good news is that there are some signs that perhaps the flu season elsewhere in the world maybe hasn't been as severe as was expected, but if you just think about the fact that we are all taking steps to adopt hand hygiene and socially distance, that actually affects the way in which flu would spread itself as well, so that's the focus of areas. Of course, from a planning perspective, we're also needing to respond as both government but also as the NHS in Wales and the care system to the end of the calendar year where obviously we will have EU exit arrangements that are in place as well. I think even as I look back over 30 years of working in the NHS in Wales, that's a bit of a mix of all sorts of different pressures that we need to work our way through but could provide quite a difficult context I think for this winter. Okay, moving next to Dan Bevan from LBC. Thank you, Doctor Goodall. Good afternoon. Going back to the topic of lockdowns, if you don't mind. What would happen to the NHS if there wasn't another form of national lockdown, whether that befire breaker, zircher breaker, as it's been known, or just another long-term solution as it currently stands? Well, if we see cases increasing as we've seen over the last two, three weeks or so, then clearly, as I said earlier, increased positive cases in a community will translate to a higher number of hospital admissions to critical care and will have other implications for the way in which we organise and manage our services. So this is not just speculating on what would happen. It's actually what we've learnt over the course of the last six months in particular. My reflection, Dan, would be that when we were working to ensure that the NHS in Wales wasn't overwhelmed, as much as we took some extraordinary decisions to put in measures that we'd never considered before, like the doubling of hospital capacity, for example, to make sure it would be available if needed. I've constantly emphasised over recent months the enormous impact that the population had by following the measures, the actions asked of them, and also the restrictions in place. So when we saw the peak happen in April, one of the reasons that peak didn't continue to increase was because the Welsh population worked with us. They supported the way in which we wanted to discharge our NHS and our care services. So it will be for the First Minister and Ministers to determine any additional steps required. Obviously local restrictions in Wales at the moment are there to have an impact and to make sure that we're able to mitigate and manage some of the current pressures. But I will await the outcome of that alongside other colleagues, but I do have an opportunity, as I've said, on my views on capacity within the NHS. They're actually part of that very balanced decision that I'm sure the First Minister will make. Thank you. And one of the purposes of the first national lockdown back in March was to prepare for the peak that we saw in April. Now, we've long known that there was likely to be a second peak during the winter. So as things stand, is the NHS in Wales ready for winter? And if not, why? Well, four weeks ago, the Minister for Health and Social Services launched the Winter Protection Plan and that is the framework for how we want to oversee and coordinate our services for the next six months. That involves our normal reflections of what we need to learn about the winter experiences that we have in the NHS and recognise that we have patients who are accessing services in many different settings. We often focus on hospital side of areas because it's very visible. The NHS has a responsibility to provide services during the winter in many different settings, particularly in primary and community settings as well. So I think from a preparation perspective, we can only use the scenarios that we have worked our way through. We can only put in the plans, but I would suggest that the scale of the capacity requirements that we're putting in to have available if needed during this winter, normally we would be putting in place around 500 additional hospital beds that are under pressure. The fact that that is 5,000 beds I hope would give the Welsh population some reassurance about the level of planning that's going in at this stage. But it's going to be very difficult, Dan, to continue to measure and monitor that because, as I said to Mark earlier, there are a combination of factors that are rather unusual for this winter period. But what I do know, as I said earlier, is our NHS and care staff will want to respond professionally to the needs of the Welsh population. I'm going to move to Amelia Shaw now from the Daily Post. Hi. We've heard members of the public say that the only reason cases are rising is due to the increase in testing and that for this reason lockdown measures aren't necessary and people won't adhere to them. What do you say to those people who are skeptical about the virus gaining momentum? As I said in my introduction, there is absolutely a factor in capacity available now which allows us to be clearer about how we manage outbreaks and the higher levels of community transition. So we are able to use the test-trace-protect mechanisms to ensure that we're in a position to coordinate the response that is necessary from stakeholders and agencies. So the increase in testing clearly helps us to have a broader understanding. But having said that, I think the translation that I've tried to outline here today of the way in which those community cases are hospital admissions and into critical care admissions and I have to say sadly into deaths and we have seen a higher number of reported deaths just over this last seven to ten days shows that there is a change I think about the way in which the NHS is having to respond to this. So my worry is in an area like critical care that whilst I said that the number of coronavirus patients have been stable over the last couple of weeks I personally feel that it's inevitable based on our experience before that we'll see those cases quite rapidly increase two to three weeks. So I would really ask the population to look at some of the description some of the numbers that we're sharing about the impact on the system and whilst I appreciate that there will still be concerns that this virus does not have the impact there is nothing different about this virus from when we experienced the peak in the first place it still remains as dangerous and can have a very serious and significant impact on those that are very affected by it and I think you only need to see some of the stories presented from some of our clinicians in Wales about the personal experiences that they've seen to really understand that. Thank you. Are the current measures that are in place in north Wales having an impact yet and are they going to be enough to avoid a circuit break or longer national lockdown? Well Amelia, I've already said to other colleagues this afternoon that clearly the process of deciding whether there will be anything different in Wales above local restrictions would be a decision that would be taken by the First Minister alongside the Cabinet and they will be actively reviewing, I'm sure whether there is a need for those types of measures. I've personally been impressed with the way in which organisations have come together in north Wales have been able to review and understand the data and to make decisions that were necessary and it was very telling that there was an opportunity that whilst north Wales measures were necessary but there was a shared discussion that took place with ministers and actually with local stakeholders to make recommendations on behalf of north Wales and that included obviously some separation of some areas of north Wales that did not have the highest level of community prevalence so I would hope that from a government perspective there will continue to be ongoing discussions but inevitably it all depends on the way in which the virus continues to develop and if the numbers increase then we have to make sure that we are able to head those levels of increases in order to make sure that we are able to provide good and safe care particularly from the NHS. Amelia, thank you very much and then a final question from Thomas Moody at the South Wales Argus. Good afternoon You mentioned earlier on about the backlog in routine operations and services are you concerned about the effects that this is going to have of these continuing to be pushed back? I am concerned I wanted to outline in my introduction about some of the impact of what the last number of months has meant I'm an operational manager by background so I absolutely understand the difficulties of trying to ensure that patients access the care and treatment that they require whether that's in a theatre environment with the clinical team or whether it's in an outpatient environment or indeed needing to access other services in primary care I think our focus over the recent number of months has always been pretty clear from a government perspective we've tried to describe that there are four areas of harm that we're trying to manage and respond to as part of the coronavirus response and that is translated into an operating framework that I've given to the NHS obviously to make sure that we're able to respond to those patients who have coronavirus and ensure the system is not overwhelmed the second is to ensure that there is an impact on other patients in our hospital settings and our broader system because of coronavirus itself the third is actually to make sure that we can respond to the harm that may be caused by those patients and individuals who can't access the normal range of services whether that's as an emergency or for some of our planned operations and the fourth harm is to make sure that we're able to consider the broader impacts and the longer term harm caused to health for example if we see difficulties around employment rates or difficulties around education so I think we've always had a very rounded approach we have actually made a progress on waiting times over the last five years and tried to ensure that that was a real focus of our actions that were in place in the NHS but in six months that progress has been taken away and as I described earlier I am personally concerned about the size of the waiting times and the waiting list and we clearly need to have a plan for what we do next but Thomas this will not just be about what we do over the next six months and during the winter this is actually going to have to be a much longer term response as in other areas of the UK in respect of NHS services about how we restore and allow patients to come back normally within our system but we have to continue to try to do that with a backdrop of COVID-19 Okay thank you and also I just wanted to ask about what the PPE situation was for NHS Wales staff and sort of how far through the winter are you prepared for at the moment I think our PPE supply chain is in a very good position at the moment clearly we have a responsibility to ensure that PPE is available to discharge a safe environment for our staff but of course to discharge safe care to our patients in all of our different settings and as you know we had changed our PPE distribution processes to make sure that this wasn't just about the NHS and our different sectors of the NHS but that we had extended that to the care sector also at this stage so we have provided around 370 million items of PPE to date about half of those actually in the social care sector we currently have about 181 million items in stock and we have over 300 million items on order but by the end of November and I was really pleased to receive this update in an NHS board meeting a couple of weeks ago we expect to have 24 weeks supply by the end of the month by the end of November which will give us a really good supply particularly on the critical items of support and if I can compare and contrast that with where we were earlier in this response we did actually find some other items getting down to just a few days' worth of supply so I think having 24 weeks really puts us in a very strong position for the winter and that was a key part of our winter protection plan that was announced by the Minister just a month ago okay thank you very much Thomas for that question that brings us to the end of today's session Jochun Barriang, thank you very much