 Mae'r dda i'r ddweud o'r ddweud o'r ddweud o'r ddweud o'r Minister yng Nghymru yw Llywodraeth Cymru, Llywodraeth Llywodraeth, Lord Morris of Aberavon. Lord Morris yw Llywodraeth Cymru yw Llywodraeth Cymru, Hal Dwyllian, Jim Callahan a Tony Blair. As former Welsh Secretary and Attorney-General, he became Wales's longest-serving MP, representing Aberavon for more than four decades. Lord Morris has been described as the grandfather of devolution and our thoughts are with his family at this sad time. I'd like to pass now over to Julie Morgan. Borydor. Good morning. Thanks to advances in medicine and public health, we're all living longer lives. This is something to celebrate, but it's also something that we as a society need to plan for. It's estimated that in less than 20 years there'll be nearly 150,000 more people aged 75 or older in Wales. That's about the same as the population of Newport. And a projected increase of 61.3% in people aged 85 or over. They're likely to require more care as they live for longer. We want everyone to live a healthy and independent life for as long as possible. But to achieve this, we need to transform the way we deliver social care. Shifting our focus to aging well, preventing health problems from escalating too quickly and reducing hospital stays. Staying too long in hospital can actually cause people's health to deteriorate. So we need to ensure that they can get the care they need at home or in the community. Health care is provided by local health boards and social care is provided by local authorities. But an individual's health and social care are closely related. So we need to continue to build on best practice of joined up working. Over the coming weeks, in the context of the cooperation agreement, we plan to set out a vision for social care in Wales for the next 20 years. But we need to start shifting the focus to community-based health and social care right now. And that is the purpose of our announcement today. Some of that work has already started. Thanks to our regional partnership boards, where representatives of health boards, local governments and the third sector, as well as other delivery bodies come together, there are many excellent examples across Wales of the NHS and social care working together. Last week, I visited South Pembrokeshire Community Hospital with the health minister and saw the excellent work going in their coordination, where health, social care and voluntary sector professionals worked together to decide on what care people needed at home, or when leaving or preparing to go into hospital. On site, they also have a reablement suite and a step down facility next door at Martello House, where people are supported to get back to living independently more quickly. The health board is also working on pilot schemes with therapists from local leisure centres and with firefighters to give them the extra skills to support frail people in their homes or communities. There are examples of this kind of innovation across Wales. Last winter, by working closely with our health and social care partners, we delivered an extra 670 community beds across Wales, so people could get care closer to home. But we need to go further faster, and today we are announcing up to £30 million of new investment to do that. The investment we are announcing today will be used to deliver thousands of extra hours of reablement services across Wales, providing as a safe alternative to hospital admission and to keep people at home, also people can recover at home more quickly after a stay in hospital. Recruit more community workers to advise people on how they can access the right support and services to help them recover and lead independent lives. Ensure every local authority has a technology enabled care responder service by winter 2024. Currently only 10 local authorities have this facility. Using the latest monitoring technology, this service will ensure people can get the health they need as quickly as possible and move towards 24-7 community nursing by increasing the availability of community nurses across Wales for an extra 10 hours a day on Saturdays and Sundays. Strengthen community specialist palliative care by making specialist nurses available overnight. Offering practical support for local services to collaborate and put in place an individual care plan for those people identified at most risk for urgent care. This will help to reduce hospital admissions. We want to see consistency across Wales in the standards of care frail people can expect to get in their community. Today's investment is the start of that, eventually leading to a community care service for Wales. I'll hand back to the minister. Last winter our health service faced unprecedented pressure. We all saw the pictures of ambulances waiting outside hospitals and health boards had to appeal for families and friends to take their loved ones home to free up beds. There's no sign of these pressures letting up in future. One of the biggest issues we had was that many people were ready to leave hospital but they didn't have the care packages when they got home in place so they were unable to leave blocking the flow in the hospital system. We managed to create an extra 670 community beds last winter without which the situation would have been much worse. Now we need to build on that good start and go further and faster in transforming community well-being, social care and healthcare services. Research has shown that people recover better in the comfort of their own home rather than in hospital where they're less likely to become decondition, lose muscle tone and less likely to pick up infections. We must focus on transforming the way we provide care to enable this. We need to move the focus from teaching short term episodes of ill health to meeting the needs of more frail and elderly people with multiple health conditions so everybody can live their best life in their communities. I've told health boards that addressing the issue of delayed transfers of care needs to be their number one priority because without improving the flow through hospitals almost all other aspects of healthcare including waiting lists will be impacted. The additional funding we're announcing today will help them to meet that challenge. Now I'm happy to take some questions as Julie will be. Diolch yn fawr. First question is from Telaid i Glyn John BBC Wales. Diolch yn fawr iawn, gwynyddiwg. This question is for you and if you could answer Engymraeg in Welsh and in English we'd appreciate it. Fallen Wiley the head of the RCN has told BBC Wales in an interview that you've got her number and that they'd be willing to pause this strike action immediately if there was a commitment to meaningful talks. So you could stop this strike action at very short notice. Why won't you? We've been having meaningful talks for months upon months upon months and we were really pleased that unions collectively came to a decision to accept the offer that we put on the table. There are still lots of non-pay issues that we need to address but I'm afraid we are at the point now where there is no more money and any additional money would compromise the kind of services that we're able to offer the public. So it is disappointing that the RCN has decided to take this action today. We are of course always open to discussion and we have been discussing. There was a discussion only yesterday with the RCN so those discussions will continue. We are very anxious to see the end to these strikes and we're very pleased that almost all other unions have now decided to accept the offer and have pulled off their strike action. Yn ni'n siomedig bod y RCN wedi penderfynu i gymryd y safbwynt yma ac wedi mynd arstraeg heddiw, un i wedi dod i sefyllfa'r lle mae pob un o'r yn debyg iechyd wedi penderfynu fel colegdi, fi dderbyn y caneg yn iddo i ar y bwrth. Un i wedi bod yn trafod gyda'r RCN am fisoedd lawr oedd hyd yn ôl ddau ond i'n dal i drafod gyda nhw. Mae arnau ofyn bod naddwym arian ar ôl ac byddai unrhyw arian ychwaneg o'n golygu tori ar y gwasanaethau sydd ar gael ar gyfer y cahoedd, felly un i'n barod iawn i barhau gyda trafodaethau ond yn anffodus os mae'n ymwneud gyda arian ychwaneg o wedi ma hwnna ym mynd i fod yn anod. Diolch. Richard Miclwright, y fformer independent board member of the Betsi Cadwaladr health board, has described the way they were forced to resign by you as tantamount to bullying. What's your response to that? Well, I would say that the definition of bullying has changed quite a lot. I never met him as a member of the board before and to read out a legally approved statement to somebody that I've never met before. I'm not sure how that would tantamount add to sound like bullying, but listen, we took the action we did. We are in the process of making sure that we can turn around the Betsi Cadwaladr board. That's the most important thing for the people who live and work in Betsi Cadwaladr health board, and that's what we're determined to do. Dwi ddim yn derbyn bod bullio wedi digwydd i rioed wedi cwrdd a ddyn yma ag nes i ddarlen allan cyhoeddiad o ddweud i cael ei derbyn yn gyfreithio ac wedi cael ei cechion gyfreithio, felly dwi ddim yn derbyn bod bullio wedi digwydd. Nid i'n benderfynon Llywodraeth Cymru i droi os fel ymbwrdd iachid Betsi Cadwaladr y Gwmpas, erlith y bobl sy'n gweithio yn ymbwrdd a hefyd erlith y clefion sy'n byw yn yr adau. So, Ian Lang, ITV Wells. Yeah, with the nurse's strike, listening to what you were saying there, basically there's no more money, so it's basically going to be who blinks first, and this strike is going to go on and on. What do you say to that? Well, we've been in negotiations for months upon months upon months. We recognise that there is a lot of frustration amongst NHS workers, and that's why we have moved Heaven and Earth to try and find this additional funding. We've put not an ungenerous offer on the table when you consider the financial constraints that we're working in under at the moment. So, we've got a lot of sympathy for the position. Our problem is that we do not have more money. If we were given more money by the UK government, we might be in a different situation. That is not the position we're in at the moment, and we have gone a very long way, I think, to addressing the issue, which is why we're very pleased that, as a collective, the health unions have agreed to the payoff that we've put on the table. With Betsi Cadwaladr, I live in North Wales. There is considerable disquire amongst members of the general public about this situation. When are you going to sort it out? What I will tell you is that every single day, tens of thousands of people get an excellent service in the Betsi Cadwaladr health board. I receive emails on a daily basis from people telling me what a great service they've had. Of course, there are pockets that we need to focus on, and that's what the new board is doing. We have a new interim chief executive who is taking the situation very seriously. We've got experts in there who are helping to turn the situation around. There is an issue of culture that needs to be addressed in the health board. That's fundamental to turning it around. I'm confident that the new interim board is making and taking the steps that they need to take in order to make sure that we can offer the best possible service for the people of North Wales. Dan. Thank you, Minister. If I could also have this answer in English and Welsh, I appreciate that. You've said today that you're anxious to get these strikes coming to an end, but from conversations with the RCN that I've had today, I understand that you wrote to health boards asking them to look favourably on the mandate to be extended until August. Now, tell me when it comes to, well, just to add to that, obviously that means that the strike mandate would have ended by now. Do you not bear some responsibility for the strikes going ahead today? Look, we've tried to work with our trade union partners. You know, we work in social partnership here in Wales. I think we have a better relationship than they do with many trade unions across the United Kingdom, but of course we are disappointed that they have determined to take this stance today, which has disrupted a lot of patients who were hoping to have their problems seen today and tomorrow, so that has created a problem, of course. We are anxious to see an end to the strikes and we are disappointed that they have determined to take this industrial action, and I think it's probably worth reflecting on the fact that actually the vote by the RCN was very, very close, but we obviously understand the frustrations that they have, but the fact is we simply do not have any additional funding. Yn isiwm adeg iawn bod y RCN wedi Cymru'r camem yn yw wedi Cymru'r heddiw i Cymru'r action fel strike, mae gweddill ar yn debyg iachid wedi penderfynu i derbyn yr arian fydd yr RCN yn derbyn yr arian sydd wedi cael ei penderfynu, ond yn amlwg, i ni'n gobeithio, a dyma bod y werth tan yn elu bod y bleidlais yn agos iawn o ran pobl sy'n ei loddau o'r RCN, ond yn anffodus, mynd wedi penderfynu gymryd yr ymgyrch yma i lefel arall, felly ni'n siomedig ond yn ei dal, ac mae bod y rhywbeth o'r iawn bod rhaen i parhau analyse. Yn y gallu gwybod â'r ffordd, if you want to see the strike action come to an end, then why did you recommend that the mandate get extended? Well, the mandate was extended a while back, so obviously that hasn't been a recent decision, but that, I hope, shows that we are trying to bend over backwards, to try and a'r ysgolodau i'r cyfnodd a'r cyfnodd o'r RACN. Mae'r ysgolodau i'r cyfnodd yn gweithio yn gweithio. Rydyn ni'n nhw'n gweithio y rACN yn gweithio'r ffondi gyd, yn ymgyrchafol ar y cyflwyn o'r cyfrifyddydd yn ei ddweud yn y cyfrifyddydd, sy'n gweithio'n gweithio'n gweithio'n gweithio'n gweithio. Yn y cwestiynau, mae'r ddechrau'r ysgolodau a'r ysgolodau i'r dweud, Gallwch chi'n meddwl o'r awr o'r blaen ym cause a'r rhaid o'r staff? Gallwch chi'n meddwl, gallwch chi'n meddwl o'r straen ffordd nhw'n a'r straen syr? Yn enwedig mae'r sgwrs yn oed o arnau rhaid o rhaid o'r adrenffydd a'r wneud o'r staff hwnnw cogueilso yn y rodgylu ei wyl. Rwy'n gweithio ar gyfer cofnodol â'r w establishedion hwnnw. a we have the We Care Wales campaign, which is widely advertised, advertising the benefits and the enjoyment of working in social care, which obviously is a wonderful job to do. So we are spending a considerable amount of money advertising the jobs, providing training. We provide training for 500 people. This is an attempt to address the issue that we experienced in particular during the winter, when we couldn't get enough people to have packages of care at home, couldn't give people the support in the community, and people were stuck in a hospital where, of course, they shouldn't be. Back on strike, throughout the entire strike they've been telling us that staffing levels have been a big concern for them, some nurses telling me that in intensive care units they're a third of what they really should be for safe levels of practice. How can you ensure that within these new social care measures that that staffing level will be appropriate and best to deliver the best care? So I'll start if that's okay. So we are training more nurses than we've ever trained before. We are recruiting more nurses from overseas, so we're making every effort. But this is a worldwide issue. There are challenges across the globe in terms of getting enough nurses. We are working with our trade union colleagues to see what more we can do in relation to retention, but also to see if we can divert nurses from working for agencies so that they work directly for the NHS in future. On the social care side of things, I'd like to ask Julie to contribute. Well, as I've already said, we're making big efforts to attract social care workers, and it certainly is a career that people are interested in. We've paid the real living wage now to all social care workers, putting £70 million this year to raise the amount of money that social care workers receive. And through the social care fair work forum, we're looking at the terms and conditions of social care workers because our ambition is to professionalise the service and ensure that we have people there working in social care who are working on parity to the NHS system. For you, Health Minister, I spoke to Helen Wiley yesterday and she said in terms of negotiations there have been times where she has contacted you to sort out negotiations and she's heard nothing back from you. Is this true as there has been somewhat of a breakdown in communication? And if not, what states are the negotiations in at the moment? So, my officials meet almost on a daily basis with the RCN. So, my officials, that's the route for the negotiations to happen. And at the end of the process, then I become involved. So, if there is no more money that we can offer, which is the request, then obviously that creates a problem. And the negotiations, the discussions will continue with my officials. We're always willing to talk, but I'm afraid if it involves more money that is going to be extremely difficult. I can't tell you how pressurised the NHS budget is this financial year. We are contending with massive inflationary pressures. Without additional funding from the UK government. So, everything that we've been able to offer is having to come out from mainstream NHS budgets. And we do have to think, not just of the workers who obviously we rely on completely for the NHS, but we've also got to think about the patients and their needs and the decisions, the very difficult decisions we're going to have to make very soon in terms of how we bridge this funding gap that has been created as a result of inflation. Will. Hi. This to the health minister, please. How much of the issues in the health service do you think are down to underfunding by the UK government? Well, what's worth looking at is how there was an increase in funding under the previous Labour government. Huge increases that got us up to about the European average. Since about 2010, if you compare how much additional funding has gone in in the United Kingdom, compared, for example, to Germany, the difference is striking. And let's not forget that during that time we've had a COVID pandemic. So there were a couple of years where we had additional funding for COVID, but we've gone right back to austerity measures now. That is not a sustainable situation when you've got an ageing population, where you've got technological advances and new medicines that are very costly. All of that is difficult. We obviously would like to see more money coming from the UK government, but we already spend more than half of the Welsh budget on the NHS. OK, thank you. On Betsi, as you say, you're in the process of trying to sort the problems out at that health board, but it has been in special measures on and off for eight years now. I don't think it's a reasonable question for people in north Wales to ask when will they have a health service in north Wales, which is up to standards. Are we talking months, years, next cent of election? Well, I think we've got to be clear this is not going to be a short term fix. This is going to take a while. We need to make sure that the people who work for the health board understand the changes that need to be made. We do need to think about a new culture in the health board. We need to make sure that performance measures are improved. So our team here in Welsh Government are trying to hold the hands of the people who are responsible for delivering for the people of north Wales. That is the health board themselves. So we do not directly, as Welsh Government, provide health services. It is the health boards that deliver those services. So we've now put in, obviously, new independent members to change the way that the top of the organisation works. My understanding is that there's been a real change in terms of tone and relationships at the top of the organisation, but that now needs to filter through to the rest of the organisation. There's a lot of work to be done in Betsi Cadwaladr, and this is not going to be something that we're going to be able to turn around overnight. Jenny Sims. Hello. Thank you very much for letting me ask this question. In terms of patients being in hospital and ready to be discharged, and there are many, can you give us any idea of the numbers that might be because there are not places in the community to look after them? Thank you. Thanks. Well, part of the reason why we're making this announcement today is because we are very aware of the issue of delayed transfers of care. So we know that there are, on average, around 1,000 people who are ready to leave hospital but unable to because the support in the community is not available. This shift in resources of up to 30 million pounds to give that support, to shift that support into the community, not just to address the issue of what happens when people have been to hospital and need to be discharged, but also to prevent them from coming in in the first place. So we've been working with local authorities over several months to build up this proposition to make sure that we can get ahead of the problem, identify the people who are most likely to be hospitalised, that when you have very vulnerable people who are very frail, actually the last place they need to be is in hospital. So what we need to do is to provide that support in their own homes and this is a beginning of a shift, a significant shift that has been a long-term proposal of ours in the healthier Wales, which is our strategic plan and we hope that this now it's been something that lots of people have talked about for a long time. We're actually getting on with the job of shifting those resources to where we think they need to be. Jenny, have you got another question? Yes, as we've first read on the pay, may I ask about doctors and where is the Welsh Government currently talking with doctors near NHS? So we are in the middle of those pay discussions with doctors. Obviously we are very anxious to make sure that we try and avoid a situation where we have the kind of industrial action that they've seen in England. So those discussions will continue. There is an understanding that there's been a lot of frustration in particular with junior doctors and certainly when I gave my evidence to the pay review body that was something that I was very keen to emphasise that actually there does need to be a focus on junior doctors in particular. So we will continue with those negotiations and obviously we're very keen to avoid industrial action because every time we have industrial action there is an impact on patients. You will have seen that over months and months and months our waiting lists have been coming down in Wales while they've been going up in England. There was an exception to that and that was last month and I think that was partly as a result of the industrial action that was happening and so we're very keen to avoid industrial action in order to make sure that we can address that issue of the backlog. Thank you. Great and Tom Magner. Thank you minister and good morning also Deputy Minister. You said earlier on that health and social care is delivered by local authorities and health boards and unless I missed it and forgive me if I did you didn't mention the people who provide 96% of care widely acknowledged across Wales that unpaid carers they're reading this announcement as pushing the burden even more on to them in the home as they would see it out of sight, out of mind. Do you accept that your timing in this announcement is particularly unfortunate given they're in the middle of National Careers Week when the thing is visible and supported? Our viewers would say you believe the opposite. Winston, your thoughts. I think you probably had an invitation to our press launch on Thursday which is marking National Careers Week when I will be announcing and kickstarting the 9 million pounds that we've put into respite for carers. We'll be starting a short break scheme developed a lot through the voluntary sector and I think we all know the huge amount of debt of gratitude we owe to unpaid carers and as you say Tom they are the bedrock of the services provided. So we are putting in this 9 million pound. We've also put in considerable amount of other resources to unpaid carers. So I hope you recognise that we do really recognise what unpaid carers are doing. I think if I could put this respectfully unpaid carers that I've spoken to, the hundreds that I've spoken to thousands possibly over the years, they say they're tired of being faint and they want some actual assistance. Doesn't the fact that you're concentrating on discharge I appreciate you saying that people will recover better in the home but that marks the reality that the burden is again on unpaid carers and they may see the measures that your excuse for now is not enough frankly. Have you been interested in hearing what your thoughts are on that? Well certainly I've mentioned the 9 million pounds we're putting in for the respite carers. I'm sure you're also aware of the 4.5 million carers fund that we have set up which is there available to any carer to apply for and we've had thousands have benefited from it and we have in that way identified many people who'd never even thought themselves as carers before so that is proving very effective and of course we were able to give the £500 extra to those people who are in receipt of carers allowance. So I think along with the money that we give to the third sector to support unpaid carers I think we have got a package there for unpaid carers that is very important in supporting them but we also give £1 million to the health boards to specifically work with carers on the discharge of their loved ones from hospital. So I think we recognise all the different areas that need help. Of course it would be great to do a lot more and we'd like to do a lot more but I think we do recognise carers and there has been certainly a significant development in the amount of health and recognition they've had. Diolch yn fawr iawn i chi'n gyd.