Jeremy Miles
Welsh Labour and Co-operative Party · Wales
“I think the Member is right to point out that there are challenges in recruitment, and that can affect certain disciplines within oncology. I think it’s a challenge that other parts of the UK also share. The Member shares statistics and numbers with us today that suggest this is a pattern not exclusive to Wales.”
“Byddwn i’n argymell iddo fe edrych ar y gwaith mae canolfan genomig Cymru yn ei wneud yn y maes hwn, yn aml yn gweithio ym maes canser—maes canser yr ysgyfaint yn ddiweddar; gwaith blaengar iawn wedi bod yn digwydd fanna.”
“I thank the Member for that question. I was recently able myself to experience first-hand the audiology services available on the high street and understand just how important that can be.”
“Well, I agree with the Member's enthusiasm for the project. I've been myself to the buildings that are currently there to see the vision that the partners, together with the Welsh Government, have for this development.”
“Well, I am disappointed that the general medical services contract negotiations this year have concluded without a resolution obviously, and equally disappointed that the General Practitioners Committee Wales have decided to ballot their members on the offer made.”
“Dwi ddim yn gallu rhoi amserlen benodol i'r Aelod, ond y math o beth sy'n cael ei ystyried ar y cam yma yw'r elfen weithredol, yr elfen o ran ariannu ac elfennau ymarferol eraill. Felly, mae'r gwaith hwnnw yn mynd rhagddo ar hyn o bryd. O ran ffynonellau ariannu, mae amryw o ffynonellau sydd yn bosib ar gyfer hyn.”
The complete record
Every one of 145 lines we hold for Jeremy Miles, in date order, each linked to its source. Free to read, in full, without an account. Page 1 of 3.
“We've invested £12 million over that intervening period to help build GP practice capacity, with additional staff specifically to support that commitment, but I think it is fair to say that there's been quite substantial progress, but there is obviously more to do, and I would want to see all practices meeting that 100 per cent commitment.”
“We are told by practices on a self-referred basis that 97 per cent are meeting that requirement to provide a blended model of access with a mix of remote, face-to-face, urgent, on-the-day and pre-bookable appointments, to make access as flexible as possible. But she will know, as I know from my own constituency mailbag, that there are practices that aren't living up to that full expectation, and they should be. So, if she could let me know, I'd be very grateful. In addition to that, we have sought to support practices to meet that aim.”
“Well, I thank the Member for the work that she has been doing in her community in relation to this really important matter, and I'd be very, very happy both to visit a practice with her in her constituency and also, obviously, to receive the findings of the research that she has undertaken. I would say, and I should have said this to Buffy Williams earlier, that if you have particular surgeries where you are hearing that people are struggling with access, then please do let me know, because I'm keen to understand that, not least because in 2022 we revised the general medical services contract to include the access commitment, as the Member has acknowledged in her question, and that is designed to specifically address the 8 a.m. bottleneck, as she referred to it.”
“Ensuring good access to GP services across Wales is a priority for this Government. We have worked with the GP profession to introduce legislative changes that support access improvements, and investment though the additional capacity fund has helped practices take on more staff to deliver better services to their patients.”
“So, the allocation of the £50.4 million is aligned to the health boards who have the biggest backlogs of patients and the longest waits, and, of course, Powys residents are included within those figures.”
“Well, I don't mean there to be any confusion, so let me try and spell it out. Of the £50 million, there is a £3 million fund, which is allocated between health boards in relation to children's neurodiversity waits. Powys will have a share of that, based on performance in relation to the numbers of people on the longest wait lists it has. The balance of the funding—[ Interruption .] I'm happy to answer the Member's question, if he's prepared to listen to it. The balance of the funding is issued to health boards as providers and recognising the longest waits within their footprint as providers. Powys doesn't have long waits for the services that they themselves provide.”
“Powys Teaching Local Health Board, as a provider, will receive their share of the additional £3 million to improve children's neurodiversity waits. The 164 Powys residents waiting over two years across Wales will benefit from the money given to the other health boards where they are currently waiting.”
“Dwi ddim yn gallu rhoi amserlen benodol i'r Aelod, ond y math o beth sy'n cael ei ystyried ar y cam yma yw'r elfen weithredol, yr elfen o ran ariannu ac elfennau ymarferol eraill. Felly, mae'r gwaith hwnnw yn mynd rhagddo ar hyn o bryd. O ran ffynonellau ariannu, mae amryw o ffynonellau sydd yn bosib ar gyfer hyn. Mae'r integration and rebalancing capital fund yn elfen bwysig o hyn, ond mae swyddogion Llywodraeth Cymru wedi cael trafodaethau calonogol gyda Chyngor Sir Ynys Môn a'r bwrdd iechyd ynglŷn â'r datblygiad hwn a'r potensial o edrych ar gronfa Transforming Towns hefyd, oherwydd mae elfen o adnewyddu yn dod yn sgil y math yma o ddatblygiad. Felly, does dim cynnig wedi cael ei dderbyn i'r gronfa honno eto, ond mae mwy nag un ffordd y gellid cyfrannu tuag at hwn.”
“Rwy'n ymwybodol iawn o gynigion ar gyfer canolfan iechyd a lles newydd yng Nghaergybi. Mae Llywodraeth Cymru nawr wedi cael cais am gyllid ar gyfer datblygu achos busnes.”
“Sometimes it’s about insourcing activity into secondary settings. But there is also an element of commissioning from the private sector, which we’ve had to do from time to time. A commitment that I give and that we give as a Government is that that will never be at the expense of the long-term sustainability and improvement in the public health service in Wales.”
“I thank the Member for that question. I was recently able myself to experience first-hand the audiology services available on the high street and understand just how important that can be. The funding that we have made available in recent weeks has been specifically in relation to plans by health boards to tackle the longest waits in their areas. I would need to write to the Member separately in relation to the specific allocation for audiology. I will say that, as you will have picked up from what I’ve said in the Chamber recently, as part of that broader mix of additional investment in the system, much of that will be around changed approaches within secondary care settings to deliver services in different ways—so, sometimes, high-volume clinics for low-complexity interventions.”
“I think it’s an exciting development, and, as I mentioned in brief earlier, it will provide a diagnostic capability as well as elective surgery, often in areas where we have some of the most challenging waits at the moment. So, I think it’s a step forward. It’s not a step forward in the immediate short term. So, the funding that we’ve provided over recent weeks—. Cwm Taf Morgannwg will, of course, be participating in that. And in addition to that, we’ve been able to provide support for the health board to deal with the consequences of the developments at the Princess of Wales Hospital, which is, actually, affecting the entire footprint of the health board, for reasons that I think will be obvious.”
“Certainly. The Member touches on the range of steps that we are taking as a Government to improve access to care and to speed up access to medical appointments and to treatments. Residents in her constituency, as in all parts of Wales, will benefit from that. She asks me specifically about the developments at the Llantrisant health park. There will be a meeting later on this week of all the partners to identify progress in relation in particular to the design plans for the project. But work needs to continue in relation to the operating model, which will need to be a regional model, as well as a workforce plan in order to support the development there.”
“'A Healthier Wales' sets out our vision for primary and secondary care services in Wales. We're working with NHS Wales to improve access to services in the Rhondda and the rest of Wales, in line with our plan.”
“I think the Member is right to point out that there are challenges in recruitment, and that can affect certain disciplines within oncology. I think it’s a challenge that other parts of the UK also share. The Member shares statistics and numbers with us today that suggest this is a pattern not exclusive to Wales. That isn’t good enough as an answer, but it is part of the important context. I think that the ability to attract staff in this area will be enriched and supported by developments in digital, by developments in genomics, by developments in research and innovation, which we know, across a range of disciplines, are able to attract practitioners. That’s why, actually, developments, and pursuing those as well, in parallel with recruitment strategies aimed specifically at the workforce, are part of the overall picture.”
“Byddwn i’n argymell iddo fe edrych ar y gwaith mae canolfan genomig Cymru yn ei wneud yn y maes hwn, yn aml yn gweithio ym maes canser—maes canser yr ysgyfaint yn ddiweddar; gwaith blaengar iawn wedi bod yn digwydd fanna. Ac mae cytundeb wedi ei gytuno’n ddiweddar gyda Illumina, cwmni biotech rhyngwladol, er mwyn gwneud mwy o waith, sydd ar flaen y gad, os hoffwch chi, yn rhyngwladol, a dyna’r union sgwrs roedden ni’n gallu ei chael gyda nhw. Roedden nhw’n gweld manteision mawr i weithio gyda Chymru ym maes genomig, gan fod gyda ni un system a bod gyda ni boblogaeth cymharol fach. Felly, mae manteision, a, lle mae gennym ni fantais naturiol, rŷn ni wedi bod yn llwyddiannus, er enghraifft, yn genomig, yn symud ac yn gwneud cynnydd sylweddol iawn. Mae mwy i'w wneud, ac mae’r cyfle yn sylweddol iawn.”
“Mae digideiddio yn rhan bwysig o sut rŷn ni’n gallu esblygu gwasanaethau iechyd i gymryd mantais o’r dechnoleg, ond hefyd i sicrhau gwasanaethau sydd yn effeithlon ac yn ddiogel. Felly, mae e’n flaenoriaeth i’r Llywodraeth. Mae gennym ni amryw o raglenni o fuddsoddiad mewn prosiectau digidol ym mhob rhan o’r gwasanaeth ac ym mhob rhan o Gymru, yn aml yn digwydd ar lefel genedlaethol, ac, o bryd i’w gilydd, yn digwydd ar lefel leol. Ac mae Sarah Murphy, fy nghyd-Weinidog i, yn gyfrifol am y maes polisi hwn. Byddwn i hefyd yn cymryd—. Mae’r Aelod yn gwneud pwynt pwysig am gymryd mantais o faint system, a maint cenedl, i allu gwneud cynnydd yn y maes yma.”
“Fe fyddwn i yn dweud, yn amryw o'r mathau o ganser y gwnaeth yr Aelod sôn amdanyn nhw yn ei gwestiwn, fod datblygiadau technolegol cyffrous yn digwydd yn rhyngwladol, yn cynnwys yma yng Nghymru, yn cynnwys gydag AI hefyd, a dŷn ni'n edrych ar sut y gallwn ni ddefnyddio'r rheini i allu sicrhau bod mwy o bobl yn cael triniaeth bwysig cyn gynted ag sy'n bosib.”
“Wel, mae gwasanaethau canser wrth gwrs yn flaenoriaeth i'r Llywodraeth. Roedden ni yn siomedig â'r ffigurau perfformiad, y rhai a gyhoeddwyd yr wythnos diwethaf. Fe welson ni ostyngiad o ychydig yn y perfformiad ar draws y system yn gyfangwbl. Mae'r darlun yn amrywio o le i le ac yn dibynnu ar y math o ganser. Roeddwn i'n gallu bod, er enghraifft, yr wythnos diwethaf mewn canolfan canser y fron a oedd wedi dwyn gwasanaethau at ei gilydd ac yn cyrraedd y nod o rhyw 79 y cant o bobl yn cael eu gweld o fewn y 62 diwrnod. Felly, mae enghreifftiau llwyddiannus yn y system hefyd, a beth dŷn ni eisiau ei weld, wrth gwrs, yw hynny yn ehangach ar draws y system.”
“Well, I'm sure both GPs and certainly I don't regard negotiating through the Member in the Chamber as the most effective way of addressing what are difficult circumstances; both parties would acknowledge that. All I will say is that we have had good and constructive discussions with general practitioners, in a challenging context. As I say, I'm disappointed that the step has been taken as it has, but I hope there'll be an opportunity to continue those discussions. And, as I say, I want to see staff in general practice get their pay uplift as soon as possible.”
“It is absolutely critical that we have high-quality primary care services that people can access close to home. It's a priority for this Government. I absolutely value the work that GPs and their teams do in providing these essential services, and I expect that we'll have an opportunity to continue those discussions with GPs over the coming weeks.”
“Well, I am disappointed that the general medical services contract negotiations this year have concluded without a resolution obviously, and equally disappointed that the General Practitioners Committee Wales have decided to ballot their members on the offer made. I want to see us in a position where hard-working staff in general practice are able to get their pay uplift as soon as possible, together with changes to the service that I think everyone recognises will have the effect of improving patient care, which is what we all want to see. The offer that we have made to BMA Cymru—and I've met with them myself, as I indicated to the Member a moment ago—meets the pay review body recommendation for GPs as well as practice staff and builds on investment over several years.”
“I'm absolutely aware of concerns raised, directly to me by the BMA and others, in relation to the impact of national insurance contributions, both on primary care providers—GPs and others—and social care providers. We are monitoring the situation in discussion with them to understand in full the implications, and, equally, having discussions with the Treasury through officials in my friend the Cabinet Secretary for finance's department. The UK Government has confirmed that the definition it will use for the support it will provide relates to public service employees only. We are not currently in a position to understand the full effects of that decision on the sectors, but we are in ongoing discussions.”
“The Member puts the point to me as though he has no responsibility for the situation that we are in. The UK Labour Government has had to make very, very, very difficult choices to clean up the mess his Government left—an appalling state in the public finances: £22 billion of mess that his Government left. So, the UK Labour Government has had to make difficult choices in order to do that. None of us want to see those choices being the kinds of things that have had to be taken, but I'm afraid that there is an absolute responsibility on that side of this Chamber for the circumstances that Sam Rowlands sets out. Decisions on national insurance contributions are, of course, as he acknowledged, made by the UK Government.”
“No, I can absolutely confirm to Altaf Hussain that the plan is both for diagnostics and surgical procedures, including orthopaedics, but other surgery as well, in that elective, green environment, and he'll know what I mean by that. I just want to acknowledge the point that he's made about the Royal College of Surgeons. There's a very persuasive argument that they have made, in particular in relation to orthopaedics, but in other surgical contexts as well. I've had an opportunity, not just to read that work, but to discuss that with them, and I am actually speaking at their conference later on this week, and I hope that will be an opportunity to engage further with them on the vision they share with us in this kind of development.”
“So, there's a piece of work in relation to design and construction, a piece of work in relation to modelling the funding implications of that, a piece of work in relation to the operating model that engages not just the health board, but neighbouring health boards as well. And then, finally, a workforce plan to support that development. I'm keen to see it progress. As well as being an exciting development on its own terms, I think it can be an exemplar for that way of working in other parts of the NHS in Wales.”
“That is absolutely critical to the success of the project, and I will want to take steps to make sure that that happens if they're needed. The business case is currently being developed. The health board is, I know, looking at best practice across the NHS and developing a clear workforce plan to support the project. The next step is that the health board and its regional partners are due to give a presentation and take questions at the infrastructure investment board meeting in the next few days. This I hope will be demonstrating progress and will set out the proposed funding requirements for the next phase of the scheme.”
“Well, I agree with the Member's enthusiasm for the project. I've been myself to the buildings that are currently there to see the vision that the partners, together with the Welsh Government, have for this development. It is a model of diagnostics and surgery that evidence both within the UK and internationally tell us can make a significant contribution to better outcomes by locating those facilities out of what's often regarded as the hot environment of an emergency hospital setting. So, in that sense, it's aimed at a transformation in regional planned care, and will clearly support the reduction in regional waiting lists. I have been clear that this does need to be a regional solution that supports both the footprint of the health board itself but also neighbouring areas.”
“Plans for the regional treatment hub are progressing. The hub will improve care and deliver accessible and safe services to thousands of patients annually across south-east Wales. A temporary diagnostic service has been delivered from the site since April 2024, which has had a significant impact on waiting times.”
“It's taken more than two years to bring it to this point because we've been following due process, which Members will obviously also acknowledge is not always quick and has involved extensive engagement with stakeholders, two public consultations, detailed and lengthy consideration of legal and policy points, in addition to the complexity of legal drafting, to create a unified regulatory framework for this mandatory scheme. I hope those comments help provide some further context, Dirprwy Lywydd, and I hope Members will feel able to support the regulations.”
“Work in relation to the regulations commenced in 2018, so well in advance of the point at which we left the European Union, but Members will be very, very keenly aware, I'm sure, of just the incredible burden of legislative work that that involved. So, whilst, obviously, that doesn't account for the entire period, I will just be clear that work was under way in 2018 and 2019 in relation to this important matter, but that was eclipsed by those urgent priorities that Members will appreciate. Since the beginning of 2022, when my officials were able to resume work on the legislation, they've worked continuously to bring it to the Senedd today.”
“Diolch, Dirprwy Lywydd. Can I thank Mike Hedges, in his capacity as the Chair of the Legislation, Justice and Constitution Committee, for acknowledging the context for the delay? I’m grateful to him also for the points he made in relation to the work of the civil service on this important matter. I obviously failed to persuade other Members in the Chamber about the reason for the delay, but I know that there will be lawyers all over the Welsh Government celebrating the points that the Member for Blaenau Gwent was making in support of adding to the legal capacity of the Government. The Counsel General I'm sure also will be pleased to hear that. I just wanted to make a few points clear on the question of timetabling.”
“Diolch, Dirprwy Lywydd. Dwi'n gwneud y cynigion a dwi eisiau diolch i'r Pwyllgor Deddfwriaeth, Cyfiawnder a'r Cyfansoddiad am ei waith yn craffu ar yr offerynnau statudol yma.”
“And the reason for that is, if the pool of people to which we require the ambulance service to respond most quickly has expanded as dramatically as it has, for reasons that, often, aren't about an increase in the number of people with life-threatening situations, then we have to test whether that remains appropriate, because the consequence of that could be that those with the most acute need are not getting the fastest possible response, and that's obviously what we want to see, and I know that's what the Member wishes to see as well.”
“On that patient's experience, I'm very sorry to hear that and it's obviously completely unacceptable. What I hope they will hear me say today is that we are taking action to make sure that the way we measure the performance of the ambulance service enables those in the most acute need to get the fastest response. And I've accepted the recommendations that the health committee have made in full, because I think it's important for us to have that thorough review of how we measure performance.”
“Because, naturally, if you're waiting as part of a pool of patients that is three times the size, then, if you're at the more acute end of that range of need, you're likely to be getting a less speedy response than if the target was more narrowly focused. So, that's why it needs to be a clinically led review. That's really what this is about: what are the clinical requirements of individuals and how can we make sure that we match the speed of response to the very most urgent needs.”
“Whether you'd say it was more or less modest is a matter of judgment, but it's about 90 per cent within 15 minutes. So, it's a very different approach. And so I think looking at different approaches in different parts of the UK and internationally is a really important aspect of this. At the heart of it, though, is making sure that those people who have the most life-threatening needs get the fastest response, and so I think it's absolutely right that we should look at a category that has trebled since the target, even in its current form, was introduced in 2015, and look to see what's going on there.”
“Well, the whole point of the statement today is to outline how we are looking at whether that target remains appropriate, and, if not, how best to make sure we improve performance. So, in a sense, the statement is the response to the Member's question. I do think it's important to say—. She describes the target as a 'modest' target; there are different approaches in different parts of the UK in relation to how ambulances are required to respond to the most immediately life-threatening situations for individuals. And she's absolutely right to say that we are talking about percentages and times, but, actually, this is about individuals needing support. There isn't really an equivalent in any part of the UK to the approach that we take in Wales, but you could say that the target over our border is—.”
“So, that suggests to me that there are initiatives happening in the emergency departments that are beginning to bear fruit, but the challenge then remains the context in the hospital overall when flow isn't working sufficiently well. Those initiatives at the emergency department level aren't able to respond to that larger challenge.”
“So, the role of this particular group will be to look at the target itself, but we will look at the work in the context of the Getting It Right First Time analysis that has been undertaken, and also the work of the performance group and other initiatives, to have that holistic picture about how we can improve flow through the system. I think it's also worth recognising that it was the busiest October for attendances at emergency departments generally, and, actually, the level of admissions to hospital was down on last year, indicating that people are being treated other than by being admitted to hospital, despite the very significant increase in demand at emergency.”
“I thank the Member for that question, and I was very interested to hear the discussion that she had with the ambulance service itself. I think that focus on remote management of patients' needs, an increasing role for clinicians in the control room and in that triage process, the greater roles for advanced paramedic practitioners as well—so, there are a range of interventions happening within the ambulance service. She's right to mention flow in hospitals as being a critical part of this, and absolutely right to say that we need to have a holistic view of what are often interconnected challenges in the health service.”
“I would say—he was inviting me to comment on the approach to reform in the ambulance service itself—I think we see good initiatives being undertaken by the ambulance service, recruiting new clinical navigators that enable us to provide more appropriate care to those people waiting for an ambulance. There has been funding to increase recruitment within the service specifically, so I think there is good practice in the ambulance service itself, but, as I think a number of the questions have been pointing towards, there are factors outside the control of the ambulance service that often are a considerable part of the challenge.”
“I just think that's an important part of the culture that we need to try to nurture. It is true to say that ambulance patient handover times are far too long. I'm not happy with that level of performance in the system. Reducing those delays is a key priority for the health service. It's set out clearly in our planning framework. As I mentioned earlier, we've published our new handover guidance. The NHS Wales Executive will monitor and audit compliance with that guidance throughout the course of the next year proactively to make sure it's being specifically followed, and, indeed, this comes on the top of the additional funding that we provided to the system this year in relation both to handover, but also to flow more generally.”
“And so the kind of initiative that he's talking about, and that's funded by funding that the Welsh Government has provided for the six goals programme, is a good example of that. And he will have heard me say, probably ad nauseam, in the time that I've become Cabinet Secretary for Health and Social Care, that I think there is good innovation and good practice happening in different health boards. The task is to universalise those, and, actually, what I would say is that that challenge is being grasped, in the sense of people understanding where good performance is in the system and trying new approaches. And I think it is incumbent on us to encourage that, but also to recognise that that won't always succeed, and to allow space for people to learn from where those initiatives aren't always successful.”
“I think what I would say on the point the Member makes in relation to bed space: I do think we have to, in the long-term lens that Members rightly encourage us to apply and which we see very much ourselves as the way of looking at reform in the health service—. I think if the solution to that continues to be the context of bed space, we will not fully be able to transform the service into the kind of service that we need in order to support people in the best way possible. So, actually, what we need to make sure—and his last question was I think aiming at this, really—is that the services aren't designed simply to draw people into hospital, and we need to make sure that more services can be accessed either in a primary setting, or very often in a community setting.”
“I thank the Member for his welcome for the review. The reason the statement focuses on the review rather than the range of issues that the Member covered in his questions is because that's what we are announcing today, and that is what responds to the point that the committee specifically asked us to take into account, so I hope that he understands and appreciates the context for that. I think the questions that the Member set out illustrates, I think, very well the interdependence of the system, and that, as I was saying in my last response to Sam Rowlands, this is one piece of a much larger landscape. And I think actually seeing the full picture is important.”
“So, the work of this group specifically will be looking at the targets, but the Member will know that other work that we have under way, whether it's the Getting It Right First Time programme or the work of the performance ministerial advisory group, will have a bearing on this. And there's the 50-day challenge that we have set for health boards and local authorities and which is being grasped by the system. All of those have different impacts on handover and on flow, and so I think this is one piece of a much larger jigsaw.”
“I think he's right to say that, obviously, a number of the pressures the ambulance service is under, as it relates to the timeliness, if you like, of its response, is the product of other pressures in the system, and he is right to say that far too many ambulance resources as it were, both in terms of time and vehicle resources and human resources, staff resources, are tied up in delayed handovers, and we absolutely recognise that that needs to be a focus. We've reissued the guidance in relation to hospital handovers. We've provided, I think, this year, £180 million of additional funding to improve handover and flow. We continue to report on the targets that we set for the service, which enables you to hold us and health boards to account.”
“And I don't think the Member was saying this, but I just want to be clear: we cannot have a debate about targets where any attempt to look at a target comes with an inference that the Government is seeking to avoid accountability. I mean, that way lies madness. The health service is hedged around with dozens of targets. There is not a shortage of targets in the system. But if we are to have an honest discussion about performance in the health and care systems, we have to apply that rigour to how we look at the priorities that we set and the targets against which we measure performance. So, I think it's really helpful in this setting to be able to have an open discussion about that, and I hope that that's what he was inviting me to do.”
“So, I think, when we look at a target that's based on 65 per cent of a pool that, when the target was set in 2015, was a third of the size it is today, it's pretty astonishing that the level of performance is as it is. Obviously it is not sufficient, but if you look at the broad context for it, that suggests there is a high level of performance against a very challenging context. But the task that I'm describing in the statement today is how we can make sure that the current approach, the current set of targets that we set, continue to be appropriate. I do want to say it's very important that this step is taken on the back of a specific recommendation from the committee.”