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 3 of 3.
“The challenge now is for services to be reconfigured so that all parts of Wales offer as many of those as possible. He makes an important point about resourcing. In the discussions that we've had with both health board and local authority partners, there's been a recognition that the regional integration fund, together with the Further Faster fund and others, are in the system and are capable of being deployed to support some of these initiatives. Many of them are actually cost neutral and others involve the reallocation of existing resource. What is new here, I think, is the recognition of most effective interventions and the readiness to reconfigure services to reflect those in all health board areas.”
“I thank the Member for those questions. Perhaps I might suggest that the point at which to assess the success of this initiative is after it's completed rather than before it starts. But, on the point that he puts specifically to me, this is an example of the approach that I've been advocating, as he knows, since I took on these responsibilities, which is to identify rapidly within the health and social care system those interventions that many parts of the system are already undertaking and that have had demonstrable success and making sure that those are identified and rapidly spread through the system. So, this is an example of that happening in action. Of the 10 things on the action list, most of them are already being taken forward in some parts of Wales.”
“The 50-day winter challenge identifies 10 best-practice initiatives to help people to stay well at home and leave hospital once clinical needs are met. It challenges both health and social care partners to target support on the 25 per cent of those patients with delayed discharges, putting plans in place to support them to return home.”
“An earlier stage of work resulted in upgrades to clinical spaces at the hospital. We've also awarded £4.2 million to the health board as part of the Re:fit Cymru programme to install new solar panels, improved heating systems and LED lighting at hospitals across Powys. Russell George asked me to confirm the position in relation to the north Powys health and well-being campus. The health board has confirmed that it still remains committed to the development of the campus in Newtown, and there are still discussions going on with my officials in relation to the strategic outline case for that. Subject to us approving that, the health board will then launch further conversations with local communities, as the Member would expect, on the next steps that would be needed to develop the outline business case.”
“Our ability to invest in public infrastructure, including the NHS estate, has been severely compromised by political decisions taken by the previous UK Governments, which had the effect of restricting the flow of capital funding to Wales and the Welsh NHS. The first budget by the new Labour Chancellor, Rachel Reeves, has signalled a welcome change in direction, with a marked increase in the availability of capital funding for Wales this year and next. Despite the constraints on our capital budgets, we've continued to invest in the NHS estate. Powys Teaching Health Board, for example, has just announced a programme of essential improvement works to replace windows, resurface roads and footpaths, and carry out repairs to the roof, for example, at Llandrindod Wells Memorial Hospital.”
“For example, each has appointed a retention lead to ensure that the principles and best practice in the NHS Wales national retention programme are applied in the best way to make sure that continuity of care is maintained. We're supporting initiatives that highlight and encourage health and care professionals to consider the unique opportunities that working in rural communities offer. We also embed rural placements in our education and training programmes, so the future NHS workforce can experience these and make informed choices about their careers. I was asked about the NHS estate, Dirprwy Lywydd. Overall, the Welsh capital budget is worth 8 per cent less in real terms in 2024-25 than when it was set in 2021.”
“Well, I wouldn't accept that characterisation. I will come on and touch on that in a moment. Health Education and Improvement Wales has developed a scheme to encourage dental trainees to work in rural dental practices, and the Welsh enhanced recruitment offer incentivises dental trainees to undertake their foundation year in practices in more locations. Now in its second year, it offers an additional £7,000 in salary, plus additional educational and well-being support. All available places were filled for the September 2024 intake. More broadly, health boards serving rural populations continue to work hard to meet the different workforce needs and to attract and retain staff.”
“The recruitment and retention of healthcare professionals can be harder in rural areas and is a key part of our strategy for improving access to NHS care, including dentistry. We're looking to identify and establish innovative opportunities to upskill and improve career pathways to make working in rural Wales more attractive still.”
“I want to use this opportunity, Dirprwy Lywydd, to share some examples, as I’ve been invited by Members, of how health boards are developing new ways of bringing healthcare closer to people in more rural areas. In north Wales, Betsi Cadwaladr health board has launched a mobile audiology service, to provide high-quality NHS care for some of its local communities. Powys Teaching Health Board, as we’ve heard, is using a mobile dental unit—and I’m pleased to hear that being welcomed—to provide NHS dentistry in underserved areas. A mobile dental unit in Hay-on-Wye is offering the same range of dental procedures as would be available in any high-street practice, from extractions to crowns and dentures.”
“The electronic prescription service is a major element of this portfolio, and a major change programme is being rolled out across Wales, practice by practice, community pharmacy by community pharmacy, including in rural Wales. At the beginning of October, the service was live in 13 GP practices and 51 community pharmacies. The pace of change will now begin to pick up quickly. Once it’s been deployed across Wales, the service will allow prescriptions to be transmitted swiftly between England and Wales, and the cross-border flow of prescriptions is important for many, especially those who live and use pharmacies in rural communities near and along the border. Once rolled out, it will mean, ultimately, that people will be able to nominate any pharmacy in Wales or England to dispense their prescription.”
“Last month, the Powys Teaching Health Board announced £1.7 million for new digital x-ray equipment, which will be installed in two phases: the first beginning this month in Ystradgynlais, Llandrindod Wells and Welshpool, and the second phase will begin in early January 2025. We have funded this, and the new equipment will produce faster, clearer images, helping to improve diagnostic testing for people in Powys, by reducing waiting times and providing quicker and more accurate results. We are also funding the digital medicines transformation portfolio, which will digitise all prescriptions across both primary and secondary care.”
“Diolch, Dirprwy Lywydd, and this is an important debate reflecting the importance of rural healthcare to communities all over Wales. And my vision, in response to the question that colleagues have asked, is that everyone should be able to access quality NHS care as close to home as possible, wherever they live in Wales. We continue to work with the NHS to move more care out of hospitals, which is in line with the approach set out in our long-term plan, 'A Healthier Wales'. This does include investing in digital, in equipment and in services, investing in our NHS workforce, especially attracting healthcare professionals into rural areas, and in our NHS estate as well, and providing strategic guidance to health boards to plan local services, and we’ve heard how important that is today. I’ll say something about each of these areas.”
“—funding decisions, and we are committed to the principle of providing more care closer to home. Dirprwy Lywydd, I'm grateful to you for allowing me to speak a little beyond my time. I would like to say that I'm grateful for the relationship we have with the GP profession in Wales, and we'll continue to work with GP representatives to ensure that Wales has a sustainable model for general medical services as part of a thriving primary care model into the future.”
“I know Members are concerned about the future of the GP workforce. We've increased the number of GP trainees—199 were recruited last year and we continue to provide financial incentives in the way that Jane Dodds was asking about to encourage GPs to work in areas where recruitment has traditionally been difficult. We are also reviewing the National Health Service (General Medical Services—Premises Costs) (Wales) Directions 2015 to support investment in GMS facilities across Wales, which will help improve the sustainability and safety of patients and staff in GP practices. Dirprwy Lywydd, we've made a choice to commit £1 billion over the course of this Senedd term to clear the backlog and reduce waiting times, which built up during the pandemic. By necessity, this means that a larger proportion of funding has gone to secondary care.”
“In response to the point that Julie Morgan made in the debate, I am aware of a report from Cardiff University, which looks at the distribution of funding and addresses the question of the Carr-Hill formula, which she rightly identifies as being the formula that provides most of the practice-level funding to GPs. Whilst I am not able to comment on the specific situation in Cardiff North, though I'm very happy to look into it, I'm also aware that there is a connection between that report and Deep End Cymru, to which Jenny Rathbone referred in her contribution, which has done very valuable work in helping us understand exactly that challenge of the pressures on practices serving particularly disadvantaged communities. And I'm glad that the Government has been able to contribute to the funding of that work.”
“This will further increase the support available to GPs via community resource teams, whilst helping people living with frailty. We've also targeted investment at increasing staffing in general practice to improve access for patients. An additional £4 million has been made available via health boards over the past three years to support practices to increase staffing resources. This funding enables GP practices to take on additional administrative and clinical staff. And we are continuing to invest in multidisciplinary teams to ensure that people can access a wider group of primary care health professionals, including practice nurses, physiotherapists and pharmacists.”
“Dirprwy Lywydd, part of making general practice sustainable is about allowing GPs to care for their patients more efficiently and relieving some of the pressure and demand they're experiencing, by working more collaboratively with other primary care services—a matter I discussed in my recent meeting with the Royal College of General Practitioners. In the last year, pharmacies have created additional capacity by delivering more than 600,000 consultations. Urgent primary care centres have been developed across Wales to help respond to demand and are now seeing more than 70,000 people a month. We've invested £5 million a year in allied health professionals and more than £8 million to increase the community nursing workforce at weekends.”
“Cafodd y contract unedig newydd a gyflwynwyd y llynedd ei ddatblygu i gydnabod bod meddygon teulu yn rhan o'r system ofal ehangach honno. Rhoddodd eglurder defnyddiol am ba wasanaethau y dylai pob meddygfa yng Nghymru eu darparu.”
“Mae ymgyrch BMA Cymru Achub ein Meddygfeydd a’r ddeiseb yn tynnu sylw at rai agweddau pryderus iawn o weithio yn y maes hwn heddiw. Rwyf am sicrhau meddygon teulu ein bod ni wedi clywed y negeseuon am y galw mawr a’r pwysau ar les staff, fel soniodd Jane Dodds. Rŷn ni wrthi’n cymryd camau i fynd i’r afael â’r materion hyn. Mae meddygfeydd Cymru yn gweld tua 1.5 miliwn o bobl bob mis, sydd yn nifer syfrdanol, ond efallai nad oedd angen i bob un o’r 1.5 miliwn hyn weld meddyg teulu. Gallen nhw gael eu gweld gan aelod arall o’r tîm gofal sylfaenol neu gan wasanaeth gofal sylfaenol arall. Fel Llywodraeth, rŷn ni wedi bod yn datblygu gwasanaethau gofal sylfaenol a chymunedol i’w gwneud hi’n haws i bobl gael y gofal cywir yn gyflymach gan y person cywir ar yr adeg gywir.”
“Diolch, Dirprwy Lywydd dros dro. Mae meddygaeth teulu yn darparu gofal ataliol hollbwysig, ac rwy’n hynod ddiolchgar i feddygon teulu a’u staff am weithio mor galed bob dydd. I lawer o bobl, fel rŷn ni wedi trafod yn y ddadl, y feddygfa yw eu cyswllt cyntaf a’u prif gyswllt gyda’r gwasanaeth iechyd, ac mae’n ddealladwy iawn felly fod deiseb sy’n mynegi pryder am ddyfodol meddygfeydd wedi denu cymaint o ddiddordeb. Rŷn ni i gyd eisiau sicrwydd y bydd ein meddyg teulu lleol yno bob amser i ddarparu’r gofal rŷn ni ei angen, ac rwyf i am fod yn glir ein bod yn credu y bydd meddygon teulu yn parhau i fod yn gwbl ganolog i ofal sylfaenol nawr ac yn y dyfodol, yn enwedig gan ein bod am symud mwy o ofal allan o’r ysbyty ac i gymunedau lleol.”
“We seek to publish data on a regular basis in relation to the performance of the health service and care services in Wales, and that data is available for Members to scrutinise, as it ought to be. It is often used as a basis for how I am challenged appropriately in this Senedd. I think that's in the interests of transparent public services and also improving our delivery of them. So, I very much welcome that.”
“Rwyf wedi ateb rhai o'r cwestiynau yna eisoes yn fy atebion i Sioned Williams. Gobeithio y bydd yr Aelod yn ffeindio'r atebion hynny o gymorth i'w gwestiynau fe. Mae data a rôl datblygiad digidol, wrth gwrs, yn y gwasanaeth iechyd yn flaenoriaeth i'r Llywodraeth hon. Mae'n rhedeg fel llinyn drwy bopeth rŷn ni'n ceisio ei wneud yn y gwasanaeth iechyd. Ond o ran yr amgylchiadau a godwyd yn yr ymchwiliad ddoe, sef testun y cwestiwn gwreiddiol, rwy'n gobeithio bod yr atebion rwyf eisoes wedi eu rhoi wedi bod yn ddigonol.”
“I think the Member will have heard the answer that I gave to Sioned Williams a moment ago. Whilst evidence is being given by the Welsh Government in the inquiry, I'm not sure it's particularly helpful for me to provide a commentary on that. Obviously, we're midway through quite an extensive inquiry, and the Member's question, actually, casts the timeline and the scope of that question very much broader. We have a mechanism for giving evidence and for that to be challenged as part of the inquiry. When the evidence is complete, when the inquiry has reached conclusions, there will a separate mechanism for this Senedd to satisfy itself that all relevant questions have been asked, and I think that's the appropriate context in which to reflect on the question that the Member asked.”
“And the critical thing now is not just to capture the data, but to be able to use that data meaningfully to improve the experience of workers from black, Asian and minority ethnic communities in our workforce.”
“And in his evidence, Professor Khaw pointed out that the purpose of the surveillance wasn't to provide a comprehensive capture of information, and he referred to the official statistics for that broader purpose. In relation to the point that the Member makes, which is a very important point, about the capturing of data around race and ethnicity in the health and care sector, I had a meeting this morning, actually, with Professor Anton Emmanuel, who has been head of strategy and implementation for the workforce race equality standard. And as part of the broader commitment that my department is making, as part of the 'Anti-racist Wales Action Plan', there is a clear commitment, and progress has been made to improve the data that is captured across the sector in relation to the ethnic origin of the workforce.”
“Well, in relation to the last point, I would, of course, remind the Member that the reason she is asking the question is because of the questioning of a Welsh official in relation to practice in Wales, the very kind of question that I’m sure she would welcome, as do we all. In relation to the points that the Member made in her question, I think it is important to say that in his evidence to the inquiry, Professor Fu-Meng Khaw from Public Health Wales was asked specifically about the form that was put in place to provide a rapid surveillance picture, in what was obviously a very quickly evolving pandemic. And she will know that the Office for National Statistics produced, separately, official statistics on mortality throughout the pandemic, based on an analysis of death certificates.”
“I’d like to extend my sympathies and condolences to the families of the health and social care workers who tragically lost their lives during the pandemic. Data in relation to deaths as a result of COVID-19 infection are gathered from a number of sources. The evidence heard by the COVID-19 public inquiry yesterday related to the completion of rapid surveillance documentation, which was one such source.”
“And I was able to visit the regional cataract centre at Nevill Hall Hospital, actually, within the health board area, which is developing a rapid surgery process to enable the most straightforward cataracts to be dealt with more quickly, and that will help to get to grips with some of the backlogs. I should say that we've had already the proposal from Aneurin Bevan about the use of the broader funding, and we will be working with all health boards on a weekly basis to understand the trajectory they are on for delivering the outcomes that they themselves have said they can deliver in response to that additional funding.”
“I thank the Member for that. I should say that the current forecast for the health board aligns with the minimum requirements in the accountability conditions around the funding of financial questions, and the board is making real progress against key elements of the de-escalation criteria as well. There've been some improvements in the urgent and emergency care performance, but, as her question implies, these are not yet consistent or sustained enough to deliver the de-escalation at this stage. I should say that even in advance of the budget last week in Westminster, the Member will know that we were able to make available additional funding to health boards, including her own local health board, in order to be able to tackle both the longest waiting times but also those for perhaps more routine surgery.”
“Because of the configuration of health services in Powys, it has perhaps more limited options for being able to address that than other health boards that have a wider range of services through geography. So, I think that's a particular consideration, but it's those sorts of things that will have been taken into account. And just to give him the assurance that in relation to engagement with the board, that happens very regularly at official level and also happens at a ministerial level.”
“Obviously, the board itself recognises that, clearly, and I've had discussions with the chair as part of the oversight relationship previously in place, which obviously has touched on the importance of making sure that we are able to put that plan back on track. The system is there in order to enable me to have assurance as Minister and the Government to have assurance that the support necessary to deliver better performance is in place. Clearly, as we've seen from the de-escalation today, the system is capable of delivering that outcome, which I think we should all be reassured about. It's inevitably the case, particularly in the context of escalation around financial matters, that the pressure of resource on the system clearly is a contributor to that.”
“And I should have said in my answer to Lee Waters's question that when Members see that review, they will see that a theme in it is about how we can strengthen boards to deliver the kind of scrutiny that Lee Waters also was seeking reassurance on in relation to it. On the question in relation to financial planning and the kinds of conversations and discussions that happen, the escalation in relation to Powys, as the Member acknowledges, is specifically in relation to financial and strategy planning, and that has been because the health board is not on track on its own plan to deliver the savings within the year. So, it's a plan that the board itself has said it will be able to deliver and it is not currently looking like that will be on target. So, that is the rationale, essentially.”
“I thank the Member for those questions. I think they're all fair questions to ask. On the first point in relation to the accountability review, that will be published very, very imminently, so I can reassure him very categorically about that—in the coming days, actually. Part of the reason for taking slightly longer than I think all of us had hoped was that we wanted to make sure that parts of the NHS are able to engage with the recommendations that the review makes, so that we could, in formulating our view as a Government, take full account of that. But I hope you'll be reassured by that.”
“I understand the Member's question to be implying the need to make sure that the recruitment of board members and the training of board members is at a sufficiently diverse level in terms of the range of experiences, including outside the health board, so that that challenge is both meaningful and constructive, and I would absolutely associate myself with that.”
“I think he is right to say that the system depends upon the ability of board members, and independent board members in particular, to provide critical challenge across the system and a well-functioning board, of course, will do that. I have a role in the appointment of individual independent board members. I attended, as it happens, a joint board meeting of the Hywel Dda health board and the Swansea Bay University Health Board a few weeks ago. As he will know, they're working on a regional relationship, which I absolutely wish to see succeeding. It's a result of ministerial direction to strengthen the ability to plan on a regional basis, and I was clear in the discussion I had with the boards just how important it is for board members to provide that level of critical challenge.”
“Well, I think it is important that health boards, in making the choices that often, inevitably, they have to make—and he's referring to one in his own constituency that I understand well, of course—do that in a way that commands public confidence and engages with the public and with representatives amongst them as part of that process. My understanding is that the chair of the health board did attend the meeting, the drop-in meeting, for the public to come along and challenge and ask questions in relation to that. If I'm correct in that, I think that is an appropriate thing to happen, because it provides that ability to challenge the organisation at its highest level, which I absolutely think is important.”
“So, I would associate myself with the points he is making about the importance of transparency, and I think publishing the framework in that way has enabled us to be open about the mechanism that we use. There is a body of advice that comes to me as Minister in reaching these decisions. He will understand that advice of that nature is a privilege in the usual way, but the critical thing is that it complies with that publicly available document, and I hope that he finds that helpful, as I hope that others do as well.”
“I thank the Member for those questions, which were, I think, in substance, more or less the same questions that Sam Rowlands asked, so I hope you will have found the answers I gave to Sam Rowlands equally useful to the questions that you have asked. I suppose, in specific terms, the escalation framework was, of course, as he acknowledges, published in January of this year, and the purpose of that, of course, is to provide the transparency about the levels of escalation and the mechanism for both escalation and de-escalation. It is important that that is transparently understood and that people understand in a predictable way what outcomes lead to what choices as part of that framework.”
“Therefore, there is a mixed responsibility: I'm responsible, in my role as a Minister, for the strategy, for the funding, for the direction and for the priorities, and there are others in the system tasked with the operation of the service on a day-to-day basis. I believe that we are all individually accountable and collectively accountable for the operation of the health service, and I think that is very, very well understood. I don't have the detail in front of me, I'm afraid, of the CAMHS waiting times in particular at Cwm Taf, but I would, of course, be very happy to write to him specifically in relation to that.”
“He asked me confirm what my responsibility is and what is operational. I'm not entirely sure where the confusion lies. I don't believe the health service feels there's any confusion in this space. It's my job to make sure that the health service delivers the best possible care and the best possible outcomes for people in Wales. I'm responsible within the Welsh Government for delivering on that outcome, but, naturally, day-to-day decisions about how funding is allocated at a health board level and how choices are made at a local level are, of course, matters that are, appropriately, not mine to take.”
“There is a mechanism in place, as I mentioned in passing in my statement, for periodic meetings of the tripartite system that we have, which enables judgments, then, to be made today. It is critical to the transparency of the process that we have a public framework for oversight and escalation, which was most recently published in January of this year and sets out very clearly the process by which the Welsh Government maintains oversight of NHS bodies and, as he asked me specifically, gains assurance across the system. It describes the escalation, the de-escalation and intervention process—the five levels of escalation and the six domains against which each health body will be assessed. That framework is public, it remains the framework and it operates in the way that I'm describing today.”
“I thank the Member for those questions. Just to clarify matters of fact first, there aren't 800,000 people on waiting lists in Wales; it is far too high at a little over 600,000, but just for the sake of accuracy, for the record, that is the situation. The figures haven't been escalating for seven months in a row; by my calculation, it's five months—again, five months too many, but I think, just for the sake of accuracy, it's important to set the record straight. It is important that there is a mechanism in place that is dependable and transparent in relation to oversight and escalation. I'm grateful to the Member for acknowledging the point I made at the end of my statement in relation to escalation being a mechanism to provide additional support and additional guidance, as well as expectations, rather than a form of punishment.”
“Escalation is not a form of punishment; it is the best way to support these NHS organisations to improve the quality of service and care that people receive in Wales from the health service in their local area and, ultimately, their outcomes.”
“Aneurin Bevan University Health Board remains at level 4 for finance, strategy and planning, and at level 3 for urgent and emergency care performance at the Grange University Hospital. Betsi Cadwaladr University Health Board remains at level 5—in special measures. We have agreed the de-escalation criteria it must meet to move to level 4, and today we have published the latest progress report on our website. Cardiff and Vale University Health Board remains at level 3 for finance, strategy and planning, and Hywel Dda University Health Board is at level 4. The escalation levels of all NHS organisations are published on the Welsh Government website. Dirprwy Lywydd, these decisions have not been taken lightly.”
“Dirprwy Lywydd, I turn now to Swansea Bay university and Powys teaching health boards, where we need to increase the level of support because of the growing financial deficits both organisations are reporting. Therefore, I have taken the decision to escalate both health boards to level 4, previously known as targeted intervention, for finance, strategy and planning. Swansea Bay University Health Board will also remain at level 4 for performance and outcomes and at level 3 for maternity and neonatal services. Despite progress being made in some areas, there are no changes to the escalation levels of the other NHS organisations at this stage. This means that all NHS trusts and strategic health authorities remain at level 1.”