National Assembly for Wales

Back to Search

Y Pwyllgor Deisebau

Petitions Committee

27/02/2018

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

David J Rowlands AM Cadeirydd y Pwyllgor
Committee Chair
Janet Finch-Saunders AM
Mike Hedges AM
Neil McEvoy AM
Rhun ap Iorwerth AM

Y rhai eraill a oedd yn bresennol

Others in Attendance

Ainsley Bladon Arweinydd Strategaeth Iechyd Meddwl, Llywodraeth Cymru
Mental Health Strategy Lead, Welsh Government
Dr Liz Davies Uwch Swyddog Meddygol, Llywodraeth Cymru
Senior Medical Officer, Welsh Government
Vaughan Gething AM Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol
Cabinet Secretary for Health and Social Services

Swyddogion Cynulliad Cenedlaethol Cymru a oedd yn bresennol

National Assembly for Wales Officials in Attendance

Graeme Francis Clerc
Clerk
Jonathan Baxter Ymchwilydd
Researcher
Kath Thomas Dirprwy Glerc
Deputy Clerk
Kayleigh Imperato Dirprwy Glerc
Deputy Clerk
Lisa Salkeld Cynghorydd Cyfreithiol
Legal Adviser

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Dechreuodd y cyfarfod am 09:17.

The meeting began at 09:17.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introduction, apologies, substitutions and declarations of interest

Good morning everybody and welcome to the Petitions Committee. I'll just make a note that you're welcome to speak in Welsh or English and you're probably well au fait with the equipment that's used for translation.

No apologies have been received and we can proceed to—.

2. Deisebau newydd
2. New petitions

There's only one new petition today and that's 'Save the trees and ground in Roath Mill and Roath Brook Gardens before it's too late'. The petition was submitted by Tamsin Davies, having collected 8,700 signatures. This, of course, is an ongoing matter and it refers to Natural Resources Wales. The background is that we've received an initial response from the chair of Natural Resources Wales on 24 January and the Minister for Environment on 2 February. We've all received briefing notes with regard to those letters and responses, which, of course, the committe will have had note of.

I'll declare an interest, because I've been campaigning on this and doing things like standing in front of trees and asking questions as well, really. I just wanted to touch on some of the things that we've been told. When NRW did their consultation, the figures were flawed—they were wrong, and that misled a lot of people. I just want to pick up on something as well here on page 23:

'Properties have been flooded by Roath Brook',

and it gives a number of dates. It's quite misleading, really, for anybody reading this material, because where this campaign focuses on in that particular area, there's never ever been a flood, and NRW know that. So, I think it's quite a poor show to try and mislead people, really, in my opinion.

09:20

I think their initial figures were that it had a 20 per cent chance of flooding this area, which has been revised down now to a 1.7 per cent chance of flooding, which is a huge change in its status.

Yes. The thing that really concerns me—. I went to a meeting with the Minister where residents were not allowed in—they were, I would say, treated in a very abrupt way and told that they weren't welcome; that was in December—and I was told there was no alternative. And having spoken to people who work in this area, I know there are alternatives, and one proposal could be to raise and lower the height of Roath park lake. I was told by officials that that would be highly damaging to the environment of the lake, but then I have other people, equally qualified in the area, who tell me that that's not the case.

So, I've got a number of questions, really, but I think in terms of progressing this matter, I really think we should write to Cardiff council and ask them questions, particularly with regard to Roath park lake, because I understand that there may or may not be a difference of opinion, really. This particular park—it's not just taking away trees; half the park will be ripped away, really. And I think it's an oasis in an urban area for wildlife, and it really, really should be protected. When you get it wrong, hold your hands up and just say, 'We're sorry', and move on. Because with the flood defences, the flood defence work already carried out, this area is well below. I think it's about 150 now, in terms of schemes that need doing in Wales. So, there are a lot more schemes around the country, for everybody sat around this table, that would benefit from the money that will possibly be spent, and I say very, very badly. So, there are alternatives, and I'd really like to write to Cardiff council.

I'd like to support you. As AMs—. And I am an ex-councillor myself, a member of a cabinet, but I am becoming really concerned, around our constituencies, at the disconnect when residents come out. Once upon a time, people power meant something. And I know, I've read it myself, even though it's not my own area, and I've read the outrage that people are—. At the end of day, someone has to stand up for these people and say, 'If you want this as it is, if you want what Neil is suggesting—.' Then we should, I think, try and support them. I do feel, sometimes, that the 'officials'—sorry—and officers within local authorities sometimes don't understand that these kinds of things mean such a lot to people and to their own quality of life. It's an outdoor thing, so we should be there for people.

I think what worries me a little about this is that the initial consultation, or the initial plan, was to take 41 trees out. That's now come down to 32 trees, I think—it's something like that—which makes you feel that the initial analysis couldn't have been that robust. So, I think they should come under scrutiny as far as that is concerned, unless, of course, they are now saying that the earlier works that have been done impact in some way upon the number of trees that have to come down. But it does throw up a lot of questions, I think, with regard to that.

And I think there are questions about the role of public consultation. How can you have a scheme that is quite clearly not supported by the bulk of the population in that area being progressed with, when there are schemes, for example, in Llangefni, in my constituency, and other parts, where people are desperate for money to be spent, and they're not able to progress? There's something there in the nature of the public consultation that—[Inaudible.]

Absolutely. I think the petitioner's made that particular point as well.

I think what Rhun has said makes it an all-Wales issue, because this is a park in Cardiff, but there's £0.5 million there, which could be spent much better elsewhere, including—I declare an interest—in Fairwater, in my ward in Cardiff West.

Okay. Well, the suggested possible action is that the committee could write to the NRW to ask for their response to the petitioner's proposal that the current risk of flooding should be recalculated following the completion of phase 1 and 2 work, for further details about the methodology of the options appraisal conducted during the design of the scheme and the results of that appraisal, and an update on the outcomes arising from recent discussions with the local community, which has not been made absolutely clear at this moment in time.

09:25

I'd like to write to the city and county of Cardiff engineers as well to get their opinion on the issue of the lake, because as far as I understand, it's a viable solution that would stop all this environmental destruction, and it has been dismissed. So, I really would like the professional view of the council, really.

Right, yes. I think, obviously, the other option open is that, having reached the 5,000 signatures mark, we could consider taking it to a Plenary debate. The only thing that I think we have to note with regard to that is that NRW is a body that is distinct from the Welsh Government itself, and therefore it would be just an exploratory thing with having a debate, rather than being able to influence the actual outcome of it through the Welsh Government.

Well, NRW, of course, are a wholly owned subsidiary of the Welsh Government. They would fold tomorrow if the Welsh Government didn't fund them, so they would have to listen to us—and if the Assembly didn't fund them. But can we find out first and then go along with asking Cardiff council and NRW? If we're not happy, we can still hold the fact that we may wish to have a Plenary debate. I don't think a Plenary debate is a complete waste of time because NRW rely on the Assembly to fund them. They're not a private company out there. They're a wholly owned subsidiary of the Welsh Government.

I would support that as well in terms of a future debate, certainly.

And if we could ask for an explanation in our communication with the NRW of how schemes are prioritised on an all-Wales basis and how they end up with an unpopular scheme being progressed with when there are other schemes that could get the support.

I think I've got the answer there, because they said that it's just one scheme done in three stages, so therefore it's not three schemes. But each piece of work is separate, so really it is three schemes.

3. Y wybodaeth ddiweddaraf am ddeisebau blaenorol
3. Updates to previous petitions

We move on to updates to previous petitions, and the first that we shall have a look at is 'Asbestos in Schools'. The petition was submitted by Cenric Clement-Evans and was first considered in December 2013, having collected 448 signatures. The background is the committee last considered the petition on 9 January and agreed to write to the Cabinet Secretary to ask the questions proposed by the petitioner, including over the consultation on revised asbestos management in schools, and guidance planned for early 2018, and that she ensures that all local authorities respond fully to the school condition survey.

Now, it says here that a response from the Cabinet Secretary was received on 6 February. The petitioner was informed but had not responded. But yesterday, I understand, the petitioner has responded, and therefore the suggestion is that we put this matter back—because you hadn't had notification of his response—to the next meeting. Are we in agreement there?

Yes. Can I just say, though, that at this stage it does worry me? This is an issue, again, for us all as AMs, because I know in my own constituency—. But it doesn't inspire confidence when it says that the Cabinet Secretary stated that responses to the annual school condition survey indicate that the vast majority of schools—that in itself tells you that we're talking about lots, a large number, here. It goes on that they have a management plan in place. I have parents now asking me: what is this management plan? Has their children's school got asbestos? Then it says here there are no current plans to share the data from this survey. You know, you have to have—. If there's a fear of causing panic, maybe, I don't know. But I as a parent would want to know if my child was going to a school with asbestos and how they were managing that. It was in my constituency where the Rev Tom Bonnet—his wife sadly passed away, and it was proven at the inquest that she'd been exposed to asbestos whilst working within the education environment. He's lost his wife, and I know there are lots of people who have anecdotal evidence of where they have real concerns, and I think that Welsh Government aren't taking it seriously enough, and I think it's down to us as AMs to press for that transparency and to press for proper management schemes to be in place and ones that can be scrutinised and challenged, because with budgets cut back in local authorities it's these kinds of things—and every life is important to someone.

09:30

I'm glad that Janet picked up on that because that was my question. I feel this is quite outrageous really. There's a report about something so fundamentally important and you have a Minister saying,

'At present I have no plans for my officials to share the data'.

That's outrageous. It's like a Westminster mandarin in London telling us, 'We're not going to share data with you.' The reason we have this Assembly here is for exposure and to look at issues like this that affect Wales, and I think we should really object to that. It's outrageous.

Are we suggesting that we take some action between now and the next meeting with regard to, say, writing to the Cabinet Minister and expressing our concerns that she's—?

We just ask her to release the data, you know, point blank.

Yes, absolutely. Data is an issue right across the work that we're dealing with with Government. Without data, we can't make judgments.

Fine, okay.

The next petition for consideration is 'No Further Actions on Nitrate Vulnerable Zones (NVZ) In Wales At All'. This petition was submitted by Nicola Savage and was first considered in January 2017, having collected 30 signatures—a total, actually, of 497 signatures.

The committee last considered the petition on 23 May 2017 and agreed to await the Welsh Government's chosen course of action following a public consultation on the implementation of the nitrates directive in Wales. On 30 December, the Cabinet Secretary for Energy, Planning and Rural Affairs issued a written statement. The clerking team wrote to the petitioner to share this, and she has provided a short response. The papers have been circulated to the committee with regard to that response. Does anybody have any comments to make with regard to this?

Once we satisfy the petitioner, I think it comes to an end, doesn't it?

That's right. The petitioner considers the decision of the Cabinet Secretary to be a fair decision, so I suggest that we close the petition.

Are we all happy with that? Yes.

The next petition is 'End the Exotic Pet Trade in Wales'. This was submitted by David Sedley and was first considered in March 2017, having collected 222 signatures. The committee last considered the petition on 9 January and agreed to await the views of the petitioner on the information provided before considering further action on the petition, and, once the Cabinet Secretary has considered the findings of the Scottish Government review of licensing and proposals for a new system and a new system in England, to consider whether we wish to take evidence on the issue. 

A response from the Cabinet Secretary for Energy, Planning and Rural Affairs was received on 6 February. The committee has also received correspondence from the Ornamental Aquatic Trade Association.

I will say that the Ornamental Aquatic Trade Association is very worried about the possibility of a blanket ban on exotic pets because this is a very, very large part of the pet trade industry, and they feel that it is well monitored and that it does not have an effect on the origins of the fish populations where they come from.

09:35

This was my industry previously, so I declare some kind of part interest, but I would say on this that an awful lot of people get pleasure from—. It's supposed to be therapeutic and everything, you see fish tanks in schools. It teaches children to be more compassionate and things, so I think if you were to have a blanket ban it would have a really profound effect on—.

Well, apparently the communities where these fish are captured—it is very much part of their economy and their livelihoods.

Well, absolutely. I can tell you now that I don't know of any business—I know certainly when I was heavily involved in this industry—. You simply cannot afford bad animal welfare with something like this. We're talking hundreds of thousands of pounds here, so it's in everyone's interests to ensure that, when you're importing or even going through an agent, there are strict animal welfare conditions and that they've got the appropriate water levels and the right consistencies of the water and that the pH is right. You know, it's quite a scientific, quite a technical industry. So, I don't think that we should be saying there should be a blanket ban.

Let's wait for the petitioner's response, but I would also say that I'd like to see a ban on primates. I'd also like to see a ban on animals that have to eat other live animals. There are a number that would come under the exotic pet area that have to eat live baby mice, or live mice, that are bred for the purpose. I think that those sorts of exotic pets have no place in Wales, but let's wait for the petitioner to respond.

And then any pets that are bought from captivity in any way. 

Yes. There's a sort of continuum here, and I think we really want to know where the Government are going to come in that continuum. I don't think many people believe that people should be able to keep live primates. I have a view on snakes as well, especially snakes that are potentially dangerous. But let's see where the Government come on this list, because one person's exotic pet is not necessarily defined as exotic by somebody else, and a number of people would not describe goldfish as exotic, for example. So, I think we need to know what the petitioner says and we need to know where the Government are going to come along this line.

As possible actions, the committee could await the views of the petitioner on the recent responses received from the Cabinet Secretary for Energy, Planning and Rural Affairs before considering further action on this petition. Are we happy to do that? Fine. 

The next petition is 'Protect the Razor Clams on Llanfairfechan Beach'. The petition was submitted by Vanessa L. Dye and was first considered in October 2017, having collected a total of 459 signatures. There's been quite some correspondence and action with regard to the Cabinet Secretary on this. The committee last considered the petition on 23 January and agreed to forward the petitioner's comments to the Cabinet Secretary for Energy, Planning and Rural Affairs and ask for further details of the research study and stock assessment survey. A response was received from the Cabinet Secretary for energy on 7 February.

I'd like to thank the committee thus far for having supported this petition that Vanessa sent in. Really, Mrs Dye is very representative of the massive numbers of people within Llanfairfechan who are really concerned about this. The work so far that this committee has done has helped, but we're not there yet. It is a bit disappointing also because, as I've said on more than one occasion, we have Bangor University—it's a shame they didn't win the tender, because we're talking about devolution and procurement. So, I would like, with your permission, to submit a question asking a little bit more about the tendering process, because it just seems madness to me that we're going out over to Shetland when I know myself that there are experts within the field in Bangor who are more than able to undertake this work. Anyway, that's by the by, but I'd like to know what timescales the Cabinet Secretary has—you know, how she is working towards the stock assessment method. When will that be known? And will the contract for that be put out to tender also?

And can we also go back to the Cabinet Secretary and ask her please to ensure that appropriate signage is put up? It's one thing putting a moratorium on, but it makes it very difficult to enforce if the signage is poor, and the signage is very poor. So, we want to keep those beds closed until this work's carried out, and the only way—

09:40

Is there anecdotal evidence to say that the ban is not working entirely?

Oh, people—on certain spring tides, they're still coming in, and then it becomes this mismatch of—. You can't have enforcement officers sitting waiting there all the time. Resources wouldn't allow that, but what does happen is that members of the public will say, 'Oi, you're not allowed on that', and that's when the trouble starts because those signs are not very good at all. So, we need it properly signed. If the signs are there, then you've got some control, haven't you, about how people go down there? And then of course it helps. We and the public can ask for enforcement from the Government fisheries department because there is a ban on it. So, one helps the other.

Well, the Cabinet Secretary confirmed that the fishery will remain closed until results of the stock assessment have been considered—

We are talking about a beach, a huge beach, that people can just go on. There's also the worry about the spawning season and things like that. So, we've come so far with this now, but we're not there yet, so I would ask that this petition is left open and that the questions are posed to the Cabinet Secretary and that we can have some assurances that the beds will stay closed but some better signage, please.

Fine. Is the committee agreed on that? Will we write to the Cabinet Secretary and ask her—. So the committee could await the conclusions of the research study and write to the Cabinet Secretary for an update on the stock assessment work in summer 2018. That's given the fact that the Marine Centre in Shetland—their report is due to be completed by 31 March, which gives, of course, the Cabinet Secretary plenty of time to analyse that data before—. Are we happy on that? Yes. Thank you.

The next petition is 'Petition to Protect our High Street'. This was submitted by Sally Stephenson and was first considered in February 2014, having collected 1,668 signatures. The committee last considered the petition on 6 February and agreed to give the petitioner further opportunity to comment before the next meeting on 27 February. No response has been received from the petitioner to date, so the possible actions are: the committee could close the petition in light of the Welsh Government's introduction of a permanent small business rates relief scheme from 1 April 2018 and the lack of a recent response from the petitioner.

I think it's more on the lack of a recent response from the petitioner, really. It's not up to us to decide whether the petitioner has been satisfied or not, but certainly we know that there's been no recent contact.

That's consistent with what we normally do. We give petitioners a couple of chances. If they don't respond, we take it that they don't wish to take it any further.

Exactly.

The next petition is 'School Buses for School Children'. This was submitted by Lynne Chick and was first considered in April 2017, having collected 1,239 signatures. The committee last considered the petition on 9 January and agreed to write to the Cabinet Secretary for Economy and Transport to ask him what policy work has been undertaken to explore whether it is possible to strengthen the current requirements so that children travelling to and from school on all buses should have a seat and a seatbelt and that all drivers should have relevant disclosure and barring service checks and all buses should be fit for purpose. The response from the Cabinet Secretary was received on 1 January, and the petitioner has provided further comments, which are included in the papers for the meeting today.

Does the committee have any comments with regard to this?

09:45

Yes. There is some clarity on what is devolved and what is not devolved. Perhaps it's a tad early to say we'd close the petition because there are elements that aren't devolved. We could, for example, write to the UK Department for Transport, just to perhaps seek information or clarity on any steps or investigations that are ongoing in relation to elements that have been raised by the petitioner on a UK level. Would that be useful?

Yes, I think that's fine. What they've asked for—dedicated transport, which falls under the purview of the Welsh Government—has actually been achieved. All dedicated buses must have seatbelts. All drivers of dedicated bus services must be DBS checked. So, it's already been achieved here. What I think is fundamentally wrong, and it doesn't fall under our remit, is that people can drive public buses without being DBS checked. I assumed that all drivers of buses were, because they can be left on a bus where it's just them and one vulnerable individual.

So, are we happy to write to the UK Cabinet Secretary? Okay. Thank you.

The next petition to consider is 'A call for the return of 24 hour Consultant led Obstetrics, Paediatrics and SCBU to Withybush DGH'. The petition was submitted by SWAT, Save Withybush Action Team, and was first considered in July 2017, having collected a total of 3,532 signatures. The committee last considered the petition on 17 October and agreed to write to the health board to request a response to the concerns raised by the petitioner and request details of how often dedicated ambulance vehicles are being used for the emergency transfer of women and children from Withybush to Glangwili hospital. A response was received from Hywel Dda university health board on 9 February. This includes a detailed summary of stillbirth data and a review by the Welsh Ambulance Services NHS Trust. The petitioner's provided further comments, which are included in the papers for the meeting.

I have to say that this is not my area. We're very lucky aren't we, Rhun, now that we've got a unit in our—well in my constituency, well, it's Darren's, really, isn't it? It serves my constituency and Rhun's. It must be very difficult to not have consultant-led care at the most important time. Anything can go wrong at any time. I know that thousands went out and objected and we managed to get the SuRNICC unit now. There's a lot of—

We're not altogether in the same place on that, Janet, but—. [Laughter.]

I just feel—. I like to see equality across Wales. I want mothers across Wales to feel safe when giving birth, because things can go wrong. The chances when you're travelling further—you literally are talking about life-and-death situations, and it's not just the child; it can be the parent as well, the mother. So, I'm all for—

What happened with the SuRNICC of course was that we upped the fight to keep services in Ysbyty Gwynedd and won that argument. So, absolutely, I'm with you there in wanting to make sure that people fighting for their services locally get their—to make sure that their voices are heard. Have we heard from the community health council? Do we have the community health council opinion gathered?

We haven't sought their views to date on this petition.

Perhaps we could. This isn't just a north Wales thing. This just reinforces my view that health boards covering huge areas is not a good idea. It works in urban areas where you can move services between Singleton and Morriston. There might be a bit of a moan, but no-one is going to complain too much. You can move them around Cardiff, you can move them around Gwent. People will have a moan, but you're much better off having each hospital either working with another hospital or on its own and having to work out what it can recruit. A lot of this is a recruitment problem. Rather than it being that it won't be funded, they've got a problem with recruitment.

09:50

And a failure to address and tackle the recruitment issue head-on, because what happened in Ysbyty Gwynedd's case was that we were told, 'We can't get the staff in Ysbyty Gwynedd. Therefore we are going to have to centralise the SuRNICC.' Turned up the pressure; they managed to recruit.

But if each hospital was looking for its own staff, there might be competition between the hospitals, but then you would find out whether there were people there or not. There's really very little we can do. We can write to the community health council asking for their views. This has been going on for some time now, hasn't it? And we could ask for a review of what's happened over the three years since it stopped. I think we can ask the health board to tell us what's happened over these three years, and we can ask the community health council for their comments and then come back to it. 

Just a question, really, about the data. It says that the health board has provided detailed data of the number of stillbirths across its area since 2015 and that these have been stable and 

'compare favourably with other UK Maternity units of comparable birth numbers.'

I just wondered whether or not we have those figures, really—that's the question.

The figures have been provided in a paper in the pack. The line about comparing favourably with other units—

—is a quote from the health board's correspondence.

From them. It would be good to see—. If they've got access to that data, again, it would be good to see that data.

Even redacted so it wouldn't say which hospitals they were or which areas they were but it could just give the number, so we'd see how that compared. 

Okay, I can ask the Research Service as to what data is available. If we can't get it through the Research Service, then we can write to the Welsh Government about that.

So, are we in agreement that we'll undertake further work on this issue, for example, by seeking further evidence from Healthcare Inspectorate Wales and, as Rhun has pointed out, the community health council and others?

Okay. We can move on to the next petition, which is 'Urgent Appeal for a Welsh Veterans Commissioner for the Health & Wellbeing of Wounded, Injured, Sick and Homeless veterans'. The petition was submitted by Nicola Hester and was first considered on 6 February 2018, having collected 50 signatures. The committee considered the petition for the first time on 6 February and agreed to await the views of the petitioner on the response from the Cabinet Secretary for Local Government and Public Services before considering further action on the petition. The petitioner has now provided further comments, which are included in the papers for the meeting.

Points for discussion: the petitioner has asked for further details about the armed forces expert group, and is seeking an update on the Cabinet Secretary's plans to meet with this group and the cross-party group on the armed forces and cadets during February. She has also requested an opportunity to discuss her experience with the Cabinet Secretary and the groups.

Do we have any comments before—

I think we can ask for both of those. I think it's unfortunate that the petition didn't stop at 'Welsh Veterans Commissioner'. I think I'd be much happier with it if it stopped there rather than saying it was going to deal with the health and well-being of wounded, injured, sick and homeless veterans, because veterans have lots of other problems that aren't those. I think I'd be happier if we had a veterans' commissioner dealing with all issues relating to veterans rather than narrowing it down, but that's just my view. But certainly on that point, we can go back to the Cabinet Secretary with the petitioner's requests.

Okay. So, the committee could write to the Cabinet Secretary for Local Government and Public Services for an update on the meetings planned for February—obviously, those have taken place—and for further details about the armed forces expert group and whether there will be an opportunity for the petitioner and others to contribute to discussions on this subject.

Right, that ends the petitions before us this morning. We could take a very short break, but I think if we could take the opportunity now to look at the questions for the Cabinet Secretary and to—

We can suspend for a short break.

Gohiriwyd y cyfarfod rhwng 09:54 a 10:04.

The meeting adjourned between 09:54 and 10:04.

10:00
4. Sesiwn Dystiolaeth - P-05-736 Gwneud gwasanaethau iechyd meddwl yn fwy hygyrch
4. Evidence Session - P-05-736 To Make Mental Health Services More Accessible

Good morning, Cabinet Secretary. Bore da. Can I invite you, in the first instance, to introduce your officials for the record?

If you could introduce yourselves, please.

I'm Liz Davies, the lead for mental health and vulnerable groups.

I'm Ainsley Bladon. I'm mental health strategy lead.

Okay, lovely, thank you. Just for your information, Cabinet Minister, the committee has been considering this petition since February 2017 and has previously considered several items of correspondence from you and others. Given that the committee has received several recent petitions relating to mental health services, Members agreed to hold an evidence session with the petitioner and Hafal, which took place on 21 November. Subsequently, we agreed to invite you here today for a more detailed discussion about the support that is available to people experiencing mental health issues, including crisis support. 

That just gives you a background as to the procedure that we're pursuing. The first thing, can we ask—? The petitioner told the committee that services are unresponsive to people experiencing a mental health crisis. She experienced a long wait to see a mental health professional and there is little mental health support available generally outside office hours. Could you tell us what is being done to improve this situation?

10:05

Well, obviously, I want to start by recognising that the individual petitioner is recounting her experience and I'm obviously sorry that her experience has not been a positive one of seeking support at a time of crisis. And for each individual who goes through that particular experience, we'd want to try and learn from that.

We've actually invested more in crisis care in the mental health sector—it's part of our consistent and year-on-year increased investment in mental health, and there's a range of different things that we're investing in in crisis care. There's the crisis care work with the police on the concordat that we have with them, which has seen a significant improvement so that people aren't held in police custody. We also have a range of other measures.

But the difficulty for me is, in dealing with the individual circumstances of the petitioner, I don't know all of those individual circumstances—I can't comment on what has happened and what we want to see improved. But on the more general point, we recognise there's more work that we have done and want to do so we've invested, I think, £800,000 in improving crisis care. I expect more of the money we'll invest in mental health over the next budget round will also go into trying to improve crisis care as well, so there's no complacency from the Government or the health service's point of view, and indeed, this is part of what we talk about, not just with the police, but with partners in the third sector with the mental health alliance. So, it's a regular topic, both of conversation and continued commitment to look further at what we could do to improve on our current position.

Now we all understand that GPs currently act as the gateway to mental health support in primary care. The petitioner’s experience, unfortunately, suggests that the help for people experiencing a mental health crisis sometimes extends only to prescribing medication and signposting to other services. How do you feel that that response could be improved?

Most people do go through their general practice, whether it's the doctor or someone else in that local setting, to access most forms of healthcare, and we regularly talk about this. So, over 90 per cent of interactions are in local health care, but we spent lots of our money—and lots of our attention, actually, when we talk about the health service—on the hospital sector. It doesn't just have to be through the GP—it depends how that person has been engaged in the service.

If you go back to where we were a few years ago, when the Assembly introduced the Mental Health (Wales) Measure 2010—which had cross-party support, and it's important to recognise it; it wasn't simply my party wanting to do it, it had cross-party support at the time—and then the responsibility to take forward the Measure, some of that was about trying to improve access and to make sure that access was available on a more equitable basis. And we do report on what happens generally. Part of it was about the ability to re-refer in if someone's been a part of the service. So, it depends at which point someone's had an interaction with the service initially.

I understand from the petitioner herself that she had previously had interaction with the health service, so, again, I'd want to understand more clearly how she'd interacted with the health service previously and again why, in this instance, it didn't meet her needs when she was facing a point of crisis. I think the trouble is otherwise, and this is part of the difficulty without the specifics, that we're talking in real generalities, aren't we?

This is a critical part of the first interaction with the patient, isn't it, at the GP surgery?

Hang on. It depends who that person is. For example, when I was before the Children, Young People and Education Committee recently giving evidence on their perinatal mental health inquiry, lots of those people's first interaction isn't necessarily with the GP. So, they have interactions with the midwife and the health visitor as well. It depends on the circumstance of that person, who they are likely to see. But of course GPs are a regular part of this and it's part of the training that GPs have, it's part of what they recognise is a big issue for them.

When we were going through the Health, Social Care and Sport Committee's report on clusters, lots of the activities that clusters are looking to gear up to deal with are actually in the field of mental health, from both the lower level interaction, so before something gets to a point of crisis, but also what happens at a point of crisis, both within local healthcare and indeed with emergency services as well. So, there's quite a lot of activity to try and understand how we better support people and where they present, because lots of people report at a time of crisis in an emergency department. That's often the wrong place for them to be. It's not the environment for them to receive their care, so it is about how we get people to the right part of our system. That's about relying on the different parts of our healthcare system and helping people to do that, rather than expecting someone, at a point of crisis, to be able to navigate their way around the system themselves. So, it's about how, from a service point of view, we can make it easier for the public to understand and then how we help the public, if they interact with any part of our healthcare system, to get to the right point. 

10:10

Thank you. I think Janet wants to pick up a particular point with you there, Cabinet Secretary. 

Thank you. It's almost like, 'Can we start again?' You've referenced the petitioner, you know, by referencing to her. She's got 72 other people who've signed this petition as well, Cabinet Secretary. That's 72 other people who feel, in some way, that they had the need to sign the petition. So, can we take the emphasis off the petitioner and respect the fact that, when she's had this bad experience, she's still taken it upon herself to find a way in? So, I think out of respect to her for having got this petition, it shouldn't be looking at it as though—. Your comments, to me, suggested that it was just one individual, but there are 72 other people who signed that petition so it's collectively—it's them. Really, when I come to ask my questions, and you know from my questions to you in Plenary, this typifies a lot that's going on in our own constituencies. So, I sympathise very much with this petitioner, but I don't want to feel that she's under the spotlight herself, directly, having had a bad experience, when she'd had the guts to put a petition together and bring it. We might be familiar with how the political system works, but I think this should be a good experience for her, and she should not feel that she's being talked about in a way that it's just her, because as I say, 72 other people have have bothered to sign the petition. I just had to say that. 

Well, there's no lack of respect to the petitioner. I'm trying to be sensitive to the fact she's had—and I recognise the fact—that she's had a poor experience. That's her honest recount of what's happened with her. What I'm trying to get over, of course, is that when there's a question asked about her experience, to then say, 'Is this what's happening across the system?'—that's very difficult to do, to have the understanding of what's happened in her individual circumstance, to understand what's gone wrong and then how far does that spread across the system. I recognise that for all the improvements that we have made—and we have made real real improvements in crisis care and more generally in mental health care—there is still more to do.

So, there's no attempt to hide away from that, but in terms of what is a typical experience, well that's why we have a range of different measures and reports, but lots of them just go into what happens in, if you like, in the normal mental health service where people are referred in and we have waiting time standards. We're actually working with the third sector in trying to have some outcome measures to tell you not just about how rapidly someone is seen but, actually, the value of the intervention that is provided. That, I think, should be more meaningful. Rapid access often matters a great deal more in the field of mental health than in other fields. But, actually, we still want to know: is access to the treatment doing some good? That's why we're having that joint work with the third sector. So, it isn't just the Government saying for itself and the health service, 'Here's how we will decide what a good outcome looks like'; it really is working with people who represent those individuals, who speak with and for them, and those individuals themselves.

I think there's something here about understanding how do we try and improve a system by looking at one experience, but you need to understand how far is that experience typical. And even if it isn't a typical experience, there's still room for and grounds for improvement. And then, how do you understand that for that one person, if everybody else has a great experience, it's still a challenge for that person? That's what I'm trying to recognise, to both answer the questions and then how we move forward and act on it from Government, the health service and wider partners. 

As is normal in these evidence sessions, Cabinet Secretary, I'm going to bring in some of my other colleagues on the committee to ask specific questions of you, to perhaps delve a little deeper into these matters. Mike, can I ask you to—?

Certainly. Thank you, Chair. Apart from GPs, some people end up going either to A&E or via the ambulance service. Are you satisfied that the staff who are not mental health service specialists in those areas are sufficiently well trained to have a good understanding of the needs of people with mental health problems, and where they need to be sent or where they need to be referred to, rather than just taking them to A&E and then taking them into hospital because you've got to do something, rather than making sure they get the right referrals?

10:15

This is part of the general challenge that meets our service, because if you call for an emergency ambulance then paramedics have general skills and an understanding. This is part of the challenge also with GPs and others as well, so you need enough understanding of a range measures to understand how you either help that person directly, if that's you providing treatment or advice, or if you need to refer them on or signpost them on to a different service.

In this particular area, there's already work that's going on that's actually being taken forward by the emergency ambulance services committee, to look in particular at mental health and emergency services, and to understand how do you actually direct people to the most appropriate point of care, either from the time a call is made or the time a person arrived with that person, or if there's more of a crisis when they actually arrive at a unit. It's then about how do you get that person to the right point to actually deal with their care needs, because actually mental health is part of the reason why lots of people call the emergency ambulance service, either because they are in real crisis—but it's also part of the challenge of those people who don't really need an emergency ambulance but they still have often a form of mental health need.

That's part of the work that's been done quite successfully, actually, in Cardiff and Vale, but other parts of Wales are taking that on board to then say, 'Well, this person has a health need, but it isn't for an emergency ambulance.' How do we get around that person to provide that healthcare need, to help resolve it, rather than simply say, 'This person is ringing lots and lots of times and they're a nuisance'? So, it's about that proper level of understanding. I can't remember exactly when that work is due to conclude from the emergency ambulance services committee, but we are expecting an evaluation on that work, and for that work to be shared.

It's coming in the summer. I think there's quite a few things happening around the crisis care concordat side of things. There's a lot of places of safety now established across Wales so that people are assessed somewhere that's comfortable to them after being conveyed by police or ambulance. We've had a lot of developments in terms of innovation, so having mental health professionals within the crisis room in police crisis centres, so that they can advise and assist both people calling in in a crisis and also police officers themselves, to make sure that they're working with that individual appropriately.

So, there are actually quite a few innovative things that are coming up and there's a reduction in the use of emergency methods of transport. We've made investments in liaison psychiatry as well for out-of-hours support. So, there's quite a lot of work going on in the area of crisis care at the moment. We're in kind of an exciting place, really, where there are a lot of developments springing up across Wales to improve those services. 

One of the services, of course, is one-to-one talking therapies. A lot of people speak very highly of those, but I understand they're not offered to all individuals who request them or need them. Is there a reason why all individuals who request them or are deemed to need them don't get them? Is it a shortage of people and capacity in the system, or is it that although they think they need it or somebody else thinks they need it, someone higher up in the organisation doesn't think that it's necessarily beneficial? How important do you think talking therapies are?

Well, it's all about what's appropriate for that individual. That's the point. What is appropriate to help with that person's need? So, if somebody does need one-to-one talking therapy, we are actually investing more resource in that. You'll see further investment made in that part of mental health activity with this next budget round. I think the idea that if someone requests it—that isn't the same as saying that that is a definite need, but there's still then the responsibility to say, 'What is appropriate to meet this person's health and care needs?' It's about how you have that conversation with whoever that individual is, whether it's physical health or mental health, and actually agree on a way to actually try and resolve their healthcare needs.

So, I really don't think that there is any move or any drive within our health organisations to simply say, 'I don't want this person to have their healthcare needs met by someone further up the tree.' There is individual responsibility for clinicians, and often the managers we're talking about are registered professionals as well. So, this is about how we better meet the needs of people. That's why we've got more information being published on a regular basis about not just waiting times but that work I referred to earlier about the value of those interventions as well.

Just a comment from the petitioner, who's watching: she asks that you're sensitive to everyone's experience and not just hers. I'm wondering if one of you could tell the committee how long an individual has to wait to access a PTSD specialist—post traumatic stress disorder.

10:20

Talking therapies are a whole gamut of treatments. At the lighter end, there are the computer-delivered talking therapies, which sounds a bit strange, but they're very effective, especially for young people. We move through the whole gamut then of psychological therapies, right up to the very specialised treatments, and PTSD treatment is one of those very, very specialised treatments. At the moment, the wait for those is in the region of nine months, but we are, as Cab Sec knows, moving towards improving that with a more specific service.

So, I think the petitioner had to wait 18 months. I wondered: what are you doing to increase the supply of doctors in terms of recruitment to enable people to be seen more quickly?

Well, we've only just got the money invested. So, this year, for example, there are core psychiatry, not psychology, trainees as part of our 'Train. Work. Live.' additional investment, so an additional investment in those people to undertake their training. Part of the difficulty we face here is a UK-wide challenge, actually, in this area, where there are shortages. So, England, Scotland and Northern Ireland have similar challenges. We are investing more in those trainees to try and attract them to come to Wales and to stay in Wales, as well as investment choices we're making broadly about money, because we do recognise that we want to reduce the time that it takes to receive that intervention—and these are people that have been often through significant events in their life, with significant impacts upon them, and it's how we help them. So, again, it goes back to my earlier points: there's no complacency and we're not being blasé about where we are currently or about the need for improvement. There's a real need for improvement, and it isn't just about announcing money and then automatically the issue is resolved.

I will address the issue of the petitioner: why did she have to wait 18 months to see a specialist if the wait is nine months?

Whilst I have great empathy for this petitioner, who has obviously been through a very, very traumatic experience, it may be that her needs were so severe that she needed a very specific type of therapy. But during the course of her wait, she wouldn't have been abandoned. She would still have the support of her GP, the community mental health team—

What came up last time was that it can take 10 years to receive a diagnosis. I just wondered what you thought about that, really.

This gets really difficult, because you need to understand what's happened with that individual. It is not usual to wait 10 years to have the appropriate diagnosis for the condition, and it depends at what point people interact with the system, the knowledge and information provided at the time, and that isn't typical—

That of course depends on what's happened at the time—at the time that person presented to healthcare services, and what information has been available. It would not be acceptable to have someone who presents with all of their symptoms, and there is full knowledge and understanding, and yet there's somehow been a failure to diagnose. Actually, no healthcare professional sitting in front of you would say that that is entirely appropriate, because it sounds as if, from what you're suggesting, there's been a refusal to diagnose, rather than an inability to diagnose, and the two are different. It always depends on the information available. I would want to see faster access both to diagnosis and then support and ultimate treatment. That's what we're trying to achieve.

I'll just finish on diagnosis for the time being, because I think, really, what we're talking about is resource, and if you look at part of the regional constituency that I represent, when you are referred to see a doctor—some constituents felt they were going to be diagnosed, felt they were going to talk about diagnosis, but the doctors they were seeing in the mental health clinics were not actually qualified to give a diagnosis. I just wondered what you made of that, really.

Well, again, we'd need to understand the individual circumstances that people—

Let me respond to the point, because there's something here about being asked about—. We're here to talk about the petition that's been submitted, and to then get into individual instances where you think that a doctor isn't qualified, well, I'd need to understand who and what the doctor is—

Well, you referred to doctors that people are seeing—

The point I'm making is a general point about what is happening in my region, in that once you're referred to a clinic, for example the Pendine centre, which is a centre in South Wales Central, in your initial point of contact with a doctor, that doctor will not—. There will be a doctor, but they will not be qualified to give a diagnosis. They're being supervised by just one person, who must have an enormous case load, and then that, to me, maybe suggests as to why some people are waiting 10 years for a diagnosis. I just think—. It needs to be addressed, really, and I'm making the point.

10:25

Yes. As I've made the point quite strongly, this petitioner has brought before our committee something that replicates what's happening in my own constituency, and you know—I've raised questions with you in Plenary—that I've raised questions with the First Minister. I recently managed a conference call with our mental health team, the chief executive of the health board, and I have to tell you that I get people now that come into my office in a very distressed state— and the numbers are increasing—about a lack of access. So, we've worked together now, we've agreed some agreements going forward, but have you ever, yourself as an AM now, Vaughan, more so than as a Minister—. You must get people that come in, because I do, it can't just be Aberconwy, but it's really difficult to navigate that system. I don't think it's resource that's always—. It's the structure, even, of the local mental health team. There are so many different levels. I've even tried navigating it myself, holding the hands of constituents, and it's a nightmare. And I become quite frustrated at the end of it. And you just, you do, you sort of feel, 'Aargh'. I just want to get this person seen by somebody. They obviously want to know, 'What is wrong? What are these feelings I'm experiencing?' And we do, we live in a world now, don't we, where diagnosis is key. Everybody now labels something and people are curious, but, most of all, they're frustrated, and I just wonder sometimes, as Cabinet Secretary, do you not get this in your own constituency office? 

More and more people are becoming frustrated, and it actually piles on the pressure on them just through trying to navigate the system. I get people—. The big issue that's come up with me is you don't get appointments by letter. You don't actually get told who you've seen. You get a phone call—'We've got an appointment for you on Monday'. And then people were coming to me afterwards and saying, 'I haven't got a clue who I've seen, what level they are, how qualified they are'. I think we need to start treating these people more as intelligent individuals who should receive a letter outlining exactly what their interventions are. And let me tell you: it is my belief the legislation states that they should have a treatment care plan at a certain level of intervention. You try asking for a copy on behalf of a constituent; you're fobbed off with all sorts of excuses. They're not—. The Act isn't working, and I would just say to you: these people are very vulnerable, and the north Wales stats for when things become—you know, unbelievable, in terms of—. Our suicide rates are ridiculously high for the whole of the UK, north Wales, and so I'm saying that we really do need to get a grasp of this, and I'm really pleased, as I said again, that we're able to have this debate here, but please—. You know, this is just—. This typifies what's going on, certainly in north Wales. It's a nightmare. I've pleaded with you before: get involved in it and really see how you navigate your way around the system. If I can't do it, how do people who are really suffering with stress, depression, and far more serious mental health conditions—. They need that help, they need that support, and if you've hand-held people going through the system and become frustrated—

I know. I know. Well, I could write a paper myself on this, just from my own experiences, on behalf of a number—not a low number, a high number—of people who are desperate. And you're the person that can make that difference. 

Well, there are a number of points there to respond to, Chair. Obviously, in my own constituency postbag, dealing with my constituents, I have a range of issues coming through, including mental health. So, I'm used to supporting my constituents in this field as in others. And it comes back to some of the points that I made earlier, that you've addressed in part of your remarks, about how do you help someone to navigate their way through the system. And, actually, that access, for lots of people, they will—you know, I don't think every person would say, 'I don't want to engage with the health service unless I get a letter explaining and setting everything out.' Lots of people would rather say 'I've had a phone call, I've got rapid access, I've got an appointment in quick time, that's a good thing.' The challenge is what happens with that interaction, and is it the case that they leave that interaction with the healthcare system understanding why they were there, what's happened during that interaction, and what happens next. That's part of the broader—. It sounds simple, but, actually, we need to better as a whole system at having that joint conversation about, 'What matters to me coming forward, how can I be helped, and if I can't be helped, do I understand why?' And all these things matter. So, I would expect people to leave those appointments understanding what's happened, and being in a reasonable place to understand that. Sometimes, each of us just leave even physical health appointments and don't really understand what's been said, because sometimes the news can be difficult to deal with, and we have lots of instances where that happens. So, there's still a challenge to make sure, if people recount instances where that isn't happening, how we as a system improve upon that to make sure people are better supported. Because that's the challenge—how are people properly supported in a time of need? And if we're not doing that now as consistently as we want to, how do we do that more effectively?

That's why, though, the outcomes work that we talked about really matters. It isn't just about saying, 'You've rapidly gone in to see someone', it's, 'What was the value of the intervention and the interaction that you had? Did you understand who you were seeing and why and what the next part of your treatment will be?' And, actually, on care and treatment plans, we have over 90 per cent compliance with care and treatment plans being provided. So, the challenge here is—. I don't agree with you that the Measure isn't working; I think the Measure is working and has made a real difference, and it's to the credit of all the people in the Assembly at that time who passed that Measure, and that cross-party agreement that this mattered. In that, actually, the Assembly was well ahead of Parliament in talking about the issue and in recognising the value of doing something here.

The challenge always is, 'What more do we still have to do?', because in this field, as in so many others in health, even if you achieve 95 per cent compliance with the standard, there actually may still be a number of people who will say, 'Actually, I'm waiting longer than I think I should be, and I have a problem.' Those people come to us, as they should do, as elected representatives. So, lots of what I see in the correspondence that I get either as an Assembly Member, or indeed as Cabinet Secretary, is focused on the parts of the health service that have gone wrong, or haven't met someone's needs as they would wish them to do and as they think they should do. That's where lots of our improvement activity focuses upon.

But I just want to give reassurance that the Measure has had a real impact. It does have a real focus of attention. It's one of the five priority themes for the Government in our national strategy. So, this is an area—mental health—that will continue to be important to this Government, and I recognise will continue to be important to people in other parties too. And, actually, part of our challenge is that we're seeing demand and need rising in the field of mental health, and in each of those different tiers. There are a number of different factors in there. So, what happens in the early part of someone's life, what happens with growing up, what happens with their job, and so all these things really matter, and they make a difference to the demand coming through our doors as elected representatives, and also through the doors of the health service.

Our challenge is, 'How do we do what we could and should do to make sure that those people are seen in a timely manner, are seen appropriately, and then also how do we work with other parts of Government and outside Government to try and do something about trying to stop the level of demand and need to improve people's resilience and mental health before they get to the point of needing an intervention with the health service?'

10:30

I can talk about a couple of things we're doing now, if it's helpful, in terms of service user experience and care and treatment planning. So, we've been working—. The delivery unit is currently going out to all of the health boards, and has done a bit of a review with them about their care and treatment planning processes, including talking with service users and carers about their experience reviewing the contents of those plans, how those plans are shared, all the fine detail. They'll be publishing a report now in April with some recommendations about how we continue to improve that experience. We know that everybody's 90 per cent plus are receiving a care and treatment plan, so this will be about the quality of them. 

With the data work and the outcomes measurement, over the last four years we've spoken with 900 service users and carers about their experiences, and we're currently working through a process of making sure that every interaction and intervention somebody has with a clinician, that clinician is doing some outcome measurements, both in terms of clinical symptoms but also in terms of service user experience. We're going to ask that every clinician does that with two measures, and we're embedding that throughout this year. And we have a steering group overseeing the work.   

So, we're constantly trying to improve and to hear from service users and carers, really, about their experience, and looking at ways to improve that, I suppose. 

I fully expect this to be part of what the subject committee scrutinises me on throughout the rest of the year. I know I'd expect to see me being made available on this side of the table, being asked questions with colleagues about that in that area. So, it isn't just the Petitions Committee taking an interest, it's an interest with the current inquiry that's just concluded on perinatal mental health in the Children, Young People and Education Committee, and I know they will come back about that. We're publishing—there's going to be research published on where we are during this year, and there'll be a response to Government from the health service on that. And, of course, indeed, as I say, with the health committee itself, I'm fully expecting there to be a continued focus of attention, which I think is a good thing, actually, because for a long time mental health wasn't discussed, and it wasn't an area of scrutiny. I think it's a positive that we now do that. 

10:35

Jest cwestiwn syml yn adeiladu ar hynny, mewn difrif. Mae Janet wedi canolbwyntio ar yr hyn sy'n bwysig, sef profiad y claf ei hun, ond os cawn ni jest edrych ar y system tu ôl i hynny—a oes yna ddigon o gydweithio rhwng gwahanol haenau'r ddarpariaeth iechyd meddwl, rhwng gofal sylfaenol a gofal eilaidd, er enghraifft, er mwyn sicrhau bod y llwybr yna ar gyfer y claf mor llyfn ag y gall o fod?

Just a very simple question building on that, in truth. Janet has focused on what's important, namely the experience of the patient, but if we could just look at the systems behind that—is there enough co-operation between different layers of mental health provision, between primary care and secondary care, for example, in order to ensure that that pathway for the patient is as smooth as it could be?

Well, that's been part of our focus and attention in making the Measure work, but I would never say to you or anybody else, either in this place or outside, that that means that everything is perfect. Far from it. We know that, in every single field of health, let alone health and the wider care system, there is always room for improvement between the different parts of our system. We recognise it's a big and complex beast, the national health service, and there is always room to say: is the way we run that service, and the processes that are in place—are they the right processes and systems? And then: how do we improve human relationships? Often, it's not about structures. Often it's about culture, and it's about people and how they behave with each other. I actually think clusters have been a good way to get—on local service delivery—more people to talk together and  understand what each other does. But, as I say, I recognise that there is certainly a need for further improvement. It's part of the reality of the job. The job is never done—there is always more to do. 

Ond mae yna bethau systemig sy'n gallu cael eu rhoi yn eu lle, wrth gwrs, i sicrhau bod y cyfathrebu rhwng y gwahanol haenau mor glir ag y gallai fo fod. Rydw i'n derbyn yn llwyr fod perthynas rhwng pobl yn rhan ohono fo, ond mae pobl yn gorfod gweithredu o fewn systemau sy'n gwneud y berthynas yna, neu'n galluogi'r berthynas yna i weithio yn fwy llyfn.

But there are systemic things that can be put in place to ensure that that communication between those different layers is as clear as is could be. I accept that the relationship between people is part of that, but people do have to operate within a system that creates that relationship, or allows that relationship to work better.

Yes, and we do take seriously the parts of our system to see if we can further improve them, both from enablers like our digital systems, to make sure that they're consistent and they talk to each other, the expectations about information being passed between clinicians and what appears on a GP record if there's an interaction in a different part of the system. So, of course these things matter, and if this committee felt that there was a part of the way that the system works that does not work as it should do, that would be of interest. But I'd be interested in where that evidence comes from, and an example of it, because that would be something real to talk about rather than a general statement that the system doesn't work. Because, actually, that's not a very helpful way for us to be able to proceed. I'm interested in where we get things wrong as well as where we get things right, because you need to understand you've got a problem to actually be able to resolve it.

Just the one. From the experience of the numerous cases I've dealt with on this, we talk about pressures on budgets and the availability of mental health services, and the support services across health, local government and the voluntary sector. Now, just those first two, health and local government—sometimes we get bogged down with who's involved in this particular case, and, again, the mismatch between what social services are doing in terms of support, and what the health board—. And sometimes you do get a little bit of buck passing in the first instance, when you first go in to ask, 'Who's helping this individual?' Then, eventually, it becomes clearer who's actually the one responsible in this instance, but by the time you get there, weeks and weeks have gone by. How can we get a better integration of health and social care fulfilling their own duties and responsibilities and not shying away from it? That's when it becomes resource intensive—this buck passing does allow, I feel, for, if you like, resources to be saved. But, to me, it's a false economy. I think if people access the treatment or the service sooner, you'd save money, because people become more and more distressed again by the confusion in the system.

So, I would just ask how we—? You know, as politicians, we're used to all this bureaucracy, but the average person out on the street is not and it just frightens them. It's knowing who is responsible for ensuring that I get what I'm entitled to and the help I need. That, in itself, is frustrating.

10:40

Wellm that goes back to some of the things that I've said previously, and it also goes back to, I think, the well-recognised priority to have prevention and earlier intervention and the recognition that that provides a greater benefit. The challenge always is about how we recognise which parts of our system don't work, as I was saying to Rhun just earlier, and what we do about that. So, between health and social care, the Welsh community care information system, which is about how we actually share information between health and social care, is being rolled out, and that matters as an enabler to sharing information, but there's still got to be, as I was saying earlier to Rhun—the culture about what will happen is the practical way in which people work together, because it shouldn't matter to the individual citizen. If, say, for example, they've gone to their GP and part of their challenge is in a field and another part of it isn't, you can't neatly parcel that person up. And it's actually why we see lots more social care professionals being embedded within clusters, and within individual GP practices, because they recognise that lots of the need that they see—. I was recently on a visit in Merthyr and one of the GPs said, 'We finally realised that lots of what we were seeing people for wasn't really about their health—these were social care problems', and it made a real difference to them to have a social care professional in that practice on a regular basis to refer people to the right place to get their help. That's more an issue about the general theme of what we need. It's about how you help that person get to the right point in our health and care system to receive the appropriate care and support to meet their needs.

Okay. My final point—and I don't think you're going to be able to solve this one—is: let's be honest, you cannot deal with someone within an integration of services without holding that information and sharing that information. When you've got a health service and social care systems working with different software and so not holding and being able to share those records—. You know, we've got, in our health board, non-digitalised ways of working and so they don't share in the same way, and so that, in itself, causes a huge issue. We do need to move, I believe—I think I put a written question in to you on something along these lines—to where, if you're seeing one of a number of partners, they should all hold that information, up to date to the very last intervention, and it isn't happening. I don't know what you can do about that.

The Welsh community care information system—it's one of those acronyms, I think it's WCCIS, that people refer to in shorthand, which probably doesn't mean anything to anyone outside the health and care system—is about how we share information on the same system between health and care. It has been rolled out in Bridgend—

And—sorry to interrupt you—the fire service should get access as well.

Bridgend have already started on that and Powys have already started. But it is then about, 'Well, what's appropriate to share with the fire service?' I don't think the fire service would necessarily want to see the prescription that someone has had, but it is about what's appropriate in sharing information, and—

But where you've got vulnerable people with mental health issues—

—if the fire service have an interaction with that person, do they then have the ability to be able to talk to someone in the health and care field about those needs?

Now, there are challenges there that are about people more than systems, I think. I really do think that. From a systems point of view, I think within health and social care, though, there are advantages to be gained from having the roll-out of that system, which is in some local authorities and health boards already, and that's part of a national programme to be rolled out as well. I think that is already providing real benefits within those areas that have rolled it out. There is then an issue about how you have people planning the services together, which is different to the individual citizen when they have a need at the time. So, we have public services boards, where fire and rescue services and police—even though they're not devolved, they regularly take up seats on those public services boards with health, the local authority and emergency services—

But that's about broader service planning as opposed to meeting an individual's need at an individual point in time. And if someone from the fire service attends a property and they recognise that someone may have a healthcare need, they should not find it difficult to speak to someone about that healthcare need. But it is still about how that person's healthcare need is appropriately dealt with. Sometimes, that might be an immediate intervention and sometimes it may not be. It's about how you manage that appropriately that matters, and that's why it's difficult to discuss that in generalities. So, some individual instances, if the committee has them from its evidence would be helpful—not just Members writing to me individually—but I'm robustly confident that in the other two subject committees I'll get continued scrutiny in this area for some time to come.

10:45

There is some evidence of work in north Wales where the fire officer decided that they needed to know where people were who were vulnerable, so that they knew how to react and everything, and because they were concerned at the number of deaths that were going up through fires. And Simon Smith was fantastic. Through the community safety committee, we managed to get more data sharing and more information sharing, and it was very evidential, so I'll talk to you again about that.

Very quickly from me—the petitioner wants to know how many mental health clinics you've visited since becoming health Secretary.

Well, I couldn't tell you offhand. I've visited a range of settings in physical health and mental health—not just clinics, actually, but also a range of other settings too. Valleys Steps, for example—I've visited them twice. Their work is actually about lower level intervention around mental health. We have worked particularly on the well-being bond, about which we're going to be talking about more in the coming months, as well as our social prescribing pilot. So, it isn't just about clinics, it's about that broader stuff. I've been in a range of clinics, but I couldn't honestly tell you the number because I'd be making that up off the top of my head.

Could your officials at some point? I'd be interested.

Well, they'd need to interrogate my diary to run through it, but I have visited a number of different clinics and settings.

Interrogating your diary would be really good, I think.

Can I just beg your indulgence with just a few more minutes, Cabinet Secretary? I realise the time and I'm very mindful of it. I just wanted to explore very, very briefly what happens post diagnosis, post the initial responses to the mental thing. If I can take you back briefly to a very tragic circumstance that happened in the village of Argoed, which is my home village, as it happens, with regard to that— 

—awful incident there. It came down to the fact that the person involved was not compliant with his drugs regime. Are you confident now that there are interventions in place that are robust enough to make sure that that sort of tragedy doesn't happen again?

I think this is part of our real difficulty, with respect, Chair. We have a range of need in the whole field of mental health. It's quite a normal thing for people to have challenges with their mental health at various points in their life. The most extreme end, and the highest level of need, is where we often have lots of our focus when things go wrong. The court will say, 'Can you make sure this never happens again?' I couldn't give you, or any member of the public, a direct assurance that something will not happen again in the future, because I can't tell you that every person will be compliant with the treatment regime, or even, indeed, that you can guarantee that every treatment regime works and stops and eliminates risk.

Our challenge always is how we learn from what's happened and how we do all we could and should do to try and avoid that risk in the future. That's a constant process; it isn't simply a one-off. It is about how we make sure that that lesson is learnt and not forgotten, and then how we get better at dealing with and assessing risk in individuals and how you manage that appropriately. Because part of the challenge is that person was in a community setting, and, actually, what I wouldn't want to see is that people then say, 'What you need to do is remove those people from the community altogether if there's an element of risk', because, actually, that produces poor outcomes. It costs not just lots of money, it produces very poor outcomes and doesn't actually lead to improvements in care. It's still about what's appropriate to deal with in a clinic, what's appropriate to deal with in the community, what's appropriate to deal with in a different, more secure setting, and that's part of the challenge. So, when you see the investment choice we make in mental health, you'll see investment in those different areas, but also a narrative about what we're doing and why as we take that work forward across the Government.

Fine. Well, thank you very much, Cabinet Secretary. I think we all recognise the fact that this is a very difficult area and it's a very challenging task for you to get everything right on it. But I do thank you for your comprehensive answers to our questions today, and, of course, I'll remind you that a transcript of this meeting will be available to you in the near future.

5. Cynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
5. Motion under Standing Order 17.42 to resolve to exclude the public from the remainder of the meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).

Cynigiwyd y cynnig.

Motion moved.

Thank you. I propose, in accordance with Standing Order 17.42, that the committee resolves to meet in private for the remainder of today's meeting to consider the preceding evidence. Are there any particular points you want to make with regard to this? No.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:49.

Motion agreed.

The public part of the meeting ended at 10:49.

Explore the National Assembly for Wales