Y Pwyllgor Deisebau - Y Bumed Senedd

Petitions Committee - Fifth Senedd

21/11/2017

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

David J. Rowlands
Janet Finch-Saunders
Mike Hedges
Neil McEvoy
Rhun ap Iorwerth

Y rhai eraill a oedd yn bresennol

Others in Attendance

Alun Thomas Prif Weithredwr, Hafal
Chief Executive, Hafal
Laura Williams Deisebydd
Petitioner

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Claire O'Sullivan Cynghorydd Cyfreithiol
Legal Adviser
Graeme Francis Clerc
Clerk
Kath Thomas Dirprwy Glerc
Deputy Clerk
Kayleigh Imperato Dirprwy Glerc
Deputy Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle y 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 09:18.

The meeting began at 09:18.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datganiadau o fuddiant
1. Introduction, apologies, substitutions and declarations of interest

Bore da, everybody. Good morning and welcome to the Petitions Committee. Just to remind you, participants are welcome to speak in Welsh or English. Headsets are available for translation of Welsh to English. There's no need to turn off your mobile phones or other electronic devices, but please ensure that any devices are on silent mode.

Apologies and substitutions: we have no apologies this morning, except to say that Rhun ap Iorwerth is a little late due to his commitments with the Business Committee.

2. Deisebau newydd
2. New petitions

We move straight on to new petitions. The first petition is 'Suspend Marine Licence 12/45/ML to dump radioactive marine sediments from the Hinkley Point nuclear site into Wales coastal waters off Cardiff'. The petition was submitted by Tim Deere-Jones, having collected a total of 7,171 signatures.

The background to this is that the petitioner received from—. We had a response to the petition from the Cabinet Secretary for Environment and Rural Affairs on 24 October. We have had a briefing session, and the petitioner says that he is preparing a detailed scientific report, which he intends to share with the committee in the future. So, do you have any comments to make on that, any of you?

09:20

Only one comment I'd like to make: I think this is one of the silos of the Assembly, because I think perhaps—. As Chair of the Climate Change, Environment and Rural Affairs Committee, we've sought a detailed scientific report from—. Sorry, we've sought information from NRW as regarding a detailed scientific report. We've also asked—and the people who are intending to dump there have accepted—that they would accept, if somebody can find them, somebody else to examine it. I did suggest that Cardiff University could actually do tests to test it as well. They've still got the core samples. I think that would be very helpful if they had a third party endorsement of whether it's safe or whether it isn't. It's very difficult to look at mud and actually tell what state it's in. Mud just looks like mud and, until you actually do scientific tests on it, you can't tell. We've asked NRW for a report, and I think that that is very important, but, if anybody can get a third party to look at it, I think that would also be even more important in the sense that you would then have somebody who is looking at it from an academic point of view, rather than somebody who may be seen as part of the industry.

Yes, fine. I think we ought to point out here that no disposal activity has taken place and is not likely to take place until sometime in the next year—probably around March next year. Yes, Janet.

I do think that there is—. There's a science behind everything, and I think that we as Assembly Members need to be sure that we're absolutely confident when they say the levels are so low. I think that this does need further investigation, and I'm fully supportive of this petition.

And, myself, it's clear that there is a question of public trust here, and whatever evidence was considered at the time of the granting of a licence, it's clear that this situation has changed, even if only by the level and intensity of questions being asked, quite rightly, about what is going on here, and we need the fullest evidence possible before anything can happen on this site.

Well, we're under the impression that there could be a report by the end of this coming week, but we depend on the depth of that report and, exactly as you're pointing out, it's the agencies they use to make sure that they give the correct data that we need in order to take this forward. Neil.

I probably should declare an interest, because I signed the petition. I think, for me, looking at this as a local Assembly Member as well in the region, there's a huge difference between the way the developer has approached this, as in EDF, and the Welsh Government. I met with Natural Resources Wales and, effectively, there were virtually no answers to hardly any of the questions. I met with EDF and they had answers. I want to thank them for the briefing they provided. I would note, though, that there's some data they're relying upon from 2009, and I'm still yet to see the study. So, I'd like to know where the tests were done and I'd like to be confident that the rigour in the testing was there, which is why I supported the call for a suspension, and I think the issue of the Government doing it independently is such a valid point. It really should be done. I shouldn't say I'm shocked, because it seems that this is the way things work in Wales, but I'm very, very disappointed, on something so important, that they've been unable, for the last two months, to give us answers and to deal with it in a professional way, I would say. As I said, to be fair to EDF, they have done. It's a pity the Government hasn't done so also. 

Well, some of the possible actions open to us are that we await NRW's response to the questions asked by the Climate Change, Environment and Rural Affairs Committee and the detailed scientific report being produced by the petitioner before deciding what further action to take on the petition, and/or we could invite the petitioner to give evidence to the committee at a future meeting to investigate the concerns further prior to potentially requesting a debate, or we could write to the Business Committee to request time for a debate in the Plenary.

09:25

Can I vote we do one, but don't discount doing two or three, depending on what the response is from one? 

I'd like to go to two or three, really, because this isn't some far-off time in the future: the dumping could occur at any time, really, within the next few months. So there is a lot of urgency with this, and I think if there was a time slot, maybe early in the new year, to debate this in the Plenary then that would give the Government some urgency. I mean, we may well not take the slot, but I think if it's there then it focuses minds. 

I think that's right. I think that, if we do go to Plenary, then we should have that Plenary session at some time before the dumping actually takes place. That would be very important. As I mentioned earlier, the NRW's response should be here by the end of this week. That's what they've indicated to us, so we should see that.

The thing is, Chair, NRW, when I met with them, they couldn't tell me what testing had been done, they couldn't tell me to what depth, they couldn't tell me where the sediment is going to end up. So, I've very little confidence in their ability to deal with this, really. 

Fine, okay. So, are we agreed that we'll wait for the response from the NRW, and we can consider that—?

That only costs a fortnight. I think that's the situation. We've got to—. In a fortnight's time, we can come back to this; we can see exactly what the response is. If we're very unhappy with it, or actually not content with it, then I think that we ought to go to part three. So, I don't think we're going to lose any time in doing that and I think that, if we're not happy with what the NRW are saying, then we ask for a debate. 

Okay, but what about us inviting the petitioner to give evidence at the next meeting? 

I was going to make that point. If we can be confident that we're going to be getting this response from NRW now, I think we should be seeking the response of the petitioner to that evidence as soon as possible. 

I think that's absolutely right, because we'll sort it all out at the next meeting on where we go from there. 

So, on a process point, the committee has an evidence session already booked for the next meeting in two weeks' time. We can, obviously, look to rearrange that, if that's the wish of the committee; the following meeting would not be until early January. In terms of the response from NRW, they have indicated—I think to your committee, Mike—that it will be later this week that the response is expected. In terms of our usual process, for the next meeting of this committee on 5 December, that would give the petitioner less time than they would normally have to submit their response, but, in the circumstances, the petitioner may be willing to have a shorter time to provide those documents. 

Can I make an organisational suggestion, that we only deal with the people coming in to see us at the next meeting and we postpone the updates until January on the other petitions? Because we normally have the first part as we are now, new petitions and updates—but, due to the seriousness of this, that we bring that in as the first item, and the updates, then, we postpone until the next meeting after that. 

The thing to be aware of there is that we've already started having some responses to other petitions that we would start agenda-ing for December, so there would be a decent delay, with Christmas, before the committee could consider letters that we're receiving now, but that's absolutely an option if Members wanted to go for that. 

I think that we've got to prioritise our time, and I think that this is a priority.

I've just had a note to suggest that there are also a number of new petitions we're due to be considering next time, so perhaps we could consider evidence sessions on this petition and the other petition that's already booked in and the new petitions, but not take any other updates. 

Okay. We will raise that option with the petitioner, then, to see if he's available. It's two weeks today, so he may have other commitments as well, and we will seek to arrange that. We'll be in touch with you if that's not possible.

09:30

Fine. Are we happy with that? Yes. Fine. Okay. Right, we move on to the second new petition, which is 'Save our Countryside—Revise TAN 1'. The petition was submitted by Councillor Mike Priestley, having collected 706 signatures. This is with regard to changes that have been made in the residual methodology that has been used in the past—there are changes to it. I think one of the points that he brings out is that the:

'Changes to TAN1 have forced Local Councils to allow housing developments in excess of what is considered to be local demand.'

The background to this is that the initial response to the petition was received from the Cabinet Secretary for Environment and Rural Affairs on 11 October. The petitioner was informed that the petition would be considered but had not, at this point of time, responded when the papers were finalised.

Can I just say that, on this, although it's my constituency, this is going to affect every other constituency in every other region? I have sat in meetings and watched planning officers give additional weight to technical advice note 1. Without these measures that were brought in, there's potential for us to have—I think it's 8.5 year land supply available in Conway. But, if you look at the actual figures now that we're struggling with—and sites are now popping up that are not in the local development plan—it's making a mockery of all the work we've done previously, and the cost of putting our local development plan forward. This is a huge issue. If it's not addressed, I can see communities—. Those boundaries that have been there, giving us all an identity to all different communities—I can see all that going. I have struggled with planning officers on this one, as have many other people, even the councillors themselves. This is an infringement, actually, of local democracy. I've written, myself, to the Cabinet Secretary, but this really does need to stay within this and take it as far as we can, I would say, to a Plenary debate.

Right. Fine. Thank you. Does Rhun or anybody else want to comment on that?

I think we need to wait for the views of the petitioner on it, and then take it from there.

Yes. Fine. So, the action that we suggest is that the committee await the views of the petitioner on the response provided by the Cabinet Secretary for Environment and Rural Affairs before considering any further action.

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

Now we move on to updates to previous petitions. The first one under scrutiny is, 'Please make Senedd TV accessible to deaf people'. The petition was submitted by Mervyn James and was first considered in January 2014, having collected 25 signatures.

The committee last considered the petition on 11 July and agreed to write to the Llywydd, as Chair of the Assembly Commission, to note the committee’s concern over the slow progress towards increasing the volume of Assembly proceedings that are available in British Sign Language, and to ask the Commission to explore the options for developing a programme for making BSL and/or subtitling available for other Assembly questions. A response from the Llywydd was received on 9 November, which is included in the papers for the meeting. The petitioner was informed that the petition would be considered by the Petitions Committee, but had not responded when the papers were finalised.

Does anybody have any comments to make?

Yes. Are you happy to wait? Yes. The committee will await the views of the petitioner on the response provided by the Llywydd before considering any further action.

The next petition is on child and adolescent eating disorders. It was submitted by Helen Missen, and was first considered by the committee in July 2012, having collected 246 signatures. The committee last considered the petition on 3 October and agreed to write to the Cabinet Secretary for Health, Well-being and Sport to ask whether any consideration has been given to extending the services highlighted by the petitioner. The possible actions for this are that the committee should await a response from the petitioners to the latest information provided—sorry. Yes, the committee should write to the Cabinet Secretary for Health and Social Services to ask for details of the timescales in which he intends for the review the Welsh Government's eating disorder framework to be carried out.

09:35

Again, it's a huge issue. It's one that Bethan Jenkins has fought on, this campaign, and it has my full support. We do not have the provisions available. I've got constituents who are outside Wales receiving treatment. We need to really get a grasp of this, because it's affecting so many youngsters now with the pressure—boys and girls.

Right, so we're agreed that we'll write to the Cabinet Secretary for the timescales. Yes?

The next petition is 'Demand Funding from the Welsh Government to Support Autism Spectrum Connections Cymru'. The petition was submitted by Aled Thomas and was first considered in June 2017, having collected 148 signatures. The background is: the committee first considered the petition on 27 June and agreed to write to Autism Spectrum Connections Cymru to seek their reflections on the petition and the response from the Minister for Social Services and Public Health. We have had a response from the autism spectrum people, so do you have any comments with regard to that response? 

No, other than to say that I have had contacts from others who are concerned about the need to ensure that third sector organisations have access to funding streams. Writing to the Minister makes sense to me at this point.

That's right, yes. I'd like to point out that it seems as if this particular charity is very much interactive and is being used a great deal by the local community. So, the possible actions are that the committee could write to the Minister for Children and Social Care to ask for details of the processes that were followed when awarding funding for the integrated autism service, and whether opportunities were given to third sector organisations to apply. Are we agreed on that?

The next petition under consideration is 'Introduce updated stroke advice—B.E.F.A.S.T. - and help save lives and livelihoods'. This was submitted by Phillip Easton and was first considered in July 2017, having collected 105 signatures. The committee considered the petition for the first time on 11 July and agreed to write to the Stroke Association to seek their views on the petition and give the petitioner the opportunity to comment on the Cabinet Secretary’s response and any response forthcoming from the Stoke Association. A response from the Stroke Association was received on 7 November and the petitioner has also provided further comments, which are in the papers for the meeting.

Now, it does seem that most of the authorities on this believe that the present situation with the FAST—face, arms, speech, time—applications seems to be adequate for all the analysis of stroke conditions, but we have a number. Do you have any comments on that?  

Yes, I just wonder whether we could include, in our letter to the health Secretary—if we write to him and, possibly, the Stroke Association, asking them what they do to promote bilingualism, because the recovery from stroke by someone who was educated bilingually is much quicker. It's a huge percentage, and it makes a big difference. That would be something preventative, wouldn't it, which I think may be—? But I'd be interested to find out whether the Stroke Association does promote bilingualism—Welsh-medium in Wales, obviously.

I'd certainly be happy for us to proactively, as a committee, take that step, as it is a matter that's been raised by a member of the committee. In terms of this particular petition, I'm very grateful to the petitioner for raising this issue. It's important that there are means for open contributions to the discussions on best practice. I think that contribution has been made by virtue of us communicating with Welsh Government and the Stroke Association, so I would be tempted, considering where we're at, to say, 'Thank you very much for genuinely contributing to a debate', but to close the petition.

09:40

And I think we ought to add to that that it does seem as if there is a desire out there now to raise awareness with the clinical profession of these other two symptoms of stroke, at least within the primary care people. 

So, the possible actions are that the committee could write back to the Cabinet Secretary for Health and Social Services to ask whether he considers that there are any additional steps that could be taken by the Welsh Government or the stroke implementation group to ensure that health professionals are aware of the additional symptoms of stroke, such as problems with eyesight and balance.

Can we send that and close the petition at the same time?

The next item is to discuss the petition on a 'Roundabout for the A477/A4075 Junction'. The petition was submitted by Pembroke Town Council and was first considered in January 2016, having collected 597 signatures. The background is that the committee last considered the petition on 19 September and agreed to provide the petitioners’ further comments to the Cabinet Secretary for Economy and Infrastructure for information and ask whether the petitioners can be provided with a copy of the stage 4 road safety audit when the process is completed. A response was received from the Cabinet Secretary for Economy and Transport on 6 November. Do we have any comments? Janet.

It's disappointing when you're reading the notes, isn't it, that we wrote on 5 October to Arriva, and no response?

I think that's in relation to the next petition.

On this one we're still awaiting a response from the petitioner, aren't we? So, can we await the petitioner's response?

Yes, okay. So, the suggestion is that the committee awaits the view of the petitioner on the information provided by the Cabinet Secretary for Economy and Transport, given the detailed nature of it, before considering any further action on the petition. Are we happy with that? 

The next petition is 'Free Train Transport for school pupils with Arriva Trains Wales'. The petition was submitted by Elin Tuckwood and was first considered in November 2016, having collected 937 signatures. The committee considered the petition on 19 September and agreed to write to Arriva Trains Wales to share the petitioner's further comments, and to ask for a response to the safety concerns raised by the petitioner, and also to write to Rhondda Cynon Taf council to seek their views on transportation provision for pupils at Treorchy school. I think Rhondda Cynon Taf have responded and their response is included in the papers to the meeting, but we've not received a response from Arriva Trains on this matter. But they have responded in the past with regard to this, and this matter has been explored quite considerably. 

So, the possible actions are: the committee could await the views of the petitioner on the latest correspondence and response from Arriva Trains before considering any further action on the petition. Do we have any comments with regard to that?

Are we all content with that? Yes. Fine. 

The next petition is 'Reopen Crumlin Railway Station'. This was submitted by Michael Davies and considered in September 2017, having collected 208 signatures. The committee first considered the petition on 19 September and agreed to forward the detailed information provided by the petitioner to the Cabinet Secretary for Economy and Infrastructure. The response from the Cabinet Secretary was received on 25 October, and the petitioner was informed that the petition would be considered but had not responded when the papers were finalised. 

Again, committee, do you have any comments on that with regard to the specific issue? 

09:45

Normal response: await for the petitioner to respond. But they have had progress because what they've said is going to be considered amongst the considerations for new stations.  

That's right. I think this is a standard response with regard to these requests for opening new stations, or extending or giving better facilities at stations. So, possible actions are that the committee could await the views  of the petitioner on the latest response received from the Cabinet Secretary for Economy and Transport before considering any further action in relation to that petition. Are we agreed on that? Yes. Fine.

The next petition is 'Pass Wide and Slow Wales'. This was submitted by Jocelle Lovell and was first considered in October 2017, having collected a total of 1,755 signatures. The committee considered the petition for the first time on 3 October and agreed to write to the Cabinet Secretary for Economy and Infrastructure to ask if he would consider whether additional support could be given to the British Horse Society’s 'Dead? Or Dead Slow' campaign, and write to the British Horse Society to ask for their views. Do you have any comments with regard to the responses that we received? 

Again, we need our own Welsh approach to this. I know that there are some possibilities here that we could go forward with, but—. We should write to the police and crime commissioners, I think, to ask whether any work has been undertaken by police forces in Wales to improve safety of horses and horse riders using roads, because people do—. I've seen it myself where people—. I don't know—when they come to overtake a couple of horse riders, they rev up and they won't pass very slowly or wide. It's a big issue on some of our country lanes and things, but I think we need our own Welsh approach to this. So, whether we can write to the police and crime commissioners—.  

So, the possible actions are that the committee could write to the Cabinet Secretary for Economy and Transport to ask for an outline of the activities undertaken by the Welsh Government to deliver the relevant actions in the road safety framework.

Yes. I don't think it's high on our radar here in Wales, and I think anything that this committee can do to raise the profile of this issue, you know—.

And, of course, as you're suggesting, Janet, the committee could write to the police and crime commissioners to ask whether any work has been undertaken by police forces in Wales, in particular to improve safety of horses and horse riders using roads, including to promote improved awareness of close pass campaigns. I would note that there has been at least one death and a number of horses have had to be destroyed because of the behaviour of other road users. Okay, so are we all agreed on that? 

Fine, okay. The next petition is 'Put an end to the Cross Border and Sub-contracting Taxi Licensing loophole'. The petition was submitted by the taxi drivers of Cardiff and was first considered in October 2017, having collected 390 signatures. The background is that the committee considered the petition for the first time on 17 October and agreed to write to the Cabinet Secretary for Economy and Infrastructure to share the views of the petitioners, including the suggestion that journeys should be required to start or end in the area the vehicle and driver are licensed in. A response was received from the Cabinet Secretary on 9 November, and the petitioners have also provided further comments, which are in the papers for the meeting today. 

I think that it looks as if the Cabinet Secretary has stated that reform of the law is long overdue and that he plans to publish a summary report for public consultation by the end of this year. So, do you have any comments with regard to—

09:50

Well, let's await what he publishes at the end of this year and send that on to the petitioners.

So, the committee could await the Welsh Government's summary of the outcome of the public consultation on possible reforms to taxi licensing, which is expected before the end of 2017, before considering further action on the petition. Are we agreed on that?

Yes, this is an active issue. It would be premature to take any other action. 

Yes, fine. You're happy.

The next petition is to protect the razor clams on Llanfairfechan beach. The petition was submitted by Vanessa L. Dye and was first considered in October 2017. It collected a total of 459 signatures. 

Again, a local issue, but one that raises—. There have been concerns about trafficking. There have been concerns about the anti-social behaviour and the numbers of the clams removed. Many local people believe that the amounts that have been taken away do not constitute the numbers for own use, consumption. Whether these are finding their way into the food chain elsewhere—. And I think what we should be doing here—. I know that the Cabinet Secretary has very kindly closed the beds at the moment. It does say in the paper that none have been taken since, but I know that, after spring tide, you will still get people trying to get down there. These people have been—. There have been 150 people turning up in the village of Llanfairfechan, especially after a spring tide, so I think we need to keep the foot on the pedal with this one, and, so, perhaps we could ensure—. There's a full study going ahead to seek confirmation that the fishery will not be reopened until the results of the stock assessment have been considered. 

Of course, the Cabinet Secretary has stated that they have the necessary precautions in place to make sure that no clams have been taken at this moment, and has asserted that it's not happening. 

Yes, but we need to keep those beds closed at the moment whilst the studies go ahead. 

Right. Fine. Does anybody else have any comments with regard to that?

If the local community feels that they need further confirmation that there will not be a reopening of the beds, we could certainly write to the Cabinet Secretary to ask for that.

So, we're all agreed that the committee could write back to the Cabinet Secretary to seek confirmation that the fishery will not be reopened until the results of the stock assessment have been considered. 

Are we all content with that? Fine. Thank you.

The next petition is to improve access to education and services in British Sign Language. The petition was submitted by Deffo!, and was first considered in March 2015, having collected a total of 1,162 signatures. The committee last considered the petition on 7 November and agreed to seek the outstanding response from the Welsh Local Government Association. A response from the WLGA, and an apology over the time taken to produce this, was received on 8 November. The petitioner has also provided further comments, which are in the papers for today's meeting. 

Again, a huge issue in Wales. We want to make sure that any child going through the education system can engage and communicate in any way whatsoever. I think we should be doing both of these really. We should write to the British Association of Teachers of the Deaf, and I think we should be asking for an outline of evidence. 

Are we all agreed with that? I will make the point that there is a broad agreement on the lack of suitably qualified staff available. So, we will make that point. So, the committee could write to the British Association of Teachers of the Deaf Cymru, as suggested by the petitioners and the WLGA, to seek their views on the issue raised by the petition, in particular the teaching of, and through, BSL in schools. Are we all agreed on that? Fine. That's the conclusion of the petitions before us today. We're due to move on to the evidence session, which was due at 09:50.

09:55
4. Sesiwn dystiolaeth ar gyfer P-05-736: Darparu Gwasanaethau Iechyd Meddwl Mwy Hygyrch
4. Evidence session for P-05-736: To Make Mental Health Services More Accessible

This is to consider the petition submitted by Laura Williams, first considered on February 2017, having collected 73 signatures. The petition is to make mental health services more accessible.

Bore da. Good morning to you both. Good morning, Laura, and good morning, Alun. This is obviously an evidence session with regard to a petition that you submitted to us, Laura. It's really to explore a little bit more deeply the reasons for the petition and to get your views on it. So, we'll just be asking some, I can assure you, very gentle questions, simply to give the committee a better idea of where we should go with this petition from here on. Some of the questions will be put to both of you, and some to you singly, Laura, or perhaps to you, Alun. Okay?

So, what is your experience of the treatment and support for mental health problems provided in primary care, for instance, by your GP practice or from the local primary mental health support service?

It was very poor. I waited eight months to get the help I needed. I was ringing my local mental health team in Ely—the Pendine—crying, saying that I was going to have a breakdown. There was no communication. There was just, 'Go back to your GP' and the GP was saying, 'Go back to your mental health'. So, it was just back and forth all the time. It took eight months for them to act, and that's only because I made a complaint.

Unfortunately, it is something we're seeing. It tends to be that we hear about it when it goes wrong and not when it works. When it works, it tends to also be based on people's compassion as well. I think we've got to remember that any time somebody's in crisis, it's what they see as a crisis for them and not how it fits in a slot within services.

We have triaging systems, but to be honest, I think, in Wales, we have too many teams: we have primary care teams, we have community mental health teams, we have crisis teams, we have home-treatment teams, we have assertive outreach teams. I know there is work going on to look at whether that is the way forward, because well-qualified, well-supported and well-trained members of the community mental health team can do all of that; it's about the resourcing and the management of how that works.

But I think the other thing we have is, during this period of referral, there is a concern regarding who is responsible. So, a GP would make a referral to a team. As you say, you're ringing the team and the team is saying, 'They're still with the GP'. Who is the one who is chasing that up? I think what we've got to be saying is that until the team has agreed to take over that care, the GP shouldn't just be waiting for it; the GP should be taking an active interest in that support so that, if they can't get support, at least they're speaking to the person and saying, 'Look, I've chased it up this week', or the surgery are saying, 'We've chased this up', and not leaving the person in crisis to sit at home for those eight months, wondering what's going on.

Fine, thank you. The way we normally conduct these sessions is that each of us has an opportunity to ask questions—just to explain to you, Laura, how the procedure will work. So, Neil, would you like to—?

Yes. If you don't mind me asking, I just wondered, Laura, what kind of treatment you were offered and how helpful it was.

I was offered a CPN and they come out to your home every two weeks, and they did a care plan. That was about it. I was offered medication and I said 'no'.

So, you were offered a community psychiatric nurse and they wanted to give you medication.

10:00

Yes, but I declined.

No. Well, only just recently, which has been a year now. I've only started therapy, and that's looking at a long time again—you know, a year, year and a half. 

So, what we're looking at is somebody who needed talking therapy, and if you speak to medical practitioners, they would advise that in the first instance. You were in crisis, and yet you had to wait—12 months?

Yes. This therapy didn't even come from my local mental health service. I was pregnant and, because I've got mental health problems, I was under a perinatal team, and the therapist has actually come from the perinatal team and not from the Pendine, my local mental health services.

I had a diagnosis quite a few years ago, in 2012, and that was by the PTSD doctor. I've done treatment; it didn’t work. I was basically told, ‘Off you got to do groups’, and she knew I couldn’t do groups, so she said, ‘I’m not prepared to see you again’. There is now an 18-month waiting list to go and see the doctor for PTSD again.

Okay, so, post-traumatic stress disorder, just for the people who are watching this. 

You're suffering, you're in crisis, and you have to wait 18 months.

Yes, 18 months. Yes.

Yes. This is just common, and this what we find all the time. My concern with, say, for example, the Pendine is that, when people are referred—. Are you aware that who you first see isn't even qualified to give a diagnosis?

I've seen two men, and I felt quite small, if you could say that. They were asking me questions and stuff like that.

In terms of the diagnosis, do you think it's acceptable that when people go in crisis to places like the Pendine, the people they see are not qualified to give a diagnosis?

I think there are a couple of things. I think that, when you're in crisis, you don't necessarily need a diagnosis; you need somebody to support you. We now have a crisis care concordat in Wales, where it has joined up all of the health boards, local authorities, the voluntary organisations and Welsh Government, and we should be smarter with this. If somebody is in crisis, what sort of crisis? Is it a mental health crisis? Is it a social crisis, which a lot of these can be? And what are we doing about it? What are we putting in place to support the individual, rather than—? The challenge, as you say, is that sometimes, if it's diagnosis led, it means that Welsh Government has got a guarantee that you will have access to psychological therapies in primary care within 28 days. If you step outside of primary care and into a specialist team, you're talking of a six-month waiting time. Now, we personally think that's ridiculous, because, actually, if you are so unwell that you need to have specialist services, you have to wait six times longer than somebody who goes to the GP?

There is Matrics Cymru, which is looking at all of that, which is aiming to try to set out where access should be and how that could be supported, to make sure that there is quality counselling and therapy services. But I think that, for the experience that Laura and people have, what they need is a sympathetic person the other side, asking, 'What's the problem? What do you want? What can we help you with?' It's meant to be some form of triage, so that, actually, the person gets to see the right person within the team. But I think what happens is that, where somebody is in crisis, being seen by somebody who can't necessarily pick up on the nature of that condition isn't helpful, and I think what we should be looking at is that any triage should be carried out by somebody who is competent and qualified.

Thank you. Sorry, I'll finish now.

I think one of the issues is, if you maybe move out of crisis and back to that particular centre, say, which is the same as any other centre, I would imagine, even when you see a doctor, what's surprised me with the cases that I've done is that they're not qualified, and there's a consultant overseeing cases. So, people are putting their trust in individuals, and it seems that they've not got the level of qualification to actually diagnose people. Digressing slightly, there are people, constituents, that I am aware of, who've been even hospitalised for several months and have come out with no diagnosis. I imagine that is possibly because they don't have any right then to treatment.

It can take 10 years to get a diagnosis of bipolar disorder, because it's not something that's diagnosed from a blood test, it's not something where, you know, if you take an x-ray, you can see what it is. The nature of the presentation can be: is this bipolar disorder; is it schizophrenia; is it a psychosis? And it's one of those where we shouldn't be too quick to jump to a diagnosis, because, if you get the diagnosis wrong, the treatment is quite often wrong. What we should be looking at is managing the person's needs at that time. Avoiding a quick diagnosis—

10:05

To come back on that, then, why is it that people go to the private sector, get a much quicker diagnosis and become well much more quickly?

I wouldn't like to say that they were getting the right diagnosis there either.

They are a lot better. They are a lot quicker than 10 years.

There's also the argument about the different types of therapy. You can have CBT, DBT, transactional analysis, full-blown psychotherapy—and an awful lot of that depends on the relationship between you and the therapist. If you are actually treated as an individual, if you are treated as somebody who is going to be shown compassion—. It may be that the private sector has more time to be doing that. It's not necessarily because of a diagnosis; it's because, actually, they are spending that time and working with the individual. We do have a situation where an awful lot of the supporting services to community mental health teams and primary care have been cut because of the cuts to local authorities. A lot of the local authority mental health services have shrunk very much over the last few years, which means that the pressure is back on those teams to pick that up.

For something like PTSD, a diagnosis means that you get access into the PTSD services. Where there is a diagnosable condition that means that, without that diagnosis, you can't get access to the service, that's important. But, I think that, at the point of crisis, it's not so much the diagnosis. I think that what we then have to look at is, once you've dealt with the crisis, as you say, how quickly do we proceed to 'What is the treatment pathway that that person needs?'

The crisis could have been [Correction: been addressed], when Laura attended—'Right, let's deal with that issue here today.' Even if it was somebody in that centre who was able to sit down and talk with Laura and see what her feelings were and explain that—not 'We'll put a sticking plaster over that', but 'When are we seeing Laura? When are we going to get a diagnosis? When are we going to look at which pathway she needs to go into?' But also, not necessarily fix her future with that pathway either. Mental health problems are not isolated. 

It's time. It's having time to sit down with somebody when they need you. We have cancer targets where we all worry about targets for treatment because people die. People are dying through their mental health. Unless we give people very early supportive treatment, we are going to see more deaths out there. 

That's fine. I think that much of the questioning that we had in mind has been covered by you now. So, what I'm going to do is just offer the rest of the committee an opportunity. Your answers and your responses may have opened up questions that they might want to ask in the normal fashion, so we'll do that now. Janet, please. 

You mentioned earlier about the number of agencies, and I found this in my constituency. There's plenty of help out there, but for somebody really struggling and finding it difficult to get out of bed in the morning and get ready and go out of their own home, how they navigate themselves around the system—. I'm dealing with a case right now, at this very moment, and I am really struggling to navigate around. All that person wants is a diagnosis. They have been waiting a long time for a diagnosis. They say to me, 'I really don't know what my condition is. They keep offering me a counsellor, and it's very intermittent.' It could be one week, and then they don't see them. There's no consistency whatsoever. The person keeps saying to me: 'They are offering me medications. They are offering me this. How do they know—because they are not qualified—that the medications they are offering me couldn't potentially do me more harm?' It's getting the diagnosis, certainly with the few cases that I have dealt with. And then it's that, once you step—. To me, if I say, 'Look, I really need some support', I would hope that you then become supported under an umbrella, with arms around you, and guided through the process. It's not happening, and people are just finding themselves distressed and more concerned about the lack of communication. They are falling through the net, big style, with mental health problems. I have raised it here. It's probably the single biggest issue that affects some of my constituents, and it's the hardest part of the role of an Assembly Member. When they walk into my office, I don't want them actually walking out again and going home without having received some support that day. That's what happens, because trying to access mental health services like that is really difficult.

10:10

Yes. Eight months—you shouldn't be waiting eight months. I was back to the doctors, I was self-harming and my doctor goes, 'Are you going to do that again?' and I said 'yes'. It was, 'Here's the crisis team's leaflet; go home and ring them.' I don't want people to be given a leaflet, 'You go home; you ring them.' They're not going to ring them. They're not in the state of mind to ring them. I want GPs to stop giving leaflets out and for them to do them on the patient's behalf. If they see they're not fit, they need help there and then, not eight months later.

Just a couple of points. One is: I'd be very concerned if anyone was prescribing meds without being qualified. We do have regulations. Doctors would have to be qualified to a level. It may be that the local protocols are that a senior house officer or a registrar isn't allowed by their local protocols to make a formal diagnosis, but they will be qualified medical practitioners able to do that.

The crisis situation is quite interesting. The Welsh Government—. As I said, the crisis care concordat, working with us, across Wales, with lots of agencies—. There are alternatives to crisis teams. There are examples in Leeds, in Bristol, across London, of crisis sanctuaries where people who are in that crisis can ring up, would be able to be seen within those few days, not by mental health professionals, but by people who would try and support them through that crisis during a period of social crisis—I'm not going to get access to services, but I need support through this period while I'm waiting. Those are things that they're looking to develop. 

There's also a review of community mental health teams by Healthcare Inspectorate Wales at the moment, and I think some of this will come out as well. Healthcare Inspectorate Wales are looking into community mental health teams and some of that—. What is the role of the community mental health team? Is there an engagement with primary care? Where is that engagement? We need some clarity over where that works and what these numbers are. What number do you call? You dial 999 for an ambulance, you dial 999 for the police. What do you do if you're in a mental health crisis and know you're going to be supported? Most of the people that we work with, if you ask them, they'll say, 'Dial 999 because the police are the people who will come out.' The police will always respond. 

Can I carry on along the lines of—? You listed a whole range of organisations, not all of which I wrote down at the very beginning, but I think I've got about six or seven. What I'm asking is: is it integrated? Is it co-ordinated? And more importantly, does it work with the third sector and others as well?

Patchy. You've got areas—. Across Betsi Cadwaladr, for example, organisations like ourselves have embedded family support workers. So, we have a member of staff within the community mental health team. We have, now, over the last 12 to 18 months, developed that in Cardiff, so we have a family support worker embedded in community mental health teams. But what you did have was the voluntary sector played a very large part in managing the social side of this, and being the people who you, as AMs, quite often would ring and say, 'Can you offer some support?'—because we knew the routes in. The funding from local authorities has been cut so much that it's either stuff that is very much health driven or very generic services. So, instead of you being able to get—. If Laura wanted to go and see a mental health resource centre, there are far fewer of those now. There are lots of well-being centres, which will be looking at physical disability and other areas as well. When you're in a mental health crisis, you don't want to be seeing people who don't understand where you are. So, it needs to be that we recognise mental health is something that people need to be able to access.

There's a big drive towards primary care mental health services, but again, because, I think, there was a lack of clarity as to what that meant, we found a lot of the third sector mental health services were rebranded as primary care mental health services. So, where do they fit? How does this run though? How do we get referral routes? We work with the community mental health teams, yet sometimes if we need to ring and ask for crisis care, we're told the person has to go through their GP. They go to their GP at 9 o'clock at night, the GP's never seen them before because it's an out-of-hours service; the GP doesn't know that person. Why are we having systems that block access to crisis rather than make access available? It's not through lack of strategy, it's not through lack of policy, it's not through lack of direction. It's lack of joining all of this up at local levels. That's the big problem.

That happens everywhere, doesn't it? We have really good policies at the top and we all pat ourselves on the back and say, 'This is really good,' but by the time it gets down to the people who are dealing with it, often under huge pressure, core policies sometimes are diluted—I think that's the nicest way to say it.

The other thing I was going to ask is: when you see universal credit being rolled out, you see people suffering severe financial hardship. I mean, I just think it's surprising when people don't suffer mental health problems when they're in that situation, when they can't keep their houses warm, they haven't got food. I mean, if I was in that situation, I'd suffer severe mental health problems as well. Are you seeing that growth in areas where universal credit has been rolled out? 

10:15

We're starting to see it. We're very fortunate; next week, we're actually launching—. Ourselves and three sister charities from England, Scotland and Northern Ireland have been supported by Lloyds Banking Group for two years to set up a money and mental health advice service, which is specifically aimed—. Because if you have a mental health problem, money can be a challenge anyway. If you have money problems, you can develop mental health issues. If you have both, you're in a really difficult situation, and that's aimed at trying to pick that up.

Universal credit: if you need that funding, how do you go four weeks, even, without money? What you've got is you're looking at a group of people who are struggling to cope anyway. So, taking their money off them or saying, 'Yes, you do need money, we've identified that, but you haven't got anything for four weeks'—we are finding increased use of food banks, but we're also finding that people are in turmoil through it. They're worried about it even if it hasn't happened yet because it's just—. The press are not handling it well, but also there isn't good enough information and people are terrified: 'When I get called up for my assessment, I'm going to have my benefits stopped.' So, it's fear of that that is just contributing to it all as well.

I fear we may be straying into some political arguments here and I think we ought to keep away from that. The whole idea is to concentrate on Laura's difficulties and the difficulties with the mental health services that are available. Rhun, did you have anything you'd like to ask?

Yes. We've got translation equipment for anybody who needs it.

Jest yn adeiladu ar y cwestiwn gan Mike Hedges, pwy ddylai fod yn gyfrifol? Pwy ddylai fod yn gyfrifol am wneud yn siŵr bod y gwahanol asiantaethau'n cyfathrebu efo'i gilydd? 

Just building on the questions from Mike Hedges, who should be responsible? Who should be responsible for ensuring that the different agencies communicate with each other? 

There's the challenge of, 'Is it a health provision, is it a local authority provision?' There is the development of these local partnership boards, who are supposed to be looking at a range of these options, but, to be honest, I think we could be getting clearer guidance from Welsh Government. There is a reluctance sometimes to say, 'This is how you should do it' because it tends to be that these are local matters and local solutions need to be developed, but we know that, actually, we are the same sort of size [Correction: population size] as Manchester, and Manchester is going to have a single body to manage health and social care, looking to join up the services for 2.5 million people across Manchester. Why can't we have some sort of co-ordinated system that is saying, 'This is a route through; these are the routes that you can expect'? Perhaps if you were then in Ynys Môn and there was an issue about, 'Well, actually, we don't necessarily have the infrastructure there', you tweak that to fit the area, but I think we should be setting a baseline of what people should expect anywhere in Wales. 

And, Laura, how did you have experiences of feeling that the different agencies that you were coming across weren't talking to each other, and having to start from scratch with different people where, perhaps, there should be better communication?

Well, at one point, my file was actually lost from mental health, from the PTSD clinic, from the doctors. That took about two to three months to find because, you know, it just vanished. And then I was referred to the Pendine. There was nothing: no communication with anyone, you know? I went back to my doctor and he was like, 'Well, there's nothing on the system'. Obviously they should all be linked into one system, but they're not, you know? You go to your GP and tell them, they've got it on their system, but if you go to your mental health team it's on their system. So, you know, it was just a fax there, a fax here.  

How many times would you say, roughly, you had to begin from the beginning in explaining what you were going through?

Probably about 500 times, all the time explaining my story, explaining what I've got. Then it was always a case of, 'Do you want medication?' and I was like, 'No, I've been on medication, it doesn't work for me'. It was like a dead end for them: 'Well, we don't know what to do with you now then, as you won't take medication.' But what they fail to realise is, when you have medication, you still need therapy. But, in their eyes, you've had medication, and you don't really need anything else.

10:20

How did that feel, knowing that you were speaking to somebody who knew nothing about you every time?

It's horrible because doctors are not trained anyway—normal doctors are not trained in mental health anyway. Talking to them is basically like talking to a brick wall. They don't understand. Their thing is, because they give out medication, just give out medication—'You're done. You're sorted. Off you go.' It doesn't work like that, you know. Doctors do need to be trained in mental health so they can see, you know, 'This person is struggling. Let's do something on our end as well as the mental health team, so we are talking to each other and we know what's going on, what therapy, if they are taking medication or if they are not.' There's just no communication. It's not going to hurt to pick up the phone and talk.

Through the problems that you've had, has there been one place that you've been able to turn to? It might be a charity, it might be a family member, it might be a GP, but somewhere you can turn to and say, 'You know what, things aren't quite going right now', or—. Because, with cancer, for example, you're meant to have a key worker that you can turn to. We're asking with dementia that there should be key workers that a family can go to at any point and make contact.

I've got a community psychiatric nurse. She comes out every two weeks and she just talks to me and stuff. But I couldn't just ring the Pendine and go, 'Right, can I come in and see you today? I'm really struggling. I really need to see someone.' There isn't anything like that. I couldn't ring up my GP and say, 'Can I come in and talk to you? It's really important.' The GP would probably laugh at me—you know, 'You're wasting our time. We don't deal with mental health.'

Any thoughts on that, and who should be that point of contact? It could be Hafal. It could be—

It could well be Hafal, Mind, Gofal. There's a number of organisations. Can I just ask: do you have a care and treatment plan?

Yes, I have a care plan.

Welsh Government has led the UK in legislation. We're not seeing it happening on the ground. Care and treatment plans are a phenomenal way of making sure that people know what to do when they hit crisis.

It holds people responsible. But what we are finding is that—and this needs to be considered as you see it—before the days of care and treatment plans, there were hundreds or thousands of people in secondary mental health services. It was almost a boast of, 'Look how big our caseload is.' Now that anybody in secondary mental health services has to have a care and treatment plan that sets out what they're going to receive and how that's going to be managed, we have had huge numbers of discharges from secondary mental health services. We still have systems where people are seen by specialist mental health services, but we're told they are not in secondary services. Is that because it means that you don't have to write a care and treatment plan? People can make their decisions. If you have a care and treatment plan, it says, 'This is how you have got your issues around your accommodation. This is what you are going to do about therapy and medication. This is what you're going to do about work and employment.' It also says who is the person for you to be in touch with, what's to happen in cases of crisis—if you're discharged, what the plan is for your discharge. Good quality care and treatment—.

I went to the Welsh Affairs Select Committee in London as part of the development of that Measure with Lee McCabe, who was a service user from Merthyr who had tried to take his own life twice until somebody sat him down and just said, 'What do you want from us? What can we do for you? Let's write a plan of what we are going to do and let's talk about it.' His life was massively changed. We now have legislation for it. We should be holding that to account. Because, if you have a care and treatment plan, that should set out what's going to happen with you, and, just because you don't want to take medication, it doesn't mean you should get anything less in care. Medication isn't right for everybody. Sorry.

Can I just ask a question: what is your opinion of the response from the Cabinet Secretary to your petition?

Disgusting. He's just gone, you know, 'I've had Hafal, who've given evidence', you know—

Yes, like on my thing. So, I did a bit of research, and I typed his name into Google and I found an article saying that he promised he wouldn't cut NHS services, and I've been seeing exactly that where mental health services are being cut. So, I was really disappointed. I actually went through all the petitions again, and I saw another petition to do with eating disorders. Basically, it was the same response. You know, it was just about money: 'It's ring-fenced; there's no more we can do.' There is a lot more you can do. I don't see where the money's going. Because services are being cut, so, actually, where is all the money going? Because services are being cut, you have to do more group work. There's no one to one. You have to fight for the one to one. All I was offered is groups, and I can't do groups. So, it's taken a year just to get one-to-one therapy. So, there was just no response. I was crushed. I thought it would be positive, but it was just the opposite—negative.

10:25

Have you lost confidence in our Cabinet health Secretary as a result of that response?

Yes. Because I think it's going to come to a point where he's—you know, 'It's ring-fenced; there's no more we can do'. I'll keep on fighting until things have changed.

Very briefly, if you were looking for something that could be done that would help us measure what could be done better—. Back to the point on care and treatment plans, would some sort of performance measure of how often they're done—? They're meant to happen. You're saying they're not happening as they should. Would measuring that, implementing what the legislation tells us should be happening, be a useful step forward?

It would be. I know there are reviews going on, and one of the challenges that we've made to the Healthcare Inspectorate Wales review is that one way of judging whether there was engagement of the patient was to see if they'd signed the plan. That's not engagement; that's a bit of paper stuck underneath your nose to sign. There is a strong driver within mental health services now for assessment based on the experience of the service user. So, I think, if we're looking at care and treatment plans, it's not a case of, 'Are they in place?', because you'd do an audit and 95 per cent probably would be in place. 'Do they mean anything?' is a completely different thing. What you've got to be doing is listening to the stories that people like Laura bring to it, look at where they work well—. Because we need to be cautious; our services out there—mental health services—are under huge pressure. Yes, there's a mental health ring fence but, actually, what we're finding is that I think we're talking about 11 per cent or 12 per cent of the health budget going on it, but we're talking about one in four people accessing mental health services at some point, we're talking about a huge increase in the number of referrals. So, mental health, it shouldn't just be the mental health ring-fenced budget, it should also be GPs, it should be education, it should be leisure. You go to your local leisure centre and you can get a wheelchair into the pool, you can get a hoist to take you into the pool. People with a mental health problem don't need a physical adaptation; they need somebody there who is going to support them to engage. Where's the parity that we're seeing across that?

I think there should be serious reviews taking place of care and treatment plans, which are not going into a community mental health team and going through 200 case files, but arranging to see 50 of those clients at random, away from the environment, and to say, 'How much were you involved in this plan? Do you know you've got a plan? How have you reviewed this? Have you been involved in it?' Because, at the moment, I'm just concerned that it's becoming a tick-box exercise instead of it being what it was always intended to do, which was to change lives.

And I think, Laura, your experience confirms that, because you say there's nobody that you know you can turn to at any time. That should be in the care and treatment plan that you have and hold on to throughout your treatment.

Just very briefly, more for, I suppose, Hafal, really—and Laura as well—what did you make of the £4 million over two years? How is that going to make a—? Will it make a material difference?

No. They need to sit down, and they need to go through what their big gap is in—communication, waiting times. I've been under the Pendine now for a year, with a CPN. I've not had a review yet. I've got a care plan, yet I've not had a review to say—. There's no review. There are too many patients; there are not enough mental health doctors. People are—you know, suicide and stuff, because they're not accessing—. They're accessing the help that they need, but no-one's saying, you know—.

Yes. Just out of interest, has any medical professional, GP, or anyone in the system ever told you to pull yourself together?

A couple of years ago, when I was at the PTSD clinic, they had like—. Because it's a university, they had a student, and she came out and she started to work with me. She was quite young. She went, 'I don't think there's anything wrong with you', and I stopped going to the service altogether. I thought, 'That's enough for me. I'm not doing it anymore.'

No. There is a lot—. I've been taken to hospital by ambulance because of panic attacks—which I've never experienced—and the doctors have gone, 'There's nothing wrong with you'. 'You're wasting our time'—that's what I've had a lot of times. That's horrible to hear. It makes you feel horrible about yourself, and it's not nice at all.

10:30

Just in finishing, really, I think Alun made a really good point about the physical challenges that people face and they're looked after; allowances are made for it. If you've got a broken arm, everyone can treat that, can't they?

But I think, if they're mental health issues, which so many people will have in life now—you know, it's not unusual; so many people go through different traumas, but I think the message is, at the minute, just don't have those experiences in Wales, because you will not be looked after. 

I think we have to look at the fact that there is far more empathy for someone with a broken arm than there is for someone with mental issues, and that's another part that we ought to be looking at, I think.

Can I thank both of you for your attendance here? Your answers have raised a number of issues that the committee, I'm sure, will explore in detail, and it will help us in our decisions as to how we proceed from here. What I can assure you, Laura, is that it does not end here and that matters will be taken forward in one form or another. Do you understand that? Okay, fine. Thank you.

I'll just note that a copy of the transcript will be sent to both of you with all the factual matters in that, okay.

Thank you very much.

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 for the remainder of the meeting

Cynnig:

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

Motion:

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

Cynigiwyd y cynnig.

Motion moved.

I propose, in accordance with Standing Order 17.42(vi), that the committee resolves to meet in private for the remainder of the meeting. Are you happy with that? Fine, thank you.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:31.

Motion agreed.

The public part of the meeting ended at 10:31.