|1. Questions to the Minister for Education|
|2. Questions to the Minister for Health and Social Services|
|3. Topical Questions|
|4. 90-second Statements|
|Motion to elect a Member to a Committee|
|5. Debate on the Finance Committee report: The Cost of Caring for an Ageing Population|
|6. Debate on the Economy, Infrastructure and Skills Committee Report: State of the Roads in Wales|
|7. Welsh Conservatives Debate: Housing|
|8. Voting Time|
|9. Short Debate: The white heat of technology?|
The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.
And the first item on our agenda this afternoon is questions to the Minister for Education, and the first question is from Mandy Jones.
1. Will the Minister make a statement on IT capacity in schools in North Wales? OAQ53153
The information technology capacity in north Wales varies from school to school. In addition to £5 million for broadband upgrades, I have allocated £1.7 million to support schools in delivering the digital requirements of the new curriculum, with priority given to schools most in need of upgrading in-school infrastructure.
Thank you. Minister, there have been some concerning headlines, both before and after Christmas, around the education sector. I would like to discuss today the report by Qualifications Wales at the end of last year about IT learning, particularly the reference to the out-of-date hardware, software and, in some cases, skills. Minister, can you give an assurance that schools in my region have the hardware, software and teaching staff they need to equip their students with the skills necessary in this digital world?
The Member is right to say that we need to ensure that schools have the hardware, both outside of the school premises and in school, to ensure the curriculum can be delivered. As I have said, we have committed £5 million to upgrade broadband as part of the Learning in Digital Wales programme. I'm pleased to say that of the five difficult-to-reach schools identified in north Wales, three of those schools have now been properly connected and two are in the process of being connected. As I mentioned yesterday in answers to questions regarding the beginning of online assessments, further resources have been given to the Welsh Local Government Association to address the internal needs of those schools most in need, and I continue to work with my officials in the LIDW team to look to where we can prioritise further capital investment in this important area.
Thank you, Llywydd, and a happy new year.
Minister, as you will be aware, twenty-first century technology, such as superfast broadband, is of increasing importance to our primary schools, with more bilingual digital tools and resources now available online. One major example where IT is of significant importance, of course, is the new e-sgol pilot project. As you will be aware, this has seen the use of video technology to connect classrooms in different schools across Ceredigion and Powys. I'm aware that £279,000 capital funding has been allocated to Ceredigion council to buy specialist equipment to pilot e-sgol in 13 schools. Obviously, this looks to be a good initiative. However, it is a considerable spend that could amount to millions if you are going to roll out the scheme out across Wales.
Therefore, what assurances can you provide us with here today that the e-sgol project was well costed before the pilot began and is being monitored against spend in terms of performance? And can you clarify whether you will be making the finance available following the review later on this year? If it has been a successful scheme in Ceredigion, will you be rolling it out across north Wales, and, indeed, Aberconwy?
I'm glad that the Member is aware of the innovative e-sgol project that is indeed being piloted for the Welsh Government by Ceredigion County Council. It builds on the experience of the Scottish Government in delivering education in the highlands and islands. Sometimes, we are concerned about our rurality; well, delivering education in those circumstances, in a bilingual system, the same as we have, certainly is a challenge. I was delighted to launch the project at the high school in Lampeter, and I saw for myself the innovative delivery of a further maths lesson bilingually to pupils in that school and another school in Ceredigion. Without that project, the pupils in the other school simply would not be able to take further maths A-level, a qualification that is highly desired by some top universities.
The e-sgol project is an important part of our rural schools education plan. The project is not designed to be a whole-Wales project. It is part of the solution to some of the logistical disadvantages of delivering education in a rural area. We will, of course, be evaluating the scheme in terms of value for money, but, more importantly, the impact that it has on the opportunities for students in rural areas, and if the scheme follows the success of the Scottish scheme, which I believe firmly that it will, then we will be looking to roll it out in other rural local authorities, because no matter where a child is educated in Wales, whether it be in an urban setting or a rural setting, they deserve to have the best possible opportunities.
One of the major frustrations that I hear expressed by teachers, parents and schools is the shortage of devices in classrooms—the number of tablets or laptops that are available for pupils to use. I know from personal experience that many schools are now reliant on the voluntary efforts of parents and PTAs in raising funds to buy tablets and laptops. Now, that, of course, would account to having to rely, in our day, on voluntary contributions for paper and biros. Is that acceptable?
Well, Llyr, you are right—it is the individual responsibility of individual schools to ensure that they have the resources within those schools, and should plan accordingly. However, I'm aware that not all schools find themselves in the same position, and we've just talked about equity between urban and rural education, and no school should not have the facilities it needs within the school because of an inability to purchase them through other means. As I said in answer to Mandy Jones, as we move from having solved, hopefully, across Wales by March of this year, the problems relating to capacity in the infrastructure outside of schools, we can now turn our attention to what is a fair and equitable way in which we can support local authorities and schools to develop infrastructure within the classroom. That does need to be done in a fair and equitable way, and recognising that, in some areas, the devices that children have at home are probably more powerful than what they have available to them in schools. So, there is not necessarily a one-size-fits-all solution to this. But we will be working with officials in the LIDW branch to seek to prioritise what capital resources that we have, to ensure that schools have the equipment—whether that be stand-alone computers, or hand-held devices—and that schools, crucially, have the advice to know what to buy, and to ensure that, having bought that, teachers are in a position to be able to utilise it most effectively for the learning of pupils. And, again, we are looking at how we can, at a national level, provide that consistency of support, and maybe a menu of products and support, so that schools can make really good and prudent decisions when they invest these resources.
2. What action is the Welsh Government taking to improve school standards? OAQ53132
Thank you, Darren. Our national mission is to raise standards of education for our young people across the nation. We are developing new evaluation and improvement arrangements, which will further support school improvement, and I will update Members on those arrangements in the coming weeks.
Minister, you will no doubt have seen the report in the Western Mail on Monday, where there were comments from quite a number of headteachers and teaching unions expressing a great deal of concern about the pressure that they are under. It described people being exhausted, stressed, unable to switch off, and some headteachers turning to drink as a result of the pressure that your Government is putting on schools at the moment, not just in terms of the reform agenda that is currently under way, but also in terms of finances. And, of course, we know that there is a funding gap per pupil between England and Wales. That's culminating in headteachers taking prolonged periods of absence. The report suggested that, over a three-year period, around eight years and 10 months had been lost, at least, in headteacher absences across Wales, and 108 headteachers had been off for more than six weeks. This is a concerning backdrop at a time when your Government is seeking to improve school standards. So, what are you doing to reduce the pressure on headteachers, particularly given the shortage of applications that are coming in for new headship posts when they become vacant?
Thank you for that question, Darren. Securing, nurturing, and inspiring school leaders now and for the future is an important priority for the national mission. That's why, last year, we launched the National Academy for Educational Leadership Wales, so that we can better support those who are already in the job, or those who aspire to leadership in our education system, to get the support that they need. There are statutory measures in place to support all employees, including teaching staff, to maintain their health and well-being. And, as you will be aware, we are undertaking work with how we can ensure that schools are places where well-being can be nurtured, and that's as important for the staff as it is for the pupils within the school. We will be working—. As you will be aware, a number of reports have been commissioned and workstreams are under way with regard to workload. One positive example has been the introduction of the business manager pilots, which takes tasks and duties away from headteachers so that they have got more time to think about curriculum and teaching and learning. And we will continue to work with our local authorities, the regional consortia and the headteacher unions themselves to see what more we can do. Of course, we demand high standards of our school leaders; they are integral to the delivery of the national mission, but obviously we want to do that in a way, as I said, that is nurturing and supportive, not punitive, and, of course, our reforms to curriculum assessment measures have an important part to play in that.
Minister, would you agree with me that we should recognise and celebrate excellent standards of education in Wales, such as those provided by St Julian's Primary School in my constituency, which had an Estyn inspection in October of last year that assessed them as having excellence right across the board? It's a just-under 700 pupil primary school. It's a pioneer school in terms of digital competency and professional learning. I'd very much like to pay tribute to the staff, the school governors, the parents and the children, and I'm sure you'd like to do the same.
John, you're absolutely right—we need to challenge underperformance where we find it in the Welsh education system, but we also need to recognise and celebrate success where we find it in the Welsh education system. Too often, we are ready to talk our teaching processionals and their efforts down. St Julian's Primary School—a school that I've had the privilege to visit to see the work that they are doing in terms of digital competency—is a fantastic school that does a wonderful, wonderful job for the children who attend. I would like to join you in paying tribute to the work of the headteacher and the team at St Julian's. Of course, I look forward to joining them, because, if they've been given 'excellent' by Estyn, they will be at the Estyn annual awards dinner and I will have a chance to congratulate them personally, which I will look forward to doing.
A chance now for party spokespeople to ask questions. The Conservative spokesperson. Suzy Davies.
Diolch yn fawr, Llywydd. I'm sure you're expecting me to return to the Western Mail report today, Minister, which I do. Darren Millar mentioned that school leaders are feeling exhausted and under threat and particularly
'unable to cope with impossible demands set from on high by a range of bureaucratic people'.
After citing funding, which you probably would expect, and retention and recruitment problems, those headteachers added that the—and I'm quoting from them—
'the best education systems do not recruit talent and then constrain them with top-down policy or an overly centralised...school leadership.'
And, of course, as leader of the Welsh Liberal Democrats in the past, you will have agreed with the manifesto in 2016, which stated that,
'Teachers deliver the best results when they are given flexibility and support, not smothered by bureacracy. We will provide more freedom for teachers and greater flexibility to our schools.'
The National Academy for Educational Leadership—can you explain who is shaping and driving that to avoid any concerns that this too is about impossible demands set from on high by a range of bureaucratic people?
My views have not changed since that manifesto was written. That's why we are reforming the curriculum, to move away from the tick-box expectations that we currently require our schools to undertake. That's why we are investing in support for self-evaluation for schools, so they themselves become the best judge of their own performance, because I believe that they are best placed then to understand where they are and how they can improve. That's why we're investing in class sizes, so that those teachers have the time that they need to spend with individual children, and that's why, indeed, we're investing in a National Academy for Educational Leadership to support our headteachers with the training and continuing professional learning so that they can be the very best they can be. I see no difference in that approach from what I would have taken if I was still sitting on that side of the Chamber. What we know is that, if we can build capacity within our own education system, that's the best way to deliver the national mission.
Well, we wouldn't disagree with you on that, of course, because a similar academy was in our Welsh Conservatives manifesto, and we would like to see a very successful version of that providing the results that I hope we would all see. My question was: who is actually driving that? Is it going to be civil servants who design it or is it going to be teachers? You heard from me about the concerns on self-evaluation yesterday, and I look forward to hearing a bit more from you as time goes on about how that will look.
But let's look at that curriculum reform that you were talking about. Earlier this week, those same headteachers criticised the pace of change in schools as secondary schools are—again, I'm quoting—
'dealing with reformed GCSEs and A levels at the same time as trying to prepare for the new curriculum',
something that was supported in principle by the Welsh Local Government Association, who told the Children, Young People and Education Committee in their written evidence that
'not enough of what actually matters has been included in the AoLEs…too many statements are generic, poorly defined and weak on knowledge and skills development',
and this being likely to result in pupils' development being left to chance, and a total of 30 areas of learning and experience will be
'particularly challenging for primary teachers where the load is not shared across departments/faculties.'
And, finally, most damning of all, while the
'landscape is awash with experts getting “excited” about curriculum reform…the reality is that workload-weary teachers will have to try to make it work on the ground.'
Now, you're ring-fencing an awful lot of money to train teachers for this new curriculum—for this—when we're not really clear what 'this' means, and at the same time, that means there is money not going into school budgets, which is not enabling teacher freedom and which is not enabling greater flexibilities for schools. How are you responding to the fears raised by both the headteachers and the WLGA that the curriculum, which is meant to be ready for next year, isn't going to be on time in any clear and meaningful way and what are you going to do about it?
Can I assure the Member, with regard to who is driving forward the National Academy for Educational Leadership, the academy is led by an ex-headteacher. He is supported by a range of associates to the academy, all of whom are current practitioners, who are leading schools in our nation and they are, for the leadership of our education system, designing and accrediting new professional learning opportunities for them. The very same can be said about the curriculum.
The WLGA says that it is teachers who will be responsible for delivering it on a day-to-day basis—of course they are, and that's why it is teachers themselves and our pioneer schools that have designed the curriculum. This isn't a bureaucrat in the Welsh Government who is telling teachers what they will teach in the future—it is our teachers, who are currently out there in our system now, who are designing our curriculum in a way that they belive will best suit their colleagues on the ground.
I must admit to being a little concerned in some of the evidence that the WLGA has provided to the CYPE committee. I'm sure we will want to discuss that in more detail tomorrow. In some ways, it shows a general lack of understanding of the reforms and how they will work in practice, but clearly there is an emphasis on us then to make sure that they are clearly in the picture on how this will work. And it's also to say that much of the feedback that they have reported on seems to relate to where we were in the curriculum reform journey back in July.
However, there are issues that will need to be addressed in the evidence that they have put forward and, indeed, that's why I made the decision 12 months ago to delay the roll-out of the curriculum to ensure that we did have enough time for all of our schools, both primary and secondary, to prepare for this and to ensure that our teachers had the professional learning opportunities that they will need to turn the new curriculum into an exciting reality for Welsh schoolchildren.
Well, I'm thinking that this should be an area of concern for you, then, because if the WLGA doesn't seem to understand what a teacher-designed system is going to look like, how on earth are they going to be able to help distribute the money that you're giving them now, through this ring-fenced system, to help encourage teachers to learn how to deliver a system that they themselves have designed but that the WLGA doesn't understand.
Can we just move on now to the education improvement grant that you've decided to cut by 10 per cent this year? One of the key aims, of course, of the education improvement grant was to address learners' barriers to learning and to improve inclusion, which I'm sure we would all appreciate. In areas with high levels of Welsh language education, such as Gwynedd, it is entirely reasonable to foresee that one of the those barriers to education could be a lack of Welsh language skills for people moving into the area. When you took the decision to cut the education improvement grant, I wonder if you could explain to me what assessment was carried out to see what effect that decision would have on providers who were helping people moving to the area to improve their Welsh language skills in order to access their education. And also, on the United Nations Convention on the Rights of the Child and the rights of those children to an education, in making the cuts and in moving this service, I suspect that there's going to be a problem in evidencing the fact that children's right to an education is being properly observed. Thank you.
Presiding Officer, If I could correct the Member correct the Member, it is not the WLGA or local authorities that will decide how the professional learning moneys are spent. The moneys will be made available via a grant via individual local authorities. It is schools for themselves and headteachers themselves that will decide how their allocation for professional learning will be spent. It's not the WLGA or individual local authorities, although the money goes via that particular route. It is those headteachers and those individual schools who are best placed to understand the professional learning needs of their staff so that they can realise the curriculum.
Tough choices, Presiding Officer, have to be made around budgets; these have been well rehearsed in the education committee. There is a balance to be struck between what money is made available to local authorities, which is of course where schools receive most of their funding from, and what grants are held centrally from Government. As I said, difficult decisions have to be made, but I am confident in the ability of both the authority in Gwynedd and the regional consortia and those that are committed to giving children the opportunity to learn Welsh language skills should they arrive in that county and that they will be able to do so successfully, and these issues have not been raised with me by Gwynedd.
Whilst Plaid Cymru has been supportive of some of the changes that you've made in relation to schools, when it comes to post-16 education, some of the people that I've talked to have said that they believe that the Government have taken their eye off the ball. Even the former Minister—I'm not sure of the title at the time—said that further education was not given a priority. Do you agree with that statement? Do you think that the Welsh Government have taken their eye off the ball?
Well, I am delighted to have now assumed responsibility for FE in the recent change to Cabinet responsibilities and I look forward to working really closely with ColegauCymru to ensure that FE, which is one of the stars of Welsh education in the provision that it provides, both in terms of traditional A-level courses or vocational courses or adult returner courses—it's a real strength within our system and I look forward very much to working alongside them. I'm very glad that, prior to Christmas, we were able to assist them with additional resources around issues with regard to pay for people who work so successfully in that sector.
Thank you for the reply. I appreciate elements of this is new, but, obviously, higher education isn't new. We've seen major pressures in the college sector, strikes averted at the eleventh hour, but that doesn't take away from the fact that workload pressure is still a reality. We need to see progress on Hazelkorn and on FE legislation. Where is that in the round? There are major governance issues in higher education. We've seen the vice-chancellor of Bangor having left the post recently, and serious financial difficulties there and in Cardiff with £21 million of cutbacks. If the eye hasn't been taken off the ball, what are you doing to try and alleviate some of these issues that I've just outlined here today?
Well, of course, higher education institutions are autonomous bodies and they are responsible for how they run themselves and their financial viability. What we're doing about it is implementing the findings of the Diamond review, which will see us move to a much more sustainable way of funding HE in the future.
Thank you for that answer, of course, but I think many of the universities would say back to that that they need imminent support because they are making those cutbacks in the here and now, and any intervention that you can make as Minister would be welcome.
I'd like to turn finally to Swansea University and governance issues in higher education. Yesterday, my colleague Helen Mary Jones asked a business question in relation to this and was told that the Welsh Government couldn't comment on an ongoing investigation. Now, a Swansea University spokesperson told the BBC yesterday that a thorough investigation had taken place before the suspensions, but then in the same statement said that there is an ongoing investigation. So, which is it? Can you clarify here today? The vice-chancellor himself has said that no material evidence was provided to him prior to the suspension and that there has been a serious breach of due process. This is a respected vice-chancellor of 15 years who has been suspended. He was barred from his home, under which university rules say is his home—he's required to live in it. I've been told that the process of investigating has actually stalled and not much is happening at all, and I've also been told that there's anger and concern regarding the way in which all this has been conducted. We are talking about a major institution here in Swansea, bringing economic returns for the area that know no bounds in relation to the work that has been happening in the school of management, for example, in the last few years. We've also seen that the university court has been postponed. Why is the governance element of the university being postponed at short notice, without telling Assembly Members why this is?
I, personally, don't believe that it's good enough for you to say that you have no comment to make. What are you going to do to hold these institutions to account to ensure that the governance process is adhered to appropriately and that we can be assured that Higher Education Funding Council for Wales money is being spent in the right and proper way, so that we all here can hold this Government and the university sector to account? Do we need reform in the governance of universities here in Wales?
Only this morning, at the economic development committee, we spent a great deal of time—I spent a great deal of time—being told of the importance of universities remaining autonomous institutions, without interference from the Government. There is an ongoing internal investigation being carried out by Swansea University, and it would be completely—completely—inappropriate for me to comment on the substance of that whilst that investigation is ongoing.
HEFCW are in touch with Swansea University and carrying out an overview to satisfy themselves that things are being done properly, but it would be completely inappropriate for me, in this setting, to comment on an ongoing internal disciplinary investigation of an autonomous institution.
Thank you, Presiding Officer. The children's commissioner and anti-bullying charities have called for statutory recording of all bullying incidents. The Welsh Government said in 2017 that it was reviewing the policy. Have you finished the review yet? If not, why has it been taking so long?
We are currently carrying out and in the middle of—I'm surprised the Member isn't aware—we are currently in the middle of a public consultation on future anti-bullying strategies in Welsh education. That consultation is ongoing at this moment.
Thank you for that answer, Minister. The question, really, is: you're saying that there's a consultation ongoing at the moment—fair enough, there's a consultation. However, bullying in schools isn't a new issue. This has been a devolved matter for a long time now. Why is it only now that you're coming up, or only relatively recently coming up, with a consultation? Are you going to propose that there is statutory recording of bullying? Are you going to treat bullying in the same way as other incidents?
Clearly, there is a current Welsh Government anti-bullying strategy and anti-bullying guidance that is issued to schools—that exists at the moment. I believe that that is unwieldy. I believe that it is not helpful to schools, and we have not made it easy for schools to deal effectively with this very important issue. That's why we're carrying out the consultation now, at this very moment, to improve the support that is available to schools. Young people, schools and anybody with an interest—I would urge them to respond to that consultation.
This work also sits alongside the work that we are doing to ensure that schools become institutions where the well-being of all pupils and staff is at the forefront of that work. So, this is just one of a number of streams where we want to ensure that Welsh schools are happy places to work and learn in, because what we do know is that unless we address children's well-being, we cannot expect them to excel academically.
Thank you for that answer, Minister. Well, you've thought about statutory recording of incidents of racism in schools and you've thought about paper tests for reading and other assessments. At the same time, one in 10 learners in Welsh secondary state schools suffer bullying every week. That means that there are more children being bullied than there are children not hitting literacy or numeracy targets. I've not read any news stories about a child killing themselves because they were slightly behind in their reading, but we do keep getting reports of suicides following bullying. Isn't it time that you actually—never mind about consulting about it—treated this in the same way as other things, and actually took it really, really seriously and required schools to record all incidents of bullying, and not cop out to a consultation?
Presiding Officer, I thought it was good practice, accepted across this Chamber that before Governments change their policy and impose what some people in this Chamber would regard as bureaucratic rules on schools, that we actually consult with those—[Interruption.]—we actually consult—[Interruption.]—we actually consult with those that will be responsible for ensuring that all of our children are able to ensure that schools are free from any kind of anti-social behaviour or bullying in this way. That's why we carry out the consultation.
Any child—every child—should feel safe and happy in school, and any child that is not requires— deserves—proper support. As regards those parents that have lost a child, only today I met with such a parent to engage their help to ensure that our strategy is as good as it could be.
3. Will the Minister provide an update on preparations for the 2019 summer scheme of the school holiday enrichment programme? OAQ53145
Thank you, Vikki. I am delighted that, as part of the final budget for 2019-20, we have made an additional £400,000 available for this programme, bringing the total for 2019-20 to £900,000. This will enable local authorities and partners to support even more families this summer.
Thank you, Minister, and one of the key roles of this enrichment programme is obviously to tackle holiday hunger. What discussions have you had with the new First Minister about how he plans to use educational schemes such as this to fulfil his campaign pledge to eliminate holiday hunger in Wales?
This is a shared priority for both myself and the new First Minister. We know that the food and fun clubs do indeed play an important role in tackling the issue of food hunger, but they also have an important role in preventing learning loss, which is a real issue for many children, especially those from poorer backgrounds, that can occur over the long six-week summer holiday. I'm delighted to say that we will hopefully move from a situation where we had 53 schemes operating last summer to a situation where we will have 83 schemes operating in this summer to come.
And also we've been able as a Welsh Government—recognising the pressure that is on local authority budgets, we've been able to change the intervention rates. So, Welsh Government is picking up more of the bill to alleviate some of the financial pressures that are on local authorities, and I do hope that that means that the six local authorities that to date have not offered the food and fun programme in the summer holidays will be incentivised to come forward and will want to enable that this service is available to their citizens come the summer holidays.
Minister, I too am concerned about learning loss, which has long been identified as an issue, particularly in deprived areas, where children who have made great progress in catching up on some key skills—for instance, numeracy and literacy—then lose out during the summer period. I know, when Cardiff University reviewed this programme in 2016, they said it was very important that there should be continual evaluation of the scheme and its impact, and I wonder how core the learning component is to these schemes now, and what your ambition is for it to be common and pervasive throughout them all.
You're absolutely right, David. As I said to Vikki Howells, the scheme provides two very important roles—to tackle the issue of holiday hunger, but, from an education Minister's point of view, of course, I'm primarily interested in educational attainment. And we do know, for some of these children, that learning loss is a real problem, and that those children returning to school in the September term can take many, many weeks to catch up to where they were before the summer holidays. That's why this scheme is delivered in our schools rather than in a more generic setting and also why we take the opportunity during the scheme to insist that parents come in—parents and carers come in—at least once a week, because another important role that the scheme plays is actually bringing parents into school to develop those relationships, because that also has a profound effect on the learning outcomes for those children. And, of course, as we move forward with more local authorities taking part in the scheme, we are carrying out close evaluation so that we have the evidence to demonstrate that this is money that is being well invested.
As I said, to date, there are six local authorities that have not participated in the scheme. I hope that, with the greater flexibility and the greater intervention weight that Welsh Government has put forward, more local authorities will be able to feel they can take part.
I'm delighted about the extra money for food and fun and also the hope that all local authorities will take part in this important holiday scheme. I just wondered if you can have a look at the 'Appetite for Life' guidelines to ensure that what children are offered in school is what—you know, is being effective at ensuring that children are eating healthily in school. This is so important in the context of children consuming twice the sugar intake that they should be consuming—we've seen evidence of that earlier. So, the 'Appetite for Life' guidelines need to be adhered to in the spirit and the letter of the guidelines and I have some concerns that that is not happening.
Well, if the Member has concerns then I'm obviously willing to look at that. The meals that are provided at the food and fun club are ones that are prepared and delivered by existing school catering staff. If the chicken curry that I had last year in a school in Ely in Cardiff is anything to go by, the children are very lucky indeed; it was delicious.
4. What discussions has the Minister had with further education institutions on delivering greater access to lifelong learning? OAQ53143
Upskilling and employment provide the most sustainable route out of poverty. In Wales, we have a number of programmes to help those in greatest need of our support and aiding access to lifelong learning opportunities. We work closely with our further education sector to ensure the success of all of those programmes.
Minister, thank you for that answer. I welcome the fact that you're now looking after FE as well as the other aspects and your comments earlier today indicate that you're keen to ensure that FE remains the jewel in one of the crowns of the education sector in Wales. But, clearly, many of those programmes and access to lifelong learning, which provides opportunities for people to go further on in either education, training or employment, are funded by the EU. Now, as a consequence of that, and the possibility of a 'no deal' Brexit coming on 29 March, will you be having urgent discussions with FE institutions and your colleagues in Welsh Government to look at how we can actually continue delivering those programmes, working with FE colleges, so our people do not lose out on the opportunities that they offer?
The Member, Presiding Offer, identifies a real risk to this particular agenda. Not only will I be working closely with FE colleges to mitigate that risk and to ensure that we can continue to provide these very important programmes, I hope the Member will be as pleased as I am that, in the new agreement between myself and the new First Minister, we have a commitment to exploring the right to—exploring the provision of a right to lifelong learning for everybody here in Wales. I think this is a really exciting proposition and I'm keen to work with colleagues in FE to make that a reality.
Minister, I'm interested to explore the right for lifelong learning that you said, obviously, you've signed up to with the new First Minister. I met the FE colleges the other day and they made the point that their average age of learner is about 25, it is, rather than someone who's 16 or 17, and, through the modern workplace, it is about constant evaluation and constant challenge. What do you imagine your proposals might look like—because, obviously, to sign the agreement, you must have an understanding of where you want this journey to go—and when might we see some of these proposals actually become a reality, because it is a huge issue for people to train on the job today here in Wales?
Andrew, you are absolutely right to point to the fact that the average age of a learner is not often what we would envisage it to be. Often, when we talk about learners in this Chamber, we think about 16-year-olds or 18-year-olds; we don't think about those who are older in age. You also clearly identified what is a very important issue: as the world of work changes, we need to be able to provide opportunities for those individuals to go in and out of education to equip themselves to be able to move as the demands of the economy move so that they too can keep themselves in meaningful employment or find a way in which they can aspire to better paid jobs in the industry they're already in. Too often, we've focused our courses on courses that are over a long-term commitment, and very, very few people can take significant breaks either from their caring responsibilities or work responsibilities to return to education full time. Therefore, it's important we've done this in higher education with our part-time support for degree programmes, but we will need to look at how we can support individuals, perhaps through an individual learning account, where people are able to use that right and resources to be able to access education at a time and in a way that suits them and gives them the skills and qualifications so that they can, as I said, secure employment, change employment, and respond to the economy they find themselves working in.
Minister, in recent years we have seen a drop in the number of adults pursuing lifelong learning opportunities at our FE colleges. However, the sector still provides learning opportunities to nearly 65 per cent of Wales's 250,000 adult learners. The FE sector is facing a funding crisis due to recent cuts. What assessment has your Government made of the impact these cuts will have on lifelong learning opportunities?
Well, as I said in answer to questions earlier on, we are doing what we can to support the FE sector, most recently in providing them with additional resources to tackle the issue of pay, which was the right thing to do in partnership with them. With regard to the future of adult education, you will be aware that the Government has recently concluded a consultation on the future of adult education, and I am currently considering responses to that and will make a statement in the Chamber when I am able to do so and I am secure in my way forward.
5. Will the Minister make a statement on the free breakfast in primary schools scheme? OAQ53119
Free breakfast in primary schools has been a flagship Welsh Government scheme for over 15 years. It is integral to our wider work to support our youngest learners to be emotionally and physically ready to learn by providing them with a healthy start to the school day.
Thanks, Minister. The ethos behind the scheme is first class, but some of my constituents have written to me with concerns that some children from disadvantaged backgrounds may be missing out. That's because their difficult lives at home may make it difficult for them to consistently get into school on time to benefit from the free food, which can affect their learning. It's a sad fact that there are children in Wales who live in real poverty and go hungry. So, has the Government explored the possibility of providing free food later on in the morning for those children who are unable to attend the breakfast club before school?
As of January 2018, 88 per cent of all maintained primary schools are offering a free breakfast club, allowing learners at that school to benefit, as I said, from that healthy breakfast before they start the school day. Indeed, the evidence would suggest—and I have to admit, and there are people who've been in the Chamber long enough to know that I was highly sceptical of the free breakfast scheme when it was first introduced, but the evidence and the evaluation that have subsequently been carried—[Interruption.] The evidence and evaluation that have been carried out actually have proven the fact that this does make a difference, and I would be the first to admit that, having had that evaluation carried out, this policy makes a difference. One of the ways it does make a difference, actually, is that it is the ability to access that food that is the incentive for parents and, indeed, sometimes, sadly, children on their own, to get themselves out of bed, dressed, and to the school. So, we also need to have conversations with schools about how we can ensure more children are able to do that, but I have not had any conversations about making that food available later on in the day. But there is good practice out there. I would draw the Member's attention to a school in Wrexham constituency serving a deprived community, where the headteacher uses some of his pupil development grant to create a walking bus. And, actually, staff of that school go into the local housing estate, they collect the children from home, they walk them into school, so that they can attend breakfast club and so that they will be ready for the school day. It's such innovative practice on behalf of the headteacher, enabled by the pupil development grant, that I applaud.
I seem to remember some time back, Minister, being pretty positive about the free breakfast scheme when, possibly, some Members weren't, including you, obviously, but water under the bridge. The Welsh Government's free school breakfast scheme has been a flagship policy, as you yourself said, for many of your predecessors for a long period of time, but it has come under increasing pressure over recent years, with a number of councils reducing the opening hours of breakfast clubs and others introducing charges, albeit low-level charges. What support are you giving to local authorities to help maintain access to breakfast clubs to make sure that those children who do really need that nourishment that that breakfast gives them are able to access it in the future?
I am aware that some local authorities have made different decisions about how they organise breakfast clubs. You will be aware that, in 2013-14, that financial year, the funding mechanism for free breakfasts in primary schools changed from a direct grant, and now that money is made available via the revenue support grant. Breakfasts are free, but individual local authorities and schools are able to make a small charge if, for instance, that club is being used for a longer period of time, essentially for childcare and wraparound care, which some parents do need and do utilise. But the 30-minute slot for free breakfast should not be charged for.
6. Will the Minister make a statement on 21st Century Schools funding? OAQ53139
The twenty-first century schools programme will see investment of £1.4 billion over the five-year period, ending now, this year, in 2019. A further £2.3 billion investment is planned from April of this year onward, and the programme is delivered in partnership with local authorities and others who prioritise the projects that need to be delivered.
Thank you very much for that summary, actually. You've previously told Mike Hedges that £34 million of the £51 million that went to Swansea under band A, for which—I just want to make this plain: I completely welcome that investment. But it showed that 66 per cent of the money that went into the Swansea city area went to Swansea East, and, actually, nothing at all went into Swansea West. Now, I appreciate what you said about the councils prioritising this, but I'm being told by councillors in Swansea that some schools in Swansea West and Gower are either not being told how to apply for this funding or are not told properly how they might pitch for this funding.
When band B is being introduced, would you undertake to make sure that schools are informed directly of how they might apply for this funding? Because even though they may be more affluent parts of Swansea, there are some schools in Swansea West and Gower that are basically just collections of portakabins, who are unaware that they could have actually made a bid for twenty-first century funding.
It is not for individual schools to make an application to the twenty-first century schools fund. The applications need to have come from the individual local education authority, who should carry out a needs assessment and a building survey assessment of its school estate, and, therefore, appropriately apply for priorities within their own local authority area. Those applications that are made by local education authorities are overseen by an independent capital programme board who make recommendations to me as Minister, and there is a robust procedure in place to scrutinise the applications that come forward from LEAs. But, really, the Member needs to address this concern to members of Swansea local authority.
7. Will the Minister provide an update on the impact of pupil leadership schemes in schools? OAQ53118
Pupil voice is key to informing policy and creating a productive educational environment for our schools. All pupils should have the opportunity to take part in making decisions about their learning, and we will continue to engage with children and young people as the new curriculum is made available for feedback.
Thank you, Minister. Coed Eva Primary School in Cwmbran has recently been praised by Estyn for creating strategies to develop pupils' independence and attitudes to learning, one of which includes a pupil leadership scheme that involves the pupils conducting lesson observations, focusing upon learners' learning behaviours and attitude to learning and where they provide feedback to pupils and staff, including ways forward that impact on teaching and learning. They also give feedback to the senior leadership team and the school governing body. As a result of this and the other innovative work at Coed Eva school, pupils' well-being and attitudes to learning are reported to be very strong, and nearly all pupils behave in an exemplary manner in lessons and at break time. Will you join me in congratulating Coed Eva school and Blenheim Road school, the federated school, on their excellent work in this area? But can you say, as well, what lessons you think can be taken from this excellent practice and rolled out elsewhere in Wales?
Well, I'm delighted to do so. I've been fortunate enough to—well, in fact, I got to open the new Coed Eva Primary School, and I have visited its federated twin on a number of occasions, most recently, I have to say, on a very innovative mental health day that the children—not the staff, the children had planned, not just for their benefit, but, actually, for a range of primary schools in the local area to highlight areas around mental health and well-being. Gill Ellis, who is the head of that federation, is also one of our associates on the new academy of educational leadership, and it is by those kinds of mechanisms we can ensure that this good practice is spread throughout the system. So, Coed Eva should be congratulated. Although they are not alone—I know that Mike Hedges will be devastated that he's not in the Chamber to hear me say this, but on a recent visit to Ysgol Tan-y-lan with Mike Hedges in Swansea—. They've introduced a new system where pupils, for an afternoon a week, get to choose what they want to study. And that increase in pupil voice has led to increased attendance at the school and better results from the children themselves, which just shows the power of listening and empowering children in their own education and the difference that can make to them.
8. Will the Minister make a statement on acceptances to university courses in Wales? OAQ53127
I have noted the UCAS statistics on acceptances to full-time undergraduate courses for 2018-19. The slight reduction reflects the ongoing decline in the number of 18-year-olds in the United Kingdom. I am, however, encouraged by reports from some universities of increased applications for postgraduate and part-time undergraduate courses.
Thank you for the answer, Minister. According to the admissions service, UCAS, Wales is the only part of the United Kingdom where the total number of students given places fell last year, when compared to the previous year. Figures show the number of students accepted on full-time courses at Welsh universities fell by 5.7 per cent. Figures show also that Welsh applicants are the most likely to study outside their home country, in contrast to Scotland and Northern Ireland, where there are financial incentives for applicants to study at home universities. What action will the Minister take to reverse this decline and what incentive will she offer to encourage more Welsh applicants to study in home universities, please?
Of course, Presiding Officer, recruitment is a matter for individual institutions. What Welsh students have the advantage of is the most progressive and generous system of student support anywhere in the United Kingdom.
With regard to incentivising students to study in Wales, the Member will be aware, because, again, we discussed this this morning at the committee, when it comes to support for postgraduate study, that is only available for eligible applicants who undertake their postgraduate study in a Welsh institution.
The next item, therefore, is questions to the Minister for Health and Social Services, and the first question is from Hefin David.
1. Will the Minister make a statement on the availability of over-the-counter pharmaceutical drugs? OAQ53150
Thank you for the question. There is good evidence that many general practitioner consultations are for minor ailments that could potentially be dealt with effectively by a community pharmacist, with medicines readily available from pharmacies without a prescription. Choose Pharmacy means that these ailments can be safely and accurately diagnosed with no need for medical interventions.
Some of the issues that the Minister is referring to were raised with me by Norgine, a pharmaceutical manufacturer in my constituency with a significant presence and it happens to be a Welsh anchor company, as well. The company made me aware of the consultation that the All Wales Medicines Strategy Group are currently undertaking—I think it closes on Friday—that is looking at conditions for which over-the-counter items should not be routinely prescribed in primary care. It seems to be a cut-and-paste consultation from one that took place earlier in England. The document lists 1,314 medicines available over the counter that are currently prescribed by GPs in Wales, covering 35 conditions. Norgine have raised some concerns with me, particularly the potential unintended consequences of adopting the guidance, including increased costs; disempowering prescribers; putting patients' outcomes at risk; creating inequalities in healthcare; and putting the most vulnerable members of society at risk. Will the Minister reflect on those concerns and also tell the Chamber when he plans to report back to this Parliament on the outcome of that consultation?
Yes, I'm happy to indicate that the consultation, as you indicate, is nearly finished, but it is a consultation. Because there is evidence that some over-the-counter medication does not represent good value, either in terms of value for money or efficacy, as well. So, I think it's quite right and proper to review that information and then to come up with new guidance.
There is always, though, the reality that the individual prescriber, whoever they are, has an individual responsibility to make an appropriate prescribing choice for the individual person in front of them. Now, I recognise some of the concerns the company has raised and that you've repeated here. They're concerns that I'm alive to, but I'd be more than happy to make sure that this Chamber is updated on the outcome of the consultation and on any new guidance that I may choose to endorse.
In their preparations for a possible 'no deal' Brexit, the UK Ministers for the NHS, at least in England, proposed allowing pharmacists to substitute certain drugs for ones with similar effects, where their professional judgment supports that. Does the Minister agree that, actually, generally, we should be allowing pharmacists greater discretion to deploy their professional judgment to serve their patients, to take pressure off GPs and to ensure cost-effective delivery?
Yes, there is a challenge here about generic medications being more widely available and used within our whole healthcare system. There is then the related, but slightly different, challenge of making best use of the skills of our staff within the system, and pharmacists are absolutely within that domain. We've spoken on a number of occasions, in this place and outside, about making better use of the skills that the pharmacists have, not only in terms of assisting their colleagues within primary care, but actually being a port of call for citizens to receive advice and, if necessary, to have prescribed medication. So, not just in terms of our preparations for a catastrophic 'no deal' Brexit, but more generally about improving the efficacy and value for money and the experience of health and care, I expect us to make ever-greater use of the skills and expertise that pharmacists have to offer.
A constituent has contacted my office this morning, Minister, incredibly worried that she's not able to obtain a specific drug, which she needs to control her epilepsy, even though the drug is freely available from pharmacies in England. The drug I'm referring to is called Epilim Chrono slow release. Now, she will run out of this drug shortly, she explained to my office staff this morning. So, will you urgently look into this matter to ensure that my constituent can receive this specific drug from a local pharmacy here in Wales? And if I do commit to write to you this afternoon, could I ask you to reply with urgency, Minister?
If you write to me with the details, I'll make sure that an appropriate response is provided. Of course, you will understand that I can't intervene in individual treatment matters, but I'm more than happy to make sure that a proper response is provided, and I recognise the urgency with which you raise the matter.
2. Will the Minister make a statement on the delivery of planned healthcare in Montgomeryshire? OAQ53117
We continue to work with Powys teaching health board and other partners to take a range of actions to improve access to planned healthcare services that are safe, sustainable and as close to people’s homes as possible.
Thank you, Minister. I'm pleased to hear that. We're soon to hear the conclusion of a consultation that will see the outcome of a consultation in Shropshire. That will see the reconfiguration of services in Shropshire, and I believe, certainly, it's essential that we see some planned delivery delivered locally in our local community hospitals such as Newtown, Llanidloes, Welshpool or Machynlleth, to, of course, reduce the need for patients to travel even further following changes in Shropshire. And, of course, some—I emphasise 'some'—planned care procedures can be delivered more locally, which of course makes community hospitals more sustainable, and there are obvious other benefits of patients and families not having to travel even further again for some planned care. So, I'd be keen to understand how you believe that the Welsh Government, in partnership with Powys health board—how you can work with the health board, taking into account the expected changes that we're expecting to see happening in Shropshire.
There are two points here. The first is that Powys teaching health board already deliver a range of planned healthcare, and they actually have a very good track record on delivering that within time. They also have real ambition, which we're happy to support, to continue to deliver as much planned healthcare within Powys or as local to Powys as possible too. On a range of visits that I've undertaken out to settings within Powys, they've been talking about what else they are able to deliver within those settings, to reduce the time that people would otherwise take to travel to different centres. For example, in maternity care, more women are able to access complex maternity care that is midwife led within Powys, rather than having to travel further afield to do so, and those aspirations are, of course, supported by the general scheme within our plan, 'A Healthier Wales', the long-term plan for health and social care here in Wales.
I also recognise your broader point about the consultation within Shropshire, the Future Fit consultation, and I know that you've spoken about this on a number of occasions. The preferred option, option 1, would see the emergency care site remain in Shrewsbury, with planned care moving further away, and that is also the preference of the health board. We will know at the end of this month what option is to be pursued, and I look forward to having a properly constructive relationship between Powys health board and their partners. Of course, that will include seeing them through the current period of special measures within Shrewsbury, but Powys health board, you will be pleased to know, are on top of that situation and making sure that work that they commission on behalf of Powys residents is undertaken at the right time and at the right quality.
Can I just take the opportunity formally to congratulate you on retaining your post? I look forward to working with you. I meant to do that in committee this morning and apologise for neglecting to do so.
To return, obviously, to the issue of planned healthcare in Montgomeryshire, you'll be aware, of course, of the important role that GP surgeries can play in this regard and some of the major challenges that Powys health board is facing in recruiting and retaining GPs. One of the issues that has been put to me as a matter of concern is that GPs often have large and quite-expensive-to-run-and-maintain premises, and that there is increasing reluctance amongst younger doctors to take on the kind of commitment required to run those kinds of premises, as well as to be delivering primary healthcare. What support and guidance is the Welsh Government giving to health boards to enable them to work constructively with GPs, particularly as those GPs may be moving up towards the age of retirement, to ensure that we can retain these important facilities, particularly in those rural communities?
Yes, of course I recognise the challenge. It's not simply local to Montgomeryshire, as I'm sure you and other Members know. Around the country there are challenges with facilities that have served their local population well over a period of time, but we now recognise we all want to see them reformed and improved. So, that's being resolved in a number of different ways, with health boards having partnerships with individual practices, with groups of practices, and indeed with local government and housing partners too. You can see a range of areas where that partnership has been a good thing for the provision of local services to move into new purpose-built facilities.
There's also the broader challenge, not just about premises, but indemnity and last-man or last-person-standing potential liabilities, which are a real issue for younger GPs, who may not wish to enter into a partnership, but more than that, a change in the way that people want to work. A number of younger GPs, regardless of those issues, simply don't want to buy into a practice and give a very long-term commitment. All of those things are a regular part of our discussion within the general practice committee of the British Medical Association, and they're a regular feature of my discussions with each individual health board and their partners.
Questions now to the Minister for the party spokespeople. Plaid Cymru spokesperson, Helen Mary Jones.
Thank you very much again, Llywydd.
Minister, we were discussing in committee this morning the ongoing concerns on some of the issues around Brexit and the healthcare system, and you'll be aware that on 17 November the issue of The British Medical Journal starkly stated that patients will die if we can't maintain the medicine supply chain. Can you update us on the contingency plans that your department is putting into place to ensure the supply of medicines, particularly medicines with limited shelf lives that cannot be stored in the event of a 'no deal' scenario, which, of course, we're all hoping may not occur, but is becoming increasingly a risk?
Thank you for the question. As you know, I've made statements in this place before about our preparations for any form of Brexit, but in particular a 'no deal' Brexit. I've set out the range and the seriousness of my concerns about the impact of a 'no deal' Brexit. And the undeniable truth is that if we crash out without a deal at the end of March, it will have a real and almost immediate impact upon people's health and well-being. The reality is that if we have challenges about trading arrangements, not simply about whether people do or don't wish to continue to supply a range of medical devices, equipment and medicines, then there will be an impact.
I have a further meeting with the health and social care stakeholders in Wales, focusing on Brexit, tomorrow. Myself and the Deputy Minister will be attending. We'll continue to outline with them the current state of our preparations, both within Wales and, indeed, the measures we are seeking to take together with partners across the United Kingdom. I may well be in a position to update this place with a further statement on our preparations for, and the impact of, a 'no deal' Brexit within a very short period of time.
I'm grateful to you for that, Minister, and I think the whole Chamber will look forward to that update. As I've said, it's a situation that we're all hoping will be avoided, but does seem to be becoming more of a real threat. I'd like to give you a specific example to illustrate the dangers that we face, which I'm sure you're very well aware of. The radioactive isotope technetium is used in about 850,000 scans in the UK for a whole range of conditions, including heart disease and cancers. This product has a half-life of just 66 hours, meaning that it can't be stored and stockpiled. Currently, the UK as a whole relies on a continuous supply of this product from France, Belgium and the Netherlands, and that supply is governed by the Euratom agreement. The nearest potential non-EU suppliers are in South Africa and Ontario in Canada, and obviously couldn't be useful to us in this situation. And, obviously, this is only one example, because there are many types of isotopes that can't be stockpiled. We know that even under the existing arrangements Northern Ireland had problems twice—in 2009 and 2013—due to the logistical challenges of getting this product in time. Can you explain how hospitals in Wales will be getting these types of products in the event of a 'no deal' Brexit?
In the event of a 'no deal' Brexit, it will be virtually impossible to continue supply chains in exactly the same way as now. Much of this comes on road freight and the undeniable reality is that if there are problems in road freight that affect our ports, as you'll have seen from the exercise undertaken recently and reported in the Financial Times—hardly an organ of fearmongering or left-wing conspiracy theories—it demonstrates the significant and quite shocking impact of minor delays for all freight transport coming into the country. The alternative plan, which is not a secret, is about, if that were to be the case, whether medicines with very short half-lives before they're no longer useful—and I've regularly talked about nuclear medicine and radioisotopes in the past as well—for those to be flown, and that would undeniably provide an additional cost, and it may affect the supply. But the additional cost would then have to be borne by the taxpayer. So, there is, undeniably, a challenge, and I've also regularly talked about the challenge for insulin that is made for type 1 diabetics. We make nothing like enough insulin for type 1 diabetics to cover our own population. And, again, in a 'no deal' Brexit, that is one of the very real risks to directly affect people's health and well-being almost immediately.
Thank you, Minister, and perhaps you can give us some further information following the stakeholder meeting about the precise arrangements if we do face the issue of having to fly medicines in.
You mentioned in your response the additional cost to the NHS. As part of the potential 'no deal' Brexit preparations—. I must say that I have some frustrations with Members there; I'm sure that you will have opportunities to respond to these points to the Minister, but it's very difficult to have a sensible conversation about these issues when people are making comments from a sedentary position.
Minister, have you made any assessment of what these potential extra costs might be, and how is that being built into your contingency planning? I realise that these potential costs are, at this stage, theoretical, and hopefully that's an issue that we won't have to face, but I'm sure that you would agree with me that it's crucial that, in terms of planning for the worst-case scenario, you have some clear idea about what those additional costs you may need to face are.
Yes, there's a challenge about theoretical costs, but costs are actually being soaked up now. For example, there's the additional cost that the health service across the four nations of the UK is undertaking to increase storage capacity, and the costs that we are spending now on planning for potential scenarios, when we know that at least one scenario is not going to be—well, more than one scenario is not going to be the reality where we find ourselves at the end of March. Every Government within the United Kingdom is having to run through this particular challenge. Officials regularly speak to each other, as well as our individual conversations within each of the four UK nations. I do hope to be in a position to provide more information about cost, about the arrangements that we are undertaking. I also hope that there will be a positive response from health Minister counterparts across the UK—four health Ministers of different Governments and different political backgrounds—to nevertheless have a constructive and upfront conversation about what we can do to support each other, and the risks that we each recognise exist, depending on whatever form of Brexit occurs, should we leave the European Union, and the impact that would have on our health and social care system. I know that my colleague in Scotland is equally keen to have that meeting with our counterpart in the United Kingdom Government and whoever would attend from the Northern Ireland Government—whichever official that may be.
Diolch, Llywydd. Minister, can I ask you why it's taken you so long to intervene in the situation in Cwm Taf university health board?
It hasn't taken a long time at all. I've kept this Chamber updated at all points on the intervention around the initial issue around maternity care, and, indeed, following the very recent tripartite meeting between the chief executive of NHS Wales, Healthcare Inspectorate Wales and the Wales Audit Office, I made an early choice—as you will have seen from today's written statement—to change the escalation status of Cwm Taf from 'normal' to 'enhanced monitoring'. And I of course will be answering a topical question on this matter in a few minutes' time.
It was on 4 October, Minister, that concerns about maternity services were first exposed at the Cwm Taf university health board. Your statement today refers to non-compliance with health and safety and radiation regulations, quality of governance and serious incident reporting arrangements, the lack of action and response to healthcare inspectorate reports, and staffing shortages also in that health board being problematic. Many people in that health board area will be wondering why on earth it's taken three months—more than three months—for the Welsh Government to escalate the situation there in order to secure some improvement.
Of course, Cwm Taf is not the only health board that is currently in escalation measures. Five out of seven Welsh health boards, supporting 2.4 million people in Wales—three quarters of our population—are currently being served by health boards that are subject to intervention. Does that not concern you, in terms of the speed of the response, because it certainly concerns me?
Well, I would hope there would be a more rational and factually founded response on these matters. Trying to conflate the issue of maternity services with the areas that are outlined in my written statement today simply does not stand up to honest scrutiny. On maternity services, we acted properly and promptly, with the conversations that took place between the chief nurse's office and the health board, and the decision that I then took that the review jointly by two royal colleges should be undertaken independently, with the Government actually being, if you like, the sponsoring organisation, rather than the health board. I expect to have that report available in the spring. So, these matters are being addressed appropriately and are being addressed speedily by the Government and the broader health service. I look forward to being able to provide more facts on this matter as that report is provided, as indeed I expect to have more to say on the actions that will be taken by the health board in response to my decision today to change the escalation status of Cwm Taf university health board.
The situation, of course, should have been escalated from day one as soon as the maternity situation had been exposed in that particular health board, and I'm sure that many people will have been disappointed with the speed at which the Welsh Government has acted.
You failed to respond to the fact that five out of seven health boards are currently in escalation intervention arrangements of some form and that three quarters of the Welsh population are being served by those health boards. Doesn't that tell you, if five out of seven health boards are currently in escalation arrangements—many of them have been in for a long time, including the Betsi Cadwaladr health board, over three and a half years to date and no sign of it being taken out of special measures yet—doesn't that tell you that you are a failing Welsh Labour Government that's failing to get to grips with the problems in our national health service, and that you are not acting swiftly enough to remedy them?
Well, it is much easier, as the Member demonstrates, to chase headlines than to deal with the facts in front of them. It would have been entirely wrong—it would have been entirely wrong—as the Member knows very well, to have intervened in October on the very first day when concerns were raised about maternity services. I am doing the right thing by the country and by the people served by these individual health boards and indeed by the staff who deliver those services. I expect there to be proper scrutiny of the choices that I make and of the conduct of each and every health organisation within the country. An escalation, of course, has taken place for different reasons in different health boards and I look forward to organisations reducing their level of escalation as well, as I expect will happen at various points over the next year and more.
We are planning for the future, and we are delivering that future, and, indeed, the people of Wales have great faith and confidence in our health service, as every single recognition of people's experience of healthcare demonstrates. The future for health and care services is a difficult one. We face a rising tide of demand, fast and rapid technological change and, of course, as we all know, a period of continuing austerity. Regardless of that, we have planned for the future. We have a long-term plan—a joint plan—for health and social care and I look forward to the United Kingdom Government catching up and having a joint plan—
The Minister may recall that last October I raised with him the non-availability for patients of GPs in north Wales of the internet tool myhealthonline for making appointments. He kindly wrote to me subsequently saying that this wasn't a policy decision, but sometimes this system wasn't available because it was impossible to match patient need to GP availability in practice, in particular where there were large numbers of locums. The implication, of course, being that there are periods of time when it's not possible to access the service. Is he aware that there have been successful trials in London of this tool in GP practices, whereby administration has been cut and efficiencies have been improved? In one particular instance, GP waiting lists were cut from four weeks to just one day, and 25 per cent of 2,500 patients needed an appointment, so 75 per cent were able to be dealt with without taking up GPs' time in the surgery, with many other advantages as well, and GPs processed 30 online patient queries in the time it took otherwise to see 18 face to face. So, clearly this is an important and useful tool, where we're constantly facing the problem of matching needs to means. So, can the Minister assure me that he will pull out all the stops to ensure that this internet tool is available as often as it is needed, not just in north Wales but throughout the NHS in Wales?
I think that the challenge that you've set out is not how we simply continue to deliver what we have now, but what the future looks like and the necessary reform to get there, and not just in the area of making better use of technology. In the long-term plan for health and social care, you will see a significant section on making better use of technology and, in particular, digital technology.
That's partly about access, and the examples that you gave are about access, and I don't think it's just about one particular tool. A range of different computing tools, as it were, are available to try and enhance and make better use of staff time in doing so. It's also about then having the staff who are able to operate that system, and not just to operate the system as a digital technician but then to provide the clinical support to enable the system to work properly. So, there's more that we could and should do, and we expect to do, in local healthcare but also in hospital-based care about access, about diagnosis and treatment and making better use of technology that should ultimately mean that it's a better place for our staff to work as well as a better experience for patients when they do need healthcare themselves.
I thank the Minister for that response, and, of course, he makes some very important and sensible points in response to my question. He'll be well aware of the problems that we had faced in Wales in the NHS Wales informatics systems, and the Public Accounts Committee published a report a very short time ago that says that we believe that NWIS is primarily focused on running outdated IT systems, and that at a time when the potential of digital healthcare is capturing the imagination and improving patient outcomes, just 10 per cent of NWIS's activities are focused on innovation.
The clinical trials that I mentioned a moment ago in London were carried out by a medical software company called EMIS, but that has now lost its preferred vendor status as a result of a decision of NWIS here in Wales. So, here we've got, first of all, a damning report of NWIS's activities in recent years and the failure of their attempts to modernise the NHS computer system, and yet, on the other hand, they're taking away provider status from a company that has been successfully providing exactly the kind of services that we need. So, can the Minister tell me what he is doing to ensure that we don't get the kind of administrative crossing of wires that this kind of thing seems to have brought about in this instance?
With respect, I think they are two different points. The first is about our system that we wish to have here within Wales and our strategic oversight, and about the level of resource that we could and should commit to maintaining our current systems. That is, in itself, a significant undertaking in addition to our ability and the resource that we put into reform and innovation. Of course, we'll respond to the PAC report and I expect that to be a regular topic of conversation now and in the future.
The point about EMIS is not so much that this is an example of people who have great innovative ideas who have been taken out of the system and that there is a disconnect, but actually what took place with EMIS and GP systems is that there was a tender exercise and they chose to submit a bid that did not comply with the basics of the tender. That decision not then to allow them to nevertheless carry on as a potential supplier was not simply made by the Government; it was actually supported by the general practice committee of the British Medical Association themselves. A representative group of doctors agreed that, given that EMIS had refused to comply with the tender, they should not therefore be rewarded in any event and be allowed to come back into the system. And unusually—because there were questions in the Chamber at the time from people from more than one party—since that time, there has not been a significant amount of complaint about it because we provided the support that we said would be made available, and broadly the GP community have accepted that we made the right choice in not allowing EMIS into the system when they'd refused to comply with the tender details.
The chairman of the Royal College of General Practitioners, Dr Rebecca Payne, said at the time that she was very concerned about the potential impact of this on practices in north Wales, because 89 out of 118 practices were with EMIS. It's hard to see how we have the clinical staff in Wales to mitigate the potential problems that might arise. But going on from that to changing IT systems, obviously it has the potential to create all sorts of practical difficulties when it sometimes has to happen, of course, because existing systems become outdated or technology moves on. There are many people who think it will take three years before all patient records will have settled down on replacement systems, and patients need medical record integration between primary and acute settings, and current circumstances in north Wales are not producing this. So, can the Minister tell me what specific measures we're taking in north Wales to minimise both patient suffering and lost opportunity to deliver improved patient efficiency in this region?
I think the first point I'd make is that the now past chair of the Royal College of General Practitioners in Wales, Dr Payne, did raise concerns at the time, as did a number of other stakeholders, but, as I say, the representative body of general practitioners who are involved and engaged in actually assessing the responses to the tendering exercise agreed with and positively supported that choice. David Bailey is many things but he's certainly not a patsy for the Government, and he supported the choice that was made not to provide EMIS with an opportunity to try and be a supplier, having failed to deal with the tender.
On the broader point about people's access to records, it's not just within the health system; we've had a challenge of joining up records, say, within a pharmacy setting. That's what Choose Pharmacy is allowing us to do—so, a version of the GP record being available and to make entries into, but also doing more about making records available within that community pharmacy setting as well. But on access between the emergency ambulance service and between general practice, and indeed hospital practitioners as well, we've actually made real steps forward within the last few years here in Wales to do so. But there is always more to do, including the continued roll-out of the Welsh community care information system, which means that we can actually share information between health and social care.
Now, there are a range of parts of Wales where that has been rolled out and, in virtually every area where that's taken place, practitioners in health and social care recognise it's been an improvement. It means they spend less time on chasing information, and they believe that not only is their job better because it's less frustrating, but that they are providing better care for the citizen.
So, yes, there is more to do, and I accept there will be always other ideas about what we could do to improve, but this is not an area that is marginal. It is core business for health and care services, and I expect to answer more questions on this now and in the future.
3. Will the Minister make a statement on the performance of Abertawe Bro Morgannwg University Health Board? OAQ53131
Thank you for the question. Performance is improving across a number of key areas. Progress has been made in cancer waits, diagnostics and referral-to-treatment times. ABMU has received £8.3 million out of a performance fund that I created for this financial year. We expect to see further improvements by the end of March 2019.
Minister, it's highly concerning for patients in south-west Wales that ABMU health board has been under the Welsh Government's targeted intervention status since September 2016. Concerns remain around specific elements of performance that are failing to be met, and people understandably want to see improvements. As the health board is now in the process of completing its organisational strategy, clinical services plan and the three-year integrated plan 2019-22, can you update the Chamber on recent discussions that your officials have had with ABMU health board and when you would expect to make a decision on the sign-off of the three-year integrated plan?
Well, the first point is that I'd need to see that integrated plan delivered and provided. There is a regular source of not just correspondence, but direct meetings between officials within the Government and the health board, and actually the improvement that I refer to is, I think, a positive in terms of the job that Tracy Myhill, the chief executive, and her team are doing with the board. There is real improvement and it's being sustained. The challenge will be whether they're able to give enough confidence—not just their plan on paper, but the confidence they will be able to deliver. That is part of the point. There are many people who write great-looking plans in very many aspects of life, but we need confidence they can actually deliver against that. They may be in a position to have an approved three-year integrated plan at the start of the next financial year. Even if they don't, I am confident that this health board will continue to make strides forward over the next year and I believe that you and other residents of the health board area can have greater confidence about the ability of the board to deliver against its plans and its financial means, but also, of course, delivering high-quality care for people across the region.
Could I turn to the performance of ABMU in respect of one of their prime assets, which is Maesteg Community Hospital? There's a plaque in the hospital with my name on it; it celebrated its hundredth anniversary only a few years ago. I intend, with the sustenance of our national health service and breakthroughs and innovation in health, to be there when it celebrates its second hundredth year as well. I'm going to be as old as Job.
But, can I say, there was a massive, packed-out meeting on 14 November in Maesteg town hall. It was very well attended, very passionate, and eloquent speeches were made by local people in the consultation on the closure of the Maesteg Community Hospital day unit. Now, alongside that closure of that day unit and the proposal to transfer it to Bridgend Princess of Wales, there is also enhancement of services being proposed, including a doppler service, a leg unit, alongside the wound clinic and other services that are there now, and including the step-down ward that they currently have, with beds in the ward there.
Now, what I'm seeking from ABMU, but also as it transferres to Cwm Taf, imminently, is that the long-term future of Maesteg Community Hospital is guaranteed. It is an essential part of the 'A Healthier Wales' approach in terms of services closer to the community. I will shortly be meeting with the chair of Cwm Taf to make sure that this isn't the case, but could I ask the Minister, please, in your meetings both with ABMU chair and chief executive and with Cwm Taf chair and chief executive to make that same point: that no matter the reconfiguration, the services here should be enhanced in line with 'A Healthier Wales', and the future of Maesteg Community Hospital should be written in stone outside, if not next to the plaque with my name on it?
Well, I applaud the Member's ambition to be around for the second centenary. I'm not sure I'd make such a pledge or ambitious statement myself.
I recognise the points the Member makes and about services that are changing, which is, obviously, a cause for concern for the local population as services move, and at the same time seeing, on the other hand, services move into that setting as well. But that is part of the challenge we've set out in 'A Healthier Wales'—how we move around some services to be more concentrated in fewer settings, and at the same time to have more services then going out into community settings to be delivered more closely to home. So, I think there's nothing inconsistent with what you've set out.
I don't think that the boundary change should have any difference in terms of the longer term future of the hospital, and I would be happy to make sure that, when I do meet Cwm Taf health board, as I'm sure to in the near future, I raise the fact that you've got those concerns and you'll be wanting an answer direct from the health board too.
4. When does the Welsh Government expect hospitals to meet the four-hour emergency waiting time target? OAQ53134
I expect local health boards to plan effectively to deliver safe, timely and high-quality health and care services to meet the needs of the communities that they serve.
Thank you for that answer, Minister. You'll be aware that, in north Wales, there are particular problems in each of the three main district general hospitals, all of which have been failing to meet the emergency waiting time targets for some time, including at the hospital that serves my constituents, which is Glan Clwyd Hospital in Bodelwyddan.
The situation appears to have been deteriorating and, in November, the figures were much worse than they were three years ago, in November 2015. This, of course, is a health board that is in special measures. Your responsibility is to improve the outcomes for patients as a result of your intervention in that health board, and yet the situation is getting worse. Can you explain to my residents and those in other places in north Wales why, in a health board that is currently in special measures, the situation is getting worse in terms of performance and not getting better?
I have real concerns about the four-hour figures from each of the three centres in north Wales, but I've never tried to hide from those concerns. They're absolutely part of the conversations I've had with the new chair about the need to see improvement. They have got a 90-day improvement plan, but the point that I have made is, 'It's fine to have a plan, but you obviously need to be able to deliver on it and to deliver improvement, and to take the staff with you'. The worst thing that we could do would be simply to say, 'People need to try and work harder' and that's it. Actually, there are changes about how the services are organised, about getting people to the right place within our heath and care system, and having the right capacity within the system as well. It's instructed to me that there's something here about supporting good clinical leadership, because if you look across north Wales, then, at present, the area, certainly in the recent past, that has had the greatest physical challenges is Ysbyty Gwynedd. Yet, actually, often, their performance is better than the other two sites.
So, it isn't simply about the physical settings, but sometimes the physical setting does matter. It is about having the right clinicians in the right place and about leadership and actually about persuading members of the public to try and use different points in the system at the right point in time. But I expect that you and other Members from every party will continue to not just question me but to ask again—once we've had a 90-day plan, I expect to come back and have questions about that and what difference it has made. I do think the national arrangements we put in place with the national clinical lead, with Jo Mower, have been helpful, because, of course, she has the credibility of still being a serving clinician in an emergency department. So, I'm cautiously optimistic that we'll see improvement, if not in the busy time of winter, because that really is a hostage to fortune, but I expect over the next year that your constituents and others can have a better experience with shorter waits within emergency departments. But this is a longer term challenge and not something I'll be able to resolve with a click of my fingers, as much as I would like to be able to do so.
Minister, I'll look at the two aspects of the four hours—that's the beginning and the end of the four-hour period. At the beginning, clearly, we can ask people to choose better with the prudent health approach and look at using different facilities such as minor injuries units across south Wales, and particularly in my area the fantastic services at Neath Port Talbot Hospital. I want to encourage more people to take up that opportunity. But also, at the other side of the four hours is the transfer of patients into hospitals. Last year, ABMU held a consultation on bed closures. It was a skewed—in my opinion—consultation, because the questions being asked were more towards the answers they wanted. But in future consultations, will you ensure that health boards have to put the question as to how it impacts upon accident and emergency services, because the removal of beds means fewer opportunities for patients to be transferred from the A&E into a bed in the hospital?
There are two broad points that I'd make in response to the Member. The first is that I completely agree with him—I think that's the best use of the whole system. Neath Port Talbot Hospital is a good example of a minor injuries unit where people sometimes underestimate the range of services that are available. There's often easier transport than going to either the Princess of Wales or indeed to Morriston, and there is often a much shorter wait as well. Actually, making available publicly some of the tracker times about how fast you're likely to be seen has been helpful in diverting people to those areas. There's also, of course, the job of the ambulance service to work together with the health board and make sure they take people to the appropriate setting.
On your second point about beds across the system, there is a challenge here, and I know you've set out both in private and in this place your view on the previous exercise undertaken by the health board, but it's actually about capacity across the whole system. Because what's been really interesting for me in meeting with lots of emergency department clinicians is they do have a view on capacity within the hospital system, but they actually have a view about flow within the hospital part of the system and in and out of the hospital setting itself as well. I think it's really important to set out not just what happens with a number of the beds within one part of our health and care system, but actually to be sure that it's a joint plan between health and social care about how capacity is going to be met. Because often the right place to treat someone is not in a hospital bed—it's often somewhere else, but you need to plan for that and not simply talk about it. When reducing capacity in one part, if you haven't then also planned to increase and improve capacity in another part of our wider health and care system—. That is a conversation I've had this morning with a range of local authority members.
5. What is the Welsh Government doing to improve health services in Pembrokeshire? OAQ53115
Thank you for the question. We have a wide range of improvement activity that we expect the people of Pembrokeshire to benefit from. In addition to service-specific improvements, we expect Pembrokeshire to benefit from the transformation fund and our long-term plan for health and social care, 'A Healthier Wales'.
Minister, one way of improving health services in Pembrokeshire, and indeed throughout Wales, is to support my autism Bill next week and allow it to go forward to Stage 2 of the legislative process. I appreciate that the Government is bringing forward a code of practice but my proposed Bill is not in competition with some of the measures that the Government have introduced or are introducing. It looks to build on some of that good work. In the circumstances, will you therefore consider working with me to ensure that the Bill can go forward next week for further scrutiny? Because I genuinely believe that passing this legislation will improve health services for many people in my constituency, and, indeed, for thousands of people across the whole of Wales.
I recognise that the Member does genuinely wish to improve services for autistic people, and more than that to improve people's lived experience—there's no dispute between us on that. The challenge is whether or not the Bill that you propose will actually deliver that—that's not an area that we agree on. We'll have plenty of time to talk about that next week, and, indeed, to consider the reports of a variety of committees that have considered that and the views of a range of stakeholders.
So, I'll happily leave that conversation until next week, when we will have it in detail. Of course, you're aware that we've met several times during the passage of the Bill to date to discuss these matters. I'm sure that, should the Bill proceed, we'll continue to talk.
6. Will the Welsh Government provide an update on the action it is taking in relation to HIV prevention? OAQ53146
Thank you for the question. A number of projects are under way to improve access to testing, including the provision of self-sampling HIV tests and a pilot for online testing. Pre-exposure prophylaxis is providing protection for those with lifestyle risks. These measures, supported by effective medical care, mean we are continually reducing the risk of HIV infection.
Thank you, Minister. I've been closely following the encouraging response to the introduction of PrEP last July. I'm really impressed by the large numbers already benefiting from this preventative treatment. The introduction of a national approach to PrEP and HIV prevention that is being taken here in Wales by the Welsh Labour Government shows a clear commitment to these issues. What plans are in place to build on any early findings? Would you be able to provide an update on further results when these become available in due course?
Yes, I'm very pleased and proud of the national approach that we've chosen to take here in Wales—a genuinely national approach based on clinical need being the criteria for access to PrEP. That's in contrast to the approach taken in both Northern Ireland and England, where there isn't a national approach and, of course, the Terrence Higgins Trust and others are fundraising to be able to make the funds available for people to actually be able to use PrEP. That isn't a challenge we have here.
We now have, from the end of September, 697 people in Wales who've been prescribed PrEP, and 386 are currently taking the preventative treatment. There have been no new cases of HIV within that group of people, and that is a real success story for all of us.
We do, though, recognise that about one in four people who are potentially eligible for PrEP don't come back for follow-up and don't actually take it up. So, part of our challenge, in research that is ongoing, is both to properly understand the impact of providing PrEP and to make sure that we continue to see that reduction in HIV, but also to try to understand why some people don't access PrEP when it is potentially available.
There is a range of research, including funding that we provided to Cardiff University—£400,000 of funding—to carry out research into the behaviours of those who choose to take PrEP, because we do recognise that there is a high incidence of sexually transmitted infections being acquired by people who are taking PrEP, so it's actually getting to the right sort of cohort of people.
I will, of course, though, in terms of your final point, happily update this place when we do have the results of either further incidents of the numbers of use, but, in particular, the research trials that we are already supporting.
7. Will the Minister provide an update on the construction and planning of the Grange University Hospital? OAQ53138
I am happy to confirm that construction on the Grange hospital site commenced on 30 October 2017. It is on schedule and on budget, and due to open in the spring of 2021.
What proportion of the staff at the hospital would the Minister expect to want to live in Cwmbran and the locality of the hospital? Does he consider that sufficient housing is being built locally to satisfy that demand?
The Deputy Presiding Officer (Ann Jones) took the Chair.
I couldn't forecast for him the level of demand that may come from people who have yet to make choices about where they do or don't wish to live. Of course, the overwhelming majority of staff who will work at the Grange are already within NHS Wales now. A number of people travel to work over relatively significant distances in addition to those who choose to live within a much shorter period of time of wherever their main site of employment is.
I do expect that conversation to continue with the local authority about housing need, to make sure that they have plans in place to make sure they meet that need in the future. But I think we can look forward to a very positive future for the Grange and the economic impact it will have on the local area, indeed both in the constituency of your colleague Nick Ramsay, and, of course, the constituency of my colleague the Member for Torfaen.
8. Will the Minister make a statement on vascular services in Ysbyty Gwynedd? OAQ53125
Thank you for the question. Betsi Cadwaladr university health board has approved plans to create a specialist vascular unit for north Wales at Ysbyty Glan Clwyd. There are no plans to close any vascular departments. The health board will continue to treat patients with non-complex needs at all three north Wales hospitals, including Ysbyty Gwynedd.
The proposals before us now undermine the excellent work done in Ysbyty Gwynedd. This week, I and other elected Plaid Cymru Members in north-west Wales have asked for a full assessment from the Welsh Government of the impact of the decision taken by the the Betsi Cadwaladr university health board to centralise vascular services at Ysbyty Glan Clwyd. A month ago, the board went back on its word and broke a pledge to safeguard certain services at Ysbyty Gwynedd. Assurances had been given that vascular surgery services would be maintained and, crucially, the ability to take emergency cases in Ysbyty Gwynedd would continue. That won’t be the case now. The fear, clearly, is that this will have a detrimental impact on patients in the north-west, who will face a journey, some of them, of an hour and a half for emergency access to treatment that is being provided excellently at Ysbyty Gwynedd. Now, will you commit, therefore, to carry out that impact assessment study? It’s the least that patients deserve.
With respect, I don't share the view that he provides about the service change that is being planned for, and I would point out that this is a planned service change that is supported by the relevant professional body, the Royal College of Surgeons, including by the council here in Wales. And not only that, though, but because of the changes that are being made, the health board has been successful in recruiting new consultant vascular surgeons. They've offered posts to nine consultant vascular surgeons and, of those, four have now commenced employment and two commence in April 2019. That will give a complement of eight substantive consultant surgeons across the health board—a significant improvement. And of all those people who have started or are due to start in the health board, the planned service change has been a real factor in them choosing to undertake employment within the health board. Far from this undermining the service available to patients in every part of north Wales, this service change and the additional recruitment that has taken place on the back of service change is actually a positive for staff and patients.
Thank you very much, Minister.
Item 3 on our agenda this afternoon is topical questions, and the topical question this afternoon comes from Dawn Bowden.
1. Will the Minister provide the users of services in Cwm Taf University Health Board with reassurance as to the purpose of the enhanced monitoring announced today? 253
Thank you for the question. The purpose of the enhanced monitoring is to provide additional support to the health board to enable them to focus on appropriate actions and to return to normal monitoring arrangements as quickly as possible.
Thank you for that response, Minister. As your statement acknowledges, since the escalation framework was introduced in 2014, the health board has always been in routine arrangements. And as well as their good financial track record, we've seen many good clinical and care initiatives delivered by the health board. So, while I was aware of the situation surrounding maternity services that we discussed in the Chamber a few weeks ago, I was surprised to see your statement this morning raising their status from routine arrangements to enhanced monitoring, due to the concerns in the areas that you've highlighted in your statement. However, I do think it's the needs of the users of the service in Cwm Taf that must be paramount at this point. So, can you assure me that the reasons for this escalation to enhanced monitoring are being clearly communicated so that users are provided with the extra reassurance that they need about local services? And can you give an indication of timescale for the resolution of the issues identified?
Yes, and the health board should not be surprised by today's decision. There's been regular communication between the chief executive of NHS Wales and the chief exec of the health board. And since the issues were raised about maternity services, I've spoken on several occasions to the chair of the health board. And the additional matters that were raised by regulators in the audit office are ones that I do not think would have been appropriate to ignore. So, you reach a point where you either choose to do something or choose to avoid doing something, and I think it is the right thing to have made this decision, and to be clear about the limited and specific areas that are of concern. But those concerns do not mean that this is a health board that provides poor-quality health and care to its citizens—far from it. We know from not just patient satisfaction but a range of measures that this is a health board that is performing well in terms of its delivery against time measures, but also against financial performance as well, and there is regular positive patient feedback. I expect, having made the statement today, that the health board will communicate directly to its staff and to its public, but also the timescale for this should be viewed as within periods of months rather than years. There are specific issues that I expect the health board to have a clear action plan to address, with timescales that they can be properly measured and assessed by. Again, the point about reassurance for yourself and the constituents that you serve is that this isn't simply a matter of political convenience made by a Minister for a Minister. There'll be the reassurance that will be those—. The review arrangements by the chief executive of NHS Wales, Wales Audit Office and Healthcare Inspectorate Wales will provide me with advice on whether it's appropriate to change the escalation status to return to normal monitoring, but that is what I expect the health board to plan for and to deliver within a period of months.
Minister, I'm grateful for the statement that you issued this morning. To the normal reader looking at this it would clearly indicate that this decision was taken out of the normal cycle of evaluation. I think I'm correct in saying that, but if you could confirm that I'd be grateful, because it would look to me as if a special meeting had been called in December for this measure to be taken today or announced today.
We must remember that 300,000 people depend on this health board for their healthcare and many thousands of staff depend on the health board as their place of employment and the service and professional development that they want to exercise in delivering excellent quality of care. But the list that you've identified in your statement this morning does cause great concern. Because, as the Member for Merthyr indicated, initially, obviously, this statement—. The Minister provided a statement on maternity services, now we have a list seven-strong, from staffing levels to delivery of Health Inspectorate Wales reports. This is a concerning time—that this isn't some sort of vortex that the health board is going into and ultimately more problems will be identified. Are you confident that the list that you've identified in your statement is a comprehensive list of the issues that this health board needs to address, and are you confident that the support that you identify in your statement in relation to governance arrangements and the support that you will be offering the board will rectify the problems and the health board will emerge out of this enhanced level of monitoring? Because to date I don't think a health board has emerged out of enhanced levels of monitoring here in Wales. As the health spokesman for the Conservatives identified, five of the seven health boards are in special measures at the moment here in Wales.
First, to do with your point about—. Every health board has challenges to face in almost every single area of activity. We regularly discuss the rising demand, the changing nature of that demand, and, of course, those are challenges for a health board in the services that it provides. I don't think any person of any party political persuasion would be able to define an exhaustive list of challenges for the health board. What I have done is provide a clear list of the issues that have led to my decision to change the monitoring status of the health board. I expect these issues to be addressed and, if they are, then I would expect there to be advice that would mean that the escalation status of the health board could return to normal monitoring.
This was a meeting outside of the usual cycle, and, again, that is a choice. We can either choose to say, 'Let's park the issue until the normal cycle takes place in a number of months', or we could say, 'There's a list of issues in front of us now and so a meeting should take place now to assess what the appropriate course of action is', and I do believe that was the right choice to make. There should be that reassurance for staff and the public that this is a specific list of issues to address. I do not expect there to be any kind of suggestion there is a list of issues that will see the health board return further and higher up the list of escalation status. I expect them, as a high-performing board, to take seriously the statement that has been made today and I expect them to respond appropriately and have a clear plan that they will adhere to to actually return to normal monitoring, as I've said, in a period of months.
Thank you, Minister, for your statement today. Of course, the priority for this intervention is to ensure that the board and its staff are supported and that my constituents and other constituents can have the utmost confidence in their local health services.
Your statement highlights six areas of focus and I think this is important, as other Members have said—that it reinforces that this enhanced monitoring is only in certain areas of provision and not across the piece. How can we make sure that local people in communities like Cynon Valley, who may only be aware of the headline news, know that this does not refer to the overall quality of services? And how can we get that reassurance to people, using the NHS in Cwm Taf, and, of course, the hard-working staff who are employed there?
I welcome the comments by the chief executive of Cwm Taf that the health board is determined to work with the Welsh Government so that routine measures can be returned to as soon as possible, and I welcome your assurances on how long you expect that process to take, but could you provide any further details on the type of monitoring that will take place in the interim?
Referring back to your statement from October last year on maternity services in Cwm Taf, then you said you'd asked your officials to seek reassurance from all health boards in regard to incident reporting and escalation arrangements. In your statement today, one of the areas of focus is the quality of serious incident reporting. What initial findings have your officials found about the quality of incident reporting more generally across the Welsh NHS?
My final question relates to governance arrangements. In your statement, you note the need to provide external support in light of the relatively recent tenure of board members, and I think that's really important. I'm concerned that this type of support is only coming now after board members are already in post and concerns have been identified, so how can the Welsh Government in future best work with newly appointed board members before they take up their roles to ensure that they're all well placed to fulfil their obligations?
Thank you. I'm happy to reconfirm and to reiterate that this statement does not affect the overall quality of services, and it should not lead to a loss of public trust and confidence in the overall quality of services provided by Cwm Taf university health board. I hope that making that as a very clear statement will be helpful, and I'm sure the health board will be reiterating that to both its staff and the population that it serves. I'm pleased that you have contact yourself directly with the health board. I think it would be sensible for the health board to directly contact stakeholders like constituency and regional Members to confirm the steps that they are taking directly to reiterate the points about the seriousness with which they take it but also the steps that they are taking.
There is, of course, regular contact with my officials and the health board itself. I expect that to be more regular now following the decision that I've made and announced today, and, of course, I'll continue to speak with the chair as well. I'll make sure there is a regular conversation between me and the chair, not just about the plan but actually about how far ahead we are in doing it to make sure there is appropriate oversight.
The point you made about the quality of serious incident reports—this is something that is regularly discussed during the regular escalation conversations that take place. There is a range of areas that both the Wales Audit Office and the inspectorate actually raise, and this is a regular feature of it. So, there is the challenge about making sure that both the serious incidents are reported and reported in good time and that the quality of the information that is shared is appropriate as well. This should not be a difficult issue to resolve, and for me it's really important—it's about that culture of openness and not wanting to try and downplay the seriousness of it, because it's the nature of that open reporting and that appropriate learning takes place from them.
On your broader point about board development, I think it's a fair point about how we constantly review the board development measures that are in place as people take up their posts and then whilst they're new in post as well to make sure that they continue to have support to undertake their conduct effectively. And, certainly, following this, I'll be interested in looking again, not just in Cwm Taf, but across the broader system, to make sure that we're getting that right.
Many of my constituents, particularly to the east of Ogmore in Llanharan and Gilfach Goch and elsewhere, will be served by Cwm Taf health authority, both in primary care and secondary care and acute pathways as well, and it is worth reiterating that, up until now, of course, Cwm Taf have indeed been a high-performing board and organisation right across the piste with much to praise, so this is a bit of a knock-back, but there is much good in the performance of this organisation, regardless of this. But I note that, beyond the maternity services, which we knew of already, of the other points, we are talking about issues of compliance, actions not having been taken, reporting not having been up to spec, response to actions to Healthcare Inspectorate Wales inspection reports and actions not completed, compliance with the nurse staffing Act. It seems to me that these are things that can be done, can be achieved, in fairly short order if they get their act together, but the one that concerns me is the one in the middle of the list in your statement today, which is concerns in respect of quality governance arrangements. Now, I just wonder what does the Minister think in terms of whether the health board have got a real tight grip on needing to respond rapidly to these actions across the piste and bring it back into a health board that, across the piste, is once again high performing and takes itself out of the escalation measures today. Do they appreciate the seriousness of the Minister and the seriousness of the message that he's put in front of them—that there is no complacency, no resting on past performance; they need to get a grip and get out of this escalation?
And my second question is whether this has any implications for the issue of the transfer of the Bridgend area of ABMU across to Cwm Taf. I'm sure it doesn't, and this is a high-performing organisation across many areas, but I think many of my constituents, not simply in the Llanharan, Gilfach Goch area, but in the wider Maesteg, Garw, Ogmore valley areas, Sarn and elsewhere, who up until now have been served by ABMU, who are in the middle of that transition now across to Cwm Taf, will want to hear reassurance from the Minister that they should not have any worries based on what we've heard today.
I'm happy to give reassurance and confirmation on your second point simply at the outset. This won't affect the timetable for boundary change. I believe it would be entirely the wrong thing to do to try and pause or interrupt that now. That boundary change is due to take place from the start of April, and this should not affect the health board's ability to deal with the list of areas. The external review of maternity services has already been commissioned; they will need to respond to that. And the areas, as you rightly highlight, of additional concern that are in my statement, many of them are about compliance, about making sure that things are done properly and in an appropriate timescale.
The challenge about in respect of the quality of governance arrangements, that is partly a question for officers, employees of the health board, but it's also a challenge for the non-exec board members as well. It goes back to the point that Vikki Howells made about making sure that board members are in a position to properly undertake their functions, to both scrutinise the health board and not simply to be champions for the organisation. That is a dual role, but it's one we'd expect members to undertake.
So, that's my expectation, and I do think there is always learning to be taken from where things are not optimal. And I do expect that, within this, there'll be learning for other health boards to make sure that they look again at their own compliance again to make sure they're doing what they should do, when they should do it, and that, equally, members are supported to be able to undertake effectively their role as board members.
Thank you very much, Minister.
Item 4 on our agenda is the 90-second statements, and we have one this afternoon from the Llywydd, Elin Jones.
On 9 January, 1839, exactly 180 years to the day, Sarah Jane Rees was born in Llangrannog, Ceredigion. Better known by her bardic name, Cranogwen, she challenged all the restrictions of a woman’s life in the Victorian age and enjoyed a groundbreaking career. In the words of Professor Deirdre Beddoe:
'Cranogwen was the most notable Welsh woman of the nineteenth century.'
In her late teens, she persuaded her father, who was a ship’s captain, to take her on board ship. For two years, she worked as a sailor on cargo ships between Wales and France before returning to London and Liverpool to further her nautical career. She gained her master mariner certificate, and, at the age of 21, she established a school in Ceredigion where she taught seamanship to local young men.
In 1865, she became an overnight sensation as the first woman ever to win a poetry prize at the National Eisteddfod, beating the major male poets of the day. Cranogwen’s winning poem, ‘Y Fodrwy Briodasol’—the wedding ring—was a stirring satire on the fate of the married woman. She went on to be one of the most popular poets in Wales, exploring themes ranging from patriotism to shipwrecks.
She was a lecturer and a preacher in an age when public speaking by women was frowned upon. She established a women’s magazine, Y Frythones. She established the South Wales Women’s Temperance Union in order to secure the safety of women in both their homes and within society.
One of her most progressive ideas was a refuge for young women, and while she did not live to see her dream of a home for homeless women being built, the Llety Cranogwen shelter was opened in her memory in the Rhondda in 1922.
Cranogwen is one of the five Welsh Hidden Heroines subject to a public poll this week. The winner will be immortalised by a public statue. The other four are Elizabeth Andrews, Betty Campbell, Elaine Morgan and Lady Rhondda. This poll will open at 9.30 p.m. this Friday night. I will cast my vote for Cranogwen from Ceredigion, but all five, and more, deserve to be both remembered and honoured.
We now move on to a motion to elect a member to a committee, and I call on the Member of the Business Committee to move the motion formally.
Motion NDM6916 Elin Jones
To propose that the National Assembly for Wales, in accordance with Standing Order 17.14, elects Rebecca Evans (Labour) as a Member of the Business Committee in place of Julie James (Labour).
Thank you. The proposal is to agree the motion. Does any Member object? No. Therefore, the motion is agreed in accordance with Standing Order 12.36.
Motion agreed in accordance with Standing Order 12.36.
Item 5 on our agenda this afternoon is a debate on the Finance Committee report 'The cost of caring for an ageing population'. I call on the Chair of the committee to move the motion—Llyr Gruffydd.
Motion NDM6908 Llyr Gruffydd
To propose that the National Assembly for Wales:
Notes the report of the Finance Committee, 'The cost of caring for an ageing population', which was laid in the Table Office on 12 October 2018.
Thank you very much, Deputy Presiding Officer. I'm very pleased to speak in this debate today, as Chair of the Finance Committee, on our inquiry into the cost of caring for an ageing population. And although I wasn't a member of the committee during the evidence sessions, I would like to thank everyone who contributed to those sessions, and to the previous Minister for Children, Older People and Social Care for his response to our report, and particularly for accepting our recommendations, either in full or in principle.
One of the six areas we covered in our inquiry, namely the fiscal levers available for funding social care, was debated in Plenary yesterday, of course, and so, I will focus on the five other levers in my contribution today. However, as I noted yesterday, I was disappointed that the Government didn’t feel able to work with the committee on the scheduling of their debate, to provide a more joined-up overview of the social care funding system. We heard stark evidence during the committee's inquiry that there was widespread confusion about the system that we have, and we were told that it would be impossible to create a more complex system even if one tried to do so. But fragmented debate on a fragmented system doesn’t help to bring the clarity that is so important in terms of this issue. So, I've made the point that we've missed an opportunity, and I know that the Trefnydd is here in another capacity and will respond to this debate as the Minister for Finance, but I just wanted to make the point that I'm more than willing to look at any more creative ways of using this place's time more effectively and more efficiently in future.
Now, the committee heard that although spending on social care has been protected in relative terms, the spending per capita on people over 65 years old had decreased significantly, partly due to the increasing older population. The committee is concerned that, unless action is taken, continuing pressures on social care budgets from increased demand will result in a weaker service and inadequate provision for older people, ultimately.
Concerns over the growing pressures is further compounded by the reliance on the invaluable role played by the 370,000 unpaid or volunteer carers, a contribution that has been valued at over £8 billion per year to the Welsh economy. And I would like to acknowledge the vital role that they play and to reiterate our view that, despite the value of that contribution, depending on unpaid careers is not sustainable in the longer term.
Our report emphasises our concern around whether the assessments that carers are entitled to under the social services Act are being carried out, and, where they're being carried out, whether needs are being assessed correctly. The support provided to carers is crucial, of course, and the committee was concerned by the approach to assessments. We recommended that the Welsh Government conduct a review of carers’ assessments to evaluate whether the social services and well-being Act is strengthening support to carers. And I’m pleased that this review began in November, and look forward to its conclusions.
The committee heard concerns too around financial and staffing pressures in the care sector. We were concerned to hear that, in some cases, providers of domiciliary care are responding by handing back contracts to local authorities as they are not financially viable on the fee levels paid. As is noted in our report, it is essential therefore that contracts issued by local authorities are realistic to avoid an increase in any unmet need that would in turn lead to increased pressure on the NHS.
We heard of a crisis in the recruitment and retention of social care staff, with low pay and perceived low social status being contributory factors. The social care sector is especially susceptible to additional workforce pressures, as a high proportion of the staff themselves are ageing. And we are also particularly concerned about claims that staff, after being trained by care providers, are being lost to the NHS, or to local authorities, which, of course, have more attractive working conditions and employee packages. We emphasise in our report that addressing workforce issues is fundamental to ensuring the sustainability of the system. People need to see social care as an attractive career option in order to encourage new recruits, and to retain experienced staff. Working conditions in the social care sector must be on a par with those offered to staff in the national health service, in order to demonstrate how valuable these roles are. Therefore, we recommend that the Welsh Government prioritise the process of developing a strategy for the social care workforce, to address these concerns. And this should include taking action to raise the status of those working in the social care sector, in order to ensure that this in an attractive career option, which is appropriately remunerated.
I am pleased that this recommendation has been accepted, and that the Government, in its response, recognises the importance of ensuring a sustainable social care workforce, and I welcome the Government's commitment to delivering improvements. And the committee will look at the effectiveness of the measures implemented recently, as well as those being rolled out later this year, when we undertake our review of the progress made in implementing the recommendations in 2020.
Now, the committee welcomes the increase in the capital threshold for contributions to non-residential care from assets, but is concerned as to whether Welsh Government has provided sufficient funding to cover revenue lost by local authorities. We welcome the recent announcement, of course, on the final increase to a £50,000 threshold, as well as the additional £7 million to fund this, but, most importantly, we welcome the commitment to monitor and also to adjust this funding, should that prove to be inadequate.
Although we welcome the inter-ministerial group on paying for social care’s plans for public engagement to better inform the public of the charging framework in the coming year, the committee is concerned by the general lack of awareness around paying for adult social care, and particularly the fact that the complexity related to the current arrangements can lead to unfairness in respect of those eligible to receive publicly funded formal support.
As part of our inquiry, the committee considered options for fiscal reform, including the proposal made by Professor Gerry Holtham for a contributory scheme of compulsory insurance. Now, we welcome the work commissioned by the Welsh Government in developing this proposal as a positive step in acknowledging that the existing system will need to change to meet future demand.
The committee endorses calls made by stakeholders for a national conversation about the standard of the care that the public wants, before decisions about future funding are made. We therefore recommended that the Government should engage with the public about the future funding of social care, in order to discuss what the public would expect to receive in return for any additional contributions in the future. In particular, we recommended that, before introducing a levy to raise additional funding for social care, the Welsh Government will need to be able to justify how any funds raised will be used, and to demonstrate that this funding will make a difference. Now, this process should include explaining the level of care that the public should expect, since it's unlikely, of course, that the public will support this if the care provided remains as its current level. And listening to the comments of the health Minister about this national conversation yesterday, of course, was encouraging.
I welcome the Government’s acceptance of recommendations 7 and 8, and particularly its commitment to develop innovative funding models, to ensure resources are available to meet future social care needs, as well as its recognition that significant public engagement will be needed before decisions are made.
Finally, the committee is aware of the conclusions of the parliamentary review of health and social care in Wales. Now, the committee heard that the proposal for a single system of seamless health and care was broadly welcomed, but we're also aware, of course, of the concerns that exist that social care can sometimes be seen as a cinderella service. Now, the committee recommended that the Welsh Government explores how the proposal of a seamless health and care system, advocated in the review, could combine a fund for social care as well as the national health service, which would be free at the point of contact. This recommendation was accepted in principle only; therefore, we would be grateful for more information from the Minister as to how the Welsh Government envisages this idea developing.
The cost of caring for an ageing population is one of the biggest and most important issues facing Wales today, and it is reassuring that the Government accepts all the recommendations, bar one, in full. The Government’s response refers to a variety of activity on the subject, including the creation of inter-ministerial groups, the multiple long-term strategies being developed, the consultations and awareness raising, all of which, of course, is encouraging, and we do hope to see positive outcomes from these initiatives when we review all of these recommendations in the year 2020.
However, it is vital that changes are made. Firm and urgent action is needed, in order to find the best solutions for Wales and in order to ensure that the people of Wales can see progress. The cost of caring for an ageing population is an issue that should never be far from our thoughts, and it's a problem that directly or indirectly affects us all. Thank you.
I'm pleased to contribute to this debate and, indeed, to have been a member of the Finance Committee and to have taken part in the report of the Finance Committee review. It was a thought-provoking inquiry about an issue that, as the Chair of the committee has said, is of growing concern and should be of growing concern to all of us. As we've heard, the proportion of older people in Wales has been increasing over the last decade, and projections show that this trend will only continue. There are serious questions to be addressed with regard to the level of resources available to maintain services and the pressures upon them.
So, where do we go from here? This is what we tried to address in the report. Well, as has been said, Professor Gerry Holtham has suggested a common insurance fund to cover future costs of adult social care, and the committee looked at this, as well as other possible solutions, and I'll come on to those in a moment.
First of all, if I can turn to some of our key recommendations, recommendation 1 calls on the Welsh Government to develop more targeted research, so that we have access to the most up-to-date and accurate data to base future projections on, and, as we know from experience, some of the limitations of Welsh-only data to date has been an issue for this Assembly. Recommendation 2 calls for a full review of carers' assessments and whether the Act has actually delivered stronger support for carers on the ground—its whole intention.
Now, our inquiry looked at the fragility of the provider market, and the evidence provided to us suggested that the market has been fragile for some considerable time, and this is leading to increasing in-sourcing by local authorities to try and reduce the risk exposure for the independent sector. Public Policy Institute for Wales highlighted to us how some providers are returning their contracts to local authorities, because they can't provide at the set fee level. So, whichever way you look at it, this is—over the longer term—an unsustainable situation.
If I can just say a little bit about the workforce pressures and retention, the committee received a great deal of evidence that pointed to the difficulties in recruiting staff to the social care sector in the first place, and indeed subsequently retaining those staff. Care Forum Wales said that care workers can often earn more stacking shelves, unbelievably, than working in the sector, or that's the perception, at least, and that cannot be right. I'm pleased the Minister has committed to raising the profile of social care workers so that it can be seen as a more positive career choice, because that was certainly lacking from the evidence that we took from the sector. But we need to do more than that; it's more than just perception. We do need to retain those employees once they're recruited.
Just moving on to the proposed social care levy that the Chair has mentioned and Professor Gerry Holtham's favoured solution and its key tenets. Those are contributions made as a proportion of income, with rates remaining constant throughout a person's life, although they would be higher the older a person is when they enter the scheme. Professor Holtham was quite honest and said that more work would need to be done on whether you would have a sliding scale, for instance, of contribution or a flat rate of, he suggested, 1.5 per cent. So, there are many variables.
Professor Holtham also admitted his suggestion that reversing the 20 per cent decline in spend per head of population, which he identified, may or may not be sufficient to tackle the problems that we face. He said that it might be better to talk in the region of 23 per cent at the higher end or 17 per cent at the lower end and that either of these may work, or they may not, and that a great deal more work would need to be done to find out exactly what level that would need to be set at.
There's also, of course the important issue of how you sell all this to the public. Do you refer to the new scheme as a levy—effectively a tax—or do you label it as compulsory insurance? Of course, even if you do the latter, it may come to be regarded as a tax anyway, so you may as well, in some cases, bite the bullet on that, but the public must know that there is a big problem here and they must be on our side in finding a way to tackle it.
Crucially, I think, this has to have cross-party support and be supported for the longer term. That's the only way that this will work and be accepted. You also have to have agreement on how to cover the costs for those who may not have made any significant contributions throughout their lives through illness or through not working for other reasons.
So, do we have a separate levy or incorporate it into the Welsh rate of income tax? That option will soon be open to the Welsh Government. The latter is a simpler, as the former finance Minister said, way of doing things and the structure is in place, but, again, the public may need to see clearly that the amount being collected is going towards their social care.
So, finally, the Minister said—or the former Cabinet Secretary, as he was—that a UK-wide solution would probably be the best solution and I can see his reasons for saying that. The costs are so great that spreading this across the UK would probably be beneficial. But that said, if this does ultimately fall to Wales to make headway on this issue, then so be it. This is an issue that cannot be ignored for any longer. It was a pretty bleak picture that the report painted, but there were also a number of solutions in there and I think we all have to look at that across parties to find a way to move forward that's acceptable to all of us here and also to the public at large.
I'm delighted to participate in this debate, although I am not a member of the Finance Committee, but I welcome the report and the background work underpinning it, and we heard the arguments in the Government’s debate yesterday.
The funding system for social care—as the Chair has already outlined—is very complex indeed and it wouldn't be possible to come up with a more complex system even if you tried, as the Chair said. Having said that, it's not just a matter of money. As I said yesterday, we need to look in the round at the significant challenge of providing elder care and to try and view it from a positive perspective. We have an opportunity to create a national care system here, because I do think we need to change the structure. We need to be radical because it is going to take funding and we have to convince the public that there is a valuable system, based on a similar system to the health service. Everyone loves the health service of course, well, why not structure our care service so that it becomes more similar to our health service? Because there will be economic gains from that too, in providing jobs, salaries, training and so on and so forth, just like the workers in the health service, in those areas of Wales that find it difficult to provide jobs in the first place, and we need to develop a social care service as an economic development tool.
Because the system, as Nick Ramsay said, is not sustainable at the moment. We must have some way forward and not just think about how we're going to fund an already failing system. Because, at the moment, given the financial limitations on social services within our county councils, the threshold for people to receive care is increasing annually. I see this constantly: older people facing a number of physical and social challenges, they deserve care, but they don't reach that threshold—a threshold that increases every year, the threshold to receive care free of charge from the county, because the funding simply isn't available. I know what people are saying. They're saying, 'Well, pay for it then; pay for your care privately.' That’s what I hear, and we heard that yesterday. But, of course, that isn't an option for very many of our older people; they can't pay, and they go without any publicly provided care, and without any care, and the entire burden falls on the family, if you're fortunate enough to still have family nearby. That’s what we sometimes forget.
Why is this important? Because people are dying because of these cuts in funding and a lack of care provision. People are dying as a result of this. There was a review in The British Medical Journal in 2017 outlining the appalling situation of care in England, where social care funding has suffered a double blow. [Interruption.] Nick.
Thanks for giving way, Dai. I agree with much of what you've just said. Do you agree with me that, during the course of the inquiry, it was ironic that Professor Holtham pointed out that when he looked at public opinion in Wales, it seemed to be that there was a lack of understanding, to a great degree, about the scale of the problem that we're facing? That shows how we really need to address this and get people to understand how we've all got to face this together.
Yes, I would agree 100 per cent, because we need restructuring; just talking about the funding isn't enough. We have a failing system here. We see it from the figures—as I was just going to say—in England. There was a review carried out in the BMJ on care in England, and that the problems in the care system in England had led to 22,000 deaths above what would have been expected. That’s 22,000 additional deaths annually in England because there was no care provision available. So, trying to throw some more money at a failing system without a substantial reform is not going to work and, of course, if our care system fails, then the health service will fail too.
Now, as I said yesterday, we have a partly private system, partly public system, and partly charitable. That’s what health was before Aneurin Bevan insisted on the establishment of a comprehensive national health service to save lives, because thousands of people in the 1930s couldn't access health service treatments at all. That is the situation facing people with care today and the needs of social care, therefore, deserve the same solution as health, namely a national comprehensive care service. Thank you.
Not being a member of the committee, I was not involved in the deliberations leading to this report, but I would like to thank the Finance Committee for their carefully-thought-out report on the cost of caring for an ageing population. Advances in health and social care enable all of us to live longer and healthier lives. Coupled with an increase in population, it is not surprising that the issue of paying for it is coming to the fore and that is why the committee's report, together with the independent report by Professor Gerald Holtham, which we debated yesterday, are entirely timely.
If we look at the current spending, we see that it has, in fact, decreased by 14 per cent between 2009-2010 and 2016-17 as services focus on supporting people with higher levels of need. This means that there are more people with perhaps less acute care needs who are receiving care in their own homes. Of course, it may be that a spouse or partner is providing that care. So, when we look at funding social care, we must give very careful consideration to carers themselves, particularly family members who are providing care for their loved one. In fact, there are around 370,000 informal carers in Wales. We hear many stories of these carers missing their own medical appointments or social activities because of their caring responsibilities. Young carers in particular need our support, and I know that Members from all sides of the Chamber would wish to pay tribute to the work that all carers do on a daily basis. I am pleased, therefore, that the Government has accepted the committee's recommendation that they review whether the assessment that carers are entitled to under the Social Services and Well-being (Wales) Act 2014 is being carried out, and whether those needs are being assessed correctly.
Turning to the demands on the social care system, the ratio of over-70s to those aged 20 to 69 is going to rise by the early 2040s from 23 per cent to 37 per cent. So, that's a 50 per cent increase within the population—and perhaps I ought to confess a degree of guilt for that statistic myself. The demand for spending on social care is projected to rise by over 85 per cent by 2035, at 2016-17 prices, so that's a 20 per cent increase in spending per head and an increase in numbers requiring care of over 55 per cent. These figures highlight clearly the need to face up to the long-term realities of funding social care. For too long we haven't really grappled with this issue enough. As the committee have stated, the evidence shows that funding pressures along with an increase in population are resulting in a funding shortfall. This is further complicated by the complex arrangements associated with paying for care, which often lead to unfairness.
Of course, there has been much debate about the prospect of a social care levy, and the committee have given this very careful consideration. I'm pleased to see that one of the recommendations is that the Welsh Government would need to be able to justify how any funds raised will be used and be able to demonstrate that it will make a difference. This should include explaining what level of care the public could expect in return for their contributions, since it is unlikely that they would support proposals to pay more if the level of care is the same as at present. Before we consider any new taxes, for that is in effect what the levy would be, the public need to be sure that they are getting something that is quid pro quo, and certainly we on these benches would not be able to support a new levy unless and until it is fully justifiable to the taxpayer.
A point my colleague Neil Hamilton made during the committee's deliberations is that we also need to radically improve productivity and efficiency in the health sector. We must ensure that people are able to see their GP when they need to. This would reduce A&E attendances and hospital admissions. Getting people discharged from hospital more quickly and back into their homes, with suitable adaptations and care packages, will also help to reduce the long-term burden on the social care sector.
The Minister previously announced a falls response project, in conjunction with St John Ambulance, to deal with some of the pressures on the NHS over the winter. We should look at all of these types of projects to evaluate their benefits on social care. To be fair to them, the Welsh Government have already undertaken some excellent work in this area, but to meet the challenges of the future, we must do more.
Finally, we need to deal with population growth, and that means having a migration policy that suits our national economic interests. We must therefore have proper border controls so that we can truly assess those who have a desperate and proper need for asylum, but with stricter controls on those who come here for economic reasons, and who will, inevitably, put yet more pressure on our already overburdened health and social care system.
As the Chair's foreword to this report states,
'Much of the evidence referred to the Social Services and Well-being (Wales) Act 2014 and whilst witnesses were generally supportive of the Act, there was some concern over the application of eligibility criteria, the undertaking of carers’ assessments and the variation in fees across local authorities. What was also clear was the unexpected costs associated with the Act'.
In its response, the Welsh Government states that its
'programme for transforming health and social care is set out in detail in A Healthier Wales'
and that it commenced a three-year
'evaluation of the Social Services and Well-being (Wales) Act, to explore the implementation of the Act and the impact on those who receive care and support, including unpaid carers,'
in November 2018.
When I accepted an invitation to work with the last Welsh Government to incorporate proposals within my withdrawn Community Care (Direct Payments) Wales Bill, the subsequent Social Services and Well-being (Wales) Act 2014 code of practice put in place a system where people are full partners in the design and operation of care and support, giving people clear and unambiguous rights and responsibilities. It states that assessing the needs of individuals should be based on the principles of co-production, ensuring that it involves a relationship where practitioners and individuals share the power to plan and deliver support together, and recognising that all partners have vital contributions to make in helping to meet identified personal outcomes. And the ways of working that the public bodies listed in the Well-being of Future Generations (Wales) Act 2015 must demonstrate also include working with others, including third sector bodies and communities, to help achieve goals that have been decided together.
However, a series of reports have indicated that the legislation is not being implemented as envisaged, that the better lives and reduced costs intended are not being delivered, and that urgent intervention is required accordingly. Last winter’s Age Alliance Wales newsletter stated that
'Third sector representatives on Regional Partnership Boards have reported feeling excluded, or at least not fully engaged',
and that the third sector has been seen as a bit-part player, with little or no strategic involvement in the integrated care fund and little input into programme planning. Despite their subsequent engagement with the then Minister regarding this, I'm reliably informed that this continues.
Last March’s evaluation of the integrated autism service commissioned by the Welsh Government found that although
'the focus upon co-production and prevention is expected to help improve effectiveness and reduce demand'
'success requires a co-productive approach involving staff, service users and carers in the design, implementation and evaluation of the service',
there are concerns that the top-down approach has stifled this. Only last Friday I attended a meeting with Flintshire council and members of the local autism community to discuss the north Wales integrated autism service hosted by the council, the needs of autistic service users and working together better going forward.
Last November's analysis by mental health charity Hafal of the Welsh Government’s 'A Healthier Wales' plan stated that it
'fails a test of indicating how things might actually change for individual consumers as opposed to providers',
'it's an example of policy made by providers for providers'
and that whilst the provider viewpoint should be respected,
'it is just one perspective and should be wholly subsidiary to that of consumers'.
The results of the survey conducted by the Wales Neurological Alliance on behalf of the cross-party group on neurological conditions, 'The Social Services and Wellbeing Wales Act—experiences of people living with a neurological condition', published last month, found that although the Act has been in force for two years, people living with neurological conditions are not being asked what matters to them, are not being made aware of their rights to an assessment, are not getting information about support and advice services, and are having to pay out of their own pocket for support.
Shockingly, the survey even found that guidance with this Act has been used to prohibit the direct payments that have successfully provided quality person-centred care previously. And only last week, hospices providing key front-line services told me that although health boards are expected to submit their three-year palliative care plans to the Welsh Government by the end of January, their health board has not engaged with them at all.
This is the harsh reality, and it demands urgent action to address the unnecessarily damaged lives and wasted resources resulting from this.
Can I now call on the Minister for Finance and Trefnydd, Rebecca Evans?
Thank you. I thank the Finance Committee for undertaking what is a really important inquiry, because the way that a society treats its older people is very much a reflection of its values, and I do commend the committee for choosing this particular important area to consider. There's a real focus in the committee's report on aspects of social care policy, and we've heard lots of those just now in Mark Isherwood's contribution, as well as on the important wider financial challenges of caring for an older population. I'm really pleased that the Welsh Government has been able to respond positively to the suite of recommendations in the report. I put on record my gratitude to the former Minister for Children, Older People and Social Care for his work on this particular agenda.
The Welsh Government is already making some demonstrable progress on improving the vital care and support that older people require. We're committed to making Wales the best country in which to grow old and, as was highlighted during the inquiry, we're reshaping the way that care and support is delivered so that this vision does become a reality.
With this in mind, I'll briefly set out the work that's being undertaken in the key areas that the committee highlighted in its report, building, of course, on the issues raised in the debate on the Holtham report on paying for care, led by my colleague the health Minister yesterday, which outlines one potential way forward.
Informal carers, so those family members and friends who provide care on an ongoing basis, play a vital role in supporting people in later life, and I think Dai Lloyd's contribution in particular reminded us very powerfully of that.
The committee's recommendation to conduct a review of carers' assessments is being undertaken through an evaluation of the impact of our social services and well-being Act. This commenced in November and it will include engagement with carers themselves. It will consider what impact the Act is having on informal carers and what has changed since the Act come into effect. It will identify to what extent the Act is facilitating the critical support they require to continue caring and also whether any further improvements will be necessary. In addition, we're undertaking a major publicity drive to raise awareness of the Act, a particular strand of which will be to ensure that informal carers are aware of their rights and are encouraged to seek information and a carers' assessment where they might require them.
Without an appropriately trained and experienced social care workforce, any attempt to implement improvements or raise quality are doomed, and I think this was well recognised in the chair of the committee's contribution. The committee fully recognised this in recommending that we prioritised the development of a strategy for the social care workforce. The Welsh Government committed to this in 'A Healthier Wales: our Plan for Health and Social Care', with a range of workforce improvement measures being implemented. These include regulations to improve terms and conditions by reducing the use of zero-hours contracts, a suite of health and social care qualifications to provide a clear career pathway, and rolling out registration to reflect our commitment to professionalise the workforce.
High on our agenda is the long-term funding of social care, which is core to its sustainability. The committee emphasised the growing demand for care that we could see in the future from an ageing population and the challenge that this poses. Due to this very challenge, we prioritised social care in our strategy 'Prosperity for All', which commits to developing innovative funding models to meet anticipated demand. You'll know from yesterday's debate of our commitment to explore options for new Welsh taxes, including a potential social care levy, to raise additional funding. These proposals form the basis of the work of our inter-ministerial group on paying for social care, established last summer and tasked with providing the policy perspective to these financial considerations. Its work is at an early stage but we will continue at pace this year to enable an informed judgment on the viability of a levy, for example, and whether this would realise the benefits that we envisage.
I think that Nick Ramsay's contribution in particular outlined just how challenging this agenda is and how big some of the questions are that we have to grapple with, and I completely agree with Nick that a good way forward is one that would develop some kind of cross-party consensus, because this is a challenge that will be facing all of us, regardless of our parties. And I know that the health secretary and I are both very keen to listen to other parties and their ideas and explore the way forward together. And I have to say as well that I do welcome the way and the spirit in which Members are engaging in what is a really important agenda.
So, alongside this we'll be engaging with the public regarding their views on paying for care and its implications for them. And as the committee rightly recommended, we need to undertake such engagement, and will shortly consider a proposal to undertake an awareness-raising campaign to ensure that people understand the importance of social care and the system that is currently in place. And the Chair of the committee referred in his speech to the widespread confusion that currently exists in terms of paying for care.
I think this piece of work will pave the way for a more targeted engagement on the options to raise additional funding as these options unfold, and, certainly, Mark Isherwood reminded us of the importance of putting the individual at the heart of these decisions.
Finally, to pick up on a specific recommendation, I'm pleased to confirm the completion of our 'Taking Wales Forward' commitment to increase the capital that those in residential care can retain without having to pay for their care. This was to raise the figure from £24,000 to £50,000 within this Assembly term. This amount is currently at £40,000 and we intend to raise it to the full £50,000 from April. To support the implementation of this, we've announced a further £7 million a year in the local government settlement from 2019-20, taking the overall implementation funding provided to £18.5 million a year. As the committee recommended, we will continue monitoring to ensure that this funding is sufficient to enable authorities to fulfil their social care obligations, and I look forward to continuing the discussions that we've had over the past two days. Thank you.
Thank you. Can I now call on Llyr Gruffydd to reply to the debate?
Thank you very much, Deputy Presiding Officer. Could I thank everyone who has contributed to the debate? I won’t refer to every contribution, please forgive me, but I’ll just endorse a couple of the points that have been made. Certainly, in the contribution made by Nick Ramsay, the reference to the level of salaries within the sector compared to those stacking shelves—I think that is one that does underline where the sector is in that context at present. And, of course, in her response, the Minister did refer to some things that the Government is doing to look at terms and conditions of that kind of employment. The bottom line, of course, is that people will want to see an increase in salary, and until that happens it will be very difficult to show the people who work in the sector that society does value the contribution that they make.
Nick mentioned the references that were highlighted during our work around the need for a UK-wide resolution, and I think that probably reflects the view of the committee or its preference in that respect, but, of course, if that isn't forthcoming then we need to get on with it and do it ourselves. I'm hopeful that the Government is of the same belief, because, as Nick said, we're in an unsustainable situation in the long term, although I think the long term isn't as long as some people think or hope it might be.
David Rowlands reminded us of the young to old people ratio that's changing fast, and that, of course, is demanding a big response from our health and social care services. It's for us, therefore, to find a way of delivering those services. Mark Isherwood reminded us as well of the value and the opportunities that come from a co-productive approach, of which I'm sure the national conversation could be the start of.
I also want to thank Dai Lloyd for his contribution this afternoon. There is an opportunity here, as Dai suggested, for us to be ambitious and to be innovative. We need to show the same ambition, the same innovation and the same bravery and courage that we saw when the NHS was created, and not throw money at a failing system. That’s not the answer, as Dai said. We need to change the system as well so that we have a more sustainable system.
So, I want to thank the Members who contributed to this debate and I also want to thank the clerking team of the committee and everyone who gave us evidence as part of this process. I’m very pleased that the Welsh Government has accepted all of the nine recommendations that were made, either fully or in principle. There is a consensus, I’m sure of that, that we need to act now and that the time has come for us to tackle this situation once and for all.
I want to close by echoing the recognition that we as a committee want to give to the voluntary carers out there—the glue that holds the service together. The reliance on them is very heavy, but is does cause a risk to the sustainability of social care provision in Wales. We’ve heard about the concerns about pressures on the workforce. We’ve heard about the challenges facing us.
Could I thank you all and could I say that it has been an encouraging response by the Government? But, of course, all of this activity now that is happening needs to lead to results and changes to a funding system that, I think we can all agree, is running out of time. Thank you.
Thank you. The proposal is to note the committee's report. Does any Member object? No. Therefore, the motion is agreed in accordance with standing Order 12.36.
Motion agreed in accordance with Standing Order 12.36.
Item 6 on our agenda this afternoon is a debate on the Economy, Infrastructure and Skills Committee report, 'The State of Roads in Wales'. I call on the Chair of that committee to move the motion—Russell George.
Motion NDM6907 Russell George
To propose that the National Assembly for Wales:
Notes the report of the Economy, Infrastructure and Skills Committee, 'The State of Roads in Wales', which was laid in the Table Office on 24 October 2018.
An audio-visual presentation was shown to accompany the debate.
Diolch, Deputy Presiding Officer. I move the motion in my name. The condition of Wales's roads is a matter of great importance to all of us. Whether we drive, cycle, or take the bus, we're all road users in one way or another. The everyday things that sustain us, including much of our food, are, of course, transported via the roads.
In addition to the importance to us all as part of our lives, the road network is one of the nation’s greatest assets also, worth an estimated £13.5 billion, and covers over 21,000 miles. Our inquiry has looked in detail at how we maintain our roads, how we improve them, and whether this approach meets the expectations the Welsh Government has set itself in the laws it has passed.
Committee members were mindful of how much the public talk about the state of our roads, so we were keen to enable people to contribute to our work. We therefore held a photographic competition to encourage people from all parts of Wales to submit images that represent the network. The images we received are playing on the screens here in the Chamber, and covered a wide range—some funny, some sweeping landscapes and some pothole-ridden tarmac.
The Minister will recall that he accepted many, but not all, of our recommendations. One of the sobering aspects of this inquiry has been how many of the issues raised in previous studies remain difficult. There is an overwhelming consensus that long-term funding for local government and trunk road agencies would lead to improvements, yet we remain stuck in an annual cycle. Twelve months ago, in a statement on the future of Transport for Wales, the then Cabinet Secretary said that he had:
'committed to a five-year programme of transport capital funding through Transport for Wales.'
He claimed that this would lead to 15 to 20 per cent efficiencies.
The committee recommended that the five-year funding model that was being applied to Transport for Wales—or rather is—is also applied to local authorities. However, the Government has rejected that call. While saying that it's sympathetic to such calls, the formal response sets out a number of reasons why this is difficult right now. It refers to the fact that local authorities receive funding from a range of sources, not just the Welsh Government. It also cities uncertainty around the planned UK Government spending review, combined with austerity and Brexit. While it commits to working with local government to provide
‘indicative information to inform their forward planning’,
it’s unclear how this funding uncertainty affects the five-year programme of capital funding committed for Transport for Wales, so I hope the Minister will be able to clarify why the two bodies see such a different approach.
If there was one key thing to take away from our report—one recommendation we considered in detail—it was this one, recommendation 12:
'The forthcoming Wales Transport Strategy should set a clear priority for maintaining the existing road network, mainstreaming and upgrading active travel infrastructure, and prioritising access, in preference to building new roads.'
I am disappointed that the Government rejected this recommendation.
Now, we know that money is tight, and we know that there is a strain on the current network and there's a strain on the cost of maintaining it, but we also know that investing and maintaining saves money in the longer term. The committee and the Minister have indicated the need for greater spending on active travel infrastructure. It seems unlikely that this will be possible on any scale without re-prioritising the spend within the transport budget. In addition to these financial reasons, there is the pressure provided by the Well-being of Future Generations (Wales) Act 2015 to consider the wider impacts of investment. More roads equals more traffic, equals more pollution.
I should make clear that I—my views and the committee's views—. I’m not saying that we don’t build new roads. That's not what we’re saying at all—far from it. We're about to see the opening of the Newtown bypass in my own constituency—a massive infrastructure project much needed for many, many years. There are cases where roads need to be moved, or addressing pinch points would be the best possible solution. So, our recommendation is about a focus on the other activities, rather than saying, 'Don't build new roads'. [Interruption.] Yes, of course.
Thank you very much, Russell, for giving way. It's an important point, particularly in respect of the Active Travel (Wales) Act 2013, which he mentioned. When it was passed back in 2013, it talked about making walking and cycling the most natural way of getting about in Wales but, of course, we know that when roadworks are done on existing road infrastructure, it's very often the walkers and the cyclists that are the forgotten ones, the most inconvenienced. It tends to be the cycle paths that tend to be used as the overspill from the roadworks and they're blocked—there's no diversion, no alternatives taking their place. Despite the fact that Welsh Government has made it clear that it wants that to happen, it doesn't seem to happen. And I think one of the—. I'm interested in whether the committee looked at this aspect of whether the delivery guidance for the design guidance under the Act properly addressed this issue because, surely, if we're trying to promote active travel and make this the most natural country in which to walk and cycle, then, when we do any roadworks, new or old, we want to make sure that the cycle lanes and the walkways are still there, and we're not pushing people out into the middle of traffic or into a field.
Well, as it happens, we did look into that in a separate piece of work that we did last year in regard to active travel. We actually undertook our own survey of users that asked, 'What stops you from cycling or using paths?' and it was, indeed, the state of roads. And I think that is in line with what you're saying, so I very much agree with that point; I think it's a point well made.
The committee made a number of recommendations that I’m pleased to say have been accepted, and these include exploring the potential of apps to provide real-time feedback on road conditions, improving the transparency and availability of highway asset management plans, creating a panel of experts to advise on best practice in road mending, and limiting the cases where it might be prudent to use the mutual investment model of public-private financing. On the latter note, the Chair of the Finance Committee wrote to me earlier this week responding to our concerns about the mutual investment model, and I was pleased to read that they will be doing a wider piece of work on capital funding during the coming year that will consider these issues.
I anticipate lots of contributions today, as lots of us will receive e-mails and letters about the state of roads in our own regions and constituencies, so I look forward to hearing what others have to say this afternoon.
In Wales, we have just under 35,000 km of roads. Most people's journeys involve the use of the road network, a figure that has been static since records began in the 1950s. We also rely on roads for a high proportion of our domestic freight. Across the UK, Cycling UK’s 'Fill that Hole' website notes an average of 13,500 potholes reported annually. Both of these statistics indicate something of the scale of the challenge before us, and they also show that the condition of our roads is a topic of concern to many Welsh citizens, a point that the Chair of our committee, Russell George, has already noted.
For my contribution to today’s debate, I want to focus on three recommendations in particular, and it's disappointing that all of these have been rejected by the Welsh Government. So, I would hope the Minister in his response could look at how the evidence we received may be taken on board. First, recommendation 3: now, this was about incentivising local authorities to invest in maintenance. In my own local authority of Rhondda Cynon Taf, plans were recently approved to invest a further £23.5 million over the next three years. A sustained focus on improving the highway network means that, since 2011-12, the percentage of classified roads requiring attention there has shrunk by two thirds.
I want to commend the council for their hard work in improving the road network, which has seen the completion of over 1,000 carriageway schemes. I welcome the Welsh Government's substantial funding to local councils over a four-year period for road maintenance. However, I hope the Minister could outline how he will best work with councils to ensure that this remains a priority. I'm very conscious that it's all well and good residents of one authority having well-maintained roads, but what if they travel to another authority where the situation is very different? Maintenance of roads in one authority is perhaps the service that can most affect residents living in another. So, we need to make sure that we adopt a joined-up approach to this issue.
Secondly, recommendation 4: now, this is about looking at a five-year model for support for councils. Key here is the capacity for long-term planning at all levels. I do accept the Minister's reasoning and note that, where possible, funding has been provided on a longer term basis. For example, I alluded to the £60 million pothole fund allocated to authorities over a three-year basis. I mentioned that councils can make long-term plans, as in the case of Rhondda Cynon Taf and its three-year model.
I think the more positive response to recommendation 6 addresses some of our concerns. With the continuing pressure of austerity, we need to ensure that we make the right long-term decisions that deliver the right long-term solutions. That's better than quick short-term fixes, which only lead to further cost overall. I look forward to the publication of the five-year maintenance plan referred to in due course.
Finally, recommendation 8: at its core, this is around clarity and prioritisation of road infrastructure improvements, and explaining, when timescales slip, why this is the case. I think this is vitally important. One of the sources of greatest frustration to my constituents has been the delays in completing the dualling of the A465 Heads of the Valleys road between Hirwaun and Abergavenny. Now, the need for improvements to that three-lane very dangerous stretch of road were identified nearly three decades ago. The slippage in the time frame on this long-promised project, often without clear answers why or when, has left a bitter taste. I would say it's no coincidence that my party has struggled to hold the council seat in the ward of Hirwaun, one of only two seats that we've failed to hold in the Cynon Valley.
Similarly, whatever Members' views on the M4 relief road, questions about the timescale there have not benefited anyone. I think it's important to note the sense of frustration may not be just about road replacement projects. It also affects public transport improvements too. I welcome the Welsh Government’s commitment to review whether greater clarity can be given as to the stages of development within the national transport finance plan. I hope that this can be made as clear as possible so politicians and the communities we represent all have the right information. Thank you.
I'm grateful for the opportunity to speak on the Economy, Infrastructure and Skills Committee report on the state of roads in Wales. May I begin my remarks this afternoon by paying tribute to my predecessor on the committee, Mark Isherwood, for all his work in helping to produce this valuable report? The state of the roads in Wales is a vitally important subject that affects the lives of everyone in Wales. We all use the roads as drivers or passengers, for leisure or for work or for just getting on with our daily lives.
Roads are vital for the Welsh economy. The Federation of Small Businesses pointed out that its members frequently complain that the state of our roads is getting worse and that congestion is hampering their businesses. They went on to say that, when questioned, most businesses' priority for investment was transport infrastructure. A survey in 2014 revealed that over 60 per cent of FSB members said that roadworks, congestion and the state of repair of roads were having a negative impact on their businesses. In 2016, another survey suggested that congestion and the state of repair of local roads, as opposed to the strategic trunk road network, was a significant concern.
Local roads are of course looked after by local authorities rather than by the Welsh Government. Indeed, the Welsh Government's own published data shows that the condition of local roads is significantly worse than the trunk roads or motorways. There can be no doubt that the problem of maintaining local roads has been exacerbated by cuts in local authorities' funding. Many responses to the committee made clear that local roads would deteriorate if funding levels were not maintained. I welcome the announcement that was made back in February last year of an extra £30 million for local road improvements, but this is only a fraction of the sum required. Swansea city council, for example, itself estimates the cost of this backlog of repairs at £54 million. The committee concluded that funding for local roads needed a longer term approach than that provided by the current annual settlement system. It is disappointing, therefore, to note that the two recommendations made regarding funding have been rejected by the Welsh Government, and yet there is a precedent for a longer term deal. Transport for Wales already benefits from a five-year programme of capital funding. If Transport for Wales can receive this certainty of funding, why shouldn't local authorities also be able to benefit?
In the current financial climate, local authority budgets are under severe pressure. It is unlikely that they will be able to find the significant additional funding that maintenance of the infrastructure requires. Innovative ways need to be found to incentivise local authorities to invest in essential maintenance. I would ask the Welsh Government to reconsider their rejection of those two recommendations.
Deputy Presiding Officer, it is not enough to take comfort from the conclusion that the condition of Wales's roads is not worse than those in other parts of the United Kingdom. Although this may be true, this issue is far too important for us to be complacent. We must face the challenge presented by the current state of the roads in Wales. I believe the recommendations in this report do just that and would significantly improve our road network for everyone's benefit. As the now Deputy Minister was one of the members of the committee who actually signed off those recommendations, I hope the Government will look sympathetically on this, and I commend this report to the Assembly. Thank you.
I will speak very briefly. I wasn't a member of the committee that carried out this inquiry, and, oddly enough, there was some mockery when that competition was launched for people to send in pictures of potholes to the committee. Some doubted the seriousness of that, but it was an useful step, and what was shown in people's response was just how much this touches the lives of people wherever they are in Wales. Our roads, after all, are one of our greatest assets, worth over £13 billion, and each and every one of us in one way or another uses those roads, and each and every one of us, I would go so far as to say, have come across potholes in our roads. It was a very useful exercise, I think, in real engagement between our national Parliament and the people of Wales on an issue that was truly important to them.
And there were no prizes for thinking what some of the conclusions of this inquiry would be, nor what some of the recommendations that would emerge would be, but it was very important indeed that they were noted in black and white, and I'm very pleased that we do have this report. It was no surprise to see through this report that funding is too tight within our local authorities in Wales for them, without additional support, to tackle this particular problem; it was no surprise to see that we needed a long-term funding plan, as other elements of our transport system receive; it was no surprise to see that long-term management and ensuring that this asset was maintained in the best possible condition for the longer term would be more cost-effective than responding to problems as they arise, and we have recommendations now that I hope that the Government will implement.
But there's no getting away from the fact that there is a dire financial problem at the core of this situation. The annual local authority road maintenance survey, which was drawn to my attention today, suggests that local authorities in Wales had spent 40 per cent less than local authorities in England on road maintenance in 2018. That’s not sustainable. I understand in my constituency that the funding available for road maintenance has almost halved in a period of around 10 years. That is not sustainable. I see one authority talking about a backlog of £50 million for road maintenance. The statistics from Swansea have again been drawn to my attention today.
And a situation can deteriorate over time. I’ve had a case in my own constituency recently where a change in agricultural practice, heavier vehicles being used on rural roads, does exacerbate the problems and causes problems anew for rural roads, and that, in turn, leads to further costs. So, this isn’t a problem that’s going to go away; it’s a problem that we have to take seriously.
And one can’t ignore the fact that, in Wales, at the moment, there are road schemes worth up to some £2 billion in the pipeline—that could happen for one scheme, and there are other significant schemes worth tens or hundreds of millions of pounds and we must safeguard the fundamental asset. We must safeguard that asset and we must put long-term spending programmes in place— five years is the suggestion made in this report, and I would agree with that—long-term funding schemes in order to ensure that our local authorities can put programmes in place in order to safeguard that asset for the longer term. And I’m very pleased that this report has been drawn up, never mind the mockery of the photography competition at its start.
Well, echoing some of the words of Rhun ap Iorwerth, during our evidence sessions on the state of the roads in Wales, many, if not all, stakeholders were adamant that there was a need for longer strategic planning, and this could only be achieved by long-term budget proposals from the Welsh Government, most advocating this be at least for a term of five years. It is therefore regrettable that recommendation 4 in our report is rejected by the Cabinet Minister. Although an explanation is given for this rejection, should Government not acknowledge that short-term solutions to the road network are far more costly over time than well-thought-out medium to long-term projects? So, it seems strange that you accept our recommendation 6, which, again, calls for long-term planning, although this acceptance seems to be based on better, longer-lasting, road metalling materials.
Given that financial restraints are the primary cause for the Government's inability to facilitate long-term budgets, should such restraints be a fundamental factor in the Cabinet Minister's deliberations over whether to go forward with the M4 relief road? Surely the release of the huge capital sum envisaged for the bypass would alleviate all the restraints outlined in your rejection of the suggestions contained in the committee's recommendation 4.
Turning to the Government's rejection of recommendation 12, where we asked that there should be a clear priority given to maintenance of existing roads, and enhancement of the active travel network, your rejection simply states that it is the national transport finance plan that sets out the investment programme, not the Wales transport strategy. However, does this address the fundamental principle of our recommendation, which addresses the question of prioritisation, given that both the strategy and the finance plan are both under the remit of the Welsh Government?
In conclusion, the two fundamental findings our inquiry's identified are that the trunk roads of Wales are generally of good standard and are being upgraded in a timely and cost-effective manner. However, the same cannot be said for the road network administered by local authorities, and that this is mainly due to financial constraints. We therefore call upon the Welsh Government to rectify this imbalance so that those using the network in Wales find all roads are maintained to an excellent and safe standard.
One area that I would like a particular focus on is the surface water flooding, and when we took evidence, Leeds university mentioned climate change in their evidence to the committee, and particularly, the increased incidence of heavy rainfall, which, in its turn, increases flooding. I note that sustainable drainage systems for new properties have come into force this week. However, dealing with flood risk and aquaplaning, which is potentially lethal in its consequences, must be written, I believe, into both road building and maintenance schedules, whether that is maintained by local government or other highway bodies. I look forward to it being included in the five-year maintenance plan.
I do welcome the extra funding that has come into local government, particularly to address this problem in response to its needs, but I will be and will remain consistent about surface water flooding, because the outcome and the result of it can be absolutely lethal.
I'd like to thank the Finance Committee for their report. The state of our roads is one of the frequent complaints I receive as an Assembly Member. Anyone who uses any of Wales’s 21,000 miles of road will tell you that many of those roads are in a poor state of repair. Avoiding potholes has become a fixture in our daily commute.
According to the Asphalt Industry Alliance, it will take over 24 years and more than £0.5 billion to get Wales’s roads up to scratch. We have a massive backlog of road repairs, which has also led to increases in compensation and insurance pay-outs due to damage and injury caused by potholes. Potholes are one of the leading causes of car accidents on our roads and are responsible for the death or serious injury of many cyclists each year. Local authority cuts and a couple of harsh winters have contributed to a sharp rise in the number of potholes plaguing our highways and byways. Without extra investment and forward planning, our roads will deteriorate much further, well beyond the ability to apply a quick patch. Poorly patched potholes can make the situation much worse, as road salt and below-freezing water during the winter months undermine the patch, often leading to an even bigger pothole.
Forecasters are predicting yet another harsh winter, which will further undermine the condition of our road network. I therefore welcome the Economy, Infrastructure and Skills Committee’s recommendations and regret that the Welsh Government have failed to accept them all. The roads in the worst state of repair are our local roads—the responsibility of Wales’s 22 councils—yet the Welsh Government refuses to ensure ring-fenced funds for our roads or to ensure that we move away from year-to-year budgeting to more strategic transport investment plans. It is this short-sightedness that has led us to where we are today, where roads are left to deteriorate until they are almost unusable, then hastily and shoddily patched and allowed to deteriorate further before they are eventually resurfaced.
We need to move away from this reactionary approach and take a more strategic approach towards our national infrastructure. A properly planned and adequately financed programme of road repairs and surface replacement is badly needed. We also need to look at ways in which technology can help address the issue of potholes. New machinery and new developments in bonding agents mean repairs can last longer than the original road surface. New advances in road surface material science has led to the creation of self-healing roads, which are being built in the Netherlands and China.
We need to ensure that our roads, the lifeblood of our economy, are fit for the future by ensuring that we utilise the very latest technology, which will undoubtedly lead to future cost savings as well as reducing the number of accidents, deaths and serious injuries that occur on Welsh roads. With these points in mind, I urge the Minister to reconsider his opposition to recommendations 3 and 4. Thank you very much.
Thank you very much. Can I now call the Minister for Economy and Transport, Ken Skates?
Diolch, Dirprwy Lywydd. It's a great pleasure to be able to respond to this important debate today. I'd like to begin by thanking the Chair and the members of the committee for their hard work. I'd like to thank all Members who have contributed this afternoon, and I'd also like to thank the Chair of the committee for providing the complementary visuals to today's debate. I hasn't realised that the photographic competition had drawn any scorn; I actually think it's a really innovative way of attracting interest from the people that we serve in the work that we do, and I'd like to congratulate the committee for deciding to hold that competition.
Deputy Presiding Officer, I've always been very clear, throughout my time in office, that the Welsh Government is committed to a high-quality, integrated, low-carbon and multimodal transport system that can support our communities, our economy, our public services, right across the length and breadth of Wales. I know that the public perception might be that the Welsh Government is stuffed full of road engineers that only want to build new roads—I've heard the joke many times before—but it is simply not true. Look at what we've put forward as a Government in recent years. Proposals for a new £5 billion rail service, exciting new plans for metros in the north and in the south, a big increase in active travel investment, and a major new public transport White Paper proposing ambitious reform of our bus and taxi sectors, I think, prove that point.
But whatever the future looks like, having a reliable and well-maintained road network that can serve those communities and regional economies I talked about is a vital part of the equation. At over 1,700 km in length, the motorway and trunk road network is one of our most valuable assets, worth approximately £16 billion. Through improving connectivity and boosting economic activity, it supports the delivery of many of the objectives in 'Prosperity for All' and the 'Wales Infrastructure Investment Plan'. To put it simply, we are responsible for three areas: we are responsible for constructing new roads and improving the existing ones; we are responsible for renewing roads, bridges and other structures; and we're also responsible for the day-to-day road maintenance of the trunk road network and motorway network, including, of course—crucially—winter maintenance.
Work is continually required across the network to ensure its safety, and work is currently managed by two public sector agents: the South Wales Trunk Road Agent, managed by Neath Port Talbot council; and in the north and mid Wales, it's the North and Mid Wales Trunk Road Agent, which is managed by Gwynedd County Council. And I think it is fair to say that recent harsh winters have not been kind whatsoever to the network, causing significant disruption, and we've experienced a rapid deterioration in road surface conditions, due to the freeze-thaw cycle across Wales that many Members today have talked about. But even during these challenging times we continue to operate, maintain and upgrade the network, allowing 10 billion vehicle kilometres of use per year throughout all seasons. The nature of the work is incredibly costly, and in the last financial year, we invested over £146 million in maintenance and minor improvements alone. We'll continue to focus on ensuring value for money and driving efficiency in all of our transport schemes. With regard to recommendation 4, we recognise and we are sympathetic to the calls from our public sector partners and businesses for budgeting over a longer period whenever possible, in order to support forward financial planning, but our ambition to publish plans for longer than 12 months must be balanced with our ability to provide realistic and sensible planning assumptions.
Our capital budget is 10 per cent lower in real terms than at the start of this decade, and potholes are a clear, visible and daily reminder of the UK Government's austerity programme. The continuing financial uncertainty and the considerable insecurity surrounding the shape and nature of the negotiations for a future deal with the European Union mean that we have taken the decision to publish capital plans for the next two years, 2019-20 and 2020-21—the period for which we have a known settlement. An additional £32.5 million of specific grants were allocated in the last financial year to local authorities to improve the condition of the road network, and we'll be providing a further £60 million specifically for highway refurbishment over the three years between 2018-19 and 2021-22. Decisions on local roads and the prioritisation of repairs and improvements are, rightly in my view, matters for local decision makers.
An extra £100 million general capital being provided between 2018-19 and 2021-22 as part of the additional funding package for local government announced in November will go a huge way to support local councils in improving the condition of their road network, and allow them to deliver other local transport priorities, which of course are much more widely appreciated than just road users.
We are progressing major projects to improve the road network across Wales, particularly at pinch points where congestion can be a major problem. By making our network more efficient we not only improve productivity, but also enhance access to jobs, services and leisure. Rectifying pinch points can also play an important role in overall emissions reductions, as well as providing significant air quality, noise and active travel benefits for local communities.
Our national transport finance plan sets out an ambitious five-year rolling programme of transport interventions that we are taking forward across Wales, and the plan was updated in December of 2017 with an intention to review on an annual basis to reflect developments over time and the changing profile of needs across Wales. The current Wales transport strategy is also under review, having originally been published in 2008. That strategy, which will be published this year, will provide an opportunity to adopt new approaches and engage with stakeholders during key stages of its development. Officials are already engaging with the Future Generations Commissioner for Wales on the direction of this strategy, and we also worked with the future generations commissioner to launch the Welsh transport appraisal guidance.
To complement our capital budget, we have also developed a range of innovative financing schemes, including the mutual investment model, to finance major capital projects. This will support additional investment in social and economic infrastructure projects and will help to improve public services across our country. The MIM includes important provisions to promote the public interest. The model extends the Government's approach to community benefits, which have been a key feature of the other schemes delivered to date. It also incorporates our commitments to ethical employment and sustainable development, and will contribute to the delivery of the Well-being of Future Generations (Wales) Act 2015. We've made it clear that the mutual investment model will only be used when other forms of capital have been exhausted. I know that officials have already briefed the committee on the model, but further briefing will be provided during the procurement of the first MIM scheme, which is to complete the dualling of the Heads of the Valleys road, the A465.
Officials continue to liaise with various practitioners throughout the UK to share best practice, including Transport Scotland, Highways England and local contractors. This has resulted in a new specification for road surfacing suitable to meet the challenge of durability, sustainability and the environmental effects of climate change. We're also fully aware that mobile apps are increasingly become the norm, and that they could be incredibly useful in assisting with maintenance planning. It's recognised industry wide that current surveys lack an effective real-time approach, and the geographical information system would be able to highlight condition issues and inform planned maintenance decision making on a rolling basis.
So, in conclusion, Welsh Ministers are directly responsible for the motorway and trunk road network in Wales and have a statutory duty to maintain its safety and operation. We will continue our sustained investment in the maintenance and improvement of this critical asset.
The Llywydd took the Chair.