Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd
Health, Social Care and Sport Committee - Fifth Senedd19/09/2018
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Angela Burns AM|
|Dai Lloyd AM||Cadeirydd y Pwyllgor|
|Dawn Bowden AM|
|Jayne Bryant AM|
|Julie Morgan AM|
|Lynne Neagle AM|
|Rhun ap Iorwerth AM|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Enrico Carpanini||Y Gwasanaethau Cyfreithiol, Comisiwn y Cynulliad|
|Legal Services, Assembly Commission|
|Paul Davies AM||Yr Aelod sy’n gyfrifol am y Bil|
|Member in charge of the Bill|
|Stephen Boyce||Y Gwasanaeth Ymchwil, Comisiwn y Cynulliad|
|Research Service, Assembly Commission|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Gwyn Griffiths||Cynghorydd Cyfreithiol|
|Lowri Jones||Dirprwy Glerc|
Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.
The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.
Dechreuodd y cyfarfod am 09:30.
The meeting began at 09:30.
Bore da i chi gyd, a chroeso i gyfarfod cyntaf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon y tymor yma yng Nghynulliad Cenedlaethol Cymru. Bore da i chi gyd.
O dan eitem 1, a allaf estyn croeso i fy nghyd-aelodau o'r pwyllgor yma, ac ymhellach egluro bod y cyfarfod yma yn naturiol ddwyieithog? Gellir defnyddio’r clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar sianel 1 neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. Dylid dilyn cyfarwyddiadau’r tywyswyr os bydd y larwm tân yn canu. A oes unrhyw un sydd eisiau datgan buddiannau? Dim, fel sy'n arferol. Rydym wedi cael neges y bydd Dawn Bowden yn cyrraedd yn hwyr y bore yma, ond rydym ni’n ei disgwyl hi.
Good morning, everyone, and welcome to this first meeting of the Health, Social Care and Sport Committee this term in the National Assembly for Wales. Again, good morning to you all.
Under item 1, can I extend a welcome to my fellow members of this committee, and further explain that this meeting is naturally bilingual? You can use the headsets to hear interpretation from Welsh to English on channel 1 or for amplification on channel 2. You should follow the instructions of the ushers should the fire alarm sound. Does anyone wish to make a declaration of interest? As usual, no. We've received a message that Dawn Bowden will be running late this morning, but we do expect her to arrive later.
Felly, gyda chymaint â hynny o ragymadrodd, fe wnawn ni symud ymlaen i eitem 2, ac ymdrin â Bil Awtistiaeth (Cymru). Hon ydy’r sesiwn dystiolaeth gyntaf ar y Bil pwysig yma ac rydw i’n falch iawn i gyfarch ac i groesawu Paul Davies, Aelod o’r Cynulliad, yr Aelod sy’n gyfrifol am y Bil yma. Bore da, Paul. Croeso i’r pwyllgor.
Therefore, having said those few words, we'll move on to item 2, which is on the Autism (Wales) Bill. This is the first evidence session on this important Bill and I am very pleased to welcome Paul Davies, Assembly Member, who is the Member in charge of this Bill. Good morning, Paul, and welcome to the committee.
Diolch yn fawr iawn.
Hefyd, Stephen Boyce, o'r Gwasanaeth Ymchwil—hen ffrind i’r pwyllgor yma, yn naturiol, nid bod hynny’n cyfrif am ddim y bore yma, yn naturiol, o reidrwydd. [Chwerthin.] A hefyd, Enrico Carpanini o’r gwasanaeth cyfreithiol. Bore da i’r tri ohonoch chi. Yn unol â’n traddodiad yn y pwyllgor yma, yn naturiol rydym ni wedi bod yn darllen pob math o bethau yn y cefndir, gan gynnwys y Bil ei hunan, ac felly, gyda’ch caniatâd, awn ni’n syth i mewn i gwestiynau.
Also, Stephen Boyce from the Research Service—an old friend of this committee, not that that will count for anything this morning, of course. [Laughter.] And also, Enrico Carpanini from the legal services. Good morning, all three of you. In accordance with our custom on this committee, we have read all kinds of submissions in the background, including the Bill itself, of course, so we will move straight into questions, if that's all right with you.
Ocê, diolch, Paul. Mae’r cwestiynau cyntaf o dan ofal Rhun ap Iorwerth.
Okay, thank you, Paul. The first questions are from Rhun ap Iorwerth.
Bore da a llongyfarchiadau ar gyrraedd at y pwynt yma yn cyflwyno'r ddeddfwriaeth arfaethedig yma.
Os gwnaf i ddechrau’n eithaf cyffredinol, mae yna drafod, wrth gwrs, wedi bod ers tro, p’un ai ddeddfwriaeth sylfaenol neu ryw fodd arall ydy’r ffordd orau i ateb y problemau sy’n wynebu pobl sydd ag anhwylder sbectrwm awtistiaeth. Pam eich bod chi wedi cael eich argyhoeddi mai deddfwriaeth sylfaenol ydy’r ateb?
Good morning and congratulations on getting to this point in introducing this proposed legislation.
If I could start with a general question, there's been some discussion for some time as to whether primary legislation or some other means is the most appropriate way of meeting the needs of people with autism spectrum disorder. Why have you been convinced that primary legislation is the solution?
Rydw i’n credu taw deddfwriaeth yw’r ateb. Rŷm ni, wrth gwrs, wedi gweld strategaethau ers 10 mlynedd bellach, a 10 mlynedd yn ôl, er enghraifft, roeddem ni’n trafod nifer o faterion fel diagnosis, fel data, fel hyfforddiant, fel cyflogaeth, ac yn anffodus, rŷm ni o hyd yn trafod y materion yna. Felly, dyna pam, nawr, rydw i yn credu ei bod hi wedi dod yn amser i roi gwasanaethau ar lefel statudol. Dyna beth mae fy Mil i yn ceisio ei gyflawni—sicrhau bod gwasanaethau yn y dyfodol yn cael eu rhoi ar lefel statudol. Ond mae e hefyd yn mynd i sicrhau bod strategaeth yn mynd i gael ei chyflwyno ar gyfer anghenion pobl a phlant sydd ag awtistiaeth; mae e’n mynd i sicrhau bod llwybr clir a chyson i gael diagnosis o awtistiaeth; mae e’n mynd i sicrhau bod y data priodol yn cael ei gasglu er mwyn sicrhau bod byrddau iechyd lleol ac awdurdodau lleol yn gallu cynllunio yn y dyfodol; mae e’n mynd i sicrhau bod staff sy’n gweithio gyda phobl sydd ag awtistiaeth yn derbyn yr hyfforddiant priodol; ac mae e’n mynd i sicrhau bod yna ymgyrch parhaol i godi ymwybyddiaeth o awtistiaeth.
Felly, rydw i yn credu ei bod hi’n bwysig nawr ein bod ni yn edrych i gyflwyno deddfwriaeth. Hefyd, mae yna adroddiad y llynedd, er enghraifft, gan y London School of Economics. Maen nhw wedi cyhoeddi adroddiad o’r enw ‘The Autism Dividend’, ac os caf i ddyfynnu beth maen nhw wedi’i ddweud yn eu hadroddiad nhw—maen nhw wedi dweud hyn, ac fe’i dywedaf yn Saesneg:
I think that legislation is the solution. We have seen strategies, of course, for 10 years now, and 10 years ago, for example, we were discussing many issues such as diagnosis, such as data, training, as well as employability, and unfortunately, we remain in the same position of still discussing those issues. So, that's why I now believe that we have reached the point where we need to put services on a statutory level. That is what my Bill is seeking to achieve—to ensure that future services are put on a statutory level. Having said that, it's also going to ensure that a strategy will be brought forward for the needs of children and adults with autism; it will ensure that there will be a clear and consistent pathway to receiving a diagnosis of autism; it will ensure that the appropriate data will be collected in order to ensure that local health boards and local authorities are able to plan in the future; it will ensure that staff who work with people who have autism will receive the appropriate training; and it will ensure that there will be a continuous awareness campaign in relation to autism.
So, I believe that it's important, now, for us to look to bring forward this legislation. There's also a report from last year, for example, by the London School of Economics, which was published under the title, 'The Autism Dividend', and if I may quote from what they've stated in that report—they have said this, and it's in English:
'The Welsh government rejected calls for an Autism Act, believing that other current developments will support autistic people effectively. However, without such legislation, government initiatives lack statutory force resulting in an inability to require local authorities to implement the strategy to the full.'
Felly, mae'r adroddiad yna'n eithaf clir ei bod hi yn bwysig ein bod ni yn gweld deddfwriaeth, ac, wrth gwrs, rydw i'n siŵr eich bod chi hefyd yn cael etholwyr yn dod atoch chi yn galw am ddeddfwriaeth. Fel rŷch chi'n gwybod, rydw i wedi rhedeg dau ymgynghoriad yn ystod y broses hon ac mae hi'n amlwg bod mwyafrif y bobl sydd wedi bwydo i mewn i'r ymgynghoriadau yna eisiau gweld deddfwriaeth. Rydw i'n credu ei bod hi yn bryd nawr ein bod ni yn gweld deddfwriaeth i sicrhau bod gwasanaethau yn cael eu rhoi ar lefel statudol a'n bod ni'n gweld cysondeb hefyd ar draws Cymru.
Therefore, that report is quite clear that it is important that we do see legislation being brought forward, and, of course, I am sure that you will also have had constituents coming to you calling for legislation. As you know, I have undertaken two consultations during this process and it's clear that the majority of people who have fed into those consultations do wish to see legislation. I think that it is now time that we see legislation to ensure that services are put on that statutory level and that we also see consistency throughout Wales.
Ac rydych chi'n hollol iawn bod y farn honno wedi dod yn ôl ac rydym ni wedi ei chlywed hi fel Aelodau gan y rheini sydd ag aelodau o'u teuluoedd ag awtistiaeth ac ati. Ond mae llawer sy'n gweithio yn y maes yn credu, o bosib, nad oes angen mynd i lawr llwybr deddfwriaeth. O ystyried mai nod canolog, am wn i, eich Bil chi ydy cael strategaeth a'r angen am strategaeth ar seiliau cyfreithiol, rydych chi wedi bod yn feirniadol eich hun o strategaethau. Pam ddylai hwn fod mor wahanol os mai creu strategaeth arall ydy'r nod, mewn difri?
You're entirely right that that view has been expressed, and we've heard it as Members from those who have family members who do have ASD. But many of the people working in this area believe that you don't need to go down the statutory route. Now, given that the central aim of your Bill is to have a strategy in place and putting that strategy on a legal basis, you have been critical yourself of strategies in the past. So, why should this be so very different if you're just creating another strategy, essentially?
Wel, achos mae'n amlwg nad yw'r strategaethau ddim wedi gweithio oherwydd nad ydym ni wedi gweld gwelliannau sylweddol, fel y dylem ni fod wedi eu gweld, dros y 10 mlynedd diwethaf. Rydw i yn derbyn, wrth gwrs, ein bod ni wedi gweld rhai gwelliannau. Rydym ni wedi gweld y Llywodraeth yn ddiweddar yn cyflwyno rhai mesurau dros y flwyddyn i ddwy flynedd diwethaf sydd wedi gwneud gwahaniaeth, ond nid wyf i'n credu bod y gwelliannau wedi mynd yn ddigon pell a dyna pam mae yn awr yn bryd gweld y ddeddfwriaeth i sicrhau bod gwasanaethau yn cael eu rhoi ar lefel statudol yn y dyfodol. Wrth gwrs, os pasiwn ni'r ddeddfwriaeth hon, bydd yn sicrhau bod rhaid i Lywodraethau yn y dyfodol sicrhau bod gwasanaethau ar gael i bobl ar draws Cymru a'n bod ni'n gweld diwedd yr anghysondeb yma.
Well, it's because it's obvious that those strategies haven't worked, because we still haven't seen substantial improvements, as we should have done, over the past 10 years. Now, I do accept, of course, that we have seen some improvements. We've seen the Government recently introducing some measures over the past couple of years that have made a difference. However, I don't believe that those improvements have gone far enough and that is why it is now time that we see legislation in order to ensure that services are put on that statutory footing in future. Of course, if we do pass this legislation, it will ensure that Governments in the future will have to ensure that services are available for people throughout Wales and so then we will see the end of this inconsistency.
Ond mae'r comisiynydd plant, er enghraifft, yn poeni—. Rydych chi, drwy'r ddeddfwriaeth yma, gobeithio, yn mynd i ddarparu gwasanaethau sy'n gyson a pharhaus. Dyna ydy eich nod chi. Ond, mae'r comisiynydd yn dadlau na all y gofynion yn y Bil arwain at ddim mwy na fod y ddarpariaeth bresennol ar gael—hynny ydy, nad ydy o yn sicrhau hygyrchedd i bawb at wasanaethau.
But the children's commissioner, for example, is concerned—. Through this legislation you hope to provide services that are consistent and continued, and that's your aim. But the commissioner argues that the Bill's requirements couldn't lead to anything more than the current provision being available—namely that it doesn't secure accessibility for all to services.
Ond beth fydd y Bil hwn yn ei wneud, wrth gwrs, yw sicrhau bod rhaid i awdurdodau lleol a bod rhaid i fyrddau iechyd lleol ddarparu gwasanaethau i bobl sydd ag awtistiaeth, oherwydd nad yw'r strategaethau sydd gyda ni ar hyn o bryd yn gwneud hynny. Nid wyf i'n credu y bydd y cod mae'r Llywodraeth yn edrych i'w gyflwyno dros y misoedd nesaf yn gwneud hynny chwaith, o beth rydw i wedi ei weld a'r trafodaethau rydw i wedi eu cael â'r Ysgrifennydd Cabinet.
But what this Bill will do, of course, is ensure that local authorities and health boards will have to provide services for autistic people, because the strategies that we currently have in place are not doing that, and I don't believe that the code that the Government is seeking to introduce over the coming months will do that either, from what I've seen and from the discussions that I've had with the Cabinet Secretary.
Ond nid ydych chi'n nodi beth ydy'r gwasanaeth a ddylai gael ei ddarparu. Nid ydych chi'n nodi hynny, mewn ffordd, yn y Bil. Os nad ydych chi'n nodi beth ddylai gael ei ddarparu, sut ydych chi yn gallu sicrhau bod gwasanaethau'n cael eu darparu'n gyson? Sut mae mesur?
But you don't note what service should be provided. That isn't included in the Bill. If you don't do that, then how can you ensure that services are provided consistently? How can you measure that?
Wrth gwrs, wrth basio deddfwriaeth bydd rhaid i awdurdodau lleol a byrddau iechyd ddarparu'r gwasanaethau yma, a hefyd, os ŷm ni yn pasio deddfwriaeth, mae pobl yn glir wedyn ac yn deall bod rhaid i'r awdurdodau hyn ddarparu'r gwasanaethau yma yn y lle cyntaf. Os nad ydyn nhw, wrth gwrs, byddan nhw'n gallu mynd i lys barn i herio hynny.
Of course, by passing legislation, local authorities and health boards will have to provide the services, and if we do pass legislation then people will be clear and will understand that these authorities will have to provide the services in the first place. If they don't then do that, they will be able to take it to the courts and challenge it.
A bydd gwendidau yn cael eu hadnabod yn y broses o adnewyddu bob tair blynedd. Ocê, diolch yn fawr iawn.
And weaknesses will be identified in the renewal process on a three-year basis. Thank you very much.
Ar gefn hynny, a allaf i jest ofyn o'r gadair? Un o'r problemau fel meddyg teulu, nawr—a dyna pam rwyf i'n cefnogi Bil awtistiaeth—ydy, wrth gwrs, rydym ni'n gwneud y diagnosis o awtistiaeth yn y gwasanaeth iechyd ond mae'r driniaeth yn aml o dan adain llywodraeth leol, megis ym myd addysg neu wasanaethau cymdeithasol. Ar hyn o bryd, nid oes yna ddim grym gan y meddyg teulu i arallgyfeirio pobl a mynnu gwasanaeth o dan yr adain llywodraeth leol. Rwyf i'n gallu arallgyfeirio pobl i'r ysbyty neu i weld arbenigwr neu i weld seicolegydd ac ati yn y gwasanaeth iechyd, ond ni allaf i ddim mynnu bod yna wasanaeth yn digwydd o dan adain llywodraeth leol. A wyt ti'n rhagweld y byddai hynny'n gallu newid o dan dy ddeddfwriaeth di?
Just following that, may I ask from the chair? One of the problems that I have as a GP—and that is why I support an autism Bill—is that we make the diagnosis of autism in the health service, but often the treatment comes under the aegis of local authorities, such as through social services or education. The GP currently doesn't have the power to say that people have to have the service from local authorities. I can refer them to the hospital to see a consultant or a psychologist and so forth in the health service, but I cannot insist that a service is provided by the local authority. Do you foresee that that could change under this legislation?
Liciwn i feddwl y byddai hynny yn newid oherwydd y byddai'r Bil yn sicrhau bod awdurdodau lleol a byrddau iechyd yn gorfod darparu'r gwasanaethau yma.
I would like to think that that would change because the Bill would ensure that local authorities and health boards would have to provide these services.
Ocê. Grêt. Symud ymlaen i'r gyfres nesaf. Angela sy'n mynd i ofyn y cwestiynau yma.
Okay. Great. Well, we'll move on to the next series of questions from Angela.
Good morning, Paul. Thanks very much for bringing all of this forward to us. I would like to just, if you like, challenge you on behalf of the Welsh Government, who obviously feel that actually there is no need for this Bill at present, and that it's a very costly way of providing a level of services to a group of people who should be able to access these services throughout Wales right now and have the same equity of access to services as anybody else in Wales to any other service. So could you first of all just deal with that viewpoint of theirs?
Well, I think the difference that this Bill will actually make, obviously, as I've just been saying, is that it will ensure that services are put on a statutory footing. But my Bill, compared to the strategies we've seen, and probably the code that the Government is looking to introduce, will make some significant differences. For example, waiting times for diagnostic assessments are still unacceptably long, and in some parts of Wales they far exceed even the Welsh Government's waiting times standard of half a year from referral to first diagnostic assessment. In one area, people have to wait two years, and in my own area people have had to wait up to seven years before their children have had a diagnostic assessment. Now, this Bill would actually introduce a three-month waiting time. This Bill also provides that needs assessments following diagnosis should be undertaken within 42 working days of a diagnosis or any post-diagnostic meeting. So, this Bill would actually go further. Yes, I've made it absolutely clear in the explanatory memorandum and in the regulatory impact assessments that there will be a cost of just over £7 million over a period of five years, but I believe that my Bill will have huge long-term savings because, by identifying people with autism early, it will ensure that we reduce costs on reactive services.
Do you not think, though, that things like the Social Services and Well-Being (Wales) Act 2014, or the national integrated autism service, and the new additional learning needs Bill that's come into play, or is coming into play—do you not think that all of these initiatives that have been put in place by the Government will be able to achieve what you're setting out to achieve in this Bill, but without the need for legislation?
I've already said, of course, that the Government has introduced measures that have resulted in some improvements. You mentioned the social services and well-being Act and the Additional Learning Needs and Education Tribunal (Wales) Act 2018. Now, both Acts are in their own ways more limited in scope than my actual Bill. Firstly, these two Acts are concerned primarily with social services and education respectively. My Bill is much broader than that. For example, my Bill places duties on NHS bodies, and it's interesting to note as well that the Welsh Government is intending to use the powers in the National Health Service Act 2006 to actually issue a code of practice with respect to NHS bodies, not the social services and well-being Act.
The data collection provisions in the social services and well-being Act are much more limited than in my Bill. For example, the social services and well-being Act requires regional partnerships to undertake population assessments and identify services to meet their needs. The assessments carried out so far illustrate the lack of available data on autism. My Bill requires the collection of data on numbers and on also on diagnosis and the needs of people with autism.
Now, the additional learning needs in section 2 of the additional learning needs and education tribunal Act are narrowly defined, and as such risk excluding people with autism who may be relatively high functioning educationally but require other support and services that will not be captured by the Act. The additional learning needs and education tribunal Act only captures young people up to the age of 25, whereas my Bill is actually focused on both children and adults with autism. And, let's face it, autism, of course, is a lifelong condition, and therefore if we just rely on that particular Act, what support will be available for people over the age of 25? That's why it's important, therefore, that my Bill is passed.
Now, the generic additional learning needs and education tribunal Act and the social services and well-being Act do not actually address all the needs of people with autism. Supplementary legislation is sometimes needed to fill these gaps, and setting out in law that there needs to be a clear pathway for people with autism to access support, and making it clear that adults with autism can't be denied access to services based on their IQ, would actually help to ensure that their specific needs are met as well. But I've been clear from the outset that my Bill doesn't substitute or replace any provisions in these particular Acts. My Bill will actually supplement and complement these two Acts as well.
I totally take on board your point about the fact that there's been a major problem. Like yourself, in my area—we both hail from the Pembrokeshire area and we've both had constituents who've waited six, seven years for a diagnosis, and we know that your life chances diminish if you don't get the help as early as you can. But to be fair to the Government, they do say that they have put in place an awful lot of these measures, and that what they need is the time for them to bed in. It's the old story—Rome wasn't built in a day. Do you really believe that the measures that Welsh Government have put into place and their strategic plans, and all the rest of it, and these various Acts that do take time to get traction and to start biting—that if you bring alongside, then, separate legislation, that that will be able to be more effective more quickly, and to deliver those changes that we all need in the provision of autism services throughout the whole of Wales?
My Bill will obviously complement these two Acts. It's not there to compete with these two Acts; the Bill is there to support these two Acts as well. But as I've just mentioned, I've given you a comprehensive list there, I think, of how the two Acts won't actually meet the needs of people with autism. And that's why it's important, therefore, that we see legislation pass to make sure that these services are available, because we are seeing gaps across Wales, and my Bill, hopefully, will make sure that there is consistency of services across Wales in the future.
Okay. Thank you.
Diolch, Angela. Symudwn ymlaen. Mae'r cwestiynau nesaf o dan ofal Jayne Bryant.
Thank you, Angela. We'll move on. The next questions are from Jayne Bryant.
Thank you, Chair, and good morning. We see that the Welsh Government intends to publish their code of practice, and you've already touched this morning on the fact that you don't believe that the code of practice will be sufficient. Perhaps you could outline your main concerns on that.
First of all, of course, a code can be easily revoked; it's not necessarily there on a long-term basis. The difference between a code and legislation, I think, is absolutely clear. Obviously, once legislation is passed, it's much more difficult for a future Government to change that; they would have to pass further legislation to make this particular legislation defunct. So, a code can be easily revoked.
Now, I was given early sight of the Welsh Government proposals for this code, but I didn't believe that this would actually achieve the objectives I actually set for my Bill. For example, there was no commitment to a shorter waiting time target for assessment, or to improved data collection on autism. So, there are major differences there, I think, between my Bill and the code that perhaps the Government is looking to introduce. But, of course, we don't know what the content of that code is yet; I understand that the Cabinet Secretary for Health and Social Services will be making a statement next week on this issue, so we will have to wait and see. But from the original proposals that I actually saw from the Government, I believe my Bill will be much stronger than the Government's code.
Do you believe that, if the issues could be resolved, there would still be a need for legislation?
Because of the two points I made earlier, the code originally didn't actually include a shorter waiting time target for assessment or to improve data collection on autism. Obviously, if they looked to include those sorts of measures in the code then, yes, I would look at that. However, as I mentioned to you, the code can be easily revoked, in my view, in the future, by future Governments. So, I think passing legislation is probably much stronger than introducing a code. And don't forget, also, my understanding is that, in the code, I think the Government is not going to oblige local health boards to deliver services; my legislation will.
Okay. Thank you. We've had, or there's been, evidence, including from the National Autistic Society and NAS Northern Ireland, that similar legislation in other nations has been largely ineffective. Research carried out by NAS Northern Ireland suggested that far more people feel that services have got worse for autistic children and adults than feel they have got better. So, they've come up with evidence that it hasn't led to better access to services in the majority of cases. How would you respond to that?
I disagree with the view that other legislation in the UK hasn't actually made a difference. For instance, the Royal College of Psychiatrists commented in a consultation on my Bill that one of the benefits they were seeing of the legislation in England, for example, was that statutory bodies were under pressure to take action, even when budgets were actually tight. And, likewise, the National Autistic Society has also commented that the legislation in England has made a massive difference to how autism is thought about locally and nationally. In England, there were previously instances where people were refused diagnosis purely on the basis that they were over 18; legislation in England has actually stopped that from happening. And, most notably, as a result of the England Act, nearly every local area in England now has a diagnostic pathway in place. Before the legislation was in place, only 48 per cent had a specialist diagnostic service, and, likewise, 93 per cent of local areas now have an autism lead, compared to only 39 per cent before the Act. So, to suggest that perhaps legislation in other parts of the UK hasn't worked, I don't think that is the case.
Of course, it's not perfect, but the legislation that I am proposing here is actually different to the legislation that has been passed in England, and indeed in Northern Ireland. The difference, I think, in my Bill compared to the England Act is that the England Act was concerned only with adults who have autism; my Bill is quite clear that, obviously, it includes children and adults, and my Bill sets out the key issues that a strategy must address, and that is not the case in Northern Ireland and in England. So, there are significant differences between my proposed Bill and legislation in other parts of the United Kingdom. But to suggest that the legislation hasn't actually had any effect at all in other parts of the United Kingdom is not right.
Okay. Before we move on, Dawn, you've got a supplementary.
Yes. It was on that point. Good morning, Paul; sorry I was late coming in. But it's on that particular point about the comparisons with legislation in other countries, and you said that it has had a significant impact.
Well, I said it has had an impact.
An impact—okay. The evidence that we've received seemed to be saying—the written evidence that we had—that it's been successful in terms of getting autism up the agenda, but when people were questioned, at least 70 per cent said they're still not getting the services that they need. And they said that, nearly a decade on, the needs of autistic people are still unmet, and the expected economic dividend has never materialised. So, how is it going to be so materially different here than it has been in England, 10 years on from the introduction of the legislation in England?
Because my proposed legislation, of course, is different—
It's slightly different—I understand that. It includes children as well. I understand that.
It does. And it is certainly different to the legislation that's actually been passed in other parts of the United Kingdom. And I think what my Bill will actually do, it's not just about passing legislation for the sake of it—I genuinely believe that passing this legislation will ensure that services are put on a statutory footing, because I think that's absolutely crucial, as I said from the outset of this meeting. Unfortunately, we're still talking about the same issues 10 years later, after a strategy was first introduced. So, clearly, strategies aren't working, and that's why it is important now that we see legislation being passed. And I think it's absolutely crucial. And, as you know, Dawn, from the consultations that I have run, the majority of people who have fed into those consultation processes also believe that legislation is the right way forward.
Okay, back to Jayne.
There's also been some concern that the Bill's focus on diagnosis is at odds with the recent positive trends to move away from tight diagnostic groupings, and moving away from a holistic needs-based approach. Do you think that it could be seen as a backward step to focus so narrowly on ASD diagnosis?
I don't think my Bill is just about diagnosis. Yes, it does include the provision to ensure that there's a clear pathway to diagnosis, but my Bill, I think, is much more holistic than that, because if you look at my Bill in the round it includes ensuring that there's a comprehensive strategy delivered by the Government, and it ensures that we collect the right information so that local health authorities and local health boards and local authorities can actually plan their services ahead in the future. It also includes making sure that there is the right and appropriate training for staff and professionals who deal with people with autism, and also it includes making sure that there is an ongoing awareness campaign by the Government as well.
So, I don't accept that it's just about diagnosis. Yes, diagnosis is important and, no doubt, a lot of constituents have contacted all of us because they have failed to get a proper diagnosis. I accept that it is important that we ensure that sufficient resources are invested in diagnostic services, but my Bill isn't just about diagnosis; it is about lots of other things as well, which I've just outlined to you.
Lynne, on this point.
Yes, I think that the diagnosis issue is very important, and you'll be aware, Paul, that one of the reasons there have been such huge problems in child and adolescent mental health services generally is because families are desperate to get a diagnosis, because they believe that that diagnosis will unlock services. So, have you got any concerns that an unintended consequence of this Bill might be that other children, who maybe wouldn't eventually get an autistic diagnosis, may lose out on services because of a refocusing? The Royal College of Paediatrics and Child Health, who, as you know, are very well respected, have highlighted the fact that they don't think the Bill is a child-centred Bill because they think the legislation should be focused on needs rather than on a diagnosis.
I've made it clear, obviously, in my explanatory memorandum and in the regulatory impact assessment that, of course, an additional £7.3 million would be needed, obviously, if this legislation is passed. The majority of that money would be allocated to local heath boards to deal with, obviously, the diagnostic target, because the diagnostic target would reduce from 26 weeks to 13 weeks. So, I accept that, and I think I've covered that in the explanatory memorandum. That's why I think it is important that those resources then are used in order to ensure that people get the appropriate and timely diagnosis.
But do you accept that some people may receive a less good service then by focusing on a particular group of people, rather than other young people who have got a more general neurodevelopmental disorder?
No, I don't see that that would be an unintended consequence of this Bill at all. I think this Bill is absolutely clear. The reason that I'm introducing this Bill is not just about diagnosis—there are other issues, as I've just mentioned—but, yes, diagnosis is an important part of this Bill. I don't see why other people would be disadvantaged because of this piece of legislation. What this piece of legislation is trying to do is to make sure that everybody actually gets a timely diagnosis.
Happy with that? I think that about covers the rest of your questions as well, Jayne. So, moving on, Julie has got the next block of questions.
Yes, this is about diagnosis as well, so it's just continuing the diagnosis theme. Lynne has spoken about how other children or people would be affected by the concentration. Do you think that the quality of the assessments being provided could be affected with the 13-week target?
No, I don't think so. Obviously, the reason why I've made it clear that it should be a 13-week target, first of all, is because those are the National Institute for Health and Care Excellence guidelines. I don't understand why the Welsh Government aren't adopting this target either. I don't know why the Welsh Government has adopted the target of 26 weeks. I don't know where they've got that figure from, because the NICE guidelines are absolutely clear on that. Of course, the Welsh Government do actually adopt other NICE guidelines when it comes to multidisciplinary issues, for example, so I don't understand why the Welsh Government aren't actually adopting the 13-week target. But, I don't accept that there would be issues around reducing this target, because as I said to Lynne, obviously, my explanatory memorandum and the regulatory impact assessment make it absolutely clear that the majority of the resources that I've mentioned in this Bill would actually be targeted towards diagnostic assessments and making sure that people get their diagnostic assessments within the 13-week target.
So, you don't think that the Bill could take away the focus from service provision to concentrate on meeting those diagnostic targets.
No, I don't accept that. I don't see any reason why that should happen at all.
Right. And of course there would be a capacity issue in terms of meeting those targets.
Well, no doubt there are ongoing capacity issues within the current system, and of course I accept that the Welsh Government have been trying to address some of these issues over the last few years. Those issues would be ongoing, of course, but that's why I've made it clear that extra resources would be required in order to meet that particular capacity.
Would you agree that, in terms of diagnosis, it's the post-diagnosis work that is very important as well?
Yes, absolutely. That already happens of course, because with the new integrated autism service, for example, those are there already. But what my Bill is trying to do is to make sure that there are clear pathways as far as diagnosis is concerned and as far as post-diagnosis services are concerned as well.
Grêt. Ar gefn hynny, Paul, a allaf i ofyn o'r Gadair? O gymryd y bydd y Bil yma'n dod yn gyfraith nawr—rydym ni'n derbyn hynny yn y lle cyntaf—fe fyddech chi'n disgwyl gweld felly, gan fod yna gyfraith gwlad yn dweud bod angen cael diagnosis o fewn hyn a hyn o wythnosau, fod hynny'n mynd i fod yn hwb i gynyddu nifer y staff angenrheidiol dros y lle i gyd i wireddu'r weledigaeth yna, a hefyd i ddarparu gwell gwasanaeth, gwell hyfforddiant a phob peth. Rŷch chi'n gallu gweld eich Mesur chi fel hwb i ddatblygiad capasiti y staff yn gyfan gwbl, i ddelio â nid jest problemau awtistiaeth, wrth gwrs, gan y bydd yr un un staff yn gallu delio â phroblemau yn y maes niwrolegol hefyd. A fyddech chi'n cytuno efo'r math yna o osodiad?
Great. Following that, Paul, if I may just ask a question from the Chair. Taking that this Bill will be enacted—we accept that in the first place—you would expect to see that as the law says that a diagnosis must be made within so many weeks, that that would then be a boost in terms of increasing the number of key staff throughout to achieve that vision, and also to provide a better service, better training and so forth. You see what you are proposing being a boost to the development of staff capacity throughout, not just in terms of dealing with problems in relation to autism, because of course the same staff could deal with other problems in the field of neurology. Would you agree with that sort of statement?
Fe fyddwn i'n cytuno'n llwyr â'r dadansoddiad yna. Wrth gwrs, ie, byddai'n rhaid inni wario'r dros £7 miliwn rwyf wedi sôn amdano yn y ddeddfwriaeth, ond wrth gwrs byddai arbedion mawr rwy'n credu yn y cyfnod hir os byddwn ni'n sicrhau bod y ddeddfwriaeth yma'n cael ei phasio.
I would agree entirely with that analysis. Of course, yes, we would have to spend the £7 million that I have mentioned in the legislation, but of course there would be major savings in the long term if we were to ensure that this legislation were passed.
Diolch am hynny. Fe wnawn ni symud ymlaen. Mae'r cwestiynau nesaf o dan ofal Lynne Neagle.
Thank you for that. We'll move on to the next questions from Lynne Neagle.
My questions are on workforce really. You'll be aware that the royal colleges have expressed concern about workforce capacity to deal with this legislation, and also they feel that the Bill could actually increase pressures, and as you know the workforce across the NHS is very stretched. How do you respond to that?
Well of course there are continuous workforce issues, even under the current system, and I accept that there are continuous pressures—of course there are—but at the end of the day, it will be up to local health boards and local authorities to actually plan. If my Bill is passed, of course, the Government will have up to nine months to actually publish a strategy. So, I'd like to think that, in those nine months, there will be sufficient time to cover some of these issues and to plan the workforce accordingly.
So, do you think it would have been a good idea for your Bill to include provision for workforce planning on the face of the Bill?
I think it'd probably be difficult to include workforce planning in the Bill, because I'm not quite sure how specific we could actually be in the Bill itself. But, again, I'm open to that. If, obviously, this Bill proceeds to Stage 2, then I'm more than happy to look at it, and, if there are any consultation responses that suggest that perhaps we should be looking at that, then I'm more than happy to do that.
Wrth gwrs, mae yna dyndra yn fan hyn, onid oes, rhwng y dystiolaeth rydym ni wedi'i chael oddi wrth bobl—ac rydym ni i gyd wedi cael teuluoedd yn dod atom ni ac yn dweud mai'r peth pwysig iddyn nhw ydy cael y diagnosis. Nid ydyn nhw eisiau aros am flynyddoedd—fel rydym ni wedi ei glywed—am y diagnosis. Ac rydym ni'n clywed o'r gwasanaeth, y gwahanol wasanaethau, fel yr oedd Lynne yn ei awgrymu fanna, nad yw'r capasiti yno i ddelifro ar unrhyw fath o addewid fel yna. Wedyn mae'r un dyndra yna yn mynd i ddod drwy'r holl gwestiynu, rydw i'n credu.
Wedyn, ar ddiwedd y dydd, mae'n rhaid cael rhyw fesur sy'n gallu ateb pryderon y ddwy ochr. Rydych chi'n dod o'r ochr bod angen i'r claf, y teuluoedd, fod yn bwysig—dyna sy'n gyrru eich Mesur chi, yn y bôn, a gyriant hwnnw ydy'r busnes diagnosis yma. Achos rydym ni'n cael hynny hefyd yn y gwasanaeth, heb ddiagnosis—nid ydym ni'n gallu cyfeirio pobl i nunlle os nad oes yna ryw fath o label gennych chi. Mae'n ddigon hawdd i rai pobl yn y gwasanaeth ddweud, 'Mi wnawn ni ymateb i angen heb y diagnosis', ond y gwirionedd ydy nad ydyn nhw yn ei wneud; mae'n rhaid cael y diagnosis. Wedyn mae yna ryw ffordd y dylem ni fod yn gallu cysoni'r ddwy ddadl yna—nid i'w dadwneud nhw, ond jest hyrwyddo pwysigrwydd diagnosis yn y lle cyntaf, fel y cawsom ni gwestiynau, wrth gwrs, gan Angela gynnau, jest i gael rhyw fesur o gydbwysedd rhwng y pryderon y mae Lynne, yn naturiol, yn eu gwyntyllu, achos rydym ni eisiau Mesur fydd yn llwyddiant ar ddiwedd y dydd, buaswn i'n gobeithio.
Nid ydw i'n siŵr iawn os oedd yna ateb i hynny, ond rydw i'n gweld dy fod ti'n cytuno, ta beth.
Of course, there is a tension here, isn't there, between the evidence that we've received from people—and we've all had families coming to us and saying that the important thing for them is to get the diagnosis. They don't want to wait for years—as we've heard can happen—for a diagnosis. And we hear from the service, from the various services, as Lynne suggested there, that the capacity is not in place to deliver on any such change. So, that tension is going to exist throughout all the questioning.
And, at the end of the day, we need to have a measure that can respond to the concerns of both sides. So, you're coming from the perspective that we need to put the needs of the patient and families first—that's important, that's what's driving your legislation, and the drive for that is diagnosis. We also have that in the service, because, without a diagnosis—we can't refer anyone anywhere if you don't have any kind of label. It's easy enough for some people in the service to say, 'Well, we will respond to need without the diagnosis', but the truth is they don't; we must have a diagnosis. So, there must be some means of reconciling both arguments—not to undermine them, but just to emphasise the importance of diagnosis in the first place, as we had in the questions from Angela, to strike a balance between these concerns that Lynne, naturally, is referring to, because we want a Bill that'll be a success at the end of the day, don't we?
I don't know if there's a response to that, but I see you agree in any case.
Rydw i'n cytuno'n llwyr â hynny, ydw.
I agree entirely with that, yes.
Reit—. O, Angela.
Yes. I just wanted to follow up on that, because we're talking an awful lot about diagnosis, and all I can go on is what I see in my constituency and people who come to me. And I think that—you know, I have a lot of people who come and visit me because they have an issue with something in the NHS, but it's not consistent, so it's not like everybody turns up to talk about a particular thing, like, I don't know, rheumatology services or whatever; it's spread around. Whereas there is a significant body of people who come to me about the fact that they can't get the right help for a child who's on the autistic spectrum.
And I've then seen the impact of trying, as an Assembly Member, to get the services for them in school, to get all those support services, because it's their only chance of actually trying to make the best of what life has given them and to make them—. I've been involved in numerous battles when it comes to the transition between children's services and adult services.
So, I wondered what work you've done or if you have any information on top of what you've already shared in terms of the consultation responses about the impact this Bill could have on the longer life. Because we're talking about that it's all about getting the diagnosis and moving forward, but I'd love to know what you think would be the benefit, long term, (a) to the individual, because they wouldn't have to perhaps fight so hard through the system, (b) to their families, because what I've seen is the destruction of families and it's been horrific and I've seen social services departments pitted against families and fighting for the services and the family saying, 'No, this child needs to go here, because of A, B and C, because this way he's going to be able to be a little bit more independent', and they're going, 'Well, no, actually, because we want to go there', and it's a very destructive scenario.
And I wondered what evidence you've got about how, if we can get it right at the beginning and smooth out that path—what the economic, social and personal benefits are to all the individuals concerned in this particular issue.
I think there have been successive reports in the past that actually show that, if we can provide those services early on, if we can identify people with autism early on, there are significant—huge—benefits, not just financial but, of course, societal as well. So, yes, I agree that that is absolutely important. That's what this Bill is trying to do, to make sure that those services are actually available to people with autism.
But I think you're also right that it is important that people know what services are available to them as well. In my Bill, it's quite clear that I've said that bodies—statutory bodies—need to make sure that they provide the right information to people with autism as well. So, that's quite clear in the Bill.
Also in the Bill is the fact that the Welsh Government should actually run an ongoing awareness campaign, which would help with issues such as employment, for example, and that's why I think it's absolutely crucial that we see this ongoing awareness campaign, which we haven't seen before, and that's why I've included that in the Bill as well.
Mae'r cwestiynau olaf—yr adran olaf—o dan law Dawn Bowden.
The final block of questions will come from Dawn Bowden.
Diolch, Cadeirydd. Paul, I want to just talk a little bit about the financial implications—you were talking about that, actually, when I came in. I don't think any of us here disagree with what you're intending to do—the proposals here and what you're hoping to achieve. But there are financial implications that go along with this; that goes without saying. Are you confident that, given all of the things we've talked about, the Bill will represent value for money, in the sense of will it actually be able to achieve what you're setting out to achieve within the kind of financial envelope that you're suggesting? Because the professional bodies seem to be saying that you've significantly underestimated how much this might cost. So, my concern and my question to you, I guess, is: are we in danger of raising the expectations of families and then finding that the cost implications are greater than we'd anticipated and we're not going to achieve the stated objectives?
First of all, the Bill is intended to provide better diagnosis, targeted and more consistent services leading to better outcomes, and will, therefore, provide value for money, in my view, on the basis of an improved system for individuals with autism—that's the purpose of the legislation in the first place.
I accept that—. Whilst no savings are quantified in my regulatory impact assessment, there is reference to National Audit Office work that actually suggests that substantial savings could be achieved with modest increases in the identification rates, for example. However, without accurate information on the costs of autism in Wales, it's not appropriate to actually make an estimate of those costs. The reason we don't have that information is because, obviously, we have asked the Welsh Government for information, but they have been minded not to give us that information, unfortunately. So, it's very difficult, therefore, for me and for my team to actually predict the costs. However, there have been successive reports in the past that actually suggest that, if we identify people with autism very early on, there will be huge savings in the future.
So, in your discussions with officials—Welsh Government—on the development of this Bill, have you been given any indication as to where the £7.5 million, or whatever the eventual costs, will be coming from? Is it expected that it's going to be within the current financial envelope, or is this going to have to be new money?
I would suspect that it could come from the current envelope. Let's be clear: £7.5 million, in the big scheme of things, compared to a Welsh Government budget of around £15 billion, is quite a drop in the ocean. I'm only talking about £7.5 million over a period of five years, but I think that £7.5 million could actually make a huge difference to people's lives.
I'm not arguing with that point. I just think you need to be clear: are we talking about new money, or are we talking about the existing financial envelope? Because, if it is the existing financial envelope, then that is likely to put considerable additional pressures on LHBs. Do you not think that there is a danger, then, that LHBs will start to divert financial resources from other services to meet the legal requirements?
Of course, it would be up to the Government to locate this money. They have found additional money for autism services over the last 12 to 18 months as well, as we know. However, the point I'm making is: this £7.5 million, in the big scheme of things, is a drop in the ocean compared to the huge difference that it could actually make to people's lives.
Yes. But the point I'm making and the question I'm asking you is: is there a danger, if we're working in the current financial envelope, that it will put additional pressures on LHBs, which may force them to divert financial resources from existing services to meet what will then become a legal requirement? The adjunct to that is, once you make something a legal requirement, you give somebody the legal right to take actions, and so health boards could end up spending money defending legal actions. Have all these implications been thought through?
Sure, but I have to come back to the point again, Dawn, that £7.5 million, in the big scheme of things, is a drop in the ocean. And, of course, as you know, I think I'm right in saying that local health boards receive around £6.5 billion of Government money. So, what I'm talking about is a drop in the ocean when it comes to their overall budgets, and I think that passing this legislation will make a huge difference.
I'm not going to get an answer to that question, so I'll move on. Okay, so the final question, really, is whether you are confident that the resources are in place to deliver the improved access to services. I think it's one thing—. We've talked about workforce, but this is wider than just workforce; we're talking about the whole resource planning. Are you confident that the system is set up and geared up to deliver what you're asking for?
Well, I'm not confident that the current system could be a resource in the future. I'm not confident that a future Cabinet Secretary or Welsh Government will actually provide resources to deliver continued access to services under the current system, and I think my Bill will actually provide legal requirements and hence greater protection if a future Cabinet Secretary or Welsh Government were to seek to reduce resources in this area. In other words, my Bill will provide that protection for people with autism.
So, do you not have any concerns—? I come back to the point I was making previously, then. Do you not have any concerns that, once you introduce a legal requirement on one particular condition, that will force health boards to divert resources to that, as opposed to those services that do not have statutory requirements behind them?
I wouldn't expect local health boards to divert resources from one condition to another. This Bill isn't about disadvantaging—
No, I understand. This is about unintended consequences.
This Bill, in my view, is not there to disadvantage people with other conditions. This Bill is there to ensure that proper services are available for people with autism.
I totally understand the intention of the Bill. I think what I'm trying to explore, Paul, is the potential unintended consequences. That's all. Thank you.
A allaf i jest gofyn o'r gadair—? Wrth gwrs, mi fydd yna ddisgwyl y bydd cynnydd yn nifer y staff i ddelifro gwasanaeth i bobl efo awtistiaeth. Wrth gwrs, mi fyddech chi hefyd yn gallu dadlau, wrth wella gwasanaethau ar gyfer pobl ifanc neu oedolion efo awtistiaeth, efo cynyddu'r nifer o staff arbenigol, wrth gwrs, mi fyddai'r staff arbenigol yna hefyd yn gallu gweithio efo pobl efo cyflyrau niwrolegol eraill hefyd. Felly, mae yna fodd i ddadlau eich bod chi'n gobeithio sbarduno gwelliant a hybu nifer uwch o weithwyr yn y maes, felly, fydd o gymorth i bobl efo cyflyrau niwrolegol eraill, hefyd.
May I just ask from the chair—? Of course, there will be an expectation of an increase in the number of staff to deliver a service for people with autism. Now, of course, you could also argue that, in improving services for young people or adults with autism by increasing the number of specialist staff, well, of course, those specialist staff would also be able to work with people with other neurological conditions. So, it could be argued that you hope to drive improvement and increase the number of staff working in this area, and that would then assist people with other neurological conditions.
Yn bendant, rydw i'n credu y byddwn ni'n gweld y manteision hynny os bydd y Bil yma yn cael ei basio, oherwydd, wrth gwrs, fel rŷch chi'n ei ddweud, Cadeirydd, byddai fe'n sicrhau bod staff yn gallu cynnig gwasanaethau eraill ym meysydd eraill.
Most certainly, yes, I do believe that we would see those benefits if this Bill were to be passed, because, of course, as you say, Chair, it would ensure that staff could provide other services in other areas too.
Diolch yn fawr. Rydw i'n credu ein bod ni wedi dod i ddiwedd y cwestiynu, os nad oes rhywbeth arall yn—. Nac oes. Diolch yn fawr, a diolch yn fawr iawn i Paul Davies, Aelod Cynulliad a'r Aelod sy'n gyfrifol am y Bil awtistiaeth. Hefyd, diolch yn fawr iawn i Stephen Boyce ac Enrico Carpanini am eu presenoldeb y bore yma a hefyd am ateb y cwestiynau mewn ffordd mor aeddfed a manwl. Diolch yn fawr iawn i chi.
Thank you very much. I think that we have come to the end of our questions, unless anyone has anything else to raise. No. Very well, thank you very much. I'd like to thank Paul Davies, Assembly Member and the Member in charge of the autism Bill. I also thank Stephen Boyce and Enrico Carpanini for joining us this morning and also for answering the questions in such a mature and detailed manner. Thank you very much.
Symudwn ymlaen at eitem 3 a phapurau i'w nodi. I fy nghyd-aelodau pwyllgor, fe fyddwch chi wedi nodi eisoes lythyr oddi wrth Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol ynglŷn ag atal hunanladdiad, a llythyr arall oddi wrth Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol ynglŷn â gwasanaethau hunaniaeth rhywedd. Rydych chi hefyd wedi derbyn gwybodaeth ychwanegol yn dilyn y gwaith craffu ar Iechyd Cyhoeddus Cymru ar 5 Gorffennaf. Mae yna hefyd dystiolaeth ysgrifenedig gan Goleg Brenhinol Meddygaeth Frys Cymru, ar gynllunio ar gyfer gaeaf 2018-19. Fe gawn ni drafodaeth hirach am hynny yn y sesiwn breifat nawr ac yn y man.
Mae yna hefyd lythyr oddi wrth Goleg Brenhinol y Meddygon Teulu ynglŷn â gwasanaethau y tu allan i oriau, llythyr oddi wrth Ysgrifennydd y Cabinet—un arall—dros Iechyd a Gwasanaethau Cymdeithasol ar raglen diogelwch cleifion a gwella ansawdd, a hefyd lythyr oddi wrth Samariaid Cymru ar atal hunanladdiad. Pawb yn hapus i'w nodi? Fel rydw i'n dweud, fe wnawn ni godi pwyntiau ynglŷn â chynllunio ar gyfer y gaeaf nawr yn y sesiwn breifat. Pawb yn hapus? Unrhyw sylw? Dyna ni. Diolch yn fawr.
We will move on to item 3, which is papers to note. To my fellow committee members, you will already have noted the letter from the Cabinet Secretary for Health and Social Services on suicide prevention, and another letter from the Cabinet Secretary for Health and Social Services about gender identity services. You will also have received additional information following scrutiny of Public Health Wales on 5 July. There is also written evidence from the Royal College of Emergency Medicine Wales, on winter planning for 2018-19. We will have a longer discussion about that in the private session in a moment.
There is also a letter from the Royal College of General Practitioners about out-of-hours services, a letter from the Cabinet Secretary—yes, another one—for Health and Social Services on the patient safety and quality improvement programme, and also a letter from Samaritans Cymru on suicide prevention. Is everyone content to note those papers? As I said, we'll discuss the points about winter planning in the private session. Is everyone content? Are there any comments? I see there are none. Thank you very much.
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).
that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).
Cynigiwyd y cynnig.
Rŷm ni'n symud ymlaen rŵan i eitem 4 a chynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o weddill y cyfarfod er mwyn trafod y dystiolaeth. A yw pawb yn gytûn? Pawb yn gytûn. Diolch yn fawr.
We'll move on to item 4, which is the motion under Standing Order 17.42 to resolve to exclude the public from the remainder of the meeting in order to discuss the evidence. Is everyone content? Everyone is content. Thank you very much.
Derbyniwyd y cynnig.
Daeth rhan gyhoeddus y cyfarfod i ben am 10:21.
The public part of the meeting ended at 10:21.