Y Pwyllgor Plant, Pobl Ifanc ac Addysg - Y Bumed Senedd

Children, Young People and Education Committee - Fifth Senedd

20/06/2019

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Dawn Bowden AM
Hefin David AM
Janet Finch-Saunders AM
Lynne Neagle AM Cadeirydd y Pwyllgor
Committee Chair
Sian Gwenllian AM
Suzy Davies AM

Y rhai eraill a oedd yn bresennol

Others in Attendance

Joanna Jordan Cyfarwyddwr Iechyd Meddwl, Llywodraethiant a Gwasanaethau Corfforaethol y GIG, Llywodraeth Cymru
Director of Mental Health, NHS Governance and Corporate Services, Welsh Government
Kirsty Williams AM Y Gweinidog Addysg
Minister for Education
Matt Downton Pennaeth Iechyd Meddwl a Grwpiau Agored i Niwed, Llywodraeth Cymru
Head of Mental Health and Vulnerable Groups, Welsh Government
Ruth Conway Dirprwy Gyfarwyddwr yr Is-adran Cymorth i Ddysgwyr, Llywodraeth Cymru
Deputy Director Support for Learners Division, Welsh Government
Steve Davies Cyfarwyddwr y Gyfarwyddiaeth Addysg, Llywodraeth Cymru
Director, Education Directorate, Welsh Government
Vaughan Gething AM Y Gweinidog Iechyd a Gwasanaethau Cymdeithasol
Minister for Health and Social Services

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Gareth Rogers Ail Glerc
Second Clerk
Sarah Bartlett Dirprwy Glerc
Deputy Clerk
Sarah Hatherley Ymchwilydd
Researcher

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

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

Dechreuodd y cyfarfod am 09:17.

The meeting began at 09:17.

1. Cyflwyniad, Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
1. Introductions, Apologies, Substitutions and Declarations of Interest

Good morning, everyone. Welcome to the Children, Young People and Education Committee this morning. We've received no apologies for absence. Are there are any declarations of interest from Members? Maybe I should just declare for the record that I sit on the ministerial task and finish group looking at the whole-school approach.

2. Iechyd Emosiynol ac Iechyd Meddyliol Plant a Phobl Ifanc: Gwaith Dilynol ar yr Adroddiad 'Cadernid Meddwl'—Sesiwn Dystiolaeth 1
2. The Emotional and Mental Health of Children and Young People: Follow-up on the 'Mind over matter' Report—Evidence Session 1

Item 2 this morning, then, is our follow-up scrutiny of the Welsh Government's implementation of our recommendation in the 'Mind over matter' report. Our first session this morning is with Kirsty Williams AM, Minister for Education, who I'm very pleased to welcome this morning. I also welcome Steve Davies, who is deputy director of the education directorate, and Ruth Conway who is deputy director of the support for learners division. Thank you for coming. We're very much looking forward to the session, and we'll go straight into questions from Dawn Bowden.

Thank you. Good morning. Good morning, Minister. Can you start, please, by telling us what steps you're taking to ensure that the work of the ministerial task and finish group is as transparent as possible, please?

Of course. I think what's first of all to say is that the task and finish group itself is only one component of the structures that have been established to assist the Government in taking forward the recommendations of the report. So, we have the task and finish group, which is, in itself, a large group, as we've just heard from the Chair. The Chair is there to ensure that the work is aligned to the recommendations of this committee's report. The group has expanded over time, so where we have felt that, perhaps there are certain sections and stakeholders that have not been represented, they have been invited. But, of course, alongside that, we also have a reference group, which includes over 40 stakeholders, and we also have a youth reference group as well. So, those are young people themselves who have volunteered to come forward to work collectively to ensure that young people's voices are head in this process.

I'd be concerned, Dawn, if there was a suggestion that the work of the group isn't transparent, because that certainly would not be my intention, and I'm sure it's not the intention of Vaughan Gething either. If there are specific organisations that have felt that way, I'd be very pleased to hear from them about what more they think they can do and why they feel they're not being informed of what's happening in that group.

We are looking at developing, on the Welsh Government's website, a dedicated section to be able to aid people in being able to find the notes and the minutes and the action plans—so, a one-stop shop—to see if that will increase transparency. 

09:20

On the website. Because I think that was the—. You just said you'd be disappointed if people were—. Some of the stakeholders have said in particular they found it was difficult in terms of keeping up with the decision making and the priorities and the work of the committees. So, I'm just wondering how all that is disseminated, really.

Sure. To be honest, in some ways, we're quite reliant on the members of the groups themselves. They are there obviously to give their professional view, and to represent the groups and their professional backgrounds. In some ways, we are reliant on them then being able to use their networks to feed back. But, if there is a specific group that has levelled that concern—I'm not sure who they are—we would want to address that. There is nothing to be gained for the Welsh Government from not being transparent in this process, and the fact that we have such a large range of stakeholders I think demonstrates our willingness to be as open as possible; they're certainly not secret meetings. So, we'd want to address that. But if, as I said, collating that information and putting it on a dedicated page so that it's easier for people to access and there's more of a highlight to it—we're actively considering that at the moment.

You'll be aware that the work was kicked off last year with a significant workshop where we had lots and lots of stakeholders together, and it is our intention to re-run that process in September of this year. So, that will mark a year since the first workshop. Again, that's an opportunity to bring all those people who were there at the very beginning, bring them all back together to be able to reflect on what's happened in the first year of work, and then to be able to disseminate information. Lots of the workstreams and individual papers are subject to wide scrutiny and consultation with interested parties. But I'm always very happy to understand who is concerned and how we can address those concerns.

If we've got stakeholders, we can let the Minister know if there are particular stakeholders that are concerned. Can we let the Minister know?

I think perhaps there's just a sense that—. Perhaps the message that is going out from you today is very helpful; if it's possible for everybody to know that those papers can be shared widely, then I think that's very helpful and we'll reassure some of the stakeholders who have raised concerns.

We have nothing to gain by making this an exclusive process. I've been very clear—if we're to make the step change that the committee rightfully has called for, we can only do that in the spirit of collaboration and people working together. There are challenges associated with that. I have been overwhelmed by the large range of people within the public sector, in the third sector, in academia, who want to add to this agenda. In a way, that creates its own problems, because there are so many people who want to be involved. I certainly, and I'm sure Vaughan does as well, recognise we cannot move forward unless we're working collaboratively, and if there are barriers in the way of that, then I want to remove those barriers. 

Thank you, that's very helpful. We've got some questions from Suzy now on funding. 

Yes. None of this is going to work, of course, unless the money follows the promises. Obviously, you supported a lot of what was in the 'Mind over matter' report. Can you tell us whether you're happy with the level of resource you've managed to find to commit to promoting pupils' mental health and emotional well-being, and is there a way of following that money?

Okay. Well, I'm always very happy to have more resources, and I've always got lots and lots of ideas about what I would want to spend those resources on. What's really important is, quite rightly, the impact of that resource. So, the resource in itself, the global sum, is one thing, but actually what does that money do and what is the impact of that money?

You'll be aware that the Welsh Government's budget for the current year includes financial commitments to improve mental health and education provision, and £2.5 million of that funding is dedicated to support the work of the whole-school approach. That in itself is not the only resource that is going in. So, for instance, we are already spending resources on the child and adolescent mental health services' inreach project. We've also been making resources aware that we're in the third year of funding the adverse childhood experiences hub, for instance. So, the £2.5 million that is dedicated to the whole-school approach supplements work that is already ongoing.

With regard to the £2.5 million, some of that money has been committed already. So, we are, for instance, using some of that fund to build on the teachers' suicide and self-harm prevention and intervention guidance. So, that money is committed to that, and I'm sure Members will have questions about that particular work stream. We are spending some of that money to support data collection and improved data collection.

So, the student health and well-being survey, we're looking to make sure that that is run again, because that gives the chance for children and young people themselves to self-report back on how they feel in school, and how they feel their school is supporting them, which is particularly valuable. But, of course, that at the moment is limited to years 7 to 11. We're working with the School Health Research Network to look at whether we can find a slightly different amended version to bring that into primary schools. Obviously, that has to be age appropriate, but we're looking to see whether we can expand that data collection into the primary sector. 

We're also using some of that funding to help develop modules for our initial teacher education providers. So, to develop modules and resources for initial teacher education as well, as I said, as maintaining our support for the adverse childhood experiences hub. Some of that money hasn't been allocated yet. For instance, we're hoping to use some of that money to take the initial findings of the child and adolescent mental health service inreach project. You'll be aware that there is an interim evaluation going to happen at the end of this year, and there'll be a further evaluation. But if we know already that there are some good things arising out of those pilots, why would we wait to the final, final evaluation if there are things that we could look to deploy now, because the feedback is strong and the evidence is good? So, we'd look to use some of that money to maybe spread some of that work from the early results of that approach. So, those are a flavour of some of the specific work streams that that money has been allocated to.  

09:25

That's really helpful, actually. When the interim report is published, presumably it will be published for us all to see, yes?

Yes. So, there's an interim evaluation for the CAMHS inreach work, which will be done in December, at the end of this year. But as I said, I'm very keen not necessarily to wait until the very end of the process if we think that there are interventions that could be applied in other places now. So, we're looking to be able to use the interim evaluation and initial feedback. So, some of that resource is being held to look to see if we can spread that work more widely.

Okay. That's great. Thank you very much. Just to finish on this, can you just confirm, then, that after the interim period, there will be an audit of all the way this money has been spent? Because from what I'm picking up, not all of it is going to go directly to schools—some of it is for planning and resource creation.

Well, the money is there to support the whole-school approach. What we know is that some of that work does indeed need to be done in schools. But some of that work needs to be done in other areas to be able to equip staff, for instance, who are going to go into our education system with the skills and knowledge that they will need. So, it's a variety of ways that that money is being allocated. Data collection—we need to know from children how things are, the impact of our work in this area. So, no, not all of it will be spent directly in the classroom.

That's fine. Is any of it going to be ring-fenced? Sorry, that was my final question. 

The entirety of the £2.5 million is ring-fenced, and we will be able to demonstrate to the committee exactly what work streams have been undertaken as a result of that investment.

As you know, the development of a whole-school approach to mental health was one of our key recommendations, and the committee is seeing that very much as a priority. Are you satisfied that this agenda is being taken forward at pace?

I would always like things to move more quickly, clearly, but I am absolutely satisfied that we have made good progress to date in the last year. I think there are tangible actions that have been undertaken. But also, I am clear that what we've been able to establish is a forum that brings people from a wide variety of sectors together that is certainly holding me and the Minister for health to account for our actions, and is helping us develop that pace. As always, there is a tension between doing things quickly and making sure things are done really, really well, and also not mistaking a hive of activity for impact.

So, it's very easy to look really busy and have lots of things going on, but whether that translates into the changing culture and the impact that we need to have in schools is a slightly different issue. Sometimes, we're working with partners who themselves are very, very busy, which means sometimes that perhaps we're waiting on some of the feedback from them before we can move forward. But that's understandable, because they too are working under a great deal of pressure. So, I'm absolutely confident that we've made progress. There's a lot of progress to be made and we will be looking to push that pace as much as possible, and we're helped to do that by the strong scrutiny that the task and finish group members provide.

09:30

Okay, thank you. You're developing the guidance, the implementation framework for schools, which is a work in progress, but can you clarify whether schools currently have access to support to enable them to self-evaluate their well-being work with pupils?

Well, you're right. What we're working on is the development of a framework to give greater guidance and greater support to schools. Now, what we have seen clearly from Estyn's report is that there are some schools that already do this very well. So, for instance, Members will be aware from reading the Estyn report the example that was given of Y Pant Comprehensive School in Pontyclun, where they hold regular audits of children's well-being. So, children have ample opportunity on a regular basis to feed back to staff about how they feel and whether these issues are being addressed. So, there is good practice out there.

Other schools need more support to do this. They're working in an environment where there are a plethora of interventions that are being offered to them and, sometimes, they need some guidance to be able to understand what to choose from those menus and how they can structure that, and how, again, it does not become the job of a single individual within the school, but the entire culture of the school, from the caretaking staff, to those staff who are preparing the meals, to the teachers, to the senior leadership team—that the entire school is working to this agenda.

We were just talking about the School Health Research Network research that was undertaken, that we have supported. Each school gets a copy of an individual school report, and that's one way in which they can look at how they're doing and amend plans going forward. That data is also published at a local authority level, and that data is also published at a regional consortia level, and I would be encouraging our partners in both of those organisations to be looking at how they're performing, how schools in their area are performing, and what they need to do in the school improvement service and in a local education authority capacity. But, clearly, the framework will be a very, very important way and it will bring in the self-evaluation work that is going on with Estyn and the Organisation for Economic Co-operation and Development, and it will give schools the opportunity to test where they are, look for gaps, and then to feed back on themselves whether the interventions they've taken have made a difference. But I don't know if, Steve, you want to add—

Just to add a few items of detail, Chair, on the work by the OECD and Estyn, I've been working with 50 or more stakeholder schools to develop the toolkit. To reassure you, mental health and well-being has a central focus within that and the framework will be used as part of it. The draft framework will be out in September and we'll be working with schools throughout next year to evaluate what is working, what's not working, and it will be refined. But that evaluation has parity with the evaluation of standards, performance, teaching and learning. So, it has that profile and expectation that schools would want to use it. And, I have to say, the feedback from the schools has been incredibly encouraging. We trialled in a series of conferences with over 700 headteachers in the spring term, trialling and sharing with them the type of information that's built in in terms of prompts for what schools should look to. But the framework will add further value to that. 

Okay. We know that one size doesn't fit all with these things and that different schools are doing different things, but would you confirm for the committee that there will be an expectation that all schools will be working to a fundamental set of principles in this area around the kind of issues that Estyn have highlighted about the fundamental nature of building good relationships?

09:35

Absolutely. There are different ways in which you can approach developing those good relationships, and different ways of doing that, but that is a fundamental, and that is a given, and that is a complete expectation. How schools go about doing that—they will want to do it in a variety of different ways, depending on where their school is, depending on the cohort of the children, depending on the age of the children. But the fact that there's an expectation that they will do that and Estyn will look at how they are performing in that area is a given.

Okay, thank you. We've got some questions now on the curriculum from Siân Gwenllian.

Diolch. Mae Comisiynydd Plant Cymru wedi mynegi pryder yn flaenorol am ddiffyg aliniad rhwng mentrau i wella iechyd meddwl a llesiant emosiynol disgyblion ar yr un llaw a datblygiad y cwricwlwm newydd. Pa mor ganolog i waith y grŵp gorchwyl a gorffen bu ymdrechion i sicrhau bod iechyd meddwl a llesiant emosiynol yn cael eu hintegreiddio yn y cwricwlwm newydd?

Thank you. The Children's Commissioner for Wales has expressed concern previously about a lack of alignment between initiatives to improve pupils' mental health and emotional well-being on the one hand and the development of the new curriculum on the other. So, how central to the work of the ministerial task and finish group have been efforts to ensure the integration of mental health and emotional well-being into the new curriculum?

Okay. So, clearly, the new curriculum gives us a wonderful opportunity, I believe, to really embed health and well-being in its broadest sense into the work of schools, giving it parity with all the other areas of learning and experience that are included within the curriculum. It's very clear from the 'what matters' statements that lie beneath the individual AoLE title that there will be an expectation on schools to work on delivering those 'what matters' statements.

Its relationship with the task and finish group—we have practitioners on the task and finish group. That's been really important, and I'm sure Lynne would agree with me it's been a really useful sense check to have headteachers as members of that task and finish group, because—I don't think I'm speaking out of turn, but, if we reflect on that very first meeting we had, there were healthcare professionals sitting around the table talking a language, and you could just see from the look on the headteachers' faces—. And we stopped the conversation, and I said, 'Can we have some reflections from the headteachers, please?' They said, 'You were talking a language that we simply do not understand in the context of the school.' Having both healthcare professionals and education professionals there, having those headteachers there, has been a really useful sense check about the theorising and the theory of some of this stuff with, actually, how do you translate that into the pressurised working of a school, five days a week, when you've got schools being asked to do an awful lot of things. I think that's been a really valuable thing to have.

Now, below the task and finish group, we have a number of groups working on particular streams of work, and there is close collaboration between the AoLE development group and the members of that work stream. So, I am confident that we have put in place structures to ensure there is an alignment between the development of the new curriculum and the work of the task and finish group.

Yn y datganiad sydd yn gorwedd uwchben y manylion am y gwahanol feysydd profiad a dysgu, yn y datganiad cychwynnol yna yn y cwricwlwm newydd, mae yna sôn, onid oes, am ei wneud yn statudol bod addysg rhyw a pherthnasoedd iach ac addysg grefyddol yn rhan o'r cwricwlwm newydd. Dydy iechyd meddwl a lles emosiynol ddim yn cael ei enwi yn fanna. Ydych chi'n ystyried—efallai bydd hyn yn dod allan yn yr ymgynghoriad—a ydy o angen bod reit i fyny'n fanna yn y datganiad cychwynnol yna? Pam fod addysg rhyw, perthnasoedd iach ac addysg grefyddol yn bwysicach nag iechyd meddwl a lles emosiynol?

In the statement that lies above the detail about the different areas of learning and experience, in that initial statement in the new curriculum, mention is made of placing on a statutory level the inclusion of healthy relationships and sex education and religious education in the new curriculum. Now, emotional well-being and mental health aren't included in that statement. So, are you considering—perhaps this will come out in the consultation, but does it need to be right up there in that initial statement? Why is relationships and sex education and RE more important than emotional well-being and mental health?

It's not more important. You will be aware that, in the five 'what matters' statements that underlie the health and well-being AoLE, how learners form and maintain healthy, positive relationships is one of those 'what matters' statements. But we have reflected on the strong recommendation by the task and finish group chaired by Professor Emma Renold, that was absolutely clear in its recommendation to me that the issue of RSE should be placed on the face of the Bill to ensure that these subjects—which sometimes people find challenging and sometimes there is controversy, as we have seen across our border, about teaching—should be on the face of the Bill. But that's not to say that it is more important. The AoLEs are of equal value. We will legislate for the necessity of schools to deliver all AoLEs, and we will be making further statements, when I respond to the White Paper consultation, on how we will enshrine an expectation on the delivery of each of the 'what matters' statements when I respond to the consultation. But it's not to say it is more important.

09:40

But can you see how that perception is coming around, because it's not actually on the face of the Bill, as compared to other more specific issues like sex education? 

Yes, I can see. I suppose, if we strip it back, we would take Welsh off the face of the Bill, because where—. We will put the requirement to teach Welsh on the face of the Bill; we will put a requirement to teach religious studies on the face of the Bill. That's not to say that they are more important or less important, but there are some subjects that have been recommended to us by experts—in the case of Welsh, Professor Donaldson himself—that they should be on the face of the Bill. So, it is difficult. In some ways, it would be easier for me if I just took them all off the face of the Bill, or—. But if we're to stay true to the principles—. We are—. Professor Emma Renold's group was very, very clear of the necessity of putting this on the face of the Bill.

But that's one pressure group, you could argue, who have won, in some respects, and they have got their subject area there on the face of the Bill. If there was a bigger—you know, if there was a similar call from another panel, or expert group, maybe you'd have done the same with this area.

I'm sure the Member would like to reflect on describing Professor Emma Renold, who is a world-leading expert in this field—

Yes, but there are world-leading experts in the other fields.

I would certainly not describe or characterise Professor Emma Renold's work—. The task and finish group that I set up, which included a wide range of organisations and a strong element of pupil voice in that work, were very clear in those recommendations. I'm also very clear of the need to ensure, in the legislation, when we respond to the consultation, that there is absolute clarity around our expectations of delivery of the curriculum across all the six AoLEs and all 'what matters' statements that lie beneath them. And I've been very, very pleased to see the positive reaction to the publication of the 'what matters' statements and the inclusion that is quite clearly there in the new curriculum and the expectation of the strong role and focus on mental health and well-being. And this provides a unique opportunity to us by placing health and well-being on a par with perhaps more traditional subjects that have long been taught in our schools.

Okay. Siân, did you want to ask anything else on this?

No. Just to say that I think that the work that's been done by the sex education and healthy relationships work is really very, very important, and I concur completely that it should be on the face of the Bill; I'm not arguing that. What I'm saying is that maybe there's a way of thinking that this particular aspect of what we're talking about today should also have that equal status and be on the face of the Bill. We differ, so that's fine.

Okay. There'll be plenty of opportunity to look at this when the Bill is published, so we'll have lots of opportunities there. Thank you for the update that you provided to the committee on the inreach pilots in advance of the meeting. Dawn has a question on this.

Yes, thank you. I was just wondering whether, in your—because you were talking, in answer to Suzy, about the interim evaluations. Would one of those—? Because you talked about, if something's working well, then you'd be looking to implement it regardless of—you know, you wouldn't wait until the end of the pilot. Do you have a view, then, already, on whether health professionals should be embedded on a permanent basis in schools? Have you reached a view on that yet? 

No, not yet. But, what I have been very struck with, in the early reports coming out of the pilots, is that we have seen a positive impact—schools reporting back positively that they feel better supported, not only in being able to identify an individual who may be suffering signs of distress, but, crucially, having identified it, actually having some help to do something about it, and that's absolutely crucial. And what we have seen is that the ability to work with a dedicated professional is making a difference to how schools feel. We are seeing reports back of schools feeling more empowered—better knowledge, better understanding and a better ability to respond—being able to make quick referrals and better referrals to benefit children. So, undoubtedly, there are some immediate benefits that are being reported back. We will have, as I said, the first evaluation at the end of this year, and we will be looking to see if there are any early lessons that we can look to roll out—resources being available—to make that support more widely available than the pilot area at the moment. 

09:45

Okay. So, there are two aspects to that one: the value of the support and whether you can afford to roll that out. Would that be a fair assessment?

Yes. And I think what's really interesting about it is that, although schools appreciate having a person, we have to build resilience within the schools themselves, and that's what's been really interesting to me, as a result of the pilots—that schools themselves, by being able to have that working relationship, they themselves feel more confident and more able to deal with these issues when they arise in school. Obviously, there are resource implications, both human resource and financial resource implications, if we were suddenly to say overnight, 'Right, that's it, we're going to move a whole cohort of professionals into schools'. So, that's—you know, we have to look at the resource in the widest possible context, both personnel and financial.

Okay. So, perhaps we'll come back to that when we've seen the interim evaluation in terms of the context of the priority. Thank you, Chair.

Thank you. We've got some questions now on inspection from Suzy Davies.

Okay. Thank you. Can I just add one to Dawn's? When the interim evaluation is published, will the methodology also be included in that so that we can see how you got that?

Lovely, thank you very much. One of the things that struck me when we had last year's Estyn report is that quite a lot of schools at primary and secondary school level are actually scoring quite well on their well-being data. But, in the Estyn thematic report on health and well-being that came out earlier this month, obviously, we got this information that only two thirds of primary schools are using the whole-school approach and only one third of secondary schools. So, to me, it sounds like there's been a bit of a disconnect between last year's Estyn report and this thematic report. On the basis that, the framework that Steve Davies was talking about earlier on, I presume that's going to be available to schools in September—perhaps you can confirm that—how is Estyn going to validate that, and how confident are you that Estyn already has the means for validating it, bearing in mind the disconnect I've already referred to?

Okay. Well, I think—. Rather than a disconnect, I think, in a way, Estyn's general work that it does on an individual school-by-school basis, as opposed to the thematic approach, is probably looking at slightly different things. Because, in our old Estyn inspection, there are quite narrow issues that they're looking at in terms of well-being, and what we asked them in the thematic approach was to actually look at this concept of whole-school. So, lots of schools are doing good things to support the well-being of their pupils, but whether that then translates into the expectation that this committee has, where it is an ethos that permeates throughout the entire school, is different from what you would look at in an individual school report. And that's why we're moving the system so that, when Estyn are looking at well-being, they will be looking at this wider set of parameters. So, I don't think it's to say that what Estyn has previously said is wrong, or to undermine the judgments that have been made with regard to well-being in an individual school. I think our thinking, our knowledge and our understanding of the need for a whole-school approach is probably moving us along and is different from what we were asking people to look at before.

Can I make the difference between the self-evaluation toolkit, which Estyn is developing in conjunction with the Organisation for Economic Co-operation and Development, and the framework? Those are two different things.

Yes, those are two different things. It is massively complex, because there's a lot of stuff going on, but I think it's important. So, when Steve was talking about something being available in September, he's talking about the self-evaluation toolkit, which looks at the performance of the entire school, both academic and results and everything else—standards of teaching and learning as well as well-being. So, what we're doing there is really putting well-being up there and saying that this is really important about the other things that the school has to do. What the framework will do is take the self-evaluation and put that in a wider framework of support and guidance to schools to develop the whole-school approach. That framework is a first draft. The task and finish group [correction:  task and finish group’s stakeholder reference group] has looked at a first draft of that. There's further refinement going on as a result of the comments from the ministerial task and finish group [correction: that group]. I'm loathe to give timescales, because sometimes, as I said, we're reliant on other people feeding into that process, but I'm hoping that with a fair wind we will be out to consultation on a final version of the framework before the end of this calendar year. So there are two different things and pieces of work that are going on: the self-evaluation toolkit in September, the framework by the end of the calendar year.

09:50

Can I ask, then—how will Estyn validate the toolkit? Sorry, my fault.

The toolkit is Estyn's work that is being done in terms of the OECD, and Estyn will be looking at schools' use of, and the robustness of using, the toolkit and the strengths of their own self-evaluation. So, rather than making an individual judgment, the judgment will be made on the ability of a school to be able to spot its strengths, to spot its weaknesses, plan for those, make changes and improvements on those, and then to feed that back into the loop. But Steve can tell us more. 

Just to add briefly to that, Estyn are partners in developing the toolkit. It's a Welsh Government resource to help school improvement, so they're well informed because they're part of that process. The framework is intended to help schools address strengths and weaknesses within that. I think it's fair to say, as the Minister said, the measures historically were quite narrow. They focused on things like how many children were excluded. Were the children in the school, yes or no, and when they were in the school, the extent to which their well-being was being managed and enabled. Going forward, I think Estyn itself has refined its understanding of the wider issues that we've been discussing within this group, and within the framework. So as Estyn engage in inspections going forward, they'll look at the quality of the whole self-evaluation, they'll give them a far deeper evidence base to see the work of the school and the impact that school has had. So I think as Estyn makes judgments in the future, this resource is going to be helpful for them, but I think more importantly is going to be helpful for the children and the school, because they will be addressing these issues in far more detail.

It also gives us a common language around self-evaluation. So, any organisation worth its salt should be engaged in a process of self-evaluation. Self-evaluation looks different, perhaps, to different people, and maybe individual schools or individual organisations are doing it in a slightly different way. This gives us a common tool and a common understanding and a common language to be used within individual schools, within local authorities, regional consortia, Welsh Government, so we all know that we're working to a common platform.

Okay. Thank you. And of course, bearing in mind the OECD's comments on self-evaluation historically, that's probably really useful. Thank you, Chair.

We've got some questions on training now, some general questions, and then we're going to come on to IT. Suzy's got some general questions about staff training.

So I do, sorry. I'm happy to take it. Apologies. You made a fair point, didn't you, in response to the committee's report that it is impossible to expect everybody who works with children to be trained to the level that we would want them to be. But in the progress update, you did say that the task and finish group are considering a tiered approach to training with an initial focus on all school staff. Where are we on that at the moment?

Yes, you're right. It's really challenging to be able to do everybody at the same time, so again it's looking at where are the immediate needs and the needs that will have the biggest impact. So, we are looking at training the school staff at the moment. That's part of our professional learning offer that we're developing, so that people have an opportunity. Our schools framework, which is currently under development, also looks at training for not just school staff—as I said, whether that be senior leaders or staff who are maintaining the school, preparing and serving food for the school, so all staff within that building. Because we recognise that, for some children, it's not a teacher who they want to talk to, it's not the teacher who they want to maybe make disclosures to or have that very close relationship with, and we need everybody in that environment to have an understanding and know what to do. School governors—because, of course, school governors are holding our headteachers to account, and if we want our headteachers and our senior management teams to develop this culture within their schools then school governors need to know about this and need to understand it so that they can hold their senior management teams to account for practice in their schools.

Our CAMHS inreach pilot has had a lot of focus actually on supporting and training up staff within schools, so that they can make more appropriate referrals and so they know who to go to and they know what other options are available to them. So, we're making some good progress, I think. ACEs—you know, any child in any family could be subject to an adverse childhood experience, which could put extreme stress on them. Maybe their parents' marriage is breaking down, a common occurrence for many of our children; a bereavement in a family, whether that be a parental bereavement or a grandad or a sibling. That can happen to anybody, and that can cause real trauma for a child. We hope by the end of this year that every single school will have undergone the ACE training—by the end of this calendar [correction: financial] year. So, we are making progress through a number of programmes, to develop that whole-staff training approach.

Do you mind if I just try and pin you down a little bit on that progress? The report is over a year old now, and I know you're keen to respond to it. So, while I'm sure we would all accept that it's great that all schools will have had the ACEs training, I'd like some kind of indication of perhaps how many members of staff might have had that and, actually, how many schools. Because it's a great ambition, but we know how complicated it is to try and get members of staff of all kinds to do continuous professional development.

09:55

I can get the actual numbers for you, but my anticipation is that all schools—all maintained schools—will have undergone ACEs training by the end of this calendar year. And what's crucial about the ACEs training is that we are moving away from just identification through to the, 'Now what?', the 'What do you do now?' So, it's all very well being able to understand trauma, but, crucially—'Okay, I understand that this child is behaving in this way because they have suffered a trauma, but, crucially, now what do I do? Who do I go to? Where are the avenues of support?' And that's what's changed in the ACE training—not just simply raising awareness but actually the 'So what?' and 'What do I do now?' But I can get numbers if the Member is interested.

Yes, it would be good to have a note on it. But Suzy said in her opening remarks that she thought the point you made in the debate about it not being realistic to ensure that all staff had training was a fair point. Well, actually, I think the committee's view was the opposite one—that we felt that it was crucial that everybody had some basic awareness of not just mental health but the importance of positive relationships. Would you agree with me that, in the course of the work of the task and finish group, that has become even more clear, really—that the skills of our teachers and our other staff in the education profession are absolutely fundamental to delivering this agenda?

That's why I asked how many individuals in a school, not just how many schools.

Well, off the top of my head, I don't know how many actual individual people, but, as I said, our expectation is that all schools will have participated. But I'm happy to get more granular data. And I would agree with you, Lynne, that what is crucial and what I have learnt through the last 12 months in that process is that we have to have that goal of ensuring that everybody is appropriately trained. We are going to have to do it in a phased approach; it can't be done overnight, but it is clear to me that that's what we need to be working towards. And we need to be able to skill different people with different levels of skill. But, no, it's been clearly obvious to me that that's what needs to happen.

10:00

Thank you. That's very helpful. We've got some specific questions now on initial teacher education. Shall I bring Siân in first, then you, Suzy?

I ba raddau y bydd y rhaglenni addysg gychwynnol athrawon newydd—y rhain sydd yn cael eu cyflwyno o fis Medi ymlaen—i ba raddau y byddan nhw’n canolbwyntio ar sut y dylai athrawon gefnogi iechyd meddwl a llesiant emosiynol disgyblion? A phryd y byddan nhw’n barod i’w defnyddio?

To what extent will the new initial teacher education programmes, being delivered from this September onwards, focus on how teachers should support pupils' mental health and emotional well-being? And when will they be ready to be used?

From September 2019, for the new accredited programmes, all programmes will—in line with delivery for the new curriculum—have well-being as part of their formal syllabus. I think it's only fair to say that that accreditation process, and that syllabus development, happened prior to the publication of this report. So, whilst I am confident, and it is confirmed by all our providers, that well-being will be a core part of their syllabus, the issues around, perhaps, more detailed understanding of child development—whether that be in the context of young children, or—. The feedback coming back very, very clearly from Estyn is around adolescents and the processes that go on during adolescence. Literally, the changes to a child's brain structure during that phase are significant. We're very well aware of the outward changes that children experience during puberty, but actually, what I've had to learn is the significant structural changes and the things that are going on inside in their brain—that we've not been very good at doing that.

So, it's too late, at this phase, to be able to get something in formally for September 2019, but there is an absolute appreciation and a willingness on behalf of our higher education providers to respond to this agenda. So, we are working with them to look at what additional support, courses, elements of training we can put in as quickly as possible, on top of their formal syllabus, with a view to the next accreditation process having this firmly embedded. So, we're looking to try, as I said, to work with very willing partners. They're not resistant to this change—very, very willing partners. That's why some of the £2.5 million will look to develop some resources for additional modules to be made available. And those modules—.

September 2020.

We think that we can get those modules ready for September 2020, but to be in the spirit of full transparency, they will be additional modules and not necessarily a core part of those syllabuses. But for the next accreditation process, then we will ensure that they are core parts. There's a real willingness on behalf of the HE providers to respond positively.

Diolch yn fawr. Dwi'n falch o glywed hynny. Y cwestiwn roeddwn i’n mynd i’w ofyn oedd a fydd yna fodiwl newydd, ond rydych chi newydd ddweud y bydd, felly dwi'n falch iawn o glywed hynny. 

Thank you very much. I'm glad to hear that. I was going to ask whether there was going to be a module, but you've just alluded that there will be, so I'm happy to hear that. 

Okay. Thank you. We've got some questions now on early intervention, prevention and resilience services from Dawn.

Thank you, Chair. I just wonder if you could tell us what assessment you've made of the current level of provision for lower-level support and early interventions, and whether, in particular, you think that they're linking in well with the primary mental health care services.

Officials have been working together with the Together for Children and Young People programme to try and get a better understanding, an alignment and an analysis, really, of any gaps. We're also working with the Association of Directors of Education in Wales as well, looking at asking local authorities to do a piece of work, again, to be able to look to see what they've got in their own authority areas that schools can tap into. I think the commitment was made by ADEW representatives at the last task and finish group that they would bring that paper shortly to the task and finish group. So, we are trying to do a mapping exercise from an LEA perspective as well to see what's actually going on on the ground so we can identify—

Sorry, Kirsty. You were going to be writing to the health boards and the local authorities, weren't you, around the capacity that they had.

Yes. ADEW are doing that piece of work for us at the moment. Unfortunately, they've not been in a position yet to bring that finished piece of work to the task and finish group. We had hoped that it would be available at the last meeting. Unfortunately, it wasn't available at that meeting, but I think we've had a commitment that it will be coming—

10:05

It'll come to the next meeting. I think that they'd had responses from schools, but they wanted to make sure they'd had as many responses to make it an informative exercise, so they've gone back out to local authorities.

The other thing I wanted to mention was school counselling, in terms of the relationship with school counsellors.

So, that piece of work from the Association of Directors of Education in Wales is ongoing, and we are also working to map the adequacy of the school counselling service and the capacity within that school counselling service. So, we are working with both our partners in local government and in the health service, recognising that schools can't do this on their own. This is one of the challenges—that if you're to have a whole-school approach, to make it meaningful, our educators need support from other services. We're asking an awful lot of our teaching professionals at the moment, and they need the support of both local government, whether that be social services or a whole range of other services that it's the responsibility of local government to provide, but also the health service, and we're very clear that that needs to happen. So, we're actively engaged at the moment to do those mapping exercises around capacity, what's out there, so then we can better understand and plan to fill the gaps.

Okay, well, you pre-empted my question on school counselling, so thank you for that. No, that's absolutely fine. That's fine. So, that's still a kind of work in progress, you're still gathering information before you can make any firm proposals on that. 

That's fine. The First Minister, when he was elected, made a manifesto commitment to require specialist educational support services to work more strategically across Wales. How does that fit in, do you think, with the whole-school approach?

My understanding was that the First Minister's commitment was specifically around educational psychologists—

—educational psychologists, who have a really, really important role to play. Educational psychology is now represented on the task and finish group [correction: task and finish group's stakeholder reference group], so that they are clearly embedded in this work and we can make sure that there's not a crossover and a duplication of what we are expecting some of our CAMHS staff to do with the specific roles and contributions that educational psychologists can bring. So, we continue to engage with the educational psychology services and their representative body to understand the constraints that they have and to understand who does what in a school and who can—because, sometimes, there's a crossover. Educational psychologists sometimes, perhaps, in the past, have dealt with or provided advice and support if a child, for instance, suffers from anxiety. We've got CAMHS doing some of that stuff as well, so we need to be very clear about who does what to avoid duplication, so that there's enough resource to go around everywhere. But they're now part of the group.

Okay, thank you for that. My final question is about the early intervention and enhanced support work stream. Information on the progress of that that's been made by Welsh Government in relation to the missing middle and showing that there's no wrong door for children and young people is somewhat limited, I think. Would you say that's a fair assessment, that we don't have an awful lot of information about that at this stage?

I think that's fair and there's more work to be done there. I absolutely agree with the concept that there is no wrong door, and we will need to, I think, put a specific emphasis on trying to make more progress in that particular area. It's fair.

Thank you. If we can move on to talk about suicide and self-harm, as you know, the committee made very clear recommendations about guidance needing to be issued to schools on talking about suicide and self-harm in order to increase help-seeking behaviour by young people. I'm personally really pleased that that guidance is now ready and that you've informed the committee that that's to be launched in the autumn. But what is really vital is that all schools actually implement that guidance, because we know that some teachers, some LEAs, are very hesitant around this area of talking about suicide. How will you ensure that all schools actually use this guidance once it's launched in September?

I think the launch in September is a really significant milestone in the work on this of the task and finish group and their response to the committee's recommendations. We're launching in September because although the guidance is ready to go now, there are some more kind of, how can I say, there's a publication process that Welsh Government documents have to go through and things like that, and we were really worried that if we launched it in July, because we're almost into July, then there would be a real lack of focus. Schools' minds are moving to other things in July, and we didn't want to just put this in at the end of the school year, because we really need it to have impact. And we're looking to do the launch to coincide with the anti-suicide and self-harm day [correction: world anti-suicide day] in September, and we're hoping that can have a larger impact.

The framework, we're looking to use the framework for schools, and that will have a dedicated section on suicide and self-harm. So, we're looking to really bring that to the fore within the framework, so it's not lost. And that will make reference to the national and advisory group's guidelines as well. So, we're looking to use the framework to really highlight the importance of that guidance and to really, really focus schools' minds on the need to engage with that guidance and to use it effectively in their work.

10:10

So, you'll have a clear expectation that all schools and local education authorities will co-operate fully in the use of this guidance. 

Very much so. And we're very grateful for the work of Swansea University, who have been working on this for us. In addition, now that that initial piece of work has been completed, we are in discussions with Professor John at Swansea over the potential to undertake more targeted research and activity to support us in this area. So, in the last few days, we have received a proposal from Swansea University, which we are actively considering, which will look to develop work on better understanding of bystander interventions, and also empathetic responses to distressed posts on social media, and cyber bullying on social media. So, we're looking to continue our relationship with Swansea University now that the guidance is done to be able to look to see if we can have even deeper work in this area. 

One of the things that struck me earlier on in your evidence was when you talked about the task and finish group, and the fact that the headteachers and the health professionals were speaking different languages, and they were brought together and they had this honest conversation that the headteachers didn't understand the language. What surprises me is that this approach is considered something of an innovation. Hasn't this happened before? Isn't this an approach that should be happening throughout the system?

It was a surprise to me, Hefin. I guess professional groups have a language and a vocabulary of their own in those different groups, and what's important is being able to bring both sides together around that table to have a shared understanding of the pressures that both sides are working with, and making it real for healthcare professionals about what it means to actually deliver this in an education setting.

Now, I wouldn't—. For many of those healthcare professionals around the room, I wouldn't expect them to have an in-depth knowledge of how the school day runs, or how the school works, or the pressures on those headteachers to effectively implement. And what teachers were saying were things like, 'We need to simplify down. We need this in plain speak, in plain language that all of our staff can understand. We don't need it in—'. 'Legalese' is the wrong word because we're talking about healthcare professions. It is surprising to me, but we're breaking down some of those barriers and we're getting that collective buy-in and that joint working, which I think will make it more effective.  

Effectively, what you're talking about here is a clash of cultures, and if that clash of cultures is so evident in the task and finish group, and is surprising both to you and to other observers, what other things are going on within the wider system to break down those cultures? So, can public services boards play a role in doing that? What other parts of the system are creating a beyond-the-school approach to this?

Well, there certainly could be role for public services boards. It's not one that I have given a great deal of thought to. That's one of the reasons why we have the CAMHS inreach project, to be able to develop those better working day-to-day relationships between healthcare professionals and schools, and getting those guys into schools so that there is a breaking down of those cultures, because there are cultural barriers.

We have to recognise that public services are under a great deal of pressure, and that sometimes means that people work in a different way, which might be counterproductive to another part of the service. But what's clear to me and what's important in this group is that a whole-school approach cannot be successfully implemented and delivered without that joint working in collaboration between social services, the health service, and sometimes other services that local authorities are responsible for—housing, for instance—and how that together—. And then you come back to your public services boards, and whether there’s an opportunity there.

10:15

Because that divide is notorious, isn't it, between health and education, and that meeting you held demonstrated it? There's also, thinking about the whole-school approach, a divide within the school system, from early years to higher education. How can you ensure that the principles of what we're asking for go beyond the school and think about early years and think about how those people with mental health difficulties will be progressing into higher education and sometimes beyond the border as well—often beyond the border? How do you ensure that this is something that goes beyond the school and is in the wider system?

Very much so. So, we now have a representative of further education on the task and finish group [correction: task and finish group's stakeholder reference group] because, initially, that was lacking and there was feedback from the group that this was an omission in our thinking in the initial phases. So, we now have FE representation on the group. It is really important to me that we see this as a continuum because children who are leaving our school system could well be going on to our FE colleges and we need to see that there is that continuum of support available both in FE and in HE, because issues can arise at different times in people’s lives and the pressures are different as we go through our educational journey.

So, for instance, we've invested £2 million into the higher education sector via the Higher Education Funding Council for Wales to work with our universities to better develop their support strategies for students and staff with regard to mental health in HE. There was an event just last week at the Wales Millennium Centre, where we were highlighting how some of that resource is going to be used by our universities. So, yes, this is definitely seen as a wider agenda, reaching into FE and HE.

You mentioned earlier that there was now somebody from the youth work sector on the task and finish group, and, as you know, this committee has taken a great deal of interest in youth work. Is there anything you'd like to add about the potential of youth work to contribute to the whole-system approach?

Absolutely. I think there’s so much that we can use our youth work service for. Clearly, it’s been a tough time for youth work, because of the constraints of public expenditure. But we're about to publish our new youth work strategy and frameworks, going forward. I think there is lots that we can do.

What we've learnt from the Estyn inspection is that those relationships are so important and we know that the bedrock—what makes our youth services so successful—is the ability of those individuals to develop those deeper, meaningful relationships with children and young people. I think that there’s lots that youth work can help us to deliver on this agenda, especially for those children who may not be in school, because this is very much focused on a whole-school approach, but actually there are children who are outside our formal education system and we need to be using every opportunity, wherever there is contact with a child or young person, to be working on this agenda, whether that’s in formal or informal education.

I think there’s also lots they can help us with in terms of the pedagogical principles, especially working with older children in the development of the new curriculum and helping us deliver, within school, elements of the new curriculum. The curriculum itself doesn't have to be the preserve, necessarily, of teachers the entire time. There are other organisations and other professionals that schools can work with to be able to deliver elements of the curriculum.

So, I think, youth work, we should never underestimate the good practice and the principles that underline the practice and the interactions between youth work and children to help us on this agenda, especially, as I said, for those children who may find themselves outside of school or for whom a trusted adult will be the youth worker, because they themselves don't perceive that person to be a person working in a school.

Okay, and you won't get any argument from the committee about the importance of youth work, but what the committee has highlighted in the past is the impact of austerity on youth work services. I know that there are youth workers out there who have actually saved lives. Would you commit, then, to the committee to be mindful of that when you publish the youth work strategy—that lots of youth services are actually really struggling with funding?

10:20

Absolutely, and, of course, we have been able to put some more resource into youth work to try and redress some of the challenging financial situations that youth work has faced in the past, because we value the impact of that work. This is a key area where youth work can make a massive difference.

Thank you. You mentioned earlier that the effectiveness of all this is largely dependent on working with social service departments, the healthcare sector. So, what further work is needed to further develop the cross-governmental links between education, health and social care in relation to mental health and emotional well-being?

I think the fact that we have those stakeholders around the table demonstrates an understanding and a willingness to work in that way. Within Government, officials from health, social services and education work closely to connect not just this programme but other programmes that the Government is working on to ensure there is an alignment. For instance, our task and finish group shares members with the ministerial advisory group on the outcomes for children looked after, so there's a recognition across those boards that we need to align policy development and policy work. Officials from across Welsh Government meet regularly to discuss the whole-school approach. The diversity of the stakeholder reference group, with over 40 members, again is another opportunity to ensure that there is a cross-governmental element. So, we're alive to that. It presents challenges, but we're alive to it and I think that we are, at this stage, doing that with reasonable success.

Okay. And how does that cascade down to the in-school experience and the support, then, for our headteachers and all their teaching staff? How do they draw on that support from social services, the healthcare sector?

What we're trying to do with the development of the framework is to be able to give very clear advice and guidance as to how schools and senior leaders would actually do that in reality. Our CAMHS inreach project is an example where we're looking to develop best practice about how schools build those relationships with services. That's not to say that schools already don't have in some cases really, really strong and close working relationships with other elements, but there's always more to do.

I'm very conscious, when I meet headteachers—they talk to me often about their frustrations of engaging with other services in a timely manner, in a manner that doesn't impact upon their ability to do their jobs as headteachers, and this is something that this group is looking to develop. We're all aware, aren't we, of the anecdotes where a headteacher will go to a meeting about a child and a different professional hasn't gone to that meeting and therefore no decisions could be taken? We're all aware of those scenarios. The health Minister is very aware of those scenarios and we're looking to try and improve that interaction between schools. That's what the additional learning needs transformation programme in part is about, isn't it? It's about building better relationships between social services and our health services for our children. 

Just before we finish, then, because we've got the health Minister in after you and we will be quizzing him on these issues, the committee was really clear that the whole-school approach would work as part of a system-wide approach to mental health. We've looked at some of those issues, but you said in answer to Dawn that you had some concerns about parts of the other work streams being in their infancy, like the early intervention work stream, and of course the Together for Children and Young People programme is closing in October—it's finishing—so there are big questions there about who's going to pick up that work. How concerned are you, then, about getting the rest of the system right so that we don't end up with schools entirely carrying the can on this?

Well, schools can't carry the can, and if they are left to do so, that will have a whole host of unintended consequences for children and young people, and, crucially, for staff. One element we have not talked about this morning is that when I'm talking a whole-school approach—quite rightly this morning we're focused on the needs of children and young people—the whole-school approach needs to take into consideration the needs of the adults and the people that work within those schools. What we know from the Estyn report is that, often, it is teacher stress that impacts negatively on the experience of children. So, when I talk about whole-school, we need to make sure we're attending to the needs of everybody within that building, and supporting our teachers as well. And that's not something we've had time this morning, understandably, to focus on. So, it can't, because it will just lead to more stress and more pressure on our teaching professionals, and I want to avoid that at all cost. We're trying very hard to look at ways of removing some of those burdens on our staff, and this cannot be about simply putting more burdens onto them—it can't be about that. So, we absolutely have to engage those other services to support our educators. Now, I'm clear that there is an absolute commitment from me and the Minister to make that happen.

Undoubtedly, in a project and a piece of work as large as this, there will be some bits that will move forward and are easier to move forward more quickly than others. I think that's inevitable. And, in a way, we shouldn't try to make sure everybody moves at the same time, because we will hold back things that we can do immediately. But, clearly, my message—and I know Vaughan agrees with me—is we can't leave it to schools alone; it has to be part of a wider system reform and a change of culture. And, sometimes, the hardest thing to change is the change of culture. And although we've made great strides as a society in talking about mental health—it is a world away from where we were 20 years ago; we are much more open—we should never forget there is still a huge amount of stigma still attached to the issue of mental health, for both children and adults, and we've still got a lot of work to do to get people to be talking about these issues. We have a false sense of security that we've truly changed some of the culture around mental health.

10:25

Okay, thank you. Are there any other questions from Members? No. Okay, well, can I thank you very much, Minister for your attendance, and your officials? I think it's been an excellent and really informative discussion this morning. As usual, we'll send you a transcript to check following the meeting, but thank you again for your attendance. The committee will break until 10.45 a.m. 

Gohiriwyd y cyfarfod rhwng 10:27 a 10:45.

The meeting adjourned between 10:27 and 10:45.

10:45
3. Iechyd Emosiynol ac Iechyd Meddyliol Plant a Phobl Ifanc: Gwaith Dilynol ar yr Adroddiad 'Cadernid Meddwl'—Sesiwn Dystiolaeth 2
3. The Emotional and Mental Health of Children and Young People: Follow-up on the 'Mind over matter' Report—Evidence Session 2

Welcome back, everyone. Item 3 this morning is our second scrutiny session on the implementation of our 'Mind over matter' report recommendations. I'm very pleased to welcome Vaughan Gething AM, Minister for Health and Social Services; Joanna Jordan, director of mental health, NHS governance and corporate services; and Matt Downton, head of mental health and vulnerable groups. Thank you for attending this morning. We're looking forward to hearing what you've got to say, and we're going to go straight to questions from Siân Gwenllian.

Dwi'n mynd i ddechrau efo lefel y buddsoddi yn y maes iechyd meddwl a llesiant emosiynol plant a phobl ifanc. Dwi'n gwybod ein bod ni mewn dyddiau o lymder ac mae arian yn brin, a dwi'n gwybod hefyd fod y Llywodraeth wedi bod yn dyrannu grantiau i gynorthwyo gwelliannau i wasanaethau yn CAMHS, ac wedi buddsoddi ymhellach mewn gwasanaethau i ategu iechyd meddwl a llesiant emosiynol plant a phobl ifanc. Ond, â'ch llaw ar eich calon, ydych chi'n teimlo bod y lefel o fuddsoddiad a'r adnoddau yma yn ddigonol, yn enwedig o gofio'r newid sylweddol sydd angen digwydd mewn ymateb i adroddiad y pwyllgor yma, 'Cadernid meddwl'?

I'm going to start with the level of investment in the field of emotional well-being of young people and children. I know that we're facing days of austerity and funding is scarce, and I know also that the Government has been allocating grants to support improvements to services with regard to CAMHS, and has invested further in services to enhance those services with regard to the emotional well-being of children and young people. But, hand on heart, do you feel that the level of investment and resources is sufficient, particularly bearing in mind the significant step change, indeed, that is needed with regard to the response of this committee's report, 'Mind over matter'?

Yes, hand on heart, the extra investment that we're making will make a difference, but part of the honesty in the conversation is to say that the work that we are still doing is allowing us to understand, on a much better level, the level of need we're still seeing coming in, because we don't have a constant or consistent picture, and I think you've got evidence from the Together for Children and Young People programme that says that there's still an increase in demand coming through. So, we're constantly needing to look at what's the right policy response, and then to make sure that our resourcing is matching and supporting that. That's why I announced the over £7 million to support the whole-school approach, and that's the health budget, and that is for work across health and education. The CAMHS inreach pilots, again, were funded from health as well.

So, we've made real and significant investment, and that's over and above the extra £35 million in the budget for mental health services, but we'll need to continue to look at what we're investing and whether it's making the difference, and we need to constantly revise whether we have got the budget in the right place. But the first thing is to understand what we want to do, and then to have the resources to try and meet and match that. So, I won't tell you, hand on heart, that everything that we need is in place now, because that would be a foolish and, frankly, dishonest thing to say. But, hand on heart, yes, we're making real investment to meet the objectives that we have, although I appreciate fully the committee want us to go further and faster.

A ddim jest y pwyllgor sydd yn dweud hynny, wrth gwrs. Mae Comisiynydd Plant Cymru—mae hi yn parhau i ddweud, er gwaethaf yr arian ychwanegol yma, y £7 miliwn—. Mae hi'n dal i ddweud dydy'r gwasanaethau yma ddim yn cael eu cyllido yn ddigonol yng Nghymru. Beth ydych chi'n ei ddweud ydy dydych chi ddim yn hollol sicr eto, oherwydd nad ydy'r darlun ddim yn hollol glir ynglŷn â beth ydyn ni angen bod yn cyllido. Felly, oes yna fwy o waith angen ei wneud i edrych yn strategol ar y gwahanol ffrydiau cyllido a gwneud yn siŵr eu bod nhw yn dod at ei gilydd mewn ffordd strategol?

And it's not just this committee that's saying that, of course. The Children's Commissioner for Wales is continuing to say that, despite this additional funding, this £7 million that you referred to—she's still saying that the services aren't being funded adequately in Wales. What you're saying is that you're not entirely sure yet, because the picture isn't entirely clear with regard to what we need to be funding. So, is there more work that needs to be done to look strategically on the different funding streams to ensure that they are aligned in a strategic manner?

I think it's a fair question, actually, because there's the money that I've announced for the whole-school approach to support that work. That includes investment in a number of different areas, including specialist CAMHS, but there are two transformation fund streams. So, there's the mental health innovation transformation, which is about mental health services, and there's the transformation fund that goes alongside 'A Healthier Wales'. Within the transformation fund in 'A Healthier Wales', I'm encouraged by the response of partnership boards. So, the committee will be aware of the proposal from Gwent, which was largely based on a transformation in children's services, deliberately tying in the third sector, local authority and health service together, and we should have some more learning from that in the autumn, which I think is really encouraging. But also in north Wales, a significant part of their transformation bid is, again, looking at the transformation that they all recognise they need to see in services for children and young people, and mental health being at the centre of that. The point about early intervention and support is to try and reduce the number of people who need our specialist services.

And outside of those specific proposals to try and speed up the transformation in services, we know that a range of our regional partners are, in any event, looking at what they will do. I've just met the Cardiff and Vale partnership board partners, and in their next year ahead they are looking at a joint approach to transforming children's services, because they recognise the need to intervene and support earlier, and that isn't on the back of transformation funding of any kind; that is on the back of them recognising both the policy drivers, to have regular contact between the Government and the health boards about what's required, and the significant cost and need pressures that local authorities see through their services, too.

The same in Swansea Bay: they've got a programme of activity there that is not supported by transformation funding, but it is about the fact that Swansea Bay partners in the West Glamorgan partnership board recognise within their own resources they need to do something anyway, because, otherwise, the demand will overtop the service. And it's a financial pressure as well as a pressure of doing the right thing in terms of need as well. So, that does give me real encouragement that this isn't something that is marginal; it is absolutely front and centre in the minds of not just the Government but our partners right across health, local government and the third sector.

10:50

Mae yna aelodau eraill o'r Llywodraeth wedi dweud ei bod hi'n anodd olrhain gwariant ar iechyd meddwl ac emosiynol plant a phobl ifanc ac, er enghraifft, bod y byrddau iechyd yn dod at eu ffigyrau nhw mewn ffyrdd gwahanol. Ydych chi'n poeni am yr agwedd yma o ddiffyg tryloywder, ac a oes angen i chi ailystyried? Rydych chi wedi gwrthod argymhellion gan y pwyllgor yma bod angen chwilio am ffyrdd o gynyddu atebolrwydd a thryloywder. Os nad ydym ni'n gwybod yn union lle mae'r arian yn mynd, mae'n anodd iawn gweld bod y gwaith yn digwydd yn strategol.

Other members of Government have stated that it's difficult to trace expenditure on the mental health and emotional well-being of children and young people and, for example, that the health boards publish their figures in different ways, in different formats. Are you concerned about this apparent lack of transparency, and is there a need for you to reconsider? You've rejected recommendations by this committee that we need to seek ways of increasing accountability and transparency. If we don't know exactly where the funding is going, then it's very difficult then to see that the work is being done in a strategic way.

I think there's a challenge here about wanting to be able to trace money and wanting to be able to trace improvements, and to make sure that the commitments that are made are then tracked. So, on some of the areas, we're saying—. For example, in the whole-school approach, I think £3.2 million of that is to be designated around CAMHS improvement, and that's to come on the back of plans we're going to receive. They're imminent—within the next week, I think, we're due to receive them. That will also be informed by some of the work the delivery unit is doing, and so we'll be able to track that money to say, 'Well, this only happens if we see a commitment', and we'll then track the outcome. But the outcome and the improvement won't all just be about that £3.2 million. I think, sometimes, we just need to be honest, and, in fact, I think some of what the committee's been driving us to do is to say that this isn't just one pot of money in one area of the service; it's actually about a much broader approach, and within that, I don't think you can neatly track the money.

So, I want to give clarity on, as far as we can, how money is spent and allocated, but I think, actually, there's a much bigger prize in saying, 'And is it making the difference that we want it to?' And that, I think, is a much more useful place for us to be, because, otherwise, it's very easy, frankly, for an organisation to say, 'Well, we don't have the money; it isn't in our allocated budget pot, so we can't do it.' And I think, actually, that gets us back into working in different streams rather than working across the piece to recognise we need to have services around the child, the young person, their family, the context they're in, to make a difference.

If you were talking about the work that, for example, Estyn have done on an approach in schools, well, actually, that isn't health funding, and to then try to badge up or match up what's happening in a school around emotional well-being and support, I don't think that would be a helpful exercise, but we can describe the money we put into school counselling. But that is only a partial explanation of the support that exists. So, I appreciate this may not be the answer everyone wants around the table, but I think it's an honest answer about how we track sums of money that are specific, but that equally are holding our whole system to account in its broader sense for making improvement real, and I'm actually more interested in that part of it than in trying to re-present the budget.

10:55

Mae yna rai rhanddeiliaid yn dweud bod y darlun cyllido ar gyfer CAMHS wedi mynd hyd yn oed yn fwy cymhleth a llai tryloyw, ac felly hyd yn oed yn fwy anodd i graffu arno fo. Mae rhanddeiliaid yn awgrymu ein bod ni'n symud tua'r cyfeiriad anghywir, mewn gwirionedd, yn lle rhoi ychydig o ymdrech i mewn i geisio canfod mwy o dryloywder ac atebolrwydd yn y ffordd mae adrodd ar wariant ar wasanaethau iechyd meddwl ac emosiynol yn digwydd.

There are some stakeholders that say that the funding picture for CAMHS has become even more complex and less transparent, and is more difficult to scrutinise. Stakeholders have suggested that we're moving in the wrong direction, truth be told, so perhaps some effort should be put into finding greater accountability and transparency in the way that funding is reported on these matters.

I genuinely think people are more interested in seeing progress. And in some ways it's easy for a politician to describe money, and say, 'Here's money that I have invested, here is money I've earmarked and allocated'. That is something that matters, and it shows that there's deliberate funding support going into something. But I actually think that it's much easier for me to talk about money than it is to say, 'And can I tell you the difference that it's made?'

Your stakeholders' statement that there's a lack of clarity in their understanding of how money's being spent—I'd be interested in seeing that specifically to respond to, and to be able to try and set that out. But this isn't an attempt to deliberately cover over or make fuzzy and impossible to understand what we're trying to do. But like I say, I would suspect that if people didn't understand exactly how money was spent, but they were happier that we're delivering the right experience and outcomes for people, then people would be a lot less worried about where the money comes from. And from the citizen's point of view, they rarely care about where the money comes from, but they care about, 'Well, does this service meet my need? Does the service understand what matters to me and how we get there?' And I accept that we aren't there in this area. If we were, we wouldn't be having this conversation, and we wouldn't have a programme and a commitment with extra investment to improve the services that we have got to make a better difference to people.

Okay. 'Mind over matter' recognised the progress that there had been in specialist CAMHS since the Together for Children and Young People programme was established following our predecessor committee's report in 2014. But the committee said in 'Mind over matter' that there was more work to do, and with that in mind we made 17 recommendations relating to specialist CAMHS. However, the Together for Children and Young People programme is closing in October, and we know that many of their work streams are a work in progress. The work on early help and enhanced support has been described as in its infancy. How is the Welsh Government going to ensure that this work continues to be taken forward in Wales effectively?

Well, there's a clarity in the commitment that comes from Ministers and the Government about the improvement in CAMHS. I'll need to make the choices about how we take that forward. I'm not persuaded that just rolling forward Together for Children and Young People is the right answer, but I don't want to lose sight of the work that is being done. So, for me, it'll be how we pick up and sustain that work rather than simply committing to a roll forward. That doesn't mean to say that rolling forward Together for Children and Young People is the wrong answer, but I want to make sure we're making the right choice, rather than having the convenient box we currently have and just saying, 'Well, that just needs to carry on'.

But it's also about the accountability that comes from Government and service. So, it isn't just about sitting down with vice-chairs; it is the regular poring over the data and the information to make sure the improvement that we want to see is real; it's the direct contact that I have with vice-chairs, that Jo Jordan has directly with people in health boards as well; it's the conversations that take place at joint executive team meetings and, equally, it is the highlighting of this as an issue with regional partnership boards as well. They recognise that it's a real and significant challenge for all of them as well. But I do recognise we need to able to describe that in a way where there's some clarity about what's happening and how that's being driven forward, and certainly before we get to the end of the autumn I want to make that clear not just for the committee, and not just for the service, but actually for stakeholders and families and people who I know are interested.

Do you recognise, then, that there are concerns about the regional partnership boards picking up all this work, and do you recognise that regional partnership boards are at different places in terms of their developments for children and young people?

Oh, yes. I've regularly talked about Gwent and north Wales because it's in their sights, and as I say from this morning, the conversation with Cardiff and Vale, their interested in the reform of children's services, and it's a clear priority for them, moving into the year ahead. Their initial focus was on older people; they are now moving to the children's service, they've got lessons they've learnt. And again, I've talked about what Swansea Bay are doing. But even within those four partnerships that I've mentioned, they're at different stages, so, of course, they are different, so that's why there is a choice that I will need to make about how we do that. And I certainly recognise the point you make that they are in different places, and it can't just be sent out to regional partnership boards and everything will be okay, because I don't think that is going to sustain the progress that all of us want to see.

11:00

Can I just add on that? Can I just say that also Hywel Dda, who I was with yesterday as part of their end-year performance for the health board, were also talking about the discussions they're having through their regional partnership board in terms of joining up the efforts around children? So, that regional partnership board is also looking at this space.

But in terms of the continuation of the work streams and Together for Children and Young People, on many of them, we're working very closely together—my team, the joint team we have with education—on the whole-school approach. There is constant dialogue and meetings, actually, between the lead players there, and we've already started the dialogue about where we think the work streams are best placed to ensure they're being delivered. That will be continued now over the next couple of months to make sure that we've got that completely cleared and squared off for everybody involved. Our really key attempt is that we don't lose momentum on this, so that's our aim, and we've just got to make sure that it's going to the right place without necessarily creating other, different groups. As far as we can, we want to bring it together, rather than—.

Okay, and you'll keep the committee—. You recognise that the committee will want to know that every one of those work streams has been picked up and is going to be taken forward as well.

It's a given that we'll need to inform the committee about how we propose to take those forward, so you can see what we're proposing to do, and I recognise you'll then want to test us to see if that's actually happening. So, I would absolutely make sure the committee are informed, both in correspondence and, I'm sure, it may then be helpful to give a presentation to the committee about how those things are working, whether that's in public or otherwise, so you can ask some questions about that too, because I know that you'll want to.

Okay, thank you. Dawn has some questions now on primary mental health services.

Yes. Thank you, Chair. Can I start by asking you about the performance of local primary mental health support services in relation to children and young people, and whether you're satisfied that it's both improving and is sustainable? I'm asking that because we're conscious that data on waiting times and assessments for interventions for children and young people isn't routinely published. So, I'd like your assessment of whether you think they're performing effectively and, if so, how do you know?

It's a mixed picture, and not one that I would say is one where I could be resolutely confident that it is absolutely where it needs to be and is in a sustainable place. If it was, then we wouldn't have commissioned the delivery unit to undertake the demand and capacity review. And the amount of information that we have is part of the reason why we're saying, 'Well, actually, we need to do this.' So, that review will help to inform us on what then takes place next. And, again, I think it may be helpful for us to share a summary of that review so you can see what the delivery unit are recommending as well as some of the responses in plans from health boards. So, we'll give you a summary of them both, because I don't think we're in a place that is properly sustainable. The achievement is too varied and not where it should be, in my view. That is a point that, again, I have made regularly with vice-chairs of health boards in my direct meetings with them and, again, it's a point that is made directly to the executive teams of health boards as well.

Okay. And in relation to the delivery unit's review, then, I think there's been something like £3.2 million allocated for CAMHS specifically to deal with the findings that come out of that review. So, I'm assuming that that money is not going to be released then until you've got the sign-off, if you like, on the review findings. So, what's the timescale on that, then?

We're expecting to have plans in within—the end of next week?

End of next week, yes.

So, we'll have those plans in, we'll need to consider them, and then, when plans get signed off, the resource will get released against those plans. We've been clear previously that each of those plans will need to demonstrate improved and strengthened linkage with schools, because it's got to be consistent with the approach we're looking to take. So, that's what will happen, when we have those plans, and we agree what we're going to do as well as announcing that we've done that. As I said, I'll make sure that we share both the summary of the delivery unit findings and a summary of those plans with the committee, so you can see for yourselves what they are saying they are going to achieve and how we then released the money, and that money will be tracked.

11:05

Okay. So, that's sign-off of the plans next week, you reckon.

Well, we'll have the plans next week for us to consider, and then when we are satisfied with them we'll then confirm that. And when we write to the committee that'll be made public in any event. So, obviously, we don't get to have secret correspondence with the committee. We'll write to the committee saying, 'Here's a summary of the delivery unit report, here's a summary of the plans.' And we'll provide that to you as well.

We would like the full report, actually, rather than the summary, and the full report for the individual health boards and, if possible, the reports that the interim improvement plans have been based on. You'll be aware that primary mental health services was a major concern in 'Mind over matter', and I think that we would like to have further assurances on this.

We'll provide as much information as we can, but I think a summary to say, 'This is what we're doing' and then the clarity and the detail, rather than having committees wanting to submit freedom of information requests. We'll provide everything that we can—

Well, no, we wouldn't want to do that. We would hope that the information would be forthcoming from you.

Indeed. But I think the summary could be helpful to say, 'Here's the range of action that's been taken. Here are the key messages that the delivery unit has provided, and then here are the plans on the back of those, and here's a summary of what that looks like in each health board', and then drawing together an overall picture as well. It's designed to be helpful rather than—

Well, I think that the committee, because of the issues that were raised around transparency and the fact that we didn't know what the services looked like for children and young people, we would like as much information as possible, so we will write to you about that in follow-up to this session. Okay, thank you. We've got questions from Janet now.

Thank you. Good morning. Recommendation 11 in the 'Mind over matter' report called on Welsh Government to ensure consistent pathways for all specialist CAMHS based on national criteria. Now, the framework for improvement for specialist CAMHS that was published in June 2016 sets out a clear definition and referral criteria for specialist CAMHS to ensure that children and young people across Wales receive an equitable service. Does the Welsh Government intend to commission a review of that framework in light of the committee's recommendation for consistent pathways for all specialist CAMHS?

We're looking to make sure that we can have a sustainable delivery of the service, and we will then monitor the need to test the consistency, because there are different messages about the consistency of the service. But will have to choose what we're going to do first. And, for me, that's about making sure that we have the capacity for demand in the right place to make sure that people aren't waiting overly long. And part of that is about checking that we have a level of consistency and equity in what different areas are doing. Part of my challenge then comes about whether we are comparing like with like across the country. So, it's not about saying, 'No, we're not going to do that', but it is saying that the first priority is to make sure that we have the service in a place where people aren't waiting too long, we understand what that service looks like, and we'll then look at the consistency in the pathways as well.

My question relates more to the fact that the framework was put in place in 2016, we are now mid-year 2019, and that framework is obviously not working—I know from my own experiences as a constituency AM—and access to referral to CAMHS can be a nightmare. So, in my opinion—and also we've got committee feedback that maybe the framework itself needs a review. The framework is only as good as how well it's implemented. So, is there any thought that you may go back to the framework you brought in in 2016 to see where the good came from it, where the not-so-good and where it's absolutely not working?

Well, the thing about the definition and the pathways is that part of the challenge is actually understanding how we have managed to implement that rather than whether, actually, the framework itself is a problem. It's actually about our ability to deliver that. And I'm interested in whether we have the ability to deliver, because that's one of the central challenges that we've had. It's why we've had to make extra investment into the service, and it's why we're looking at what goes around that too. So, I'm not saying, 'No, there won't be a review', but it's about the phasing of doing it in the right order and actually need to want to get performance in the right place and on a proper, sustainable trajectory and then to look at and to check that we have got equity in the way that the pathways are being delivered across the country.

11:10

I'm a bit of a stickler for actions being better than any frameworks that are produced. The question is that there's a little bit of ambiguity about whether you're going to revisit something that you brought—these are directions that you've set by means of a framework that is clearly not working, so whether you will—. Can we have a little bit more of an indication whether you will go back and review that particular framework?

Yes, I was just going to say that the key thing that we were trying to achieve with the framework for children and young people was that there was a consistent referral criteria—

So, that referral criteria is, in theory, in place across all health boards. We do know, and I think you've had some information from the children and young person's programme that tells you that there's been a 39 per cent increase in the acceptance of referrals to specialist CAMHS in the last couple of years. So, that's shown that there should be more consistency in terms of who has been accepted into specialist CAMHS. That work has to be driven further, but there are a couple of areas where we've seen really good improvements, we think, in terms of access to specialist CAMHS. Your area is the one area that we are working with particularly at the moment—they're focused on primary care CAMHS and they need to sort the specialist end of the service. But once we've got there, and we don't think we're far away, then we need to have another look to say, 'Are we sure that this referral criteria is being consistently applied and we can test it?' But we're not sure that that's the thing to do right now. But I don't think anybody's saying that we shouldn't do it, but it's possibly that we're not sure at this point in time that it's going to help much. We need, over the next six to 12 months, to get the service in balance and then say, 'Now, are we sure that everybody's operating against the framework and the referral criteria?' That seems to be the direction of travel.

Okay. If we can move on to waiting times. The committee's been provided with some NHS benchmarking data showing there's been a significant improvement in waiting times for a first appointment for specialist CAMHS. To what extent do you think those improvements have been the result of targeted investment and how sustainable are those improvements going to be?

Well, that's a question that I regularly ask directly of the health boards. When we introduced the new standards, so a matter of weeks and not a matter of several months, at the start of that, there was a rush to achieve and then, actually, we saw a decline afterwards. Now, we still have much better waiting times than several years ago, but to consistently achieve our four-week standard—we were just shy of that in March. I’m expecting that we’ll have seen a drop back in April, and I’m then expecting to see an improvement again through May. So, some of that was because we provided some targeted investment.

Last year, we invested around £1 million with a number of health boards to help improve their performance. That was on the basis that they should then be able to sustain their performance. And so I’m more optimistic that, over this year, we’ll see a more sustained level of achievement in waiting times to make sure that we do maintain the significant improvement that we have achieved, because the average wait now is about four weeks. We want to get to the point where our standard of 80 per cent within four weeks is not just within touching distance, but is actually something that we can achieve on a regular basis. And so there’s continued drive and expectation, both for me and in my interaction at board level, and with officials in their direct contact with officials within the service as well.

Okay, thank you. The committee also recommended that Welsh Government should move to a more qualitative way of monitoring CAMHS, so rather than just looking at waits to first appointment, to look more at what the experience of children and young people is once they've actually had that first assessment. There was no update from the Government on that particular recommendation. Are you able to tell us whether any progress has been made on that?

11:15

So, the committee are probably aware of the wider piece of work we're doing across all mental health services to put in place outcome measures, which is a long and detailed piece of work, but we are on the case on that, and that will give us something that we can compare across Wales over time, and it will be a big step forward, I think, for mental health services. The introduction of the choice and partnership approach model to specialist CAMHS, which has been rolled out now across Wales, was all about looking at the quality of the service and better engagement with parents and young people about what they wanted to achieve. That's been rolled out. The soft intelligence we have is that that's been well received and is delivering better outcomes. What we haven't yet got is a way of collecting that from all health boards. You might find that the children and young people's programme, when you see Carol and Tim this week, can give you some examples from their own health boards, but that's a question we're constantly asking them: 'How do you know that it's better? And they say, 'Well, actually, we're getting good feedback.' They're testing through patient satisfaction, but we haven't got something in Welsh Government yet that collects all that, but the general feeling is that the CAPA model, which we've been rolling out over the last few years, has made a significant difference in this case.

Okay, thank you. And we've got some questions now on early help and enhanced support from Dawn Bowden. 

Thank you, Chair. I wonder, Minister: can you clarify what your vision is in helping to shape the early help and enhanced support work stream, because we need to develop some kind of common principles and policies around that if it's to be successful. So, how do you see that being taken forward?

The early help and enhanced support looks at those children and young people whose current mental health needs are not being met in in-patient units or placements within the welfare or youth justice system. So, that's a specific strand of work that is being done, and there are stakeholders, including the children's commissioner, who are looking to discuss opportunities for a more integrated commissioning around that, to commission the right sort of care for that particular cohort of children and young people who need that particular care and support, to make sure they have the right capacity and that they're broadly in the right place within the country. 

The other early help stream on early intervention is where we're looking at the intervention in our primary care service about the earlier help, and the overall vision is, if you like, a simple one of making sure we have the right care at the right time and in the right place for people with a specialist need—what that looks like, how we make sure we commission that more specialist care, and that we provide directly, and if we can't provide it directly, then we commission it from people and we have quality assurance regimes in place. But the broader drive I think the committee had was on making sure that we don't just focus on the specialist end. But it's the story of the river that the Chair used about how we make sure we get further upstream, to intervene and support and earlier. And that early help and intervention stream is where we're focusing lots of our time, energy and effort to try to make sure that we reduce the number of people that need that more specialist help. 

Sure. And we need the common outcomes at whatever stage we're at. I think underpinning that is we want the same outcomes for these children, don't we? So, it's got to have a common underpinning throughout the whole process, whether it's very early intervention, right the way through. 

And those things will be about what matters to that child and young person in their context as well. So, the whole thing about what matters to me, and having outcomes that matter, is where we want to get to, and having our services geared up to deliver that, because, for the progress we've made, we're still not where we want to be, and where we recognise we need to be. 

Yes, I understand. Okay. In terms of what we term now as 'the missing middle'—those children that don't warrant the higher level of interventions and so on—can you set out what your expectations are for the health boards in terms of remodelling their services, and in particular in ensuring that there's kind of no wrong door that children and young people access when they're seeking mental health support?

We are driving health boards to take that approach and to have a single-point-of-access approach. So, that's already started in both Cardiff and Vale and Aneurin Bevan, and other health boards are looking to get there as well. So, that single point of access, that 'no wrong door' approach, is accepted within services as the right way to go, and some of our health boards are there. We'll then want to see what the outcome of that has been.

Again, that's partly about testing and understanding the experience of people moving through the system as well as what the staff say to make sure that that's then aligned with partners outside of the healthcare system as well. It's again why the regional partnership board conversation really does matter as well. So, part of our role is not just injecting some demand and expectation into the system about progress, but it is then also about being able to take a step back and look at what's worked. So, we're looking at how we actually deliberately share that learning. That's partly about the earlier questions from the Chair about what happens with specific work streams in Together for Children and Young People, about how we take that forward, as well as, if you like, the learning events that take place. But I don't think we can just say that having two learning events a year is going to be enough. That's why the work streams approach will still matter to us to have a proper and structured improvement approach.

11:20

That kind of brings me on to whether you are satisfied that the Government's response to addressing the issue of the missing middle has been adequate.

I would say that I could not say it's been adequate in the sense that all the problems are resolved, because they're plainly not. But in terms of whether we're making progress then, yes, we definitely are and that is real. I don't think you should underestimate the impact that the report has had within and across different areas of service and the level of commitment and activity there is to making the difference that the committee highlighted was plainly required. So, I would say we're in a better place, we're certainly not where we still want to be, there's more to do, but don't underestimate the progress that the committee has been part of making and the continued commitment to carry on doing it. That's not just because we know we'll get asked about it, it is because there is a genuine view that we do need to review the way that we deliver services with and for people, and that's why the transformative approaches and the learning that we're talking about come on the back of people genuinely changing the way that our services work around and for people.

How will that look in your eyes? When we were going through this process, there were questions about whether it's adequate. What will satisfy you in terms of the progress that's being made?

I'll be satisfied when we've got the assurance about not just meeting our performance benchmarks on the specialist end, but that actually we can describe an approach that really is about wraparound earlier intervention and support, and we can then highlight that that has made a real difference and there's more to come. That would be adequate in the sense of there being real progress consistently across the country, but there will still be more that comes from there. I don't want to get into being a Labour politician who quotes Bevan all the time, but the service will never be entirely adequate because we'll always then have more to do. That's not just about the demand that comes into the services, but it's also because we'll always learn that what we did yesterday we've actually got a better way of delivering the service today and tomorrow. But actually what we are definitely on the path to doing is recognising that we have a better way of delivering that. It's at different points in different parts of the country, so I wouldn't tell you that it is at an adequate place now, because we don't have some of the more national consistency that I would like to see in the pace and the progress of change, but I think we'll get there and then we'll have to look at what we need to do next. 

Thank you. We've got some questions now on neurodevelopmental services from Siân Gwenllian.

Pa gynlluniau sydd ar waith i sicrhau bod digon o gapasiti i ateb y galw cynyddol sydd yna ar gyfer gwasanaethau niwroddatblygiadol?

What plans are under way to ensure that there is sufficient capacity to meet the increasing demand that there is for neurodevelopmental services?

There's continuous work ongoing to try and understand the demand that exists within new services. We have invested in the services, as you know, together with the new waiting time standard, and we are seeing more demand coming into the system. Actually, we think, having introduced a target and announced some investment and new services being in place, we're actually seeing more unmet need come through. We still don't understand what that looks like to then say, 'Do we now understand how much we need on a regular and sustained basis?' So, we'll need to try and make sure we get on top of people who come in and require an assessment, and then understand how much we need to then, not just cut into waiting times, but deliver a sustained service. So, I don't think that is something that I would tell you would happen within a couple of months, but I would expect that we can provide an update on that through the year as we're getting towards, not just publishing information about referral to treatment, about the 26-week waiting time standard, but that actually, we can then have a better conversation with you and share more information with you about what generally having capacity and demand to match each other looks like. And that may well require some staff investment, which means that you can't just switch the tap on and the staff will be there. So, it will take time to understand what we need to do, as well as then understanding if there’s any further staff investment required, and then, actually, about getting there. And that comes back to the time and the pace that we're able to honestly provide.

11:25

Does yna ddim dwywaith bod yna broblem fawr yn y maes yma. Rydym ni wedi cael gwybodaeth gan fwrdd iechyd Betsi Cadwaladr yn dangos 56 y cant o gynnydd mewn referrals ar gyfer asesiadau neurodevelopmental. Rydym ni'n gwybod—mae Betsi'n dweud wrthym ni—allan o'r 1,653 o blant a phobl ifanc oedd yn disgwyl am asesiad, roedd 1,024 ohonyn nhw wedi bod yn disgwyl dros 26 wythnos. Mae yna broblem, on'd oes? Dwi'n ei weld o yn y nifer o achosion sy'n dod ataf i—rhieni yn poeni bod eu plant nhw jest ddim yn cael unrhyw fath o gymorth, ac wedi bod yn disgwyl am amser hir iawn. Ac wrth wraidd hyn, bron bob tro, y rheswm bod nhw ddim yn cael cefnogaeth ydy eu bod nhw ddim wedi cael yr asesiad niwroddatblygiadol. Felly mae hwn yn cael effaith uniongyrchol ar y cymorth a'r gefnogaeth sydd ar gael i blant a phobl ifanc, ac yn mynd yn groes i unrhyw fath o fwriad o wneud early intervention. Mae yna broblem yn fan yma, on'd oes?

There's no doubt that there's a grave problem in this area. We've received evidence from Betsi Cadawaladr health board showing 56 per cent of an increase in referrals for neurodevelopmental assessments. We know also—Betsi tells us—that out of those 1,653 children and young people who are waiting for an assessment, 1,024 have been waiting for longer than 26 weeks. So, there's obviously a problem. I see it in the number of cases that are referred to me—parents are worrying that their children are not having any support, and have been waiting for a long time. And, at the root of all this, practically every time, the reason they're not having support is that they haven't had that neurodevelopmental assessment. So, this has a direct impact on the support that is available to children and young people, and it goes against any intention to do this early intervention. There's a serious problem here, isn't there?

We know there’s a real challenge, and it’s not being ignored. That’s why we are looking to invest in and around the service. We have done so. But to get to the point where we have balance between capacity and demand is not exactly where we are. There is a point about the model of what’s delivered and wanting to have an assessment, but then what an intervention looks like. Because intervention isn't just health, and it's about the understanding of other services around that. I know Jo has actually had a direct conversation with Betsi Cadwaladr about this in the recent past.

But without the assessment, the other services aren't able to move. That's the problem. There's a bottleneck happening there, because there aren't enough people to do these assessments.

Can I just say—? If you went back a couple of years, obviously, these separate services didn't exist, so there wasn't really a service that was meeting the needs in most parts of Wales. So, the investment in the new service was an attempt to meet that unmet need. I don't think anybody would have anticipated—. I think we knew what the backlog was at that point, because some of these young people had been sat on a specialist CAMHS waiting list. But, clearly, because there hadn't been a service previously, there are, if you like, children at various ages that have now come forward for assessments that we wouldn't have seen before.

Betsi, actually, in terms of the service they were trying to offer, was an assessment and an intervention at the same time, and that’s why their performance, when we dug into it, is probably not making as much progress as other areas. The conversation that they've been having with their stakeholders recently is actually exactly what you're saying: what people really want is the assessment, because that allows access to other support in education. So, what they're trying to do now is to try and look if there's a way they can remodel their service to frontload the support into the assessment. We're talking to them about how we might support them with some additional capacity to help them with their backlog there.

And this is one of the reasons why we haven't been able to publish the data—health boards have been, perhaps, modelling this service in different ways. Some have just been, really, offering an assessment and nothing further. Others, like Betsi, have been trying to offer—which is what we had envisaged the service would do—offer an intervention as well. And, in a sense, that's—. By trying to deliver that intervention, they're slowing up the ability of people to come through for the assessment. So, this is the learning we're having, and you'll hear some more of this, I suspect, next week, on the Together for Children and Young People programme. But that's the bit that we're trying to do now: how can we do both, but as a priority speed up the assessments? I had the conversation with the Hywel Dda health board yesterday, who are in a bit of a similar situation, so we are trying to resolve that.

11:30

Yes. I understand that the data may be different because different boards are doing different things, but it's important that we have that data. Are you able to share that with us—the data around the referrals?

I think we can share some management data on what's coming in with the committee. We're not publishing it, because it's not of the standard and consistency you need to publish statistics, and it will come with caveats about the inability to properly compare between health boards, but we can share the—. I'm happy to make an offer to share the data that we have that's management information, so you can see what's being provided.

Okay. Well, again, as much information as possible is really useful for us, and in terms of transparency. Obviously, you understand that.

Okay, thank you. We've got some questions now on in-patient care from Suzy Davies.

Thank you, Chair. Can I just start, then, with the neurodevelopmental question? You committed to an urgent review of the appropriateness of placement of children with autism in hospitals in England, and with learning disabilities as well. Can you tell us how the review's going? Have you got a timeline for that, when you expect to report?

Yes. That part of the review is being led by Jean White, the chief nursing officer, who leads on learning disabilities. I've had a conversation with her recently. So, in terms of the wider review on learning disabilities placements, I think she's expecting a report shortly, and then there's the second piece of work on a couple of individual placements, and that work's ongoing. So—

And those are about autism rather than learning disabilities. I appreciate they can be—

Yes, it's about both, actually. It's about both.

Okay, will you give us—? If we can have a note, perhaps, on when that work—

Yes, certainly. We'll get that from Jean.

[Inaudible.]—July.

Oh, right, okay. That's pretty imminent, then. That's fine. Okay, thank you.

Well, the Together for Children and Young People programme, the recent update referred to the ongoing significant demand pressures for in-patient care throughout Wales, and the UK more widely, really. I think there's a second review that's due to report by April 2020 as well, on what the NHS and independent sector provision in Wales is for medium to longer term care. We know that within Wales at the moment current provision is restricted at both Tŷ Llidiard and at Abergele. The Ebbw Vale facility is not taking people from Wales anymore. This came up in questions fairly recently in the Chamber. Can you tell us what your current position is on the safety at these facilities?