Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

26/06/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Angela Burns MS
Dai Lloyd MS Cadeirydd y Pwyllgor
Committee Chair
David Rees MS
Jayne Bryant MS
Lynne Neagle MS
Rhun ap Iorwerth MS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Adam Morgan Cymdeithas Siartredig Ffisiotherapi
Chartered Society of Physiotherapy
Dai Davies Coleg Brenhinol y Therapyddion Galwedigaethol
Royal College of Occupational Therapists

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Amy Clifton Ymchwilydd
Researcher
Claire Morris Ail Glerc
Second Clerk
Dr Paul Worthington Ymchwilydd
Researcher
Lowri Jones Dirprwy Glerc
Deputy Clerk
Sarah Beasley Clerc
Clerk

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

Cyfarfu'r pwyllgor drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:30.

The committee met by video-conference.

The meeting began at 09:30. 

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

Felly, bore da i chi i gyd a chroeso i bawb i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon, yma drwy gyfrwng fideogynadledda Zoom. O dan eitem 1—cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau—dwi'n gweld bod fy nghyd-Aelodau o'r pwyllgor yma i gyd. Bore da i chi i gyd. Yn naturiol, fel rhagarweiniad, gwnaf i nodi, fel dŷn ni wastad yn ei wneud yn yr amseroedd arbennig rydyn ni i gyd yn byw drwyddynt ar hyn y bryd, fod y cyfarfod yma yn digwydd yn rhithiol—yn rhithwir—a chyda'r Aelodau a'r tystion yn cymryd rhan drwy gyfrwng Zoom.

Allaf i bellach esbonio bod y cyfarfod yma yn ddwyieithog a bod gwasanaeth cyfieithu ar y pryd ar gael o'r Gymraeg i'r Saesneg? Yn naturiol, mi fydd cyfarwyddiadau i ddiffodd y meicroffonau i'w gweld ar y sgrin, a bydd angen i ddefnyddwyr fod yn diffodd a deffro eu meicroffonau yn dilyn y cyfarwyddyd fydd yn ymddangos ar y sgrin bob tro rydych chi'n siarad. Mae yna rywfaint o oedi, fel y byddwch wedi sylwi eisoes, pan fo rhywun yn siarad Cymraeg. Mae yna oedi o ryw bum eiliad o achos y cyfieithu.

Allaf i bellach nodi, gogyfer y cofnod, os bydd yna unrhyw anhawster efo'r rhyngrwyd yn fy nhŷ i yn fan hyn yn Abertawe a byddaf yn diflannu o'r sgriniau—yn naturiol, bydd hynny'n rhywbeth anffodus, mae'r Aelodau wedi cytuno cyn hyn? Maen nhw hefyd wedi cytuno cyn hyn y bydd Rhun ap Iorwerth yn cymryd drosodd y gadeiryddiaeth o dan y fath amgylchiadau. A oes yna unrhyw ddatgan buddiant? Dwi ddim yn credu bod yna.

Good morning, everyone, and welcome to this latest meeting of the Health, Social Care and Sport Committee here via video-conference on Zoom. Under item 1—introductions, apologies, substitutions and declarations of interest—I see that my fellow Members of the committee are all here with us. Good morning to you all. As an introduction, I will note that, in these special times that we're living through at the moment, this committee is taking place in a virtual capacity, with Members and witnesses taking part via Zoom.

May I also explain that this is a bilingual meeting, and that an interpretation service is available from Welsh to English? There will be instructions to switch off the microphones and to switch on the microphones. Those instructions will appear on the screen, and you will need to switch on your own microphones following the instructions that appear on the screen every time you wish to speak. There is some delay, which you will already have noticed, when there is a contribution in Welsh. There's around five seconds' delay after the contribution has finished.

For the record, if there should be any issues with the internet connection in my home here in Swansea, and if I should disappear from your screens, we have already agreed as Members that Rhun ap Iorwerth will take the reins as Chair, should those circumstances arise. Are there any declarations of interest to be made? I don't believe that there are.  

2. COVID-19: Sesiwn dystiolaeth gyda Choleg Brenhinol y Therapyddion Galwedigaethol a'r Gymdeithas Siartredig Ffisiotherapi
2. COVID-19: Evidence session with the Royal College of Occupational Therapists and the Chartered Society of Physiotherapy

Felly, rydyn ni wedi symud ymlaen i eitem 2, a pharhad â'n hymchwiliadau i mewn i bandemig COVID-19. Dyma sesiwn dystiolaeth gyda Choleg Brenhinol y Therapyddion Galwedigaethol a'r Gymdeithas Siartredig Ffisiotherapi. I'r perwyl yma, dwi'n falch iawn o groesawu i'r sgrin, fel petai, Dai Davies, swyddog polisi Cymru, Coleg Brenhinol y Therapyddion Galwedigaethol. Bore da, Dai. Mae yna sawl Dai yn y cyfarfod yma heddiw, felly byddwn ni ar flaenau'n traed. Hefyd, croeso i Adam Morgan, uwch swyddog negodi, Cymru a gorllewin canolbarth Lloegr, y Gymdeithas Siartredig Ffisiotherapi.

Croeso i'r ddau ohonoch chi. Diolch yn fawr iawn i chi am y dystiolaeth ysgrifenedig rydych chi wedi'i chyflwyno ymlaen llaw. Yn seiliedig ar hynny, a thoreth arall o dystiolaeth rydyn ni eisoes wedi'i derbyn, awn ni yn syth i mewn i gwestiynu. Mae gyda ni rhyw awr fach, ac mae'r cwestiwn cyntaf o dan ofal Jayne Bryant. Jayne.

So, we move on to item 2, and the continuation of our inquiry into the COVID-19 pandemic. This is an evidence session with the Royal College of Occupational Therapists and the Chartered Society of Physiotherapy. To that end, I'm very pleased to welcome to the screen, as it were, Dai Davies, policy officer Wales for the Royal College of Occupational Therapists. Good morning, Dai. There are several Dais here in the committee today, so we will be kept on our toes there. Also, welcome to Adam Morgan, senior negotiating officer, Wales and west midlands, for the Chartered Society of Physiotherapy.

Welcome to both of you. Thank you very much for your written evidence that you've submitted ahead of the committee meeting. Based on that evidence, and a whole host of evidence that we've also received ahead of this meeting, we'll go straight into our questions. We have about an hour, and the first question comes from Jayne Bryant. Jayne.

Good morning. What's your assessment of how the workforce has responded to the pandemic?

Pwy sydd eisiau dod i mewn yma? Dai Davies.

Who wants to come in here? Dai Davies.

Do you want me to go first, Dai?

From a physiotherapy perspective, I think that the workforce has responded extremely well. There was a need at the beginning of the crisis to redeploy staff from areas that had wound down, such as out-patients, and then take them into areas of acute care. I think staff have done extremely well and have responded extremely well to this need. There was a lot of training that needed to happen as well, because, for example, staff from the out-patients departments might not have had the skills and knowledge that they needed. So, there was a large amount of training.

There was even then a demand for physios to take on extra roles, which they tried to do as best they could. So, given the numbers that were being expected, and the nursing ratios to patients, physios were expected maybe to do a little bit more than what they would previously have done. So, therefore, they had that extra training and took it on willingly, and were there to not only provide the physiotherapy care that would be vital for COVID patients and the subsequent rehab afterwards, but also to support our other colleagues in the nursing and medical profession by taking on some of the roles that were able to be done by physiotherapists. So, I think they've responded extremely well. However, that doesn't come alone, and I think there is an element of stress and potential burnout that could come as a result of that extra work and demand, physically and emotionally, on them, especially if a second wave was to come.

09:35

Yes, quite similar to what Adam said—so, at, obviously, the start of the pandemic, occupational therapists and other allied health professional colleagues were very much in use in managing the system. Obviously, we were expecting quite a significant input into social care and healthcare, so our occupational therapy and AHP colleagues were freeing up space in hospitals, in the NHS, and were working in social care to ensure that people stayed home and people could be managed at home.

So, there was loads of work in relation to the process and the systems and making sure that the system was functioning appropriately. Our OTs have been really innovative in the use of technology, especially our social care colleagues who haven't been able to go out and access some of the service users—so, using all sorts of technologies from WhatsApp to Google Maps and all sorts of different innovative things so that the patient can have access to the service.

I was speaking to our social care colleagues on Wednesday, and they've never worked harder. Like Adam was saying, the pressure and the level of work they have to do is something that we need to be aware of, because we don't want to burn out our staff.

So, it's loads of innovation, loads of working slightly beyond our boundaries to meet need. Obviously, we're hoping that this proves the worth of what decent AHP, occupational therapy, physiotherapy services can bring to the system in relation to keeping people at home and keeping people fit and well after they've been admitted.

Brilliant. Thank you. Are there any lessons that you think could be learnt from what staff have been through during this time for any future, second wave?

Yes. For us, it would be for AHPs, occupational therapists, to take patients at the start of the treatment—so, make sure that we've got therapists in intensive care units, in accident and emergency, as soon as someone comes into the service. The culture then is, 'How can we rehab this person?' It's very important that we remove the disease, and our doctors, nurses and others do really good work on that, but we've got to look at, 'How do we get this person better? How do get this person rehabbed?' straight from the admission. I think we've had that with OTs in GP practices and physios in ICUs and stuff. Slightly changing that culture, I think, is the main lesson—that we are there at the start.

Yes, I would completely echo Dai's point there, that we need to have AHPs and rehab seen right from the start, and then that care and rehab happening right throughout the pathway, from front door right through to community and even, then, looking at return to work. Because, for somebody who's been in ICU for three, four, five weeks with COVID or any other disease, the transition from hospital to home, or even from ICU to the ward, isn't where their journey stops. Their journey back to normality or some form of normality can take many months and even years, if they can even get back to that normality. So, I think it's really key that the AHP services are right at the front, but go right through that pathway, for societal and economic reasons alongside the personal reasons. It's really important that we have that to integrate them back into society post COVID as well, or post injury or illness.

Can I add something as well? Obviously, it's understanding what we don't want to lose from prior to this, especially in children's services. Lots of our services were based around schools and our speech and language colleagues are talking a lot about how they are unable to provide some therapies now, because of the hub model with schools and stuff. So, technology is great and the use of virtual is great, but we need to go back to a blended approach. Because, especially with children and people with cognitive issues, dementia and stuff, maybe virtual is not the best use of our therapists. So, looking at how we reopen these services as safely and quickly as possible is another lesson we've got to learn.

09:40

Okay. Thanks. You've both touched on it, talking about the potential for burnout of the workforce. How is the morale at the moment?

It's—. They're tired. I was speaking to my social care managers on Wednesday, and they're all trying to think of different, innovative ways of managing their workforce, especially in social care. Some of the counsellors, they're working from home, so that can be quite isolating for people. So, they're trying to think of ways of bringing people in, talking. We've got some—again, we've got some really good occupational health services. We've got a well-being in work service in Swansea Bay. That's where OTs and physios are based, and that's really good. But it can be patchy throughout Wales, our staff's access to a decent occupational health service that focuses on their mental health. So, yes, they're really, really proud of what they've done, but they're still human beings at the end of the day, and I think we need to support them.

Just on a physiotherapy perspective, and speaking to members, they feel that they've been running at 100 mph for the last four months. And then there's a feeling, sometimes, that now that managers have the space for considering that staff safety, now it's coming into it a little bit more—and staff well-being—whereas, at the start of it, the focus was on the operational and clinical demands and the focus on the patient—rightly so, but then staff can kind of come secondary to that. So, I think there's a danger that staff can now be feeling, 'Oh, now you're worried about us as staff.'

So, I definitely think that the longer this goes on—. And other issues that come into play as well, such as childcare issues at the minute, now, moving forward, are causing significant concern for members. So, it's a feeling of, 'Well, I've done all that, but now that initial crisis is over, then I've still got all this to deal with as well'. So, it's not necessarily the crisis they're dealing with; they're now dealing with a crisis of childcare, and that takes further emotional toll and stress on individuals.

Ocê. Reit, symud ymlaen.

Okay. Right, moving on.

Personal protective equipment and testing. Dai Rees, or David Rees. Too many Dais. Dai.

Diolch, Cadeirydd. Good morning, both. Before I go on to testing, I just want to come back to one point on these lessons learned. You've mentioned that you should be in at the beginning, and Adam, I think, highlighted that it's non-COVID as well. I'm assuming, therefore, that's a move you want to see happen irrespective, and COVID-19, I'm assuming, has highlighted this more as an example. Is that correct?

Absolutely, yes. We've been trying to highlight that with the primary care model in Wales and, obviously, 'A Healthier Wales'. We've got really good areas of practice throughout Wales, where we're in GP surgeries or where we're in A&E, and that makes a massive difference to admissions and just to keeping people healthy and fit at home. We'd like that spread out throughout Wales. So, it's been part of the campaign, the Right to Rehab campaign, for us for the last two years, to be perfectly honest. And I think our managers want to highlight that as well: it's not just COVID-19; it's the whole service that needs to improve.

Okay. Thanks for that. On testing, the CSP highlighted in their written evidence that, at the beginning of this pandemic, there were some serious questions on PPE. But I was under the impression that you felt that things were changing as a consequence of the changes to the guidelines and the information you put on your websites. Are you seeing—for both professions—an improvement in access to PPE now, and are you confident that, if it came again, that access would be available and the PPE would be available for the allied health professions as well?

At the beginning, as you said, and rightly so, we did have concerns around the level of PPE and, in particular, some specific bits of PPE. I think the partnership working that we've done with Welsh Government and NHS employers helped to allay some of those fears, because they then set up PPE briefings, which meant that we could actually see the figures that were available—based on the previous seven days' usage, how much they had going forward—and then we could hold NHS employers to a bit more account to know what would be put in place for that.

I think, at the beginning, as well, some of the main concerns were coming from community hospitals and the social care sector, and those kind of rehab settings, because they were probably a little bit forgotten in terms of what is required for PPE. So, I think there was a focus to get PPE to the hospitals, but we know that, looking back, community hospitals really have areas that weren't necessarily free of COVID and that it was just as important to have the correct PPE there. I think some of the guidance change around sustained community transmission was helpful then in clarifying what was needed in those community hospitals.

Moving forward, from the conversations we have and the regular briefings we have at this level, I feel there is sufficient PPE, and from the discussions that we've had with Welsh Government, it seems that they have secured more lines of procurement, which makes me feel more happy as a trade union representative in Wales that there will be sufficient PPE going forward. But that's not to say that we will take our foot off the pedal in holding the Government and NHS employers to account, making sure they are providing the correct PPE to keep our staff safe and our members safe.

09:45

I just want to talk about that. What Adam said is completely right and completely right from our point of view as well. So, as Adam said, we are going to keep our foot on the pedal in relation to PPE, especially in the community as things open up. It's really important community services slowly open up so we can keep people fit and well at home, and our staff need confidence, and having access to PPE gives them confidence. We haven't had many issues, as referred to, with PPE, but it is just the confidence of our staff to be able to deliver important services in the community safely. So, we'll be keeping our eye on the supply of PPE, especially to community-based services.

On that particular point on the community services, are you confident at this point in time that that is now a major consideration in supplying PPE?

From speaking to our social care managers on Wednesday, they are quite content at the moment they've got enough supply of PPE to go out into the community, yes.

Just one thing that I missed out when I was speaking was around the physiotherapists' concerns about the aerosol-generating procedures' classification of the level of need for PPE. I think in some instances, there were some arguments that physiotherapy interventions weren't classed as AGP, so therefore didn't afford them the high level of personal protection. Now, that's a wider, UK national argument that CSP have been having with public health bodies. But from a physiotherapy perspective, that did raise a lot of concern for members, because they felt they were at high risk when they were doing certain procedures, but they weren't necessarily classed as aerosol-generating procedures. I think we've overcome that with some of the arguments that members had with management and therefore we're afforded that high level of PPE.

And did both of your groups actually have training? Because one of the things that have been raised with us is the appropriate use of it so that people know how to use it correctly. So, have your teams, especially if you're going into aerosol—if you talk about going into the accident and emergency section, there's going to be a different demand on the staff going in there than there would be, perhaps, in other areas. So, have they had sufficient training?

Talking as a physiotherapist who went back and did a clinical shift as well in an intensive care unit setting, it appeared that there was very good training into donning and doffing PPE. There were some queries around the fit testing of masks that we had, but I think, on the whole, most areas had access to a fit test. I think there were some concerns about the availability of certain parts of the kit that is required for fit testing of masks, but that was more on a local basis and that one, I think, was largely overcome.

I've spoken to our OTs going into intensive care units in Cardiff, and they haven't raised any concern about training, so I haven't had any concerns about that, Dai.

Okay. On testing, how are your staff's views on the testing of staff? Clearly, we are in a generation where the Minister has said all NHS staff will be tested, but how are your members feeling regarding the testing regime that they've experienced to date?

So, from a testing perspective, I think, at the beginning, there was a lot of variability across Wales about time frames. So, I had stories of some people waiting five days for a test and getting a result in 24 hours, and people having a test in 24 hours, then getting their result in seven days. So, there is a lot of variation in terms of the time frames, and, obviously, those time frames can cause concern for members of staff. Also, we know that the testing itself isn't the be-all and end-all; there's a clinical question that needs to be asked around those tests as well. I think there was confusion around antigen and antibody testing. I think there's still ongoing confusion about antibody testing, in that nobody quite knows what it's for at the minute, and some individual health boards are doing antibody testing for different purposes that aren't necessarily clear at the minute. So, from our perspective, we're very keen that antibody testing doesn't give any level of risk to an individual returning to work, and that it should be used more for surveillance and a view of what's happening across Wales in terms of who's had COVID, who hasn't. I think there's still some confusion out there with staff. 

So, in summary I'd say staff experiences of testing were variable across Wales: some good practice, some very poor experiences and a long time frame for those tests to come. I think we could have been clearer on the messaging that we got out, and we still need to be clearer on the messaging we get out. 

09:50

Similar to Adam, so it wouldn't really add much more to that—he said it quite succinctly—there's variation, especially with our social care staff as well, and understanding the processes and stuff like that. But generally, the themes of what Adam said is correct.  

And then in relation to the OTs, the social care staff side and the social care side of things, obviously they weren't initially on the front line—it was targeted at NHS front-line staff—are they now having sufficient testing in the social care sector?

That's the argument, isn't it? They are front line, I would say—they're the ones keeping people out of hospital and keeping people from not falling over and breaking their hips, and adding on to the pressure we're already having. It's the variation, again, with the councils and the variation of the messages. It's always been a problem, and I suppose with COVID-19, and just with the testing, that's obviously magnified. It's the variation and understanding that social care staff are vital as well. It's strange that we've got to still have this argument at times about healthcare and social care, so I'd emphasise that social care staff are vital and they should have the same level of testing as the NHS.

Can I ask a question on that point, then? Is it a question of there should have been a clearer steering from Welsh Government to local authorities to ensure there was consistency across Wales?

'Yes' is the simple answer. 

Okay. Diolch, Dai. Moving on to the rehabilitation challenge ahead now post COVID. We're going to have Angela first, then Rhun, but this is your stage now, team, because some of us are absolutely convinced, with the particular type of patients we are seeing now post COVID needing quite intensive rehabilitation, now is the time to put rehabilitation properly on the front line, as you've just discussed there. Anyway, Angela, you can kick off. 

Yes. Thanks very much, and thank you both for coming before us today. One of the things that strikes me is that the pandemic has highlighted the gaps that we have throughout the NHS and social care systems, which is great because, actually, by having identified those gaps, we can now start to really understand what they are and plug them. So, I just wondered if you could go through a little bit more about the gaps that we have in rehabilitation services, and whether you have any concerns that we're going to be putting money into just trying to sort out COVID patients, and what's happening to everybody else who might have had a stroke—you might need speech and language therapy, you might also need physio to get back to work, you might need to have occupational therapy at home, to make sure that your house has got adaptations. So, perhaps you could just give us, if possible, a quick scene setting as to where you feel the position is now and what kinds of things that you think we really need. Is it people? Is it money? Is it facilities? Because I've got lots of direct questions, but I just want you to give us an overview.  

Okay. The Right to Rehab campaign has been going on for a little while, and it's trying to identify areas where rehabilitation in Wales is not as good as it should be. So, if we start at where people access services, so be that through your GP, through accident and emergency departments, through an ambulance coming to your door—we've got some services in Wales where allied health professionals are attached to those. We've got services where physiotherapists and occupational therapists and podiatrists are first-case practitioners in GP surgeries, or you've got certain teams, like the 'home first' team in Prince Charles, where you go into A&E and you get seen by a physio or an OT, and that starts the journey straight away. And like I said earlier, that starts the culture of not just getting in to get treated—you're going to get rehab as well from the start. So, you see that real potential.

So, we welcome the Welsh Government's policies at the moment, especially 'A Healthier Wales' and the primary care plan, and there are some really good intentions there. But there's always the argument for more resources and more focus on that rehabilitation area. So, we would like good practice to be highlighted and spread throughout Wales. So, that's a real big job for the regional partnership board with this transformation money.

As a college, we would like clarity in how they're determining those transformation-type examples to be spread out throughout Wales, because we wouldn't want it to be process-driven example of how you just get people through a system really quickly. We want it to be how you get a person through the system and get them better from their outcomes at the end.

So, it's really looking at where people access their health and social care, get AHPs in as soon as possible, and then properly fund it and give us numbers as we go through.

09:55

Thank you. As I see it, I think we've got a crisis of deconditioning coming our way. We know that there have been four, five, maybe six months where individuals haven't been able to access community physiotherapy, occupational therapy and speech and language therapy, and that's right from children up to older adults.

I suppose it would be helpful to set the scene of a personal story, in terms of my father who has chronic health conditions. He's been told to shield, which is fair enough, to protect him from COVID. But as a result, he's ended up not being as active. He's put on weight, which has made the lymphedema worse in his legs, which leads to further ulcers developing on his legs. And now he's got the challenge to get himself more active again and to lose that weight. And we know that there's a risk to him in terms of his physical health, but also his mental health from staying inside four walls for three or four months. I've seen the impact on him. That's an individual story, but you multiply that by the number of shielded patients in Wales, and I think it adds up to a significant challenge that we need to address. I would agree with all of Dai's points about how we address those challenges.

I think the real key perspective for me is that we welcome the expansion of student places for a number of the AHP professions, but we need to translate those into front-line workers. I think it's a very good headline to commission the numbers, but the challenge then is how you translate and how you influence the finance directors in individual health boards and the chief operating officers in those individual health boards to say, 'Listen, we've commissioned those numbers in 2021. In 2024, we need those in practice to do this work.' I think that's one of the key aspects that we need to look at—how that gets translated into front-line clinical workers.

Now, I know that in one of your evidence reports that you gave us—I'm sorry, I can't remember whose it was—you mentioned the good work of Aneurin Bevan. Because I did ask, formally, the Minister to give me a list of what was happening with the £10 million, and I'm really pleased to see—. Obviously, I don't know whether they've used some of that £10 million that's supposed to go for rehabilitation of COVID patients, or whether it was just something they've put together. But I just wondered if you could expand on that a bit, because one of the concerns I have is that when I ask the Minister—and he's come back with examples of specific projects, like the enhanced virtual ward scheme in west Wales; Cardiff and Vale is expanding its existing partnership discharge arrangements through the Get Me Home prevention Pink Army project; and the west Glamorgan partnership is doing hospital-to-home scheme—it's all about discharge, and I haven't actually spotted once in any of this the word 'rehabilitation'. It seems to be that all of the projects here are about scaling up rapid discharge schemes, providing additional bedded capacity in the community, support and equipment to maximise independence and increase and enhance community-based services, which could mean absolutely anything. I'd understood the £10 million was supposed to be driven towards proper rehabilitation, so I just wondered if you could tell us what you're seeing on the ground, tell us a bit about the good practice you've seen and where we're lacking.

10:00

So, like I said previously, obviously there's always that concern that stakeholders focus on that process-driven sort of way of getting people in and through the system, which is important because the system's got to work appropriately, but we've got quite clear legislation in Wales with the Social Services and Well-being (Wales) Act 2014 that it's about what matters to the person. So, if we're asking that question about what matters to the person in relation to their health and social care, they're not going to be, 'Let's get me quickly through hospital'; it might be, but it would be, 'I want to be able to do the things that I want to be able to do', so that's where rehabilitation gets involved. 

So, services that are based on that viewpoint seem to work better. So, we've got great examples in integrated services in Monmouthshire that focus on that. So, that's really, really important. There are excellent bits of practice throughout Wales at the moment. So, I think it wasn't within Aneurin Bevan, but I know Aneurin Bevan have set up that step-down unit in the Velodrome where AHPs are working. That's been really good and important because of that patient group. But, again, our managers really want us to emphasise it's the importance of the system. It's not just COVID-19. Rehab is rehab and they want to rehab everyone within the system, even though this has given us a real good focus on the importance of rehabilitation.

So, there are good bits of services around. We would be interested in what that £10 million has been spent on. Obviously, we had some media recently in the BBC and that was what Welsh Government told us was happening. So, I'd be more than interested to see where that £10 million has gone.

Adam, have you seen examples of best practice you can share with us or where you—? Because I think the Government's intent in giving the £10 million is absolutely pure; I'm just worried, as all these things are, that it filters through all the different layers and gets, sort of, dispersed, and actually it strikes me that we need more people who are trained on the front line to deliver the services to help people get better.

So, some examples of good practice that I've seen are around utilising our support workers in ITU, but then also seeing those same patients on the wards and on discharge to bridge a gap between hospital services and community services, for example. And I know there's some good work going on in terms of earlier discharge from stroke services. And I know what you're saying, Angela, about this, it's not always about the discharge, but actually that continuity of care can be a very important thing for individual patients and for that continuation of the rehab across the pathway.

So, there are lots of innovative ways. I think AHPs have suffered from projects though, in a way, so ICF funding and other projects, 'Set this up for two years, tell us how well you've done and then it's got to be integrated into the health board.' And then, all of a sudden, there's a wide review of all the projects that happened and they say, 'Well, we can't now afford all the 20 projects across the health board that have been done because Welsh Government are telling us we need to save £20 million, £30 million, £40 million—however many million.' So, I think AHPs have suffered from that because they feel that's the only route that they can get funding. And then it's looking at spaces again within a limited budget of how they incorporate that, and that's not where we need to go. We need physiotherapy, occupational therapy, speech and language, dietetics as key roles in the holistic care of patients, and I think it's as simple as that. There's stuff that AHPs can do that maybe doctors or nurses are currently doing, and we know the shortages with those professions, but there's much more that we can and should be doing. 

Do you think—? Before I hand over to Rhun, can I ask you one last question? Do you think you can just explain to the committee a little bit more about this apprenticeship package through Health Education and Improvement Wales and what you would hope that that might achieve and who could—? Because obviously we can't just magic resources up out of nowhere, can we? We need trained personnel. But from what I've managed to glean, this might be a really good way of bringing in new people into the profession.

So, over the last year a few of the AHPs have been working with HEIW and Skills for Wales to look at an assistant level 4 practitioner. So, they've worked really hard in developing the framework and the training, so we're really keen for it to be rolled out now. So, already, band 4, band 3 staff can be as skilled up as possible, to be more autonomous and to get extra staff, so like Adam was saying, the importance of that support worker can't be understated, actually. I was speaking to our stroke team in Cardiff yesterday and a lot of the stroke support workers do valuable, valuable work, so we're really keen for HEIW to start rolling out that level 4 apprenticeship and we're really keen for stakeholders in the NHS to look at their modelling so we have the resource to be able to get that really key part of the workforce.

10:05

So, what level can you go in as a—? How old are you? I mean, are we taking—I don't know—kids from college to try and enrol them in apprenticeships? Or is it at the next stage up? Can you make it a bit clearer for us?

It could be, obviously, school leavers to people that have worked in health and social care, so they've got to meet a certain standard. I know if they've been working as support workers in OT or physio services, they would have done the level 3 below, but not all our staff have done the level 3 below, so that's another concern. And obviously, then, I could send you the details as we go on, but it would be a certain educational standard that you would have to have hit as well.

But it does mean, then, that instead of saying we can only rely on fully trained OTs, fully trained physios, fully trained podiatrists, this is a way of getting people into the profession and then allowing them to grow through it and train through it, but they're basically useful from pretty much day one.

Yes. That pyramid, we always say, so we have the qualified staff at the top, but actually everyone's a qualified member of staff, everyone's a professional—I always say that. But it's really important that our support staff are as trained up as possible, so they can make decisions that they can do, just to get the system as efficient as possible.

My final question, very quickly then, is just: are you able to access the adaptation processes now? Has that all been opened back up again?

No, not at the moment. It's slowly starting, so I'm speaking to our managers on Wednesday. Emergency hospital discharge are still doing stuff, and obviously some emergency moving and handling stuff. It's a complicated system, because the councils have to have contractors and surveyors and they're still not working, but our therapists are still going and assessing people, I still try to point out. But it's really important, because if a stairlift saves someone falling down their stairs and breaking their hip, it's really important that we get that started again. So, yes.

Rhun, roedd gen ti gwestiynau ar yr her yma, rehabilitation, cyn i ni symud ymlaen i'r adran nesaf. Rhun.

Rhun, you had questions on this challenge with regard to rehabilitation, before we move onto the next section. Rhun.

Dwi'n meddwl bod y rhan fwyaf o'r cwestiynau ynglŷn â rehab wedi cael eu gofyn yn fanna, mewn ffordd. Un cwestiwn i'r ddau ohonoch chi, o bosib: i ba raddau ydych chi'n meddwl, os ydyn ni'n edrych ar yr anghenion rehab fydd yn codi'n uniongyrchol allan o COVID-19, i ba raddau ydych chi'n meddwl y bydd methu gwario digon ar roi'r adnoddau mewn lle i ddelio â hynny yn costio mwy yn y pen draw?

I think that the majority of the questions with regard to rehabilitation have been asked there. But one question to both of you, perhaps: to what extent do you believe, if we look at the rehab needs that will arise directly as a result of COVID-19, to what extent do you believe that failing to spend sufficient amounts on putting the resources in place to deal with that will cost more, ultimately?

Yes. I think there is no doubt that if we don't put that focus on rehabilitation, it will cost more. As you said, a hospital stay for a night in a ward bed is £400-odd per night. That's without any operation that somebody needs from breaking their hip because they've become less active and they are at a higher risk of falls. So, I think it's a fact that if we don't spend that money on proactive approaches to stop those issues arising, then it will cost more in the future. And it's, from my perspective, almost seen as the unseen victims then, further down the line from the COVID crisis. We see the media will cover the people who had COVID, recovered from it and left hospital, who are then not to be seen again. So, I think there are a couple of unseen elements there. There's the long-term, one year, two years on from having COVID, but then all the unseen victims that happen in the background, who have broken their hips because they've become less active generally deteriorate. You can't underestimate just that general deterioration of people, because they're not as active in terms of their physical and their mental health. 

10:10

So, you've got the COVID group and obviously their rehabilitation needs. Fatigue is a massive thing—it's one of the massive conditions of it. So, you've got working-age people that are working that have had COVID-19, and obviously the rehab to get them back to work is really important. So, there's that group. And we've got these 120,000 people shielding, so you've got the deconditioning concerns about that, which will increase money. You've got the massive mental health problems that will come from people isolating, and what we don't want is loads of people rocking up to their doctors and not having appropriate mental health services at that level. Mental health services: I'm a mental health occupational therapist by trade, so that primary care mental health service still isn't great in Wales, is it, with the waiting lists, and we need real focus on—. If you go to your GP, even though our great GPs are, sometimes they're not the experts on everything. So, if you go into a GP surgery with a mental health problem, you should really be seeing an OT or a community psychiatric nurse or a social worker, rather than seeing the GP, and we can get people going. So, the mental health aspect of this, I think, is going to be huge, to be perfectly honest. Mental health for keeping people fit and healthy and going back into work, because it's been such a stressful period for everyone, hasn't it? So, rehab is really important, but not just physical rehab, mental health rehab is ultimately just as important as well.

Let's park for a second something that, I think, all of us would agree on, that it's the right thing to do to offer people that level of support, be it for physical or mental health problems that arise from the situation we're currently in. Just looking at it from a cost point of view, would it be a good use of Government resources now to do a pretty quick assessment of the cost benefits of putting proper resource into rehabilitation right now?

Yes, absolutely. And I know the chief allied health professions officer is looking at the modelling at the moment, and the rehab task and finish group. So, we will always support Welsh Government in relation to that. We think there is obviously a cost benefit. The evidence from all of us needs to get better in relation to that, but we all know that it will be, you know what I mean? In areas where we've had good integrated services, we've reduced hospital admissions, we've got people back to work. We've had a pilot in west Wales, in Pembroke Dock's GP surgery, where OTs have been doing the AHP fit note, and we've reduced sickness by a third—we've kept people in work. So, there are examples throughout the UK and the world where AHPs do good work with patients, so we would definitely encourage the Welsh Government to look at that, yes.

Yes, I would agree with those points, and I think a cost-benefit analysis would be beneficial, but I also think looking at the outcomes that people achieve, because for each benefit analysis there's an individual who's now able to do even more than what they were able to do before, so it's got to be linked to the outcomes for patients alongside. Because even though there might be a big or small cost benefit for that individual, that is a huge benefit to them, as well.

Thank you, Chair. I'm very glad to hear you speak so strongly about the importance of recognising the mental health issues arising from all this, and I think they are going to be very widespread. But what I wanted to ask about today was the shielded group. I am particularly worried about the impact on the mental health of people who have been shielded. I've got constituents who are actually now so afraid to go out, that they are declining urgent medical treatment, and it seems to me that there's a real risk here that we've protected their physical health, but created another harm with their mental health. And I wanted to ask really for your thoughts about what we can do about that really, because we don't want people declining cancer treatment and other emergency help because they're shielded. How do we get over those barriers with them? 

10:15

So, I was speaking to our social care colleagues this week, and in the last two weeks, they've had an influx of referrals from people who are shielding and who are struggling—really struggling—and what they've noticed is that it's not just the physical struggling because of deconditioning, it's that their mental health has deteriorated sharply. They've got real anxiety problems. And it's not just the shielding group, it's their carers around them as well. They're talking about burnout. That's why people are starting to form their one-stop shops in the council. The carers are burnt out as well.

So, it is a concern, and it's about how we then deal with that when those concerns are picked up from that shielding group. How do they access mental health services? As you well know, Lynne, before this, the waiting lists in primary care were quite high—and that's people who qualified for primary mental health care. So, just looking at that system in relation to mental health—you know, getting the AHPs in primary care—. Looking at criteria-driven mental health services in Wales—apparently, you've got to meet 10 different criteria to get services. Let's look at outcomes instead of criteria, you know what I mean? Let's really change that around.

Working with the third sector is so important, you know what I mean? When I was in a CMHT, a community mental health team, working with the third sector was really, really important. So, your Minds and your Gofals and stuff like that—that social prescribing model as well; so, it's social prescribing in GP surgeries and getting access to that. But there does need to be, I think, a national campaign in relation to mental health, there really does. It's such a massive macro area. We just haven't got the resources in the NHS to deal with it. So, I think that Welsh Government and Public Health Wales need to put this in focus, actually—the mental health and well-being of the population—and come up with a proper national strategy now in relation to it.

From the steering group, I think the immediate reaction was, 'This virus is so bad you need to stay in your home', and every shielded person I think would have probably taken that absolutely literally. I just hear of stories of people—[Inaudible.]—and back—[Inaudible.] There's going to be an element of coaching. It's all well and good to come out and say, 'Shielded people can go out now'. But the lasting effects of that advice, whilst COVID remains in the media spotlight, are still going to create extreme anxiety about going out and going into hospital settings. Even with the protections that could be afforded to them, I think there's still going to be an element of—. Each individual person will need to be almost coached back to being able to do it, especially if they have significant concerns about it.

And I think that Dai's point on being outcome-driven—that's something that we need to look at widely across the NHS as well. A lot of these issues won't be picked up by the tier 1 targets and actual performance measures that the NHS is heavy on at the minute. A lot of this is about: what do they mean for the individual, and what are the outcomes that we need to achieve for individuals? It's not about how long it takes the majority of people to access mental health services.

As Dai said, it's very much about the outcome. What does that mean for the individual that is 28 days—[Inaudible.]? I don't know. Seventy per cent of people who need mental health input take 28 days. What happens in those 28 days? What happens to the other 30 per cent of people who can't access it in 28 days? That's what we should be focused on, I think—around those outcomes, and what that means for the individuals, and not on tier 1 and performance measurement targets.

With the shielding group, when the last change was made—and it was on the Sunday night—I was a little bit concerned that there weren't enough instructions for people. There was the anxiety of being in your house for eight weeks, and all of a sudden, they've told you, 'Oh, you can leave now.' That's going to be really difficult. So, on the eighteenth, with the letter that they are going to get, I would like a bit more advice about how you manage to gradually integrate into society. Otherwise, we are flooding people with massive stimulus—massive physical stimulus as well. Maybe there should be a bit more advice about how people can manage their mental health and slowly integrate into society. You can't go from, 'You've got to stay in, and maybe you'll be allowed out into a garden', to, 'You're completely free now.' There are massive connotations about that, so I wish that could be better planned in the next letter. 

Symudwn ni ymlaen at yr adran olaf rŵan, ac effaith y coronafeirws yma ar gyflawni gwasanaethau yn gyffredinol. Mae Rhun efo cwpl o gwestiynau, ac wedyn Lynne eto. Rhun.

We'll move on to the final section now, and the impact of the coronavirus on service delivery in general. Rhun has a few questions, and then Lynne. Rhun. 

Y ffordd rydych chi yn delifro gwasanaethau wedi newid ydy testun y cwestiynau yma. Sut fyddech chi'n dweud bod y berthynas rhwng gwasanaethau iechyd a gwasanaethau gofal cymdeithasol wedi newid? Dai.

The way that you deliver services has changed is the focus of these questions. How would you describe the relationship between health services and social care services—how has that changed? Dai.

10:20

Do you want me to start? So, again, speaking to managers on Wednesday, the areas where they've got proper integration, for whatever reason, is working well. I know Monmouthshire and Ceredigion have some good integrated services; the OTs from social care and healthcare are working on similar systems, so they attend anywhere and stuff. But, again, with social care so variant—there are 22 different local councils, so they'd be working differently. So, some of the ones up in north Wales aren't working as closely with health and social care, and that does cause some issues. But, again, this is prior to the COVID-19, so I would say it's nothing new here, really. So, that's been highlighted as an issue.

Social care is such an important aspect, and the work they've done these last three months shouldn't be understated. They've really stepped up to the mark. So, again, I want to emphasise the importance of that.

It's been interesting, in the NHS where we work, we're starting to get a bit more traction in ICU now, which, again, should have always happened. So, we've got a person in Cardiff—I assume that that's working. So, as we've needed services to go into certain areas, I think they're starting to prove their worth more now, as the things that should have happened in the first place. So, again, the concerns prior to COVID-19 just get highlighted more, about the lack of integration in certain areas, and obviously the good work that we do gets highlighted as well.

I haven't got anything specific from our members, but I'm happy to bring some stuff back to you if I ask our managers and our members. But I suppose, just reflecting on it, there was a push that the hospitals were the key area to fight this COVID-19 in the initial instance, and that led to a mass exodus from our hospitals and mass discharging. Now, I wonder how that will impact the relationship between health and social services, because we very much moved to a command and control model of leadership and, 'We must get these patients out', and it was very much that kind of command and control. So, I hope that that hasn't damaged the relationship, because we know in the media social services have been saying, 'You shouldn't have put those people out', and the health service were saying, 'Well, we had to put them out.' So, it'll be interesting to see what the long-lasting impacts of that is, but I think integration is key.

At an all-Wales level, I can speak that social care representatives from a trade union perspective have come into the fold a little bit more now in terms of the PPE testing briefings and meetings with the Minister, so there's a bit more of a closer working relationship at an all-Wales level, and we hope that filters out into the whole system. I'm sure Dai would support that.

It's interesting—when you say people coming into the fold and, Dai, you were saying social care are stepping up to the mark, I think it reflects what has happened throughout local government. It's not a matter of them stepping up to the mark, perhaps, it's us being reminded how important they are and how capable they are and what a contribution they have to make. It's holding on to that, if that's fair to say, and keeping that parity of status too.

Yes, absolutely. The system needs to work, and when it hasn't worked, it's showing that it hasn't worked. So, from your OTs but also your social care workers going in to doing the full packages of care, making sure the system works—. I was speaking, again, to social care colleagues on Wednesday. Care homes are such an important part of the whole scheme of things. Our OTs have been working really hard with the care home sector in relation to single-handed care and making sure they're as efficient as possible, because if that doesn't work, none of it works.

There are slight problems at the moment with testing in care homes in relation to the 28 days, which is right—care homes have got to be safe. But because we don't have access to some of the care homes now because of the 28-day period, that's another log jam as well. So, it shows that it doesn't take much for the system not to work as well if there are problems. So, it's that fragility in social care. Again, we've talked about this before this thing, so, again, let's really work hard at social care and giving it the proper funding.

10:25

You've both spoken about the different roles that OTs and physios have stepped into within the hospital setting. What about in the community and the way that your members have turned to new technologies for delivery of their services—remote working and that kind of thing? What's your experience there?

So, from a community physiotherapy and an out-patients physiotherapy perspective, so the musculoskeletal occupational therapy services, there's been very much a prioritisation. So, the urgent cases would still be seen face to face, if needs be. So, if there is a risk of admission to hospital for a community patient, for example, people would still go out with correct PPE.

There's been a real embracing of technology, but what I hear regularly is that the ICT equipment isn't up to standard, and that can really hinder. I mean, going forward there needs to be a blended approach, because all technology and all home visits, either/or, isn't the correct way to go. There's got to be an approach that brings both of those together, where the most appropriate intervention or route of intervention is done. So, if the most appropriate route would be a video call, then that happens. But if the most appropriate is a home visit, then that happens, or a person coming in to the service. So, I think it's about getting that approach, but we need the ICT to do it. This is something that had been banged on about for ages in the NHS around getting the technology. This has forced us into having to utilise the technology, but the ICT equipment, whilst there's been some progression on that, I think still isn't at the level we need.

So, I agree with Adam—we need a blended approach. It works well for some people, it doesn't work well at all for other people. Some people with cognitive issues struggle with it. It's ultimately what the patient and the carers can use as well. So, we could set up a fantastic system, but if the carer can't use it, or the patient can't use it, it's totally pointless. So, it's that flexibility.

Obviously, governance and clinical safety is really important, but the level of risk here—what's more important? Is it having a video-conference with someone from WhatsApp, ensuring they don't access hospital, or do you keep them safe? Or is there some governance policy that's more important than the council? So, that's what we really need to look at is what—. Obviously, we can talk about systems and stuff like that, but what can patients and carers use as safely as possible for themselves, and ease? So, that's the big thing. I mean, we've got a really good Attend Anywhere and stuff like that, but it's really looking at what the service users need and what they can use is really important.

So, we're starting to come out a bit more now, mind you. We're starting to do a bit more face-to-face because face-to-face is important. But in the future I think a blended approach would work in lots of areas as well.

And finally from me, I don't know if you can tell me what kind of proportion of physios and OTs were redeployed to other roles other than their usual jobs, and whether, now, you are starting to see a significant return to substantive roles.

I couldn't give exact proportions, but what I would say is that when you look at the services that were reduced—so you take your MSK service in the community and some of your paediatric cases, it would be a significant proportion. That's what I would say. I wouldn't like to put a number on it because I haven't got those stats, so rather than give you an estimate that might be widely off the mark, what I would say is that when you look at what services were reduced, most of those people were redeployed. The effect that had, then, was that some of our workers such as bank workers, agency workers, who haven't got the long-term, fixed-term contract, had a negative impact and then couldn't access employee support and stuff. So, our bank workers may have then ended up without work, because we redeployed staff from elsewhere to support the service and to hold up the service, and then, well, there's no need for the bank or agency workers then. So, I think that has had a significant impact as well.

Gradually and slowly. I think the new operating framework that is coming out is very much with the message, 'Proceed with caution.' So, I think this is leaving certain elements to local interpretation of what should open up and what shouldn't continue, and there seems to be an expectation that a second wave will come. So, what's happening is quarterly planning now for the NHS; whilst we need to do that to look to see how COVID is progressing, I think that may hinder, then, what gets opened up and what doesn't. There is, again, going to be variability across Wales. Whether that's good or bad, I think we will have to wait to see, because that variability may be good, because you can concentrate on where the hotspots are, in terms of what services you open, but it might be bad, because somebody in north Wales might not be able to access something that somebody in south Wales could because of the local interpretation. But I wouldn't like to say whether that's a good or bad thing at this point in time.

10:30

Again, similar to what Adam said, I would like to add a bit more. There wasn't a great amount, actually, of redeployment. Some of our paediatrics and some of our mental health practitioners were moved, but they've started to come back now. Most of our practitioners were doing their day jobs, to be perfectly honest. It's slightly different for other AHPs, with podiatry and some of the speech and language therapy—a lot more of them were moved on, so that may be something of interest to what you look at, and it's really important that we get these things started up. But it wasn't as much as we thought they would, and we didn't use any of our returners, our students—we didn't use any of them, so we had enough staff in relation to what we needed to do.

Diolch, Dai. Diolch, Gadeirydd.

Thank you, Dai. Thank you, Chair.

Ocê. Wel, mae'r cwestiynau olaf nawr o dan ofal Lynne Neagle. Lynne.

Okay. Well, the final questions now come from Lynne Neagle. Lynne.

Thank you, Chair. Can I just go back to this issue of redeployment with you, Dai, please? Because I'm interested to learn that some of the staff who were redeployed were from paediatrics and mental health. In children's committee recently, I was surprised to hear that people providing child and adolescent mental health services provision had been redeployed as well during the pandemic. I know that we had a physical health emergency, but that doesn't mean that people aren't going to have mental health emergencies during this period, and I just wondered if you thought, especially as we could see a second spike in the autumn, if there are any lessons, because people will die if they can't get crisis mental health services, in the same way as they might die if they get COVID. I just wanted to get your comments on that, really.

Obviously, we're all in new territory here with the COVID-19, and some of the modelling was pretty grim, wasn't it, really? So, you can see, culturally, why we went down that route, but also, now, culturally, we'll understand that there are consequences to the steps that we've taken as well. Someone dying from suicide is just as bad as someone dying from COVID-19, and I know our mental health occupational therapists are really concerned, especially about their secondary care patients and, obviously, the kids in CAMHS and stuff that really need that intensive interaction, and it's not just good enough maybe to speak to them on the phone once a week or doing a bit of virtual—.

So, that's the main lesson that we need to learn, that when we talk about parity of esteem between mental and physical health—. I know you wouldn't know where they start, but people who have got mental health problems die at about 65—they die, like, 15 years below the normal population. So, that parity of esteem, again, is prior to this, isn't it? And, again, it just highlights that when we go into a physical crisis like this, the focus then goes on to physical health straight away. So, again, it's that hard work we've got to do.

We can talk a good game about parity of esteem, but if you go to a community mental health team in any area of Wales, it'll be in a run-down building. The CMHTs I worked in are in run-down buildings. Again, it's not having rooms for therapy. I know I talk passionately about this, but this is my area of practice. Let's really crack on, and when we talk about parity of esteem, again, COVID-19 has really focused us on that as well, hasn't it, really? So, culturally, we need to learn massive lessons about where we deploy our staff and what's important.

Thank you. Can I just ask—? You mention students in the answer to Rhun and how you hadn't had to use students very much. Are there any other issues that the committee need to be aware of in relation to the impact on students?

I think the big concern is around the level of placements that are happening for students. Obviously, there's been a three to four month hiatus of placements. There were, obviously, plans afoot to integrate them into services under paid contracts. I think that's been rare for AHPs, if I'm honest, and if that happened there were some discussions around how—[Inaudible.]—on those paid placements, or paid contracts, however you want to term them, would integrate into their university degree learning outcomes. That hasn't really happened, so I think there's a significant risk that this is going to delay next year's qualifications.

I just speak for physiotherapy, but I think it's largely something that will happen across all the professions in that, next year, there will be a delay because there's got to be a catch-up of, I think, three or four placements for physiotherapists, and they've got to do it to comply with the Health and Care Professions Council's regulations in terms of qualification. So, it's not something where you just go, 'Well, they haven't done them but they can still qualify anyway'. They need to do these. I think there's going to be a delay next year. If there is any second wave, we really need to consider what will happen with students. We know that we need more physios and OTs coming out, yet that might not happen if a second wave comes and more placements are cancelled, therefore that pushes back even further to qualify.

I know there is work afoot to look at restarting placements as of September, but we've got to avoid this in-and-out of placement or in-and-out of employment if another COVID wave was to come, because do we just revert, then, back to the original planning of all focus on hospitals for physical health, and then trying to get the students into employment and we store up problems, again, for later? So, I think there needs to be a big consideration of how education and placements are going to happen if a second wave comes as well. I think there's already some mitigation going on around what will happen due to what's gone on already, but that could all be blown out of the water should a second wave come. 

10:35

I'd reinforce Adam's points. The students in placements—we need that workforce next year. People still retire, people have sickness, so it's really important that we manage that appropriately.  

I think there was some disappointment about how the student process was developed. I think it wasn't done in a very good partnership, when we had a really, kind of—especially, I know, being with the other trade unions. BMA had a particular concern, and the Royal College of Nursing, and so did we, so I think there was some concern about how that was done, and I think it could have been better if there was earlier engagement with the AHP student process during this COVID crisis. 

Okay, thank you. In one of your earlier answers you touched on return to normal service issues, but is there anything you would say that the committee should recognise as a priority, really, for you to be able to get back to doing the job that you normally do? 

Yes, just the stuff that I talked about earlier: getting us at the front door of services, getting us in GP practices, getting us in A&Es so that when people access services, they've got access to occupational therapists, podiatrists, physiotherapists, speech and language therapists. That was starting and there were good pockets of examples throughout Wales. Let's just really emphasise that: that we need to be at the beginning of treatment. 

I think, from my perspective, it's recognising that every individual in Wales has a right to rehab so that those rehab services are seen as just as important as the acute services of keeping A&E, ITU and the wards running. Actually, the rehabilitation services are just as important as those services for individuals. If we can recognise that need and that right for every single person, I think that will start bringing up rehab services to the level they need to be. 

Okay, thank you. And just finally from me, then, are there any other points that you feel we haven't covered today that you'd like to bring to the committee's attention? We've had a good discussion, so it's more than possible we've covered everything, I think. 

We've covered a lot, yes, definitely. 

I can't think of anything else. I'm just whizzing through my notes and off the top of my head, there's nothing else that really jumps out that I haven't said. 

10:40

From the chair, can I just ask for a point of information, really? In terms of COVID-19—because, primarily, this is a health committee review into the response to this particular pandemic—have you got figures on the number of COVID-19 survivors that require quite intensive rehabilitation services, be they physio, OT, speech and language—whatever it is? Because, certainly from the GP point of view, we see quite large numbers of people. There are those that survive, some people are minimally affected, but lots of people, particularly those who have been on ventilators, are quite drastically affected for quite some time. Have you got a handle on those numbers and potential extra numbers of staff that you will require in your different disciplines to be able to manage that workload?

I haven't got the specific numbers—I'm not sure if Dai has—but I know there have been a couple of research studies across Wales. I know somebody based in Swansea Bay was doing an all-Wales study of post-COVID-19 symptoms or effects that I'm more than happy to have a discussion with to see where that research is at and what kind of information there is. I would happily forward that to you, then, Dai, when it's in a place that it can be.  

Some NHS England modelling has suggested that 50 per cent of people who've been hospitalised would need it. But, again, we just don't know, to be perfectly honest. There are lots of people who didn't go to hospital who'll have massive issues with fatigue, because that's the big thing our therapists are talking about quite a bit, actually. I know that for some of my personal friends that haven't been to hospital fatigue is a massive thing. So, again, it's a new area of study. There are bits and bobs coming out of Italy and stuff like that. So, once we get it, we'll get it straight to you, Dai.

And I think it goes to display that rehab outcomes aren't routinely collected as part of normal hospital admission and discharge data. It's very much done on an individual service perspective that that information is collected rather than an all-Wales approach to, 'Let's look at how much this illness affected a person.'

Great. 

Diolch yn fawr iawn. Dyna ddiwedd y cwestiynau. Dyna ddiwedd y sesiwn. Allaf i ddiolch i'r ddau ohonoch chi eto—Adam Morgan a Dai Davies—am eich presenoldeb rhithiol y bore yma, a hefyd am y dystiolaeth ysgrifenedig fendigedig y gwnaethoch chi ei chyflwyno ymlaen llaw? A gallaf bellach gadarnhau, mi fyddwch chi, yn ôl ein harfer, yn derbyn trawsgrifiad o'r trafodaethau yma er mwyn ichi allu gwirio eu bod nhw'n ffeithiol gywir. Ond gyda chymaint â hynny o ragymadrodd, diolch yn fawr iawn i chi'ch dau am eich presenoldeb. Diolch yn fawr. Dyna ddiwedd yr eitem ac rydych chi'n rhydd i fynd. Diolch yn fawr.

Thank you very much. That brings us to the end of our questions and the end of our session. May I thank you both—Adam Morgan and Dai Davies—for your attendance this morning in a virtual capacity, and also for the excellent written evidence that you submitted ahead of time? And I'll also confirm that you will, as is customary, receive a transcript of these discussions to check for factual accuracy. With those few words, thank you very much to you both for your attendance this morning. That brings us to the end of the item and you're free to go. Thank you very much.

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

Cynnig:

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

Motion:

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

Cynigiwyd y cynnig.

Motion moved.

I'm cyd-Aelodau, rydyn ni wedi cyrraedd eitem 3 ar yr agenda rŵan, a chynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod heddiw. Ydy pawb yn gytûn? Dwi'n gallu gweld bod pawb yn gytûn. Felly, gallaf i gyhoeddi ein bod ni i mewn i sesiwn breifat rŵan i drafod y dystiolaeth a'r adroddiad sydd gerbron, a dyna ddiwedd y cyfarfod cyhoeddus. Diolch yn fawr.

To my fellow Members, we've reached item 3 on the agenda now, and a motion under Standing Order 17.42(ix) to resolve to exclude the public for the remainder of today's meeting. Is everyone agreed? I see that everyone is indeed agreed. So, we will now go into private session to discuss the evidence that we've received and the report that we have in front of us, and that brings us to the end of the public meeting. Thank you very much.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:43.

Motion agreed.

The public part of the meeting ended at 10:43.