Y Cyfarfod Llawn - Y Bumed Senedd

Plenary - Fifth Senedd

31/01/2018

The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

1. Questions to the Cabinet Secretary for Education

The first item on our agenda this afternoon is questions to the Cabinet Secretary for Education, and the first question, Joyce Watson.

Language and Communication Skills

1. What is the Welsh Government doing to promote language and communication skills among pupils? OAQ51657

Thank you, Joyce. Making sure that all learners develop excellent language and communication skills is a key part of our national mission for education in Wales. Our national literacy and numeracy programme, and its key policies, including the national literacy and numeracy framework, are targeting literacy interventions, supporting us to achieve this aim.

I particularly want to welcome the Time to Talk, Listen and Play campaign that was launched last week by Welsh Government. We all know that helping children have an early grasp of language is hugely important not only as they progress through school, but through life and into the workplace. I really am a huge supporter of this programme, because I think that initiatives like this, which help children to learn through what they regard as fun rather than an educational setting, really will give them the very best start in education. And I'd be interested, Cabinet Secretary, if you would give us an outturn and an update in 12 months' time to see how this programme has been effective.

Thank you, Joyce. I'm glad that you like the Time to Talk campaign. I'm sure Members across the Chamber—well, hopefully, Members across the Chamber—will have seen the adverts on television and the materials that are available on social media. I think they're really engaging and fun, and they stress the importance to parents of the huge impact they can have by taking the time to talk to your children. To further strengthen early language and communication provision across Wales, we are investing £890,000 in foundation phase oracy programmes in 2017-18. That includes funding for the Time to Talk campaign, but also to fund the four regional educational consortia to work with schools to improve language development in the foundation phase.

Cabinet Secretary, I have for many years been a member of the governing body of Meadowbank Special School, which is a school that delivers educational services for children with speech and language learning difficulties. It's been at its site in Gabalfa for over 40 years and was foremost in developing best practice in this area, not least with its parents and teachers doing so much to establish Afasic in the 1970s. I am gravely worried about Afasic's closure in Wales and what's going to happen to those skills, information and support that's been made available to parents, to teachers. I do hope that your officials will be monitoring this very, very carefully, and perhaps talking to your colleagues in the Welsh Government to ensure that a way is found that essential infrastructure, like charities such as Afasic, are kept going, because it's a great service they provide.

First of all, can I thank you, David, for your service as a governor of this school? Like you, I am disappointed that Afasic Cymru trustees have decided to end their charitable status within Wales, although I understand they will continue to work at a UK level. I can give you an absolute assurance that I will be asking my officials to monitor very carefully the impact the closure of the charity will have, and to look to ways in which we can work across Government and across the voluntary sector,= to support those families whose children need additional help and support developing their language and communication skills.

We know from figures provided by the Royal College of Speech and Language Therapists that over 50 per cent of children from socially deprived backgrounds may be starting school with impoverished communication, language and speech skills. Now, do you therefore share the Children's Commissioner for Wales's concerns that limiting the Government's childcare offer to only children of working parents, and not extending it to all children, actually risks widening that school-readiness gap amongst the socially deprived group that I referred to earlier?

Llyr, I do recognise that these issues can be particularly acute in those communities and for families where there are high levels of social deprivation, which is why, as I said, we will be spending over £800,000 this year to develop our Time to Talk programme, so that we can work with families. Of course, the free childcare offer to working parents is just one of the schemes that the Welsh Government runs, and you'll be aware of the work of Families First and Flying Start, which are particularly targeted interventions at those families and communities that need the help the most, which include a childcare element of that, as well as working alongside parents to help parents do the best job that they can do in encouraging these skills in their youngsters before they start formal education. 

13:35
Crime and Violence in Schools

2. What steps is the Welsh Government taking to reduce the risk of crime and violence in schools? OAQ51666

Thank you, Mr Bennett. Violence and aggression in schools, against teachers or pupils, is completely unacceptable. In order to tackle such violence and aggression, in and outside the classroom, working with stakeholders, we must first understand why children are demonstrating these behaviours. Otherwise we are simply treating the symptoms and not the underlying causes of such behaviour.

Yes. Thanks for that answer. I agree that we do need to understand. We also perhaps need to pursue a standard approach to monitoring the level of violence so that at least we can also ascertain how much actually is going on, which is something that the National Association of Schoolmasters Union of Women Teachers are currently calling for. So, would you be minded now to think about a standard approach to monitoring levels of violence in schools?

Thank you for that. I think it's, first of all, very important to recognise, as mentioned only recently in the latest chief inspector's report on the education system in Wales, that behaviour in schools is improving, and I would hate people to be listening to this question and thinking that we had a particularly acute problem. But clearly, as I said in my opening answer, any violence, whether that's directed towards fellow pupils or directed towards the staff of the school, is completely unacceptable to me. Welsh Government has issued guidance to schools and local authorities around safe and effective interventions, and I am always willing to consider what more steps Welsh Government can take to address these issues. I want Welsh schools to be safe, secure and happy places of learning and work. 

Cabinet Secretary, last week, I visited Monmouth Comprehensive's brand new school building, which is still to be finished admittedly, in the town of Monmouth, and that building is a fantastic, creative space that's designed to be open, transparent and to reduce the chances of physical violence happening in that space as much as is possible. But, of course, buildings are only half the story, and we know that violence takes many forms, particularly psychological violence, and in terms of schools and their pupils, cyber bullying. Can you update us on the Welsh Government's polices to tackle all forms of bullying, but specifically cyber bullying, which seems to be on the increase in certain areas?

Thank you, Nick. I think school buildings can play a significant part in helping create that environment for our children, but we have to recognise that bullying can be a problem in all schools regardless of where they are and that can take many forms. We are updating our anti-bullying guidance 'Respecting Others', and the revised guidance will be published later this year. I have also undertaken to carry out a review into the specific issues around cyber bullying, online and internet social media safety, and will continue to work in this area. This is a relatively new aspect of bullying. In days gone past, children were able to return home to a safe space. These days, their mobile phones and devices allow a constant stream of chatter to continue, and we need to equip our children on how best to deal with that, how to behave responsibly online, and, if they come across behaviour that it is irresponsible, whom they can report that to, safe in the knowledge that, having reported it, action will be taken to support them. 

Questions Without Notice from Party Spokespeople

Questions now from the opposition party spokespeople. The Plaid Cymru spokesperson, Llyr Gruffydd.

Thank you, Llywydd. It’s almost four and a half years now since the publication of Professor Sioned Davies’s report on the position of Welsh as a second language in English-medium schools in Wales. In that report, she made it entirely clear that it was the eleventh hour even then in terms of Welsh as a second language, and that attainment levels for pupils in that subject were lower than in any other subject. Had that been true about English or maths, I’m sure we would have long since seen a resolution to that problem. She concludes by saying that a change of direction is urgently required before it’s too late. So, can I ask when the Minister intends the new combined qualification will be available for teaching in school?

13:40

Thank you very much for the question. You will be aware that we have had the Donaldson review since then and that we need to consider the changes in the context of Donaldson. So, can I make it clear that I am not prepared to wait until Donaldson is in place? I think that this is something that we have to pursue now and I have asked, today as it happens, my officials to arrange a symposium to bring experts in the area together to discuss the best way for us to teach a second language. I don’t think this is a problem just in terms of the Welsh language, but it is a problem with other languages as well. My focus, of course, is on the Welsh language. I can tell you that it is a fact that I will be concentrating particularly on this issue of increasing the number of people who can speak Welsh by the end of their school years. The intention, of course, is that 70 per cent of people will be able to speak some Welsh by 2050 when they leave school. So, we do have a long way to go.

Thank you very much. I welcome that answer: that you won’t wait until Donaldson is in place because we know it will be 2025 by the time everyone has access to the new curriculum, and that’s potentially another generation of Welsh speakers lost. Can I ask you what consideration will be given to piloting or trialling this new model in specific areas in terms of combined qualification? The danger is that it will take two or three years, if I know how Governments usually operate, when, in fact, there is an appropriate workforce and a willingness in some parts of Wales to turn this around very quickly.

Well, to begin with, we need to look at what is in place today. I think that we do have to look at further resources for teachers who are teaching Welsh as a second language, and I have been talking directly with teachers who are out there in the classrooms and asking them precisely what they would like to see as forms of assistance. So, my officials are looking into what we can do to assist now, this year, and I have had a conversation with the BBC to see whether they would be willing to assist in this area also, because I think that we could do more visually in terms of teaching children in the classroom. So, actions are being taken, but I must say that I do emphasise that I think we can’t afford to lose another generation. I agree on that.

I’m sure you’ll understand the frustration, because hearing a Minister say that we’ll have to see what the situation is today, a full four and a half years after a report stated that action was urgently needed, is a cause of frustration. I do have to make that point.

Now, of course, it’s not possible to move forward meaningfully to share the target that I’m sure we share in terms of a million Welsh speakers and the role of the education system in that unless the appropriate workforce is in place to provide the necessary education. I will refer to the Aled Roberts review of Welsh in education strategic plans, which said quite clearly that,

'We must ask ourselves, what purpose is there to plan for substantial growth for Welsh-medium and bilingual education...without urgent decisions being made to train more new teachers who speak Welsh. This is particularly the case within the secondary sector.'

Now, we know that 6 per cent of the education workforce speak Welsh but don’t teach through the medium of Welsh. So, what is this Welsh Government going to do to bring that group of educators into play in this area? We also know that 80 per cent of students studying PGCE courses have come through the education system in Wales, and if they haven’t been part of bilingual education then they should have had 10 years of Welsh lessons. Okay, there are deficiencies in terms of Welsh as a second language, but there should be a foundation there to develop a qualified workforce in terms of Welsh-medium education. So, can I ask how you’re going to use and build on those linguistic skills and when will we see a Welsh-medium education workforce plan developed and implemented? Without it, we’ve no chance of reaching that million Welsh speakers.

Thank you. We do have a workforce plan in place and we have made it entirely clear how many teachers will be needed over the coming years. My hope currently is to ensure that people are aware that there are £5,000 available in addition if they show an interest in teaching through the medium of Welsh. We must make sure that people are aware of this because now is the time when people are starting to think about what they’re going to do in September. I have asked my officials—. You’ve pressed on the two buttons that I have been pressing. There are two things that are most important to me: they are getting the workforce right—because if we don’t get that right from the beginning, that is going to cause me concern—and, secondly, the need for us to think about what we need to do improve teaching Welsh as a second language.

So, I acknowledge that 6 per cent of people in the workforce currently—perhaps we could have discussions with them. So, that is something that we are paying attention to currently. So, we are very aware that we do need to move on this and I have requested my officials to give me a monthly report about the situation in terms of how many people have applied to go to these colleges, so that we are sure that we’re on the right track.

13:45

Diolch, Llywydd. Cabinet Secretary, in 2015 when the new Wales-only GCSE qualifications were being mooted and going to be introduced, my colleague Angela Burns, the then shadow Minister for the education portfolio, said that it was a short-sighted decision and that there would be adverse consequences for learners. It's now 2018, and I'm afraid that some of our concerns are materialising. More than half of pupils who took the new maths GCSEs got a D or below, according to the results that were published earlier this month. Do you now accept, and would you agree with our assessment, that your predecessor's decision to introduce these new qualifications was a mistake?

Darren, for pupils and teachers currently in the system, we have to deal with the reality of today, as do I. I have made it very clear in this Chamber, time and time again, that I want to see education raise standards for all of our children, including bridging the attainment gap between those pupils who are less well-off and ensuring that our education system is a source of national pride and confidence, and by improving GCSE results, that's one of the ways in which we can do that. I've been clear, since coming into office, that we can do better, so with regard to mathematics, for instance, we have set up the new national network of excellence for mathematics, so that we can improve the teaching of mathematics across the country, and also to ensure that, for instance, with regard to early entry, which we know in some cases can be detrimental, it should only be used in schools for those pupils who are in a position to fulfil their maximum potential rather than being sent in early for an exam and not achieve the results that they are capable of achieving after a full teaching of the course.

Those words will be no comfort whatsoever to those learners who got lower grades than they would have done sitting the previous GCSEs. We also warned, of course, that the new GCSEs would confuse employers and were likely to be less accepted by them than were qualifications from other parts of the UK, and, of course, we've been right on that count as well. We know that with applications for apprenticeships in England, which require maths GCSE and English tests—some people are having to resit English GCSEs, because the Welsh GCSE is not considered to be of equal value when trying to access some particular apprenticeships. That's unacceptable and it's young people who are paying the price because of this sop to want to go after Wales-only qualifications, and it's disadvantaging our children and young people.

What are you going to do to ensure that students, learners and people who want to go on to professions, where there are certain entry requirements, and apprenticeships where there are certain entry requirements, and where the English GCSEs that we have in Wales and the Maths GCSEs that we have in Wales are not recognised—what are you going to do to prevent our children and young people from having another barrier to climb over by having to resit GCSEs, because that's what's happening according to the evidence, in order to get there?

Let me just be absolutely clear: the Member can simply not make the assumption that those children would have done better under the old GCSE examination system. I make no apologies, Darren—and I'm surprised that you don't agree—for wanting greater rigour in our exam system, and if maths exams are introducing greater rigour, then that is something that we should be proud of, rather than dumbing down our exam system. Let me be absolutely clear as well—because you are doing a disservice to the children and the teachers of Wales by somehow peddling a myth that our examinations are not comparable to examinations in the rest of the United Kingdom. There is no evidence at all that you can bring forward to this Chamber to back that up. Our examinations, overseen by the independent body of Qualifications Wales, and modified and monitored across UK bodies, are of equal worth to anybody else's, and to suggest otherwise in this National Assembly and not come forward with any hard evidence, you are doing a disservice to those children who have got those exams. 

13:50

This isn't just me saying this—this is employers who are voting with their decisions not to take on young people from Wales who have sat some of these qualifications. This is universities—top universities around the UK—who are saying, 'We don't accept the GCSE in numeracy for people from Wales as being equivalent to GCSE maths', which, of course, is what Qualifications Wales are telling us. This is universities who are not accepting the Welsh baccalaureate as being of equal value to the A-levels that children and young people sit elsewhere across the country. So, you can get up and you can posture all you like, Cabinet Secretary—the reality is that these are clearly not of equal value in the market where they need to be of equal value, and that is in terms of helping people to get jobs and to get into those HE courses and onto the FE courses that they need to. And not only that, but one of the reasons that teachers tell me and the pupils tell me that they're getting lower grades is because, of course, they've now got two sets of exams to sit when it comes to mathematics—a numeracy one and a maths one. That is causing problems with timetabling, it's causing problems that are putting a squeeze on some of those other subjects, and it's dragging down their results. Now, I notice that last week it was revealed that there's an expert who you are employing to sell these new qualifications to GCSEs around the country, wasting taxpayers' money, because you are pursuing this differential approach. What action are you going to take to tell us how much that is costing and what has been wasted on these so far, and when are you going to abandon this ludicrous project?   

It is absolutely incredible that the Member would suggest that anybody in this Chamber would oversee an examination system that would do our children down. Darren, you and I both have children in this system. Do you think for one minute that even as a mother, let alone the Cabinet Secretary for Education, I would stand here and let my child or anybody else's child undertake a qualification that was of less value? You have no evidence that you can bring to this Chamber that would back up your assertion that our GCSEs are not of equal value. And I'm surprised—I am very surprised that the Conservatives want to abandon GCSE numeracy, because usually they're here in this Chamber saying that we need to ensure that children have the skills that workers and business are asking for, and that practical application of mathematics that is tested in the GCSE numeracy examination is exactly the kind of skill that I want to see Welsh young people learning.

And let me put the Member straight, Presiding Officer: I am not employing anyone to go around selling these qualifications. Qualifications Wales, which is an independent body, will be employing a person to ensure that universities across the United Kingdom are left in no doubt of the rigour of our examination system, and I would say that any university that turns down the opportunity of taking on a Welsh student, or any employer that turns down the opportunity of taking on a Welsh young person, they are missing out, because our young people are as good as those anywhere else.  

Thank you, Presiding Officer. In April last year, a survey conducted by the Education Workforce Council at your behest found that 90 per cent of teachers said they were unable to manage their workload. One of the teaching unions said that the survey showed that many in the teaching profession are at breaking point. At the time, you said that, as a priority, you were determined to tackle the long-running issue of workload and ensuring that teachers have the space and time to teach to the best of their ability. For the sake of the teaching staff, it's vital that something visible is done to address this. What's your assessment of progress on reducing teacher workload so far, Cabinet Secretary?

13:55

Well, the Member is right to say that workload is a continuing concern for the workforce and, indeed, for me. Workload concerns vary greatly across the education family, however. Different issues and priorities are raised depending on a variety of factors, including which school phase somebody finds themself working in, rurality, deprivation, subject area or the role that they have within an individual school, as well as individual operating practices demanded or deemed by the leaders of those schools. Our aim is to build capacity and reduce excessive workload leading to improved standards for our children but also a better ability for teachers to manage their workload.

Thank you for that answer, Cabinet Secretary. One way to reduce teacher workload, apart from reducing the amount of paperwork they're required to do, which I didn't hear you mention, would be to reduce class sizes. This is something that I feel quite strongly about. That would be to the benefit of both teachers and pupils and go a long way to delivering the world-class education that I know our teachers are capable of providing if they're allowed to. Do you agree with me? And, if so, what measures have you implemented to reduce class sizes?

On the issue of paperwork, we are carrying out a bureaucracy project to look to see what paperwork we can take away from teachers. We're employing business managers via our pilots so that those tasks that are not related to teaching and learning can be taken on by another professional in the school, and we have sent out a myth-busting document that demonstrates quite clearly our expectations of the teachers.

Now, for the first time ever, there is something that Michelle Brown has said that I do agree with. I agree with you that class sizes are incredibly important, and that's why we have made resources available to local authorities, both capital and revenue, to help them reduce class sizes in the areas of education where we know that that policy will have the biggest impact, and those are our youngest children and classes that have high levels of deprivation or high levels of children who do not have English as their first language. I would be very happy to write to the Member to provide her with an update of the plans that local authorities in north Wales have come forward with, if she's interested. 

I would be very interested, Cabinet Secretary. Thank you for that answer.

Moving on, local authorities are under increasing pressure from Welsh Government to set aside land for housing, and new housing is being built across Wales in anticipation of a rising population. Welsh Government's keen to develop Wales and attract people in. I have no problem with that. What I want to ask, though, is: in light of the likely rising population in Wales, what plans have you put in place to ensure that there are sufficient places in schools to properly educate additional children?

The planning of school places is primarily the responsibility of individual local authorities, who I would expect would be able to ensure that when dealing with, for instance, new housing developments, they have taken into consideration the ability of people who may live in those areas to be able to respond to educational needs. If the Member has any examples where she feels that that is not happening, I'd be very interested to hear from her because we can take that up with individual local authorities.

I recently had the privilege of opening a new school in the Newport area, built in an area of the city that is experiencing a great deal of house building, and in that school, the school is going to grow as the community grows. So, they have an intake of reception and year 1, and as the community grows around it, there are spaces available in that school, and that's an example of a local authority really having some forethought about how they plan for increased housing and demand on education in their area.

Sex and Relationship Education

3. What plans does the Cabinet Secretary have to improve sex and relationship education for pupils? OAQ51679

Thank you very much, Julie. I am committed to improving sex and relationship education in schools in a variety of ways. That is why I have given £50,000, for instance, to Welsh Women’s Aid to develop SRE resources. I am also considering how the recommendations of the SRE expert panel can inform plans to improve SRE delivery now and in the future.

I thank the Cabinet Secretary for that response, and I welcome the SRE expert panel report and look forward to its recommendations being put in place.

At the 'State of Child Health' in Wales launch last week, a group of young people were saying that their experience of SRE in schools is very patchy, and that, in some schools, it's very limited, especially in Catholic schools, and they raised the issue that nearly all the teachers delivering the subject are not specifically trained to do so. And, of course, we did have the Terrence Higgins Trust report in 2016, which said that the way it was taught was not inclusive at all and didn't talk about LGBT relationships, didn't talk about consent and didn't talk about gender identity.

So, how will the Cabinet Secretary address the wide variation of provision that there is at the moment? How will she address the fact that the teachers are not trained, and how will she ensure that this subject is much more inclusive in the future?

14:00

Thank you, Julie. Any Member who spends any time visiting children and asking them about their current experiences of education in PSE lessons will have heard a similar complaint. Currently, what we're delivering for children in terms of sex and relationship education is not what they want and is not equipping them, in many cases, with the information that they need. 

You're right to say that, in many cases, this is not about a lack of resources, but it's about, sometimes, a lack of confidence and understanding amongst some of the teaching workforce who are expected to deliver some of these lessons. I'm afraid to say that, with regard to inclusive sex and relationship education, there are still some professionals who are still very wary of talking about LGBT issues because of legislation from previous Governments in another place many decades ago, and that legacy, I'm afraid, is still with us in some of our schools.

I'm absolutely committed to using the expert panel to ensure that, going forward, we have sex and relationship education that is truly inclusive and will be delivered by a profession that feels well-equipped and confident in their ability to deliver those lessons. Crucially, the Member will be aware, Presiding Officer, that health and well-being is one of the six areas of learning and experience in our new curriculum, and we will, as a nation, have to develop the expertise of a new suite of professionals who will be in a position to deliver that new part of our curriculum. In years gone by, we've trained geography teachers and chemistry teachers and physics teachers, but this is an area of the curriculum where we haven't been able to create that specific career pathway, and I know that the curriculum will be the perfect nudge that we need to change that, going forward, so that children will have a better experience.

You will recall in the last Assembly the three opposition parties then worked together to secure concessions from the Welsh Government. We took them to the line over the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015, and that included a commitment from the Welsh Government, alongside support from Peter Black from your party then and Jocelyn Davies from Plaid Cymru and myself, to involve stakeholders from the violence against women sector in developing the healthy relationship education in the curriculum to be followed by all schools.

During that time, I think both you and I referred to Hafan Cymru's Spectrum project to educate pupils in schools and train teachers in schools about healthy relationships. How, therefore, will you be giving your support to the campaign being launched by Hafan Cymru on 3 February regarding healthy relationships, as they say it will support vulnerable men, women and children, help them deal with loneliness and isolation through their Men's Sheds project and, critically, teach children about healthy relationships and domestic abuse through their Spectrum project?

Thank you, Mark. I want to take this opportunity to recognise your personal commitment to this agenda. You will have heard in my answer to Julie Morgan that I'm being as good as my word in opposition as I am in Government in the fact that we have given a grant to Welsh Women's Aid to help develop resources for schools with regard to what safe, respectful and nurturing relationships look like. And I'm glad that we have a variety of voluntary organisations that are willing to work alongside us on this agenda.

The health and well-being area of learning and experience working group that is looking to develop this is taking evidence and views from a wide range of stakeholders outside of the education system to inform their work. And, with regard to the Men's Sheds project, I'm very proud, in my Assembly Member capacity, to have a good working relationship with the shed in Knighton and the shed in Llandrindod Wells, which I officially opened, because I recognise that sometimes, for men, some of these issues around mental health and relationships, they find difficult to talk about. Men's Sheds, I think, is a very worthwhile project, creating that safe space for men to talk about some of these issues that the male stiff upper lip sometimes prevents them from talking about.

14:05
Female Role Models

4. How is the Welsh Government encouraging schools to promote female role models in the classroom? OAQ51673

Thank you, Jayne. We want our young people to be ethical, informed citizens of Wales and the world, and healthy, confident individuals, ready to lead fulfilling lives as valued members of society. That means promoting positive female and male role models in the classroom.

Thank you, Cabinet Secretary. With the centenary of the end of world war one and women getting the vote over 30, it's vital that we share with boys and girls the contributions of so many women before us. Yesterday, I was proud to unveil a blue plaque for Annie Mistrick in Newport—a nurse who was on the front line, who put her own life at risk to care for and treat wounded soldiers in world war one. She was awarded the highest honour by the French Government for bravery. Pupils from St Woolos Primary School were there at the unveiling to hear about a local woman who was so remarkable, yet nearly lost from history. What support is the Welsh Government providing to schools to ensure that all pupils across the curriculum learn about women, past and present, who play such an important role and, where possible, linking schools with local women and events to bring them to life for a new generation?

Thank you, Jayne. I was delighted to listen to reports on the media yesterday of the unveiling of the plaque. It's sad that it's taken such a long time, really, for this amazing woman to be recognised by her home community when the French Government, over many, many years, at the time, recognised her immense contribution.

There is a variety of ways in which we work with a number of organisations to ensure that children in our schools have access to a wide range of opportunities to learn about women from history, and indeed their own local history. So, for instance, I'm aware that, just next month, the soroptimists of Monmouthshire are putting on an event at King Henry VIII Comprehensive School in Abergavenny where they will be talking about women in science and how we can encourage more girls in primary and secondary schools to study science. So, there's a whole variety of work going on to ensure that we have positive role models for all of our children in school, and we recognise the contribution that Welsh men and women have made, not only to their local history, but, in the case of Annie, to a bigger cause.

Well, I'm more than happy to cite Amy Dillwyn from my region as a dead role model—that's not always the most useful role model, though. One of the recommendations from the 'Talented Women for a Successful Wales' report is that we should find imaginative initiatives to challenge gender stereotypes and encourage girls and boys to consider non-traditional occupations. When do you expect to be able to give us some working examples of role models who have been persuaded to go into schools, and how schools themselves have identified those—it could be women, but it could be men as well, I suppose—so that we know what a good role model might look like? Thank you.

I think, Suzy, you're absolutely right: we need to really challenge some stereotypical images that people have. That's why I'm aware that my Cabinet colleague, Julie James, only this week was involved in the This is Me launch at a local college, really challenging what it means to be male or female and what that might mean in terms of the expectations you have of yourself, or that your peers and your community might have of you.

It's also really important in terms of Careers Wales and the offer that Careers Wales put into schools to help inform children when they're taking individual subject choices about what that means for their career going forward. So, I know that Careers Wales activities and services do challenge gender stereotypes, and they do work to facilitate education and business links, for instance, through their exchange programmes, so that people have a wide variety of opportunities to explore what they may want to become when they leave school.

This place was an excellent role model for gender equality, but since 2003, the situation has changed and has moved backwards. I'd like your opinion on the principle of introducing legislation to create equality in terms of representatives in the National Assembly as a means of leading to equality in other areas, including in our schools and education more generally.

Perhaps there's one silver lining to the predicament I find myself in: at least the Welsh Liberal Democrats can claim 100 per cent female representation in this particular Assembly term. [Laughter.] Although, I must admit that's not a particular silver lining I would have welcomed.

I have always, throughout my political career, paid tribute to other political parties that, I believe, took very brave steps to ensure good gender representation in this place. I have to admit that it's a battle that I was never able to win when I was leader of my own political party. I'm a firm believer: unless you can see it, you can never hope to become it.

But, from my perspective in education, what's really important to me is that we, via our existing PSE curriculum and our new curriculum, give young women the opportunity to learn about the political process, to understand how that political process works, and to encourage in them a desire to want to contribute to it, as campaigners and activists in their own communities as well as formal politicians who might seek to serve on councils, in Assemblies or in Parliaments.

14:10
Access to Apprenticeships

5. Will the Cabinet Secretary make a statement on the impact of travel costs on access to apprenticeships? OAQ51670

We take the welfare of apprentices seriously and we do recognise that travel costs can be a barrier for young apprentices, though this is an employed programme.  We will be looking at what opportunities are available to remove any access barriers to the programme, and that will include travel costs.

I’m very enthusiastic for there to be far clearer communication with young people at 16 years of age that they should consider apprenticeships as an alternative option. A constituent contacted me recently who was also very supportive of apprenticeships, and both his sons are currently on apprenticeships at the moment. But, he is concerned about this barrier in terms of high travel costs for those attending apprenticeships, and that that is particularly acute in rural areas where, of course, the workplace can be a very long way away. What special consideration can the Government give in light of the answer that we’ve heard from you this afternoon to very specific considerations for rural areas, where the workplace for an apprentice isn’t on his or her doorstep and can be a very long way away?

May I say that I have looked into this issue? One of the problems is that because this is an area where we do give additional funding, that could be seen as a taxable benefit, and that then creates a problem because this assistance isn’t available to all. So, what we don’t want to see is a situation where money is taken away from them because we are giving them this benefit. So, it is more complicated than you might see at first glance. 

Of course, we have had this mytravelpass, which gives a third off ticket prices for people who are aged 16 to 18, and that is currently being evaluated. I believe that that takes us in the right direction. However, I do understand that this is a problem for people living in rural areas where distances are a factor. So, we are looking into this and we are considering now what the solution is and how we should respond in terms of mytravelpass.

Cabinet Secretary, affordable transport is vital if young people are to be able to access education and training to obtain the skills our economy needs. The National Union of Students points out that some apprentices are paying 20 per cent of their income on travel and have called for the introduction of an apprentice travel card. I just heard from the Minister there about taxable benefit. I think that's not possible, because the children are always exempt from anything. So why is this? I think don't mix oranges with apples here.

Does the Cabinet Secretary agree that providing all 16 to 20-year-olds in Wales with a card offering a free bus pass would remove a huge barrier to young people accessing education, training and job opportunities, which our side of the Chamber has been asking for for many, many years? You're not even listening.

Can I point out that, when you're on an apprenticeship course, you actually receive an income, and any income is, theoretically, taxable? So, we have got to be sensitive. We have been looking at what is possible, because it has been recognised as a taxable benefit. So, we're not comparing apples with oranges, we're actually making sure that these people don't get into more trouble.

I do think that what we need to do is to make sure that we put pressure, sometimes, on some of the bus companies. If you look in Cardiff, for example, the Iff card, there are discounts for 16 to 18-year-olds, so it is possible for that to happen. But already—if it's available to everyone, it's not a problem. It's when you start just giving it to special circumstances, that's when it creates a problem.

14:15
Further Education

6. Will the Cabinet Secretary outline plans to improve further education to support more people to gain qualifications in Wales? OAQ51681

'Taking Wales Forward', the Government's programme to 2021, clearly sets out our belief that the future prosperity and stability of our nation depends on the skills and values of our people. The Government recognises that further education learning, whether lifelong, part-time, or work based, is essential for individual and national prosperity.

Thank you. Page 8 of 'Education in Wales' discusses the need for a strong commitment to effective collaboration as well as the integration of services where appropriate. Could you expand on what the opportunities to collaborate more effectively are in terms of colleges and schools? For example, the Welsh Government used to fund 14 to 19-year-old fora through the medium of Welsh, and this did try and promote collaboration between those sectors specifically. Are there any similar proposals in the pipeline, and could you tell us about those, if there are?

It is important that we do see better collaboration between schools and further education. Now, we are looking at how we can see that collaboration through the post-compulsory education and training changes that we will see in future. We'll take competition out of the system because that can create problems at present. But I do think it is worth stating that there is quite a high level of success in FE at present. About 86 per cent of people do succeed in the field of FE, so that is quite an important step. What we do need is to go even further and push those standards even higher and constantly.

Support for School Governors

7. What support will the Welsh Government provide for school governors in the next financial year? OAQ51650

The Welsh Government will support governors by working with the regional consortia to strengthen the national model for regional working and we will also respond to the consultation on school governance with proposals for a revised and simplified regulatory framework.

You'll be aware, Cabinet Secretary, that over £0.25 million that used to go to Governors Wales is not going to be forthcoming in the next financial year, and they're meeting on 16 February to decide whether to close their doors.

Governors Cardiff is continuing to exist, with a £50 levy per school, and that may be possible in an urban area where schools are relatively close together, but, given that school governors are the ultimate active citizens—they're not being paid for carrying out their duties—what are the opportunities now for governors to all get up to speed? I was looking at the Central South Consortium, and there's nothing there in terms of explaining to governors what their role is in ensuring that their priorities are met. I'm aware that Cardiff Council has cut their governor support from four officers to two, so it would be useful to know how you think governors are going to be supported to carry out their quite complex role.

I thank the Member for that. I've been very clear that, in order to protect front-line delivery for schools, I am prepared to make difficult decisions, and, in that regard, as governor support is already provided through local authorities and regional consortia, as the Member has said, we will be ending the grant to Governors Wales.

We're not seeking to replace or replicate the support previously provided by Governors Wales as we believe that many of the services offered, as I said, are already duplicated by local authorities and the regional consortia. I need to make it clear that of the approximately 21,000 governors that we have in Wales—and, Jenny, you're absolutely right, they are the ultimate in active citizens—only 2,000 of those governors were actually on the Governors Wales mailing list, receiving information from Governors Wales, and, when Welsh Government undertook a review in 2014-15 of Governors Wales activity and support, we identified, for instance, only 10 per cent of governors participating in that review used to contact the helpline that Governors Wales operated. In these difficult times, we can't afford the duplication of service, and we'll be working with the revised regional model and revised expectations of what regional consortia need to support and recognise that, in many instances,  governing bodies and governors seek support from their local authorities.

14:20
'Successful Futures'

8. What is the Cabinet Secretary doing to prepare the post-16 education sector in Wales for the implementation of the recommendations included in the 'Successful Futures' report? OAQ51676

Professor Donaldson's review, 'Successful Futures', had radical and wide-ranging implications for the education system in Wales. We've been working with a range of stakeholders to develop the plan and overall timeline. The focus is on the essential and employability skills young people need in their future lives.

Further education should be included in the design and development of the curriculum. The Baker clause has recently come into effect in England, whereby schools are required to let FE providers advertise their services to pupils in years 8 to 13, making learners aware of the range of options available to them after they leave compulsory education. With the significant reforms under way to the curriculum, and particularly governance of post-16 education as well, do we in Wales need to consider a similar mechanism in order to prepare pupils for the transition between schools and FE?

Well, 'Successful Futures' doesn't specifically mention post-16 learners, but I do take the point that, actually, it is important that there is a relationship and people understand the continuity that is necessary between school and further education. So, what we've asked is we've asked Colegau Cymru to come up with a set of recommendations in terms of what FE can do in terms of developing the new curriculum, but I think the other point is that we do need to make sure that children in school are aware of all the opportunities available to them and that the academic route is not necessarily right for everyone, and we need to make sure that perhaps we have a more objective possibility within schools in terms of allowing individuals—making it individual-centred rather than a system where there is an encouragement to stay on, necessarily, in school, which is not right for every pupil at sixth form.

2. Questions to the Cabinet Secretary for Health and Social Services

The next item is questions to the Cabinet Secretary for Health and Social Services. The first question is from Jane Hutt.

The Health of the Nation

1. Will the Cabinet Secretary make a statement on the Chief Medical Officer’s latest report on the health of the nation? OAQ51659

Thank you for the question. I welcome the chief medical officer's report, which was launched today. It has a particular focus on harm from gambling as an emerging public health issue, and I look forward to making a full statement on the report and its recommendations next week.

Thank you, Cabinet Secretary. I look forward also to looking at the latest CMO report out today, but I'd like to refer to the last report, 'Rebalancing healthcare: Working in partnership to reduce social inequity', which draws attention to a major global theme that many health problems demonstrate a strong social gradient, and there's a higher prevalence of illness and early death in more economically disadvantaged groups and areas. Indeed, Professor Marmot, earlier this week, I heard was emphasising this point. I know that you've met Professor Marmot in a former capacity in terms of your role tackling poverty in Wales. Of equal relevance, of course, for the Welsh Government is the inverse care law, the principle that the availability of good medical or social care tends to vary inversely with the needs of the population served. This principle was proposed by south Wales GP Dr Julian Tudor Hart, and has been widely adopted as a steer for health policy. Can the Cabinet Secretary identify how he is addressing the need to reduce social inequity in health status and health provision in Wales?

I thank the Member for highlighting a hugely important issue for the future of healthcare in Wales and beyond today. This, of course, is a key aspect of prudent healthcare, which my immediate predecessor outlined, and that's continuing through the service. Prudent healthcare is a key aspect when looking at, for example, the NHS Wales Awards; we look for evidence of a prudent approach to running and delivering services. It's also been highlighted and reinforced in the recent parliamentary review as a key driver for our system. There are some positive things to look at here in Wales; it's not just a counsel of helplessness. If we look at Aneurin Bevan Local Health Board and Cwm Taf Local Health Board, they've both had inverse care law programmes, deliberately going out to communities with the greatest level of risk, those people who don't engage with their own health, and the results are really positive thus far as well. I think in a previous appearance before the health and social care committee—it's not called that; it's still got sport in its title—I'd indicated that I'd write to them with an update on the initial evaluation from those two programmes from both vice-chairs. I'd be happy to share that with all Members, because it does show that that practical approach is starting to have an impact. There are lessons to learn from that approach and others for our whole service to adopt across the country.

14:25

Cabinet Secretary, such is the plentitude, if I can put it that way, of gambling opportunities that we hear today that 16 per cent of children aged 11 to 15 gambled in the past week. I do find that quite shocking. I should say that I do gamble occasionally. But we've got a real problem with gambling addiction, and now we hear from the chief medical officer that it is one of the major public health concerns that we face. Are you likely to review the current position of the Welsh Government that there's no medical intervention available to meet gambling addiction?

We will, of course, look at all the evidence available about how to treat gambling addiction in the first place, but I want to come back to your first point about the prevalence of gambling and the ease with which gambling can take place. It's no longer, if you like, an unusual or regulated activity that people have to make an effort to physically go to. There's a challenge about online gambling in particular, and there's been a recent and well-run public debate on fixed-odds betting terminals as well. Now, we're about to have new powers under the Wales Act 2017 where we could potentially do something with our powers, up to a minimum stake of £10. You'll notice that, in the report published today, the chief medical officer recommends using our powers to their fullest extent. We need to consider also the ongoing review undertaken by the UK Government where they are talking about reducing the maximum stake down to £2. The chief medical officer has put evidence in supporting that, so we need to think about how our powers may be affected if the UK Government do take that step forward. I actually think that having that general approach across the UK would be a good thing, but I'm interested in how we use our powers in restricting gambling in a way that is sensible and proportionate, recognising the harm that takes place, and at the same time about the treatments we offer for people who are caught up in gambling addiction, because I do recognise the wide social harm it can and does cause. 

Public Consultations

2. How does the Welsh Government ensure that health boards fully engage in public consultations on future health services? OAQ51671

Health boards are responsible for working together and consulting the public regarding proposed changes to health services in Wales. The Welsh Government promotes good practice in engagement and consultation and supports health boards in working together with the public, their staff and others—including, of course, community health councils—to help ensure the best possible health outcomes and planning.

Thank you for that answer, Cabinet Secretary. I'm sure, as you agree, it's very important that they do engage with the public. AMBU has recently gone through three, or is going through three, public consultations—thoracic surgery prior to Christmas, and it's currently going through the major trauma network consultation and the boundary changes. I'm hearing that, in fact, the take-up by the public in some of these public meetings is very, very small. Surely it's important that health boards, when they recognise that there are not many people attending, become proactive and actually go back out to the people to get the consultation. Otherwise, there's a report saying very little because people haven't been attending. People may not attend because they don't know. Many of my constituents didn't know these consultations were going on. We need to get them out there. They have to get engaged with the people. They have to recognise that, if they're not talking to them, if they're not attending—go back out and start again so that consultation becomes meaningful and not lip service.

I do recognise the points the Member raises. There's something important about the balance in what we have to do. We have to make sure that there is a genuine, proactive attempt to engage the public in consultations through a variety of different means. There's the personal conversation that takes place between people and staff, there's the written media, there are formal notices, there's having community meetings, there's all the online presence as well, and, of course, the community health councils and their role in engaging with the public too.

I'm happy to join in with what Julie James said yesterday in business questions to encourage people who have not yet taken part in the major trauma consultation to do so before that closes next week. But we also have to accept we can't force the public to take part in consultations. It's often the way that, when there's a big and a broad subject, the public aren't as likely to engage, but when there's a more specific and local proposal then, actually, you do tend to find that people engage. A good example is planning law, outside the field of health, deliberately. General conversations about planning tend not to have lots of people engaging, but a specific planning proposal in a locality almost always does. But I'm happy to say that I think that we are genuinely looking to learn and to improve. And of course, on one of the proposals that you refer to—the consultation on thoracic surgery—there was confirmation on Monday that thoracic surgery will be centralised, in accordance with a recommendation from the Royal College of Surgeons, and it will be centralised in Morriston in Swansea.

14:30

You're absolutely right, Cabinet Secretary, we can't force people to take part in consultations. But picking up from the point that David Rees made, there are an enormous number of really good ways of engaging people at a grass-roots level and really taking the temperature of proposed changes. Organisations such as INVOLVE, who run consultations in England—they work very hard with local authorities and health boards, they run fun days, there's all sorts of new ways of actually getting to the hard to reach, rather than the very stale paper-based, or if you're lucky and get broadband, computer-based consultations that we have in a very, very small window, almost inevitably run over a Christmas or a summer holiday. I would like to ask you to have a good look at all the alternatives we can to reach them.

But, above all, the central point of my question is: do you think it is still appropriate, given the parliamentary review, that we actually have consultations now run by health boards, or should they be health and social care, given the fact that we're looking for such an integrated and seamless way of going forward? Because anything that health decide to do will have an enormous impact on local authorities, and on the provision of social care, and the provision of housing. And if we're trying to get towards this more holistic way of putting the person at the centre of their health needs, ongoing, then we really should look at it in the round. A lot of these consultations are all about the health side, and don't really bring in the other half of the very important provision that we should be providing.

Well, there is something here about understanding the proposals referred to earlier by David Rees, who talked about thoracic surgery and the major trauma centre. Those really are specialist health service consultations that need to take place. And my concern has always been that, if we avoid dealing with issues, then we'll allow ourselves to get into a position where the debate is more difficult, and the need to change is more urgent. So, I don't think it would be helpful to try and stop the health service from running consultations on the way in which services should change and be reformed. But of course, there are a wide range of those services that are properly about how health and social care work together. So, I expect health boards to have proper relationships and conversations with social care partners.

For example, on the consultation about Bridgend, which is ongoing at present, there is absolutely a conversation, not just with Bridgend local authority, but actually with partners in Swansea, Neath Port Talbot, and of course RCT and Merthyr as well, about the potential impact of those. So, there is a willingness and a recognition that health and social care need to work more closely together. Regional partnership boards and the public service boards are part of that, and when you get to having a consultation, I expect that to be the case as well. But I really don't think there is a case to say we should pause and stop what's being done now; we need to learn and improve, rather than putting a pause button on changing, reforming and improving our health service.

My engagement with my health board is going to be a lot more difficult after the events of the last 24 hours, I have to say, now I know information will be shared willy-nilly with the Government for the purpose of traducing engagement with the health board. So, just to confirm that I hope the Cabinet Secretary can confirm today what other information the Welsh Government has around Assembly Members' own engagement with their health boards. What he has in front of him in his little file there would be useful to know.

But, from the point of view of the public, for them to get engaged in health board consultations, they have to believe that the consultation proposals are credible. Now, one of the proposals in the Hywel Dda health board area, which is likely to be put out in March, is one of a brand new hospital, somewhere in west Wales, to replace Glangwili and Withybush. For that to be a credible proposal, to be taken credibly in a consultation exercise, to be responded to credibly by the public, he has to tell this Chamber here today that the Welsh Government will provide the capital funding if a brand new hospital for west Wales is proposed. Will he do that, so that any consultation has some credibility around it?

I think there are two broad points there. The first is on the points you made about traducing Assembly Members and their efforts to engage in local health boards. I think it's really important that every Assembly Member engages with their local health board around the future of health services. We've just had a parliamentary review that set out again that the current way that services are organised have served us well in the past but they're not fit for our future. So, we need to change them. And that's the national challenge that faces us. I think every Assembly Member should be properly engaged in that conversation. Again, the maturity that led to the parliamentary review needs to continue in that continuing debate. And I think that when it comes to a debate in this place, of course, there will be to and fro in the Chamber. It's not as if Ministers—[Interruption.]

14:35

Let's allow the Minister to be heard. Carry on, Cabinet Secretary. 

It's not as if Ministers are completely free from criticism and questioning of motives and integrity in this place. I think it is important that Members are open and honest with the public and this Chamber about what our views are and where we're going. And that's a standard for all of us to reach to as well.

On your point about where we are now, Simon Thomas, with the proposals that may come in the future, I've said in the past, and I'm being as open and honest as I can be yet again, that I can't set out the position about what proposals are or are not going to be discussed and put forward in the spring, as the health board have indicated. I'd encourage everyone to engage before then and afterwards, and if there are real proposals coming forward, then of course we will look sensibly at what those are. But you know that I can't say today that I will find money or resources for a future decision because that would not be an open and honest conversation, and you're asking me to do something before there is actually a proposal for me to respond to.

I'd remind people—[Interruption.] I'd remind people that not only is there a role for Ministers in this, but we're at the point of actually constructing the Grange University Hospital right now. The structure's going up. It's been a conversation that's taken a number of years following a proposal, and following a range of ways to look at the business case, to get capital ready to do so. I made the choice for the capital case to go ahead at the start of this Assembly term. So, there was a decision there, which I made, and that was after the case had been made and agreed, with buy-in from local public and clinicians about what to do to reconfigure the health system in that part of Wales. 

I recognise the invitation to say something completely precipitous at this point, but I won't take up his kind offer to do so.

Questions Without Notice from Party Spokespeople

I call on the party spokespeople now. The Conservative spokesperson, Suzy Davies.

Diolch yn fawr, Llywydd. Minister, Social Care Wales has been leading the way in producing a new set of qualifications for care workers. And as well as simplifying the system, this is an opportunity to respond to some new issues that aren't reflected in existing qualifications. There's more public awareness, for example, about sepsis, and while care workers are likely to receive some training about recognising the signs of a stroke, they don't get that training for signs of sepsis at the moment, generally speaking. Bearing in mind that some people with comorbidities are more likely to develop sepsis than others, and that the signs can be confused with other conditions, would you ask Social Care Wales to consider including sepsis awareness training as part of the curriculum for the qualifications for care workers?

Suzy, thank you very much for raising this important point. As well as raising this point, it would be worth mentioning the work of the cross-party group on sepsis, which has raised the importance of this, particularly across social care training as well, and I look forward to responding to that after discussion with my officials.

We're all very aware now of the heightened awareness of sepsis and the importance of early diagnosis as well as early treatment. It is noticeable that even with the rise in awareness and the rise in the number of people presenting with sepsis, particularly over the last year as well, and, of course, an increase in the number of our older population who are presenting with this, the number of deaths through sepsis is declining, and it may be part of the fact of the increasing awareness, the increase in training right across the board that we are doing on this. We know that not every death through sepsis is preventable, but we know that some are. So, that early diagnosis and treatment is absolutely vital.

Now, it's hard to draw firm conclusions at the moment from year-on-year figures. It seems to suggest that we are indeed doing something right in Wales with our training and with our approach. But I look forward to responding to the comments that have been made today, but also the work of the all-party group on sepsis, because we need to make sure it's working, not only across the health sphere, but across social work as well, so that we can make sure that, at every point, there is an opportunity to do very early diagnosis and have the early treatment, and continue the good work that we're doing. 

Thank you for that answer. That was my point, really, because I'm aware, of course, that hospital workers get this training, but social care workers don't necessarily. And that's why I'd like to see it mainstreamed in the curriculum for the qualifications.

Moving on to something else now, the Cabinet Secretary confirmed to me in a written answer—last year it was—that the money that Welsh Government put towards the social care workforce development programme is match funded by local authorities. However, you went on to say in the same response that for every £1 spend by Welsh Government, 44p is spent by local Government. I have to say that that doesn't quite sound like match funding to me. While I accept that councils are strapped for cash, I do remember that your predecessor made available additional moneys for councils conditional on evidence that it was being spend on social care improvement objectives. [Interruption.] I'm afraid, yes, you did. I have the questions and the answers to prove it. As the fund is now overseen by Social Care Wales, do they have the power to ask local authorities for greater contributions to the fund and do they have a remit letter from you about the outcomes that you might expect from it, not least whether Social Care Wales is to perhaps limit its own administration costs when administering that fund? 

14:40

Thank you very much. Just to be clear, the figures that I have on the element of match funding are not the same. It certainly isn't 44 per cent. Of the £7.15 million funding to the regions to deliver social care training by Social Care Wales, I'm informed that 25 per cent of that—so, a quarter of that—is match funded by local authorities. But I'll go away and look at that figure of 44 per cent, because that certainly isn't anything that has been brought to my attention. So, yes, indeed, if the Member could send that to me I'll have a look at it. But, as she knows, within that, the priorities this year have included care and support at home, they've included recruitment and retention, career development and the implementation of the Social Services and Well-being (Wales) Act 2014.

I'm grateful as well to the Member for raising those important issues of the work that we have to do on workforce training, because actually getting people to see that this is not only a valuable profession but a profession in which they are valued means we put the investment into the training, and it is a shared ownership of this. It is a shared partnership in this through local authorities and Welsh Government. We are putting the money in. There is an expectation with the match funding that local authorities will also step up to the mark. But, of course, we'll keep this under review as well. But there is a significant portfolio of work now going on in this area, and I am constantly, whenever I visit front-line social care workers, stressing to them the importance of the work, but also the necessity of us as Assembly Members, of us as Welsh Government, and also local authorities and everybody else, to really value and speak out about the value of this work, because we know it is truly the coalface in terms of our interface with some very vulnerable individuals. 

Thank you for that answer. You'll be aware, of course, that the Public Accounts Committee was talking a little bit about this on Monday. They heard evidence about how the average working life of a social worker is less than eight years, while, by comparison, a nurse could be expected to work for 16 years and a doctor 25. While that means that new social workers are constantly needing to be trained, it also means that there is a real shortage of experience that can be passed on generationally, if you like, to trainees and newly-qualified social workers.

Bearing in mind what you've just said about the workforce fund, how do you expect to improve the numbers attracted to social work and stay in social work, more critically? Do you think that the new qualifications are material to that? Who determines the key performance indicators that Social Care Wales should be looking at in order to ensure progress on both those fronts? 

There two things. One is that there is no one answer to this—there are a multiplicity of ways in which we take this work forward—and secondly to say it won't be overnight. But you are absolutely right in saying that some of the issues that you've raised already are important. We are working with social care workers themselves to try and devise the right package of incentives that shows actually that this is a valued career path, not simply a job. Those observations that were made in the PAC committee last week are very telling in that if you go into nursing or other areas you could be two or three times as long, seeing that as career progression.

We know also that some social workers are moving from social work into other career paths as well. You look particularly at things such as domiciliary care workers within social care. So, doing things such as extending the register, as we are now doing—it's a tricky ask, I realise, for domiciliary care providers, but extending the register to domiciliary care workers on a voluntary basis from 2018, ahead of mandatory registration from 2020, is part of it. It's an essential part, because it's an essential part of the professionalisation of the workforce to ensure that we have social care workers that are appropriately qualified to deliver qualified care to the vulnerable in our society. 

It is also working with Social Care Wales, with Qualifications Wales and other key stakeholders to develop clear career pathways—not a job that you go into and there's a dead end to it, or a job you go into and drop out of early, as those figures showed, but there's a proper career pathway here, that people can see that they can develop over a long time within this career, such a valuable career that it is, with continuing education and learning that enable those social care workers to progress through their careers. And also, I have to say—I mentioned the role that I have as a Minister in doing this, and I'm sure that every Assembly Member has as well, in speaking up for the profession right across—that it's also about working with Social Care Wales to develop a marketing and a recruitment and retention campaign to publicise that positive image of what social care workers do.

One final point: we've also provided £19 million this year of recurrent funding for local authorities to work with service providers to help manage the impact of implementing the national living wage. The national living wage itself is part of this multiplicity of ways in which we say that this is a valuable profession, with valued people working in it, and we want to see more people coming into it and staying in it longer. We'll do that and we'll work with all the partners out there to make sure that this is seen as a worthwhile career for the long term.

14:45

Thank you very much, Llywydd. May I ask the Minister what assessment the Welsh Government has made of the implications for Wales of the research from the British Medical Journal recently that links cuts in social care budgets to far higher rates of death in England?

The observation is well made and we know the continuing times we are in with stretched budget pressures, and there's no point ignoring this place and stand on my feet and say that we can do remarkable miracles—we're working within the constraints that we have. What we do have in Wales, I have to say, is a very different approach to what we're doing within social care and with health, not least in the approach that's been taken with the apolitical, cross-party support that there has been for the health and social care review, if you look at what we're doing with the intermediate care fund, in that way of joined-up working. So, we're not looking for additional funding, although I'd love to have some, Dai—I really would. But it's also to do with how we use the funding that we currently have in a clever way.

I've come this morning from a visit in Cardiff, with my colleague Julie Morgan, looking at the independent living centre, which does exactly that. It uses the intermediate care funding, into which we've put £60 million over the last year, to look at the ways in which health and social care join up to provide that seamless care and allows people to stay in their homes or closer to their homes for longer, for better, and to not then wash up into later, more expensive forms of treatment and care.

So, Dai, I recognise the point that's been made in that report, because it shows that we have to continue thinking how we make the most of the money that we have. He will know, of course, as well, that amongst the four proposals discussed and put out for consultation by the Finance Secretary and my colleague, Mark Drakeford, was a discussion on a social care levy. I think it's pertinent that that is now out there for discussion because you and I and our families and our constituents will have to seriously consider, in the longer term, as we look at the trends that we've identified in the indicators that the Welsh Government has brought forward as national indicators of the strain that the system will be under, how we rise to that. Part of it is through working more cleverly and part of it is by finding the money. I would love to think that, in the next Treasury statement from the UK Government, they'd open the cheque book and say, 'Let's actually put something here', so that we can have the consequentials, but we wait.

Thank you very much for that response. Of course, the BMJ research does show that 22,000 additional deaths are caused annually in England because of cuts in social care budgets in England. That’s 22,000 people dying because of cuts to the budget. That’s what the policy of austerity is leading to. In addition to that, because the Government in England safeguarded, or ring-fenced, expenditure on health in England, the funding for social care took a massive hit as a result. That is why we see those 22,000 deaths: because of those cuts and because there isn’t enough money in the system.

Now, people always say it’s not always about the money, but, in the case of social care, money is the fundamental issue because there are people in hospitals when they shouldn’t be there. That is the outcome of the lack of social care. We will be talking about deaths in Ysbyty Glan Clwyd later on. Why are those people still in hospital? Because they can’t be discharged and go back to their own homes because of a lack of social services and a lack of funding.

As you’ve mentioned, in light of the parliamentary review into health and social care by Dr Ruth Hussey and the central importance of social care and the demand for transformation, are you, essentially, going to be calling for an increase in expenditure on social care, because that's what we need to do—not do more with funding that we don't have, but call for an increase in expenditure and an increase in the budget of the integrated care fund?

14:50

Thank you, Dai. A couple of things here: one is that, as you know, in stark contrast to what has happened over the border—I don't want to compare with what's happened over the border—what we have done is, in health and social care combined, which is the approach that we're taking, based on the Social Services and Well-being (Wales) Act 2014 and other legislation here, about that idea of integration. Similarly with the funding, there is more going into health and social care here in Wales than there is across the border. But we still know the strains on the system.

In addition to that, I have to say, these ideas of how we make that money go further—well, I've had repeated meetings, and very productive meetings, I have to say, over the last few months that I've been in post with, for example, the regional partnerships. The idea that we should do more joint commissioning—how do we actually make a bigger bang for our buck, so that we can say, 'Well, we've identified what the care accommodation needs are for the elderly'? We could apply this to other areas of thinking as well. How do we collectively say, 'We'll look at what we've got together'? How do we, on a regional footprint, provide for that and get bigger delivery—deliver more care homes and deliver more places and better outcomes for people?

One important thing with that is, I have to say, as tricky as it is, the issue of pooling budgets. This is tricky, because we're all elected Members—we have the mindset of an elected Member as well as sitting here thinking about policy in a highly strategic way. We know how difficult it is for people to say, 'Well, pooling budgets—doesn't that mean that we have to give up a little?' In some ways, yes, but if it delivers the right outcomes in terms of social care then we should be looking at that.

There are things in Wales that we can do more cleverly, more sharply and differently, and we should be doing that. But, ultimately, Dai, I agree with you—there is the bigger challenge going forward, both in health and social care, which is in the thrust of the health and social care review, which is looking at them together. That seamlessness of the pathway for somebody who is a constituent or a patient of yours—that they don't have to think about who's dealing with them or what authority is doing it, but that it feels like a wraparound. I'm convinced, as we look at some of the models with ICF funding, that that is absolutely the way that we should be going.

Thank you, once again. My final question relates to the fact that the BMJ research also discovered that one of the other things that would help in preventing deaths, in addition to further funding, is the presence of registered nurses in social care settings. That's what the research has demonstrated. Of course, as we discussed the Social Care and Well-being (Wales) Bill in the last Assembly, your Government voted against amendments that would have enabled local authorities to employ registered nurses in social care settings. Bu, there are other ways of resolving that problem. So, in accordance with the evidence, what plans do you, as a Government, have to increase the number of nurses in social care settings as part of any plan to mitigate the fatal effects of austerity coming from Westminster?

Well, Dai, thank you for raising that point. As you know, through not only the consultation that preceded this, which was quite extensive, but the bringing forward of the regulations—a wide range of regulations—part of this is also what we do with the nursing requirement, particularly in accommodation care settings. The traditional approach has been to say, in effect, 'If you can provide a nurse within a care home, then it's all hunky-dory and you're done', when, actually, what we know is that, in some care settings, you will require more than that. In other care settings, you may require nursing through the night; in others, you'll need, actually, more during the daytime or vice versa. So, within the proposals that we've taken forward, we have given more flexibility, but it doesn't take away the requirement, Dai, to make sure that the needs of those within care home settings are provided for; it gives more flexibility to do it according to the needs of those individuals.

Now, that requires, I have to say, that those care homes, and the wider monitoring of those, need to make sure that they are assessing accurately the needs of their residents and then providing for them. If that means more than one nurse, it should be more than one nurse. If it means more than one at night time, it means that, because we know that it's got to be based on the individual needs there and the collective needs within that care setting.

So, it has moved to a more flexible approach, and I realise that that has caused some people to say, 'Well, does that mean we don't need one in every home?' Well, what it needs is the right level of nursing for every single care home setting, and that's what we're committed to making sure is provided. 

14:55

Diolch, Llywydd. Minister, last week a widespread failure in the NHS IT systems caused chaos for GP practices and hospitals across the country, with many GPs reporting that they were unable to access patient records. One GP described the situation as very frustrating and rather dangerous. Hospitals were unable to access test results and one patient was told he would have to wait another month for the results of a biopsy due to the backlog caused by the systems failure. I hope you will agree with me that this is totally unacceptable. Cabinet Secretary, can you update us further on the reasons for this outage, and what lessons, if any, have been learnt?   

Yes, I recognise the inconvenience caused to staff and patients in the national health service following the incident last week. It's not thought that it was a cyber incident, on the positive, and, indeed, that it was a technical issue, although widespread. All affected systems were returned to normal by 8 o'clock on the same day. There's a challenge about having caught up with any potential delays and backlogs. Further work has been done today to provide a new firewall, and my understanding is that our systems are in a fit and proper place to move forward. But there is, of course, a broader question about investing in IT to deliver more in the here and now and in the future.    

Thank you for that answer, Cabinet Secretary. NHS Wales Informatics Service have just announced that the new contract for the GP clinical systems and services will be awarded to Vision Health Ltd and Microtest Ltd. This has caused concern for many GP practices that use systems provided by EMIS Health Ltd. GP practices have been told that EMIS Health Ltd did not meet a number of the necessary tender evaluation criteria and that EMIS practices will need to choose an alternative system. Cabinet Secretary, can you expand upon the reasons that EMIS Health Ltd was not successful at the tender stage? Is it related to the news that NHS Digital have imposed significant penalties in the order of millions of pounds for failing to meet contractual requirements of the GP Systems of Choice contract in England? 

I should start by saying it was remiss of me not to thank NWIS staff who worked hard to resolve the technical issue last week and to make sure the disruption was not more widespread, and, indeed, as I say, it was resolved within the day. 

On EMIS and the issue of systems to support GPs, I recognise it's a challenge because a significant number of GPs currently use one of those systems. I can't go into the full reasons for it because there's a period of legal challenge and so I can't make a full statement until that point in time. But Members, I'm sure, will be interested to know that the British Medical Association have issued a very brief statement, because the general practitioners committee of the BMA were engaged in the discussions about the future tendering, and they themselves have said that they recognise that, whilst it's difficult, they think the right choice has been made because minimum standards have to be met within the contract process. But I think it will be towards the end of next week or the start of the week thereafter when the legal challenge process will be over and, if there is no challenge, a fuller statement can be made.    

Thank you, Cabinet Secretary. Whatever the reasons for the decision against EMIS Health Ltd, this affects many GP practices across Wales who have been using the EMIS system for many years. The Royal College of General Practitioners are concerned that this will have a detrimental impact on both GPs and patients due to the scale of the changes needed to move to a new system. There are fears that this could risk pushing older GPs to an earlier retirement. Cabinet Secretary, how do you plan to address the concerns that an already overstretched profession does not have the time or resources to move to a new IT system, and are you confident that the new systems provided by Vision and Microtest are robust enough to prevent failures like we saw last Wednesday? 

I think that the issues are different, with respect. The issues about the data centres I don't think are the same as the software and support that we're talking about to support GPs to work in their practices. And I go back to the statement made by David Bailey, the chair of the BMA Welsh council, who is also a GP himself, and his practice actually uses EMIS systems. He's recognised that it will be a practical problem for GPs in migrating to a new system, and that's why conversations have already taken place about the required training and support to help migrate practices into a new software that meets our requirements for the system that we have to run here in Wales. And that's the point: we have to have a system that supports the aims and objectives of the way we want to run our system here, not our system being driven by the demands of an external software supplier.

I do recognise the practical challenges about whether, if GPs don't feel supported in doing this, some may make a choice to leave the profession earlier than we would of course want them to. That's why the continuing nature of our conversation with both the British Medical Association and the Royal College of General Practitioners really does matter. I want them to be assured that there is a real will and commitment from the Government and the wider health service to support them in doing so and to continue to provide excellent, high-quality care to every community in Wales.  

15:00
Community Health Councils

3. Will the Cabinet Secretary outline progress on plans to change community health councils in Wales? OAQ51680

We are giving detailed consideration to the many consultation responses to the proposals in our recent White Paper, in which changes to community health councils are one. Officials and I remain in discussion with representatives of the CHC board regarding their constructive response to the White Paper. A consultation summary report will be issued in due course. 

Well, of course, Cabinet Secretary, I think that if we're going to have the grown-up debate that you want us to have on the future of the health service, we need to have a community health council sector that is able to respond effectively to that call as well as the politicians. I believe that community health councils are crucial, but I have some reservations from my own patch about how they've reacted to previous problems with regard to Princess of Wales Hospital and, more recently, with regard to the Kris Wade scandal. But that doesn't take away from my fundamental belief that I do not believe that a Wales-wide body will solve this problem. For me, it's about trying to give community health councils guidance, to give them standards, to standardise practices across community health councils and make sure that they are visible. In fact, the former community health council chair of Abertawe Bro Morgannwg University Local Health Board actually told me that it was the best-kept secret in Wales, and I think that's quite a shocking statement to come from a chair of a community health council. So, what are you doing in relation to this concept of a Wales-wide community health council? Are you still going to go ahead with it, despite those reservations?

As I've said, we are gathering together the consultation responses, and we do continue to have a very constructive dialogue about how to take forward proposals, but I think all of us want to see a new citizen-voiced body that is able to properly cover the fields of health and social care, and you can't do that without replacing CHCs, because their current remit set out in primary legislation just doesn't stretch into the social care field. So, that's really important for us to achieve. Actually, there are some people who take your view that a national body shouldn't be the answer, but actually we already have a national body with the CHC board. It's about making it work and ensuring that we can deal with some of the concerns that people do have about a national body being set up in one remote location—whether it's Cardiff, Aberystwyth or Bangor—and that wouldn't then have the local status and the local organisation to have a presence within local communities. So, those concerns are being taken seriously, and as we both have the consultation responses and we've moved forward to then having what I hope will be proposals for a Bill, these are obviously matters that will want to set out in detail, how we propose to deal with those, but those conversations are not complete.

Cabinet Secretary, I think that Bethan Jenkins has made some very good points, and they're points that have been made to many others as Assembly Members from across Wales. I met with my own local community health council last year, and they were concerned about some of the possible proposals to come forward from the Welsh Government in this area. They're not averse to change and they understand that the system, the sector, does have to change. In terms of the structure—whether it's a national body or a local body—that's ultimately for you to decide, but will you, however, ensure that you do listen to patients, ensure that there is a patients' voice as part of this system, whatever structure that may be? Let's not lose that vital aspect of the current CHC system, which sees volunteers going into hospitals, seeing on the ground with spot checks problems that are happening, problems that patients are facing. These are what we really need to hear fed back to the system; we don't just want a bureaucracy that doesn't have the patient's voice at the centre of it.

This has been part of the very sensible and constructive conversation that we've had: how do we make sure that there is a genuine patient voice, a citizen voice, across health and social care? How is that organised in a practical way to take on board the parts that have been successful within our system and to deal with some of the challenges that no-one suggests have worked well? Part of the focus has been on the ability for a community health council or its successor to be able to actually undertake visits, and there's a challenge there about doing that in a way so it doesn't disrupt patient care but actually makes sure that there is access and the ability to undertake some unannounced visits as well, but not confusing the mission with a citizen voice body and the work of the formal inspectorates—Care Inspectorate Wales and also Healthcare Inspectorate Wales. And, actually, there is a tension there to be resolved, because at the time the CHCs were created we didn't have those other formalised inspectorate organisations. So, it's about making sure that there's clarity in the mission that doesn't stop those important visits to understand and to hear directly from citizens as they're receiving and taking part in care themselves. So, I recognise the issues and of course they'll be part of our consideration going forward.

15:05

Cabinet Secretary, the White Paper suggested that there was a duplication of inspection roles with community health councils and Healthcare Inspectorate Wales, but the community health council inspections are, in many ways, quite different. They are unannounced and can occur at any time, they include patients and relatives and they also involve follow-up visits. So, it seems to me that there's an important element there that is vital that we don't actually lose.

There was one further function, which, again, was part of the submission that I put in after various consultations, and that is the role of community health councils in the planning process. I've raised this with GP practices, but the fact is that where we have, for example, large housing developments, there is a lack of engagement, properly, with the health boards and with the local GP practices on the impact of such developments, and, also, there's the important role that community health councils could, perhaps, play within that context. It's essential that that role really is beefed up and it is an important one that we really need to develop that doesn't exist at the moment, but could be one of the very important functions that community health councils do play in the future.

Dealing with your second point first about the broader planning process, of course it's a conversation across the Government about our planning system, and the way in which, when new residential properties in particular are created, there's an impact on wider services, such as the health service, which is an obvious one, and with schools being another one and transport being obvious parts that are affected. So, there is a need to look at how different parts of not just the health service, but those actors around it, are able to take part in the process and have a proper say and a conversation with the reality of the impact of future development. So, I recognise the broad point that you make.

On the point about the difference between a CHC visit and a formal inspectorate visit, the CHCs themselves recognise that there is potential for duplication, which is unhelpful. They actually try to have a protocol between themselves and HIW in particular to try and demarcate the different roles that they have and how they should complement each other. Part of what we'll want to do in taking forward the White Paper is to make that clear so that it makes sense to the citizen, but also to the inspectorate and the people who are looking to undertake that work, because I recognise that there is real value in it.

Out-of-hours GP Services

4. Will the Cabinet Secretary make a statement on out-of-hours GP services in South Wales West? OAQ51664

Thank you. I expect health boards in South Wales West to provide safe and effective primary out-of-hours services to respond to urgent healthcare needs when GP surgeries are closed. In South Wales West, that point of contact and access is now the 111 service.

Cabinet Secretary, the BMA recently conducted a survey of GPs offering out-of-hours services. Nearly half of all respondents do not provide any out-of-hours services. Those GPs were asked to identify the main barriers to out-of-hours provision: 64.3 per cent cited exhaustion from daily pressures as the main barrier. In my region, over the last couple of years, four practices have closed and 13 are on the local health board's at-risk list, and a further 12 have indicated that their future is uncertain. If more practices close, we won't be able to provide adequate in-hours services, let alone out-of-hours. Cabinet Secretary, what plans do you have to address workload pressures to enable a greater number of GPs to provide out-of-hours care?

I think the Member comes to the point about the future of local healthcare. It goes back to some of the questions that we touched on earlier on. Trying to run the current system that we have is a recipe for failure for the future and there was a very clear message in the review for all of us to take on board.

In this Chamber, we've had a number of conversations about the future of local healthcare and what it will look like. We talked about the fact that GPs were, more and more, working in an integrated team. Many GPs are already doing that and there are other parts of our GP workforce that are still on that journey. And as we learn more about clusters and the debate that we recently had in this Chamber, we'll learn more about what works, and then part of the challenge the parliamentary review has set for us and the Government in particular is: how do we enable that to happen more consistently across the country? How do we spread learning and share learning and have less tolerance of local practice that is not good practice? How do we make the job easier and better for GPs? That's part of what we need to do and access and triage are part of that necessary conversation as well. We'll actually then have a better job for GPs already in the system. But, of course, with 'Train. Work. Live.' we do have some success in getting more trainees to come into our system as well. So, we need to both safeguard those people already in the system and make sure that their job is enjoyable, that it's done in a way that is forward-looking and not stuck in a past that existed and served us well in the last 20 or 30 years, and at the same time make sure that general practice is an attractive career that keeps people in Wales. Of course, there's a broad conversation now to be had with the wider public on the way that GPs themselves are trained.

15:10

Cabinet Secretary, I welcome the 111 approach in south-west Wales because, clearly, that is one way of choosing well, making sure we get the right choices and avoiding going to a GP out-of-hours unnecessarily. But we also need the GP out-of-hours with certain things that are necessary. As such, I'm aware that there are challenges facing these services because GPs aren't coming forward to take on those practices. In my own area, Neath Port Talbot, there's a very serious concern about some of the sessions being covered by GPs and the lack of them coming forward. What is the Welsh Government going to do to ensure that we don't lose that service in the locality? Because the Afan valley people, having to go to a GP— if they end up having to go to Morriston, it's a very long way and they're unlikely to go there by themselves: they end up calling an ambulance. It's not the right way we should be doing it. We should be making sure that the local GP out-of-hours is there for them, in that locality, if needed.

Yes, and I think that's the point: if needed, and who is the right healthcare professional. Part of the success of 111 has been the fact that most of the system that was introduced in England was actually a group of non-clinical call handlers with an algorithm—a script to go through. Often that was rather more cautious and ended up directing people into accident and emergency departments when it wasn't necessarily the right thing for them to do. In Wales, we've spent more time on developing a proper clinical desk. So, you normally have a GP, you normally have a nurse and a pharmacist, and now we're introducing a therapist, and there is often a physiotherapist. So, you get that broader team in actually answering the call at the first port of call as well, and it's been successful. There's been evidence and evaluations that have been undertaken by Sheffield university medical research centre, which shows good practice in the roll-out of 111 here in Wales and a good reason to roll it out. That has to go alongside the extra robustness of having the right healthcare professionals, including, of course, GPs, within the service. I do recognise the fragility we have in some parts of our system here in Wales; that's why getting 111 right will really make a difference so that those GPs who do take part will want to continue to staff our out-of-hours service.

'Continuing NHS Healthcare: The National Framework for Implementation in Wales'

5. Will the Cabinet Secretary make a statement on 'Continuing NHS Healthcare: The National Framework for Implementation in Wales', published in June 2014? OAQ51677

Thank you for bringing your copy again. The national framework sets out a process for the NHS, working together with local authority partners, to assess health needs, decide on eligibility for continuing NHS healthcare and commission and provide appropriate care for adults in a consistent manner across Wales. It is currently subject to review.

That's the news I was looking for: the fact that this document is subject to review, which, of course, is for adults, and this document is also subject to review, which is the document for children's continuing care. These two documents together represent the journey that a child may go through from childhood to adulthood, and I get the distinct impression that social services currently don't buy into this document, and this document is the responsibility of health services. What concerns me is that I've heard that the review is a tidying-up exercise. Well, the children's document was 2012 and the adults' document was 2014. I think we need something more fundamental than a tidying-up exercise. I think we need a fundamental review, which will engage with social services, health boards and the children's commissioner to ensure that the weaknesses that are recognised in these documents are engaged with, and reduces the need in future for health boards and social services to call for legal guidance and provide much more certainty than they currently do.

I think that it's a fair point. Following on from the question you asked the First Minister—and I recognise the point you made about social services buy-in—we'll need buy-in from health and social care into both parts, in particular not just around transition, but actually just getting the system right. So, in reviewing that, we do expect partners and other stakeholders to be involved, and I'm also pleased to say that my understanding is that the children's commissioner's office will be engaged in part of that review as well. So, we have the right people together at the right time to look at both documents together, and hopefully then to improve the system that we have. The reality is that there will still be difficult choices to make within continuing healthcare. That's why the journey of integration between health and social care is really important, to try and make it as easy as possible for citizens to navigate through the system and not to have to understand a difficult and complex system themselves. So, all of these things together really should make a difference for the individual.

Cabinet Secretary, as I'm sure you're aware, the auditor general published a follow-up report on this specific issue in 2015 that indicated that some health boards have not demonstrated that they are able to deal in a timely way with the claims they are responsible for, and that some claimants are being dealt with unreasonably. Are you now in a position to provide an update on this particular matter, and can you confirm that all health boards in Wales are now dealing with claimants reasonably and responsibly, so that people can have confidence in the entire system?

15:15

I do understand the concern that's being raised, and I'm sure that, as with other Members, I've had constituents approach me in my local Member capacity with some concerns about the process in the past. It is my understanding that there's been a significant improvement in dealing with that backlog of claims, to try and resolve them, and I have received assurance that health boards have improved the position. I would not want to try and set an absolutist position because there is always room for error in any human service. If Members are aware of individual challenges that exist, I would want them to bring them forward to their health boards. If they don't get a response there, they can always write to me. I'm not aware that there are any system-wide pressures, but I am of course always happy to learn from a further review that I'm sure will take place at some point in the future.

Neuroendocrine Tumours

6. Will the Cabinet Secretary provide an update on how the Welsh Government is supporting people affected by neuroendocrine tumours in Wales? OAQ51647

Yes. The Welsh Government is committed to improving neuroendocrine tumour services. The Welsh Health Specialised Services Committee commissions care for patients in north Wales, and is working with health boards to implement the recommendations of its service review for south Wales to look at how patients can be better supported.

Cabinet Secretary, will you join with me in congratulating my constituent, Janet Lewis, whose leadership in devising solutions to improve healthcare provision and equality for patients with neuroendocrine tumours led to her becoming the well-deserved winner of the endocrine nurse award for 2018? More generally, how is the Welsh Government working with Welsh patients and healthcare professionals to make them aware of the specialist services offered at the University Hospital of Wales site, so that they may benefit from the expertise of Janet and her colleagues?

Well, let me start by recognising the achievement of the Member's constituent, Janet Lewis. I'm always pleased to hear of yet another healthcare professional in Wales being recognised by her profession for excellence and achievement. It does say something about the fact that we are improving a range of our services here in Wales, which is not always recognised in other parts of the United Kingdom, but there is real excellence within the service here, and this is one such example. Because it did come from a review that recognised that we weren't doing well enough. Following that review, which actually brought in patient representatives as well, they had some confidence that we'd looked at the right things, and that service is being rolled out. There's been another peer review to check on progress, and that set out a number of areas for further improvement from Cardiff and Vale themselves. Again, there's something about learning, and actually that they are now being proactive and, through the commissioning arrangements of the Welsh Health Specialised Services Committee, making sure that people are generally aware of the excellence that is now being developed within Cardiff and Vale, to be made available for people right across south Wales as well.

Will the Cabinet Secretary outline what considerations are given to screening patients who are at a higher risk of contracting neuroendocrine tumours, such as relatives of sufferers or patients who suffer from rare family syndromes such as multiple endocrine neoplasia or Von Hippel-Lindau syndrome, because in all of those there's been a very clear genetic link established? I just wonder if they need to have automatic screening rather than waiting until they have actually got the disease.

This comes back to one of our challenges. I would always like it to be the case that we could have a screening programme that was effective in terms of the value that we get from it, in terms of money and also the outcomes and helping us to identify people early. But part of our difficulty in this area is that there isn't a full understanding of what causes neuroendocrine tumours. As with every area, where we look to have a screening programme we look for genuine scientific evidence. We all like to be evidence-led, not dogma-led, on this issue about what we should do. So, if there is an evidence-led process and there is an appropriate screening programme for individuals who are at greater risk, then we will of course look at that seriously, and as with other things, look to implement it here in Wales.

Preventing Ill Health

7. What Welsh Government support is available for initiatives to prevent ill-health in Wales? OAQ51653

The Welsh Government directly funds a number of national organisations, services, programmes and settings-based approaches aiming to prevent ill health. These include smoking cessation services, immunisation programmes and healthy schools and workplace programmes.

Cabinet Secretary, in accordance with the Well-being of Future Generations (Wales) Act 2015, I think it's widely accepted, and I think Welsh Government would certainly support a move to a more preventative approach in dealing with ill health in Wales, and being more proactive. Where there are examples, as I believe there is a particularly good one in Newport of the local health board coming together with Newport Live, as the leisure services organisation, Natural Resources Wales, Newport City Council and a range of sports bodies, to try and achieve a more active local population to be preventative in terms of ill health—. Where there is a good local coming together of that nature, what support might Welsh Government offer to facilitate and encourage? I know that previously there was mention, for example, of well-being bonds as being one possible vehicle to support pilots in local areas in Wales, and I just wonder if that's still a possibility or if there's some other means by which Welsh Government might offer that support.

15:20

There are a couple of specific things to talk about, apart from the generality, or the £600,000 of funding that goes through Sport Wales to Newport for core funding services and the Community Chest funding services. You'll be aware that the well-being bond is a manifesto of commitment and it's in 'Prosperity for All', the national strategy. I'll be making an announcement on that in the coming months.

There's a range of different areas where we do take action and support activity. There's a more general preventative approach in healthcare services, but working with other partners, and the continuing partnership with Public Health Wales, health boards and Sport Wales is an important one. I expect to meet with my ministerial colleague, who's not in the Chamber at the present, to have that conversation on the joint work that Public Health Wales and Sport Wales have been doing. I'm also interested in what the professional sports are doing to actually promote, not just sport, but broader physical activity, and that's why, as an example of not just physical activity, you hear about Ken Skates and active travel.

We support a range of activities. We've supported walking groups in December—further funding to have local walking groups through Let's Walk Cymru, with funding to take them through to April 2019. We support a wide range of activities. We do recognise that not everyone is interested in the world of sport. How do we make them interested in more general physical activity, and how do we make it easier for people to undertake that activity and see the benefits for themselves, and not simply for the Government?

Last November, Cabinet Secretary, the British Medical Association published a new position paper on the use of e-cigarettes, and I quote what they stated:

'There are clear potential benefits to their use in reducing the substantial harms associated with smoking, and a growing consensus that they are significantly less harmful than tobacco use. With appropriate regulation, e-cigarettes have the potential to make an important contribution towards the BMA’s ambition to achieve a tobacco-free society, leading to substantially reduced mortality from tobacco-related disease.'

In view of this, Cabinet Secretary, what action are you going to take to promote the use of e-cigarettes in Wales as an alternative to tobacco smoking? Thank you.

I think we should think again about some of the language that the Member has used: you said that e-cigarettes are significantly less harmful than tobacco. That does not mean that they're not, themselves, harmful; it's about the balance in harm. And it's also about a recognition that we don't always understand what goes into an e-cigarette. We had this debate in this term with the public health Bill, and in the last term as well there was a change of position about our ability to regulate this area. There's something about being able to regulate the products, because, actually, if you don't know what's in an e-cigarette, that's rather difficult, and I think there's something there for us to continue to consider. The Government has no intention of promoting e-cigarettes. There are choices for people to make themselves, as citizens of the country. I think that we have to, as I said earlier, continue to be led by evidence on what we could and should do, what we could and should promote.

3. Topical Questions

Item 3 is the topical questions, and the first question is from Darren Millar.

Mortality figures in Welsh emergency departments

1. Will the Cabinet Secretary make a statement on mortality figures in Welsh emergency departments? 120

You raised this yesterday with the First Minister, of course, and he made clear that the figures take no account of age, deprivation or ill health. I'll refer you back to his comments: 

'Now, the particular measure reported involved small numbers and it's consequently not age adjusted. Age is likely to be the main reason why this figure seems high, not least reflecting that Conwy has the highest percentage of over 75s in the whole of Wales. 

'More recent figures from the health board show some reduction in the peak reported. The overall in-hospital mortality rates for Ysbyty Glan Clwyd are in line with the Welsh average.'

As you will know, Conwy has always had an older population than other parts of Wales, and, indeed, historically, its mortality figures at Glan Clwyd's emergency department have been below the Welsh average. So, age is certainly no excuse for the extraordinary increase that we've seen in death rates in that emergency department in recent years. They have more than doubled since 2012, and I'm afraid that your complacent response will not wash well with patients in north Wales who want to know why they are almost twice as likely to die in that hospital as they are in other hospitals across the country, and the situation there appears to be much worse than in Wrexham and in Bangor.

This is a cause of significant concern to my constituents, many of whom have contacted me following the report, and it was clinicians who contacted me to say that they were concerned about these death rates. They say that the biggest problem in that hospital is a lack of access to hospital beds so that the individuals in that emergency department are not in an appropriate care setting to be able to look after their needs, and that is why people are dying unnecessarily in the emergency department.

Given that that is the view of the clinicians and the nurses who have contacted me to express their concerns, will you accept that the lame excuse that you've given to date is unsatisfactory? Will you undertake an immediate investigation so that we can establish whether the situation is being caused by bed shortages? And what assurances will you give to make the results of that investigation public, so that the public can see what action you're taking, given that this health board is in special measures and being run directly by the Welsh Government?

15:25

I have absolutely no intent of being bounced into an intemperate course of action by shouting and language that is deliberately fearful from the Member opposite. Sadly, he has form in this area.

Suggesting that there is complacency in the Government is simply not true. Just because I choose to remain calm and not engage in a shouting match, it's not because I do not care about the service and am not interested in improvement. It really is disappointing that an open system that we've put in place in health boards, to be open and transparent, is being traduced in this way, when you know very well that these figures are not adjusted to take account of other factors. You know that. You've seen the factual brief that comes out in stating that. 

And I really do think that the Member should take account also of the fact that within our system here in Wales, we are the only UK country—[Interruption.]

Darren Millar, you've asked your questions, now listen to the answers.

We are the only UK country that has a full review of every death that takes place within hospital. There is already learning that deliberately takes place from deaths within hospital. I expect them to have an open and learning culture within our health service, to have a proper commitment to improving the quality and improving outcomes for people. If we are to work in a system where any attempt to have open and transparent publication of data is used in this way, to promote fear—and I do not accept Darren Millar's version of events as representing the view of the clinical community in Ysbyty Glan Clwyd or any other part of the country—then we'll run ourselves into a position where, actually, improvement will not take place at the pace that it could and should do. I take my responsibilities seriously, and I believe our clinicians do as well. And, yes, the results of those reviews are generally made available so we can see the learning that takes place from each of those reviews. And, in fact, other parts of the UK system now wish to learn from what we're doing in Wales to learn properly from every death that takes place in hospital.

Well, I hope they're not learning from Glan Clwyd, Cabinet Secretary. But I would say, as the community health council said yesterday, yes, you would expect the figures to be higher, but these figures seem extortionately higher and disproportionately high in relation to the demographic difference that we do have in that particular part of Wales. So, I would ask you again to consider asking an independent person or an independent body to review those figures, so that we can have the confidence that you have—and I'm afraid I don't share your confidence—that there isn't a more systemic issue at play here that is causing what are clearly very concerning figures in Glan Clwyd.

Can I ask as well, given that you recognise that there are special demographic needs for that particular part of the country, are you confident that the board is being sufficiently resourced to address those? Because if they are, then there's another question about the way that the board is being managed under your watch in this regard as well.

I'll quote from the publication itself:

'The following chart shows the number of deaths per 10,000 attendances for each major Emergency Department (A&E). It should be emphasised the figures reported are a crude mortality, and unlike deaths elsewhere in the hospital, no attempt is made to "standardise". As such there is no accommodation for factors such as age and severity of illness, factors known to impact on the risk of death.'

We can either have a conversation where we lay into the health board and try and suggest that there is somehow a political responsibility for an unacceptable death rate, or we can try to understand what has actually taken place. I would much rather understand what is taking place and to learn from that. That's why these figures are published. That's why there is a review into every death within the hospital. And, again, I will not be bounced into a suggestion that the clinical leadership at Glan Clwyd cannot be trusted. There are challenges right across our health service, and I will not collapse into blaming our hard-working staff for a range of areas in which we know that improvement actually is already there, and these figures are part of it. 

And I would remind everyone in this Chamber that, when it comes to resourcing, the north Wales health board is the best-resourced health board in the country, per head. And actually our challenge is how we get greater value from every single £1 that we spend in the health service, including in north Wales. I do not see this as an issue of financial resourcing. If you're actually looking about the overall amount of money we have within health and social care then we're squarely into the field of austerity and its impact on public services.

15:30

Well, on behalf of my constituents in Aberconwy, I would like to thank Darren Millar for raising this issue once again in the Chamber. And I have to say I was deeply disappointed yesterday at the flippant remarks made by our First Minister in response to the question that Darren Millar posed of him yesterday, implying that age is likely to be the main reason why this figure seems high. We are talking about people who have died.

Now, when you look at the figures, compared to the population that Betsi board covers, I raised in October the board having the highest number of patient safety incidents classed as moderate, severe or death in Wales, including 41 accidental deaths. Now, in the figures coming forward, my own father is one of those statistics—accidental death resulting from an operation.

But let me take you back to A&E. In that 18 months period of my father's last remaining months of his life, I had many experiences of being caught in A&E with him, caught with other people on trolleys in corridors, ambulance men not being able to get back to their ambulances. The system, the through-flow of patients, isn't good. But I'll tell you what: you've got all your north Wales AMs here, on regular occasions, and our Cabinet Secretary, who raised the fact that there are issues—severe issues—of concern within the Betsi board.

Now, all I have—. You've been blamed and accused of supercilious arrogance. Yesterday, I accused you of disinterest. Prove me wrong, prove everybody wrong. Please, come with me—let me take you down the wards, where the people are on catheters, where you will see full jugs of water where no-one has drunk all day, where you will see catheter bags almost bursting. Come with us, Minister, Cabinet Secretary, and then, if you come with us—unannounced would be nice; I'm prepared to do it—I will show you scenes that you will find abhorrent.

Cabinet Secretary, you've accused us of political grandstanding. There is no political grandstanding worth the sorrow that one feels when you've lost somebody very close to you as a result of poor treatment in one of your hospitals. I don't blame the consultants. I don't blame the staff. I blame the process. It's not about money. It's about procedure. This hospital is under your direct control, and it ain't getting any better. Please, Cabinet Secretary, do something. Do something for all those constituents who come to me—

Okay. I have two ombudsman reports that I had to report to the ombudsman: one where someone was terminally ill, and one now, where, as a result of these problems, I had a constituent—. Both were section 16 public interest reports. So, the evidence is there, if only but you would listen. Please, for the sake of every single patient needing to go into hospital, or the ones who are already there, please do something.

Well, no-one could fail to recognise the grief that you clearly feel about the loss of your father. And I really am sorry for your loss. My job, in undertaking this role on behalf of the people of Wales, is to look at how we improve services across the system, to understand how individual examples can be used to learn from, and that's the way in which we set out quality improvement within our system. We don't just empower, we expect people to be a part of improving the quality within our service. And, actually, in Ysbyty Glan Clwyd, they have a better than average mortality after surgery, both elective and non-elective surgery. So, it actually has a good overall record. Now, that does not mean that there will never be a mistake that is made, because we don't have perfection in our system, and it's not a standard that it's fair to hold anyone to in delivering the national health service. But we'll always look for further improvement, and, for all the passion and the grief that exists and I do recognise from the Member, I don't think that I should willingly accept the accusations that are made about my integrity and interest in the national health service. I'm in the business of public life because I want to help make our country better. Doing this job is a real privilege, and I absolutely have a significant interest in the past, the present and the future of the national health service. That's why I'm doing this job. That's why I'll continue to do this job, and to work alongside people in every part of our national health service to try and make sure that the future is a better one, and that we do the maximum we can do with the resources we have to deliver better healthcare in every community in Wales, and that is absolutely my honest and sincere commitment. 

15:35

Thank you, Cabinet Secretary. The next question is from Simon Thomas.

The impact of leaving the EU on Wales

2. What assessment has the Welsh Government made of the impact of leaving the EU on Wales in light of the analysis of three scenarios undertaken by the Department for Exiting the European Union, which was leaked on Monday? 123

Thank you, Llywydd. We have published analyses on the general impact of leaving the EU, and also in areas such as regional investment and migration. Our trade paper will be published soon, based on independent analysis. We haven’t seen the document by the Department for Exiting the European Union that was leaked unofficially. We’re calling on that department to publish its analysis.

I thank the Cabinet Secretary. He will be aware, at least, from the press coverage of this analysis, that it looks at three scenarios: staying in the single market to all intents or purposes, leaving under World Trade Organization rules, and a situation where there is some sort of free trade deal of the type that the Prime Minister has been talking about.

Now, the three scenarios look over a period of 15 years, and, in each of those, there is a decline and a reduction in growth over that period of 15 years, varying from 2 per cent under the single market to 8 per cent under WTO. Now, the impact on Wales is going to be very detrimental indeed because we are far more exposed to certain aspects of this, particularly under WTO rules, such as the red meat sector, manufacturing, vehicles and so on, Airbus—just as an example of what can happen here. So, can I ask the Cabinet Secretary what the Government is going to do now in order to get hold of this analysis?

I understand that Westminster today has agreed in one way or another to share this paper with Members of Parliament in a closed room. I don’t think that that’s good enough at all. We, here, need to see this analysis too. We represent the interests of Wales as much if not more than MPs from Wales. And the Welsh Government needs to see the analysis; I want the Welsh Government to ask specifically for that. Of course, as the Scottish Government, and the Mayor of London himself, have commissioned independent reports and assessments of the economic impact of exiting the European Union, why won’t you do that and publish that too?

Now, it is about time that we realised the true cost of exiting the European Union. Yes, a decision to leave the political union has been made, but leaving the customs union and the single market will cost the Welsh economy very dearly indeed. 

The Deputy Presiding Officer (Ann Jones) took the Chair.

Well, I completely agree with the Member that the information that is in the hands of the UK Government should be publicly available, should be made publicly available and easily available, not, as Anna Soubry, Conservative MP, said in the House of Commons today, in the farcical way that the UK Government now appears to be willing to make this information available to Members of the House of Commons in a locked room, whereas members of the public can read most of it on the internet any time they care to switch it on. She described it as a collective outbreak in the Government of a form of madness. And our call to the UK Government is absolutely that, where there is information that will help to allow people to make their own minds up about this very important issue, then there is an obligation on them—this is information that they have commissioned—to make that information available to others. As far as the Welsh Government is concerned, we routinely publish the information that we commission. In the joint paper that we published with Plaid Cymru a year ago, we included in that document an analysis by the chief economist and others of the state of information at that time. Within the next few days, we plan to publish the analysis carried out by Cardiff University of the impact of Brexit on major companies here in Wales, as we have already promised to different Assembly committees. As we get information, and as we publish documents, we always publish the independent analysis that we are using to draw the conclusions that we do, so that people who would wish to draw different conclusions have that information available to them to do so.   

15:40

Cabinet Secretary, the External Affairs and Additional Legislation Committee held a very constructive and informative consultation event with a wide range of stakeholders here in Tŷ Hywel on Wales's future relationship with the EU. As a committee, we need to be fully aware of all future scenario planning and analysis to respond to stakeholders across the public, private and third  sectors, and they were fully represented on Monday. So, I'd also call on the UK Government to publish in full the leaked document on the impact of Britain leaving the EU, which predicts that economic growth would be lower under a range of potential scenarios. So, I'd like to thank the Cabinet Secretary for clarifying, in response to Simon Thomas, its own approach in terms of scenario planning and the papers that you've already published and that you are—forthcoming—publishing the trade paper and other papers, and agree, and I'm sure the Cabinet Secretary would agree, that it's vital that the Welsh Government and this Assembly is fully informed in scrutinising the UK Government's approach to Brexit. On Monday, our committee Members will visit Toyota in north Wales and Aston Martin in my constituency. Don't you agree it would be helpful to have this analysis to assist us in our visits? 

Well, I certainly do agree. Of course it would be helpful to the committee to have that information. As I understand it, from reading newspaper reports of the work that the UK Government has commissioned, it does include some element of regional analysis. So, that would be immensely helpful to the committee in knowing where the different scenarios encompassed in that work see the impact on Wales in particular of these three different routes to leaving the European Union. And it is sensible of the UK Government to scenario plan in this way, but to scenario plan in secret is no help to the rest of us, and providing the information in the way that Jane Hutt has suggested will be useful to committees here and to businesses and to ordinary citizens who want to understand what the potential impact of leaving the European Union might have in their own lives. 

You will know, as a Government Minister, that you have to have the freedom to ask your officials to do blue-sky planning, including all options, including some which you may be horrified by, so that the Government, in private, can decide what to prioritise, bring forward, propose and make public. An early draft of ongoing analysis in support of the UK Government's Brexit negotiations and preparations looked at different off-the-shelf arrangements currently existing as well as other external estimates. It did not set out or measure the details of desired outcomes, which the UK Government says is a new, deep and special partnership with the EU, or predict the conclusions of negotiations. It also contained many caveats and was hugely dependent on many assumptions where significantly more work was needed to make use of this analysis and draw out conclusions. In fact, this leaked analysis of just three scenarios was therefore incomplete and partial. As a Government Minister, therefore, how do you respond to the clear duty that Government Ministers have not to publish anything that could risk exposing negotiating positions until they have concluded what their negotiation positions are and have reached the stage where such information would not compromise them when around the table with other parties?

15:45

I have no objection whatsoever to UK Ministers commissioning analysis that looks at a range of scenarios, whichever of those scenarios they think might be useful. It is a sensible thing for them to do. But I'm afraid that Mr Isherwood was reading out yesterday's circular from central office and not today's, because today, the UK Government has agreed to make all of this public. So, I'm afraid that all the things that he was worried about, which UK Government Ministers were worried about yesterday, have evaporated today in the House of Commons.

If Governments have anxieties that documents that they put into the public domain contain information that might be damaging to the public interest, then they are, of course, able to redact parts of the information that would have that impact. It is not an excuse for failing to make available to the public information that allows a proper public debate of the most important issue that we will face during the lifetime of this Assembly and beyond to be conducted on the basis of the widest possible analysis and information.

I agree with the Cabinet Secretary that transparency is a good thing and that there's no reason why studies of this kind should not be published, because we can then draw our own conclusions, as he says. But would he agree with me that an attempt to predict what the world's going to look like in 15 years' time, especially when those predictions come from economists, is likely to be about as much value as a witch doctor examining the entrails of a chicken? If such a study had been conducted in 1990, nobody would have spotted the existence of Google, Amazon or Facebook. They are now three of the very largest companies in the world.

What we should do, perhaps, is look at the forecasting record of the people behind this. Treasury forecasters, immediately after the referendum, forecast that, in the following three months, the economy would contract by 1 per cent; in fact, it grew by 0.5 per cent. They also predicted that in the following four quarters, there would be negative growth. In fact, we've had growth in every single quarter since June 2016. They also predicted that, two years after the referendum, GDP would fall by -3 per cent to -6 per cent. In fact, in 2016, the economy grew by 1.9 per cent, and in 2017, it grew by 1.8 per cent. It also predicted that unemployment would rise by between 500,000 and 800,000. In fact, unemployment is now at a record low since the early 1970s. It also forecast that borrowing would rise by nearly £40 billion; in fact, Government borrowing has fallen by 12 per cent and is now the lowest since 2007. So, I would advise the Cabinet Secretary not to spend too much time in examining this particular piece of nonsense.

Of course, the further away we go in time from today, the more imprecise attempts of this sort to predict the future become. However, if this particular chicken had been suggesting that the UK economy would be growing by 8 per cent as a result of leaving the European Union, I'm sure the Member would have been a lot more kindly disposed towards it.

4. 90-second Statements