The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included.
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[8]
Rwyf wedi gwrando ar fwy na 1,000 o
blant a phobl ifanc mewn cyfarfodydd wyneb yn wyneb, a derbyn dros
6,000 o atebion drwy fy arolwg ‘Beth Nesa?’ ynghylch
blaenoriaethau y llynedd. Y datblygiadau hyn, yn ogystal â
thystiolaeth ymchwil am ba bolisïau sy’n
cyflawni’r canlyniadau gorau i blant, yw’r ffynonellau
ar gyfer fy mlaenoriaethau polisi canlynol i Gymru, ac rwy’n
edrych ymlaen at gael eu trafod â chi heddiw.
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I have listened
to more than 1,000 children and young people in face-to-face
meetings, and have received more than 6,000 responses to my
‘What Next?’ consultation regarding last year’s
priorities. These developments, along with research evidence about
what policies achieve the best outcomes for children, are the
sources for my strategic priorities for all children in Wales, and
I look forward to discussing these further with you today.
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[9]
Lynne Neagle: Thank you very much for those opening remarks and
we’ll go now to questions from Members. We’ve got a
number of questions first of all on one of the areas you’ve
highlighted in your strategic plan, which is bullying. So, can I
ask Michelle Brown, please?
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[10]
Michelle Brown:
Thank you, Chair. Bullying
creates—it puts children in hell, when they’re being
bullied. It can be an unbearable burden on children, and it’s
led to children committing suicide. What measures are you putting
in place in schools, or how are you encouraging schools, to address
bullying, and what practical measures are you suggesting to schools
to combat bullying kids?
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[11]
Dr Holland: Absolutely. Many of you will be aware that schools
have been trying to tackle bullying for many years. So, I suppose
it was quite disappointing, in a way, to hear from children and
young people, across the age groups—so, from age seven to
18—in my survey of 6,000 children, that it was their highest
priority for something I should be working on. So, obviously, that
was something I couldn’t ignore. So, we’ve started work
this year now in my organisation, and listening hard to
children’s experiences of bullying in more depth now. So,
we’re working through our super ambassadors schemes, in both
primary and secondary schools, to listen to children’s
experiences.
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[12]
We’re talking as well to
professionals in the field, looking for examples of good practice,
and there is some very good practice out there. I suppose, as
commissioner, I’m very keen to see that a child, wherever
they live in Wales, has got the same quality of experience, and we
know that that’s very mixed. So, while some schools seem to
be tackling bullying, and promoting healthy relationships, and
I’d like to look at it that positive way, really, rather than
just being something against something—. We need to learn
from the schools that are doing it so well and make sure that
practice is even.
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[13]
So, I’ll be taking that evidence
from children, and with children, back to Government, and, of
course, to the regional consortia, which are trying to improve
education throughout Wales. But Government are revising at the
moment their guidance on bullying; it’s a number of years old
now. So, I’m hoping that the evidence I bring this year will
strengthen that guidance. I think we need to be finding more
solutions that work for children. So, you know, we can have reams
and reams of guidance, but we actually need something that works
for children in a particular school. And, in fact, some of the best
examples I’ve seen have been developed and led by children
themselves. There are some great examples, for example, in
anti-racism and anti-homophobic bullying, which have been peer led.
Children often listen to their peers better—however
well-meaning a teacher is. If a young person in school is acting as
a young leader, and can do an educational piece with some young
people who, perhaps, through ignorance, are using inappropriate
language et cetera, then I think that can be a really positive way
forward.
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[14]
So, we’ll be highlighting best
practice, and children’s experiences of both what’s not
working for them in the current systems, and what is working for
them, over the next year.
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[15]
Michelle Brown:
So, are you going to be coming up with
concrete proposals about how bullying should be tackled? Because,
as you say, this has been going on for a very, very long
time—I mean, probably as long as children have been in
schools, it’s been going on.
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[16]
Dr Holland:
Absolutely. I think you’re
right. I don’t think it’s a new issue. I think
we’re more aware of it now and children are perhaps more
prepared to come forward and say they’re experiencing
bullying. We’re also experiencing new times, though, and some
new types of bullying through social media. I have to say that
I’ve been quite encouraged by the publication of the new
digital competence framework last week under the new curriculum.
That’s the first thing that’s come out under it.
I’ve started to look at it quite carefully and there is some
strong preventative work that could be done through that in terms
of how young people manage themselves through social media. It is a
whole new environment that we’re really trying to get to
grips with, and that’s something that I’ll be listening
carefully to children about over this next year—about their
experiences of that.
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[17]
Michelle Brown: You mention social media, have you had any
contact with people like Facebook and Twitter? You know, because a
lot of this—. The social media bullying is going to be
primarily through that. So, do you have any relationship with
them?
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[18]
Dr Holland: Not directly, no.
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[19]
Lynne Neagle: Thank you. John.
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[20]
John Griffiths:
I’m interested in the process by
which you will seek to help achieve better practice and better
policy in the schools. Obviously, highlighting best practice and
producing guidance is very important, but I’m sure that there
are many other ways in which you would seek to influence Welsh
Government, local authorities and the schools themselves. So, I
wonder if you could say a little bit about the sort of process that
you intend to follow to make sure that what actually happens in our
schools right across Wales, as far as possible, achieves the better
standards and puts into practice the lessons that are to be drawn
from the experience of the children that you will bring to the
table, as it were. Perhaps, could you also say a little bit about
what’s happened up to now in terms of your predecessors and
yourself in terms of bullying, because, as you say and as
we’ve heard, these are problems that have been around for a
long time and children have been concerned about them for a long
time, and parents and educators? Do you feel that the office of the
children’s commissioner has achieved much in terms of
tackling bullying up to this point?
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[21]
Dr Holland: Something that I’ve been thinking very hard
with my organisation about has been the impact of our work over the
last few years. I think that’s a really important question.
I’m not really interested in just doing superficial work,
where I just publish grand statements about what should be.
I’m very interested in following through and making sure that
things make a difference to children’s lives. So, we’ve
been thinking very hard about how we both achieve impact and
measure impact in terms of changes in children’s
lives.
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[22]
One thing I’ve done this year is
recently set up a new governance structure and new advisory boards
in my organisation. The part of that that I’ve got going
soonest has been my young people’s advisory board. I’ve
now got a group of 17 very wise young people from across Wales,
aged 11 to 17, who are really helping me think through some of
these questions and are really there to scrutinise the work that
we’re doing and help us think through how it can actually
make a difference to children’s lives. So, they, along with
the thousands of children engaged in our broader participation
scheme, are really—I would say to them that they’re my
ears on the ground to let me know whether my work is making a
difference and also to say what I should be
prioritising.
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[23]
The ‘Beth Nesa?’ survey that
we did last year had a lot of questions around well-being and
bullying. We did it carefully, using careful methodology so that it
would be repeatable. So, we will be able to repeat that survey,
probably at the end of my three-year programme, to see whether
children feel that any difference has been made. So, that’s
one measure that we’ll be able to make as to whether any
difference has been made. I don’t think I can tackle
bullying, or my office can on its own. I think I need to be
persuading people from the whole-school community and not just
teachers, but everyone surrounding the school
community—leaders in education and, of course, with guidance
and help from Welsh Government—to make real changes. Because
I think what children are saying is, ‘We can have as many
policies in my school as there are in the world, but, actually,
sometimes I still feel really miserable because people are bullying
me.’ I don’t think it’s an easy issue to tackle.
I don’t think I’m going to solve bullying over the next
few years, but what I would like to see is more schools having more
effective policies I think that’s a reasonable aim,
and children saying that they’re having a better experience,
in three years’ time.
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09:45
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[24]
In terms of any work my predecessors have done on bullying,
I’m going to look to my colleague to see whether we’ve
done specific work on it in the past.
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[25]
Mr Dafydd: There has been work done on complaints in
particular in the schools setting, and access for children to make
complaints on whether there is bullying going on or things are not
going right in the school setting—more around advocacy than
bullying. But, obviously, from the ‘Beth Nesa?’
consultation, it is a key strategic priority for us in this
term.
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[26]
Dr Holland: Another very specific thing we’re doing
this year is a piece of work on Islamophobia. So, a number of young
Muslim people I’ve met over the last year have said they were
increasingly worried about Islamophobic experiences they were
having, and I wanted to do something concrete in response to that.
So, we’re developing a lesson plan, which is an interactive
video plan, with young people, which will have video examples,
stories and discussion points that we will be publishing later this
year and rolling out, making it available for free to all schools
in Wales. So, that’s one specific area of bullying that I
just wanted to do something quite quickly and concretely on in
response to those young people’s concerns.
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[27]
John Griffiths: I think, Chair, it might be useful for the
committee if, as matters develop, you keep us informed in terms of
the developing process by which you will seek to make sure that
there’s consistency across Wales in tackling bullying and in
promoting those positive relationships. It would be quite
interesting to get a feel for the detail of the process, Chair, if
that’s okay.
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[28]
Lynne Neagle: Yes.
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[29]
Dr Holland: Absolutely. I’d be very happy to do that,
yes.
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[30]
Lynne Neagle: Llyr, was your question on something that the
commissioner said?
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[31]
Llyr
Gruffydd: Ar y mater yna, roeddwn i jest eisiau gofyn sut y gallwn ni
fel pwyllgor ychwanegu gwerth at y gwaith yr ŷch chi’n
ei wneud. Oherwydd, diben y sesiwn yw trio ein cynorthwyo ni gyda
meddwl strategol ynglŷn â’r flaenraglen waith sydd
gennym ni fel pwyllgor. Felly, ble ŷch chi’n gweld y
pwyllgor yn ffitio i mewn i’r ymdrechion yna i daclo
bwlio?
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Llyr Gruffydd: On this issue, I just
wanted to ask how we as a committee can add value to the work that
you’re doing. Because, the purpose of the session is to try
to assist us with strategic thinking in terms of the forward work
programme that we have as a committee. So, where do you see the
committee fitting in to those efforts to tackle bullying?
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[32]
Dr Holland: Obviously, as a committee, you know,
you’ll be setting your priorities for the next term, and,
like me, you can’t tackle every single issue, and you need to
set priorities, which is a dilemma, isn’t it? I think
I’ve got two aspects to my relationship with the committee.
One is, rightly, that the committee scrutinises my work and holds
me to account. The second is that I want to assist your inquiries
and bring evidence to them and help you to think deeply about the
experiences of children and outcomes for children. What was really
interesting about my ‘Beth Nesa?’ consultation was that
adults and children had slightly different priorities, and in fact
professionals and parents had slightly different priorities. So,
children and, to a slightly lesser extent, parents put bullying
really high up. Professionals, I think, thought, ‘Oh well,
we’ve sort of done that and moved on’. I think, you
know, if we’re going to be a nation that listens seriously to
children, we’ve got to take seriously the things
they’re putting at the top of their list and experiences. The
emotional well-being of our children, which includes experiences of
bullying but is broader than that, of course—so, it’s
stress and anxiety in our fast-moving world—has got to be, I
think, part of your priority as well as mine, because that’s
what our child population and those who care for them are telling
us is their biggest concern.
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[33]
Mr Dafydd: I think the only thing to add to that is
obviously about the curriculum reform, and how the bullying
guidance fits into the new structure of the school setting is
imperative. Obviously, the committee, in scrutiny of that process,
will also co-ordinate with the work we’re doing.
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[34]
Dr Holland: I do think that the curriculum reform process
gives us a fantastic opportunity in Wales that we mustn’t
miss, really, to address—well, as it says, learning for life,
a curriculum for life, and thinking about all of the skills and
positive relationships we’d want our children to graduate
from school with. Of course, we want them to be highly literate and
numerate and be skilled academics, but, also, children tell me they
want to be ready for life, And employers say, as well, of course,
that they want young employees, and older employees, who are good
at relationships, who are good at practical problem solving, et
cetera. So, I think that scrutiny of the curriculum is something
that I’ll be doing very closely and I’m sure you will
too as a committee. It really gives us a chance to address some of
these issues, I think, that are arising for our children at the
moment.
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[35]
Lynne Neagle: Thank you. Julie Morgan.
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[36]
Julie Morgan: Yes. I wanted to raise particularly the issue of
homophobic bullying because that is something that has been brought
to me in my constituency role, and I know the issue of language in
the playground is very difficult to tackle, but it is very
prevalent, I think, that words are being used that are quite
hurtful and disturbing to other young people. I just wondered how
that can be tackled. I think we talked about the different
organisations and people that have to be involved. How do you see
the home as well being involved in those sorts of
issues?
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[37]
Dr Holland: Yes, of course, we’re seeing a real societal
and generational shift, aren’t we, in attitudes to diversity
in our society? Encouragingly, really, many young people tell me
that homophobic bullying has decreased substantially and
there’s much more freedom to be as they wish to be as young
people. However, that’s not the case evenly across Wales.
We’re getting back to how we ensure that children, wherever
they live in Wales, have a similar experience, and I think we need
to learn from some really pioneering projects that we’ve seen
in Wales on this issue. We also need to distinguish, I think,
between different groups of children who may be experiencing more
difficulty than others, for example transgender children, I think,
who may well be exploring their identity or even transitioning
right through some of the most sensitive years of their
adolescence. They are perhaps the next frontier really in terms of
societal acceptance, and again, there’s some really good
project work going on on that issue. There are groups in more and
more schools, but probably I would still say a minority, where
there are not only support groups for young people who are
identifying as lesbian or gay, but there are also whole-school
approaches to tackling homophobia and accepting diversity within
the school. That’s actually one of the projects I was
referring to when I was talking about peer-led initiatives, and I
think they’re the ones that work particularly well.
I’ve had contact with a number of those groups over the last
year, and they are shining examples. I would like to see that kind
of work going on in every school in Wales.
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[38]
In my new youth advisory panel, I do have
the chair of Youth Pride Cymru as part of my advisory panel, so I
will be drawing on that group’s experiences and advice moving
forward. We did in the last year—so, during my first
year—publish a guide for young people in how to make
complaints about representations of lesbian and gay young people,
whether that’s social media or the media, what’s not
acceptable, and what to do about it. So, we did do something very
practical about it in the last year as well.
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[39]
Julie Morgan: Those shining lights that you’ve described
sound fantastic, but obviously the issue is how you spread that
practice, isn’t it? I mean, what percentage of schools would
be having this whole-school approach and having these support
groups?
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[40]
Dr Holland: A small minority, I would say, at the moment. I did
go to one of those groups—there’s the Digon group in
ysgol Plasmawr in Cardiff and I went to a conference they ran in
the summer for other schools to promote the practice, and I think
about 10 other schools attended that. I also went to the first ever
Youth Pride conference in Monmouthshire—I think it was the
end of last year—where, again, some of the school counsellors
in Monmouthshire had got together and realised they were seeing a
lot of individual children for school counselling who actually
probably didn’t need counselling; they needed support in
terms of their identity and in coming out as lesbian and gay. So
rather than problematising their identity and offering them
counselling, they formed support groups and worked towards a big
conference, which was a wonderful conference, I have to say.
So, that’s a good example of a whole county actually taking
an approach, and I would like to see, at local authority level or
consortia level, these good examples being promoted.
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[41]
Julie Morgan: Thank
you.
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[42]
Lynne Neagle: Thank you. Moving on to mental health, as you know,
the shortcomings in child and adolescent mental health services
have been a regular slot in all the previous children’s
commissioners’ annual reports, and the predecessor committee
to this one did a lot of work on CAMHS. Are you able to tell us
what your assessment is so far of how the Government is doing in
tackling those shortcomings, particularly through the Together for
Children and Young People programme?
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[43]
Dr Holland: Yes, I am. I
think the work that this committee did in the last term was a
really important moment, really, because it brought together all
the evidence on where we’re at with CAMHS and, really, I
think it was quite a milestone in Wales, sitting up and saying, yet
again, ‘We really need to change things’. I think it
really was the issue—and I talked about this with the
previous committee—that smacked me straight in the forehead
as soon as I started this job as an issue that is unacceptable,
really, in terms of children’s experiences. Of particular
concern are the long waiting lists, of course, but also the lack of
early intervention. So, young people are having to get to a real
crisis point before they’re getting any help or
intervention.
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[44]
In terms of the Together for Children and
Young People programme, I’m sitting on its advisory group,
which hasn’t met very often, I have to say, so far. I applaud
the ambitions of the programme and I applaud the fact that the
ambitions are comprehensive in that it’s trying to tackle
prevention, through primary care, right through to clinical care.
I’m glad it didn’t just concentrate on waiting lists,
because we know you’ve got to tackle issues earlier. The
ambitions are good, there is new money, but we know there have been
difficulties in implementation, partly due to a lack of getting
staff to the right places quickly enough. I’ve been keeping a
close eye on the waiting lists over the last year. I think
they’re still unacceptably high. They’re being tackled
in some areas more successfully than others. It’s quite hard
to—. I’m actually, at the moment, trying to get
underneath some of the figures, because, for example, three of the
most populous health boards’ figures are published together,
so it’s quite hard to know whether a child’s experience
in the Valleys is the same as that in Port Talbot or Cardiff,
because they’re all published together, and I suspect that
they’re quite different, from the casework we have coming in.
We still have children waiting months, sometimes, for a first
appointment and treatment. However, there is some good work going
in in terms of primary care—some good initiatives around
crisis care at home.
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[45]
What I would like to see is a real
emphasis on positive mental health early on right across the
curriculum for all children and young people. I’d like to see
that very much as part of the work towards the new curriculum. I
would like to see it as standard. Again, there are shining examples
in some schools of a whole-school healthy approach to mental
health. So, we have things like mindfulness, exam stress-busting
workshops, anxiety-reduction groups, methods for everyone, which
all of us could benefit from, on increasing our resilience and
ability to cope with stress. So, non-stigmatising approaches across
the school. I’d like to see that really being built into the
curriculum as early as possible. We’d really be missing a
trick in Wales if we have this very ambitious Together for Children
and Young People programme and very ambitious curriculum reform
being worked on by two completely separate departments in
Government and not looking together at how we can really meet the
needs of our young people in schools.
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[46]
Lynne Neagle: Thank you. Oscar, then Darren.
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10:00
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[47]
Mohammad Asghar:
Thank you very much, Chair, and thank
you, Sally, for this information. Pressure on child and adolescent
mental health services has grown by 121 per cent in Wales—you
know that—and the Welsh Government’s cut to spending on
CAMHS was nearly 7 per cent in 2014-15 and more than one in
eight young people are waiting for more than 40 weeks to receive
vital support. It’s not acceptable. Some young people are
waiting for almost a year, so that is also unacceptable for a
child’s benefit. Throughout the fifth Assembly, what
framework does the Welsh Government intend to put in place to
ensure that no child and their family waits no more than 14 weeks
in this part of the world?
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[48]
Dr Holland: I agree with you; it’s terribly
concerning. One of my great concerns, really, is the inequality.
Although we know adult mental health services are not a panacea,
we’re actually seeing children waiting disproportionately
longer than adults, which, to me, is a clear discrimination in our
society. Another thing I should have mentioned with the Together
for Children and Young People programme, which I think is a really
strong ambition, is the cutting on waiting list targets. So, from
April this year emergency cases—children in emergency
situations—should be seen within 24 hours, and first
referrals within—I hope I’m getting these
right—28 days. The NHS accept that they won’t meet
those targets this year, but that’s what they’re aiming
for. I applaud the fact that they’ve put those ambitious
targets in. They’re now the most ambitious ones in the UK. I
know you’re seeing the health Minister later, so I’m
sure that you will be bringing up these issues with him. We really
need to make sure that the extra investment that went in last
year—the figures were correct, as you say, for
2014-15—but the extra money that went in this year continues
throughout the term, if not increases, and that they have some
sense of when, in Wales, we’ll be able to meet those targets.
I think they’re correct targets. For a child, it is too
precious for young people to be sitting for 52 weeks on a waiting
list for something to happen. Someone’s decided that they
should be referred, and I know that there’s been an issue
about whether referrals are appropriate or not, but we have
casework coming to the office where, clearly, a young person is in
great distress. I’ve heard GPs telling me that they’re
not referring young people frivolously. They’ll be young
people who are contemplating suicide, for example. So, these are
not young people that should be waiting for 40 weeks or however
long. The ambitions are correct. What we need to do is meet those
ambitions now. I shall certainly be scrutinising that over the next
year or two, and I’ll be very disappointed if we don’t
get near those targets, within the next two years, anyway.
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[49]
Lynne Neagle: Thank you. Darren.
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[50]
Darren Millar: Thank you, Chair. You mentioned earlier on
that the advisory committee hasn’t met very frequently. How
many times has the advisory committee on the Together for Children
and Young People programme actually met?
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[51]
Dr Holland: There are two committees—and I’m
going to get their names wrong now unless Hywel can remind me.
There is a working group of senior people, which does meet
regularly. There’s the expert advisory group, which I am on,
which is a small group of four or five people. I think we’ve
only met physically once in the last year, but we have had
communication virtually, and I think that that was how the lead
planned it to work, but I have been asking for another meeting so
that I can bring up some of these issues.
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[52]
Darren Millar: To me, that gives the impression that there
is insufficient focus, really, from the Government on wanting to
address these issues. I know that you’ve mentioned that
there’s a senior team sort of working on things, but do you
think—
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[53]
Dr Holland: It’s NHS led, rather than led by
Government, I think—
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[54]
Darren Millar: Well, the NHS is—
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[55]
Dr Holland: Within the Government, yes.
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[56]
Darren Millar: Do you think there’s insufficient pace
with the progress?
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[57]
Dr Holland: I think it’s patchy. So, I think there has
been some good progress, but not perhaps as much as I would like to
have seen yet.
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[58]
Darren Millar: When you request meetings—and you say
you’ve recently been requesting some—are they going to
be granted? Is that the impression that you get?
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[59]
Dr Holland: Yes, I believe that they’re going to try
and get one in place before the end of the year.
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[60]
Darren Millar: Before the end of the year? When did you
request this meeting?
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[61]
Dr Holland: In the last month, I think.
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[62]
Darren Millar: Okay. Do you think that that’s good
enough? Do you think it suggests that they are willing and wanting
to meet? Have you attempted to hold them to account for any
progress or not?
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[63]
Dr Holland: Well, when we do meet, we will be discussing
that, definitely.
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[64]
Darren Millar: Okay, but you’d like to see more
frequent meetings so that you can be more informed as to what the
progress, or lack of progress, might be.
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[65]
Dr Holland: Yes, I think I would.
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[66]
Darren Millar: Thanks. Can I just ask as well about the
early intervention which you mentioned, which of course is
critically important when there are long waiting lists? When a
mental health problem begins to manifest itself, of course, it can
often be very mild at first before it gets into crisis situation.
You made a reference to mindfulness and some of the good practice
that you’ve seen. Obviously, there’s a project that has
been going on in my own constituency, which I know you’re
familiar with, because you came to visit the school—Ysgol Pen
y Bryn. Can you tell me where else you’re seeing mindfulness
being used in the classroom or in the education system in
particular in order to help children and young people?
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[67]
Dr Holland: There is a mindfulness in schools project.
I’m most aware of it in the north Wales area—in
Flintshire, for example, as well as in Conwy. There is quite
systematic instruction of mindfulness into schools. I don’t
think mindfulness is the only answer for prevention and I’ll
await with interest the evaluation that Bangor University’s
doing of some of those schools in north Wales to see whether it
does make a real difference to children, in which case, you know,
I’d certainly want to see it far more widespread across
Wales. I suppose with any of these projects it needs to be the
right project for a particular school and a particular population,
but also we want to—. If we want anything to come right
across Wales and be in statutory guidance, for example, I’d
want to make sure it’s completely evidence based. The
evidence is very promising on mindfulness, but I think in terms of
it being introduced on a whole-school basis, I’ll be awaiting
with great interest Bangor University’s evaluation of that
project. Certainly, the children that we met together in Ysgol Pen
y Bryn spoke very positively, didn’t they, about its impact
on their everyday learning.
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[68]
Darren Millar: And just one final question on school nurses.
Obviously, not every school has a dedicated school nurse but very
often the local health teams are in touch with the schools at
different points in time. To what extent do you think that the
school nurse system, if you like, is well equipped to deal with
children and young people that might present with mental health
problems?
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[69]
Dr Holland: I’ve had a number of discussions with
school nurses over the last year about their role in this and other
aspects; for example, keeping children safe from abuse as well. I
think there’s a real appetite among many school nurses to
have the time and training to get more involved in this kind of
preventative work, and actually I think school nurses are very well
positioned, if given the time to do so, to take on a lot of this
preventative work. There are some shining individual examples,
perhaps where schools have put extra finance in, to make sure that
they can employ a school nurse full-time, for example, where
I’ve seen some really excellent work going on. I did bring it
up in the children’s health and social care working group
within Welsh Government, which invited me to speak to them—it
was just after the election—and I was told that they were
looking closely at the role of the school nurse and expected to
make some progress on it this term. So, it’s something
I’ll be returning to. I do think that they could be perfectly
positioned, but at the moment what they tell me is that they
probably spend too much time administering vaccinations, for
example, which could be done by someone—a supervised person
at a lower grade—and their high skills could be used to do
more preventative general health work. So, it’s something
I’d really like the education system and health system to
explore.
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[70]
Lynne Neagle: Thank you. Just one final question on this.
The Children’s Society recently published its ‘Good
Childhood Report 2016’ and that found that there was a
widening gender gap in well-being, with well-being falling for
girls. Is that a trend that you’ve noticed in your work?
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[71]
Dr Holland: Yes. I mean, in my ‘Beth Nesa?’
survey we did see some gender differences, for example, in
well-being. They were very similar to patterns that we see
elsewhere with girls, as they get older, reporting more low mood
than boys, for example. I think the Children’s Society annual
reports are becoming a really important source of evidence for us
in the UK. We do need to bear in mind that most of their survey
work is done in England; they were drawing on things like the
millennium cohort study data for Wales, rather than direct survey
work for Wales. Having said that, I wouldn’t expect the
findings to be any different in Wales. As my small survey showed,
they were very similar, and in fact, we were advised on our survey
by one of the key officers of the Good Childhood survey, so we used
a lot of the same methods. I think it is a concern. We know that
issues around body image, for example, are real concerns for girls,
as is sexual harassment and negotiation of relationships. My office
has been partly involved in a project led by Emma Renold of Cardiff
University. This year, she’s been working with young people
to develop peer-led healthy relationships guides for schools.
I’ve seen the draft of that. It’s not guidance;
it’s tools—really practical, fun tools,
actually—developed by young people, to really embed healthy
relationships work in schools. That’s going to be launched
this November and I’ll be part of that. I feel quite
optimistic that there are ways that we can work on this, but we
need to take it seriously, and schools need to take it seriously.
Girls are talking about everyday harassment, everyday anxieties,
and we need to find new and imaginative ways to tackle those.
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[72]
Lynne Neagle: Okay; thank you. John Griffiths, then, on
poverty.
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[73]
John Griffiths: Two things, if I may, Chair, if I could link
it with play. Two of your priorities, commissioner, are to address
poverty and social inequalities in Wales, and obviously that cuts
across many aspects of the quality of life and the experiences of
children. Also, with play, three to seven-year-olds have
highlighted their desire to have better access, and there’s a
link with deprivation there in terms of lack of adequate access.
I’m just wondering really what your thinking is in terms of
how progress can be made. I think, with poverty, obviously, some
levers are within Welsh Government control, others are very much
with the UK Government. Quite a lot of work has taken place by
committees here in terms of reports on tackling poverty, and Welsh
Government and other agencies, and finding practical ways forward
and ways of addressing those concerns of young people is obviously
no easy matter; it’s very complex. I just wonder what route
you see through in terms of the role that you can play as
children’s commissioner.
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[74]
More specifically on play, I’m wondering whether you see many
links with issues around community-focused schools, which I think
is quite patchy. In some areas of Wales, schools are open to the
community, to use the facilities at weekends, during holidays and
evenings, but not so in a consistent manner, I don’t think.
I’m aware that on council estates, for example, in my area,
the stock transfer that took place—taking housing stock from
the council to a registered social landlord—has put in place
the basic improvements of the quality of housing—the new
windows, doors, kitchens, bathrooms, which is really important
stuff—but they’re now moving on to the general
environment and looking at the land that’s there on the
estates. I think there may be opportunities there to make points as
to what children would like to see in terms of opportunities for
play.
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[75]
And, just finally, Chair, there’s also the Tanni
Grey-Thompson report, which is all about physical literacy in
schools, and very important in terms of Donaldson’s work and
the curriculum review. We need children to be physically literate
to enjoy the opportunities for play. So, there’s quite a lot
going on, and I just wondered what you see as the route through all
of this, really, as far as your role is concerned.
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|
[76]
Dr Holland: Okay. There’s a distinction, of course,
between my role and Government’s role and local
authorities’ roles et cetera. Just quickly—I will come
on to my role in a second—on Government and public
services’ roles, firstly, although there was a welcome very
slight decline in child poverty figures this year, I hope
that’s going to become a trend. We’ll be able to assess
that over the next couple of years. We absolutely cannot become
complacent about the levels of child poverty in Wales, which are
still shockingly high, really, and inequalities in experience of
childhood in Wales has got to be really my No. 1 priority. I really
mean my overall statement that I want every child in Wales to have
an equal chance to be the best they can be, and poverty is one of
the things that is one of the main humps on the road that children
face in becoming the best that they can be.
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10:15
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[77]
So, first of all, we need to just keep people really alert to the
fact, because I think the general population really needs to still
be—as we all do—sort of angry about the fact that so
many children are living in poverty in Wales. I think we need to
acknowledge the fact that, although the tax and benefits system
play a huge part in child poverty, as you say, Welsh Government
does have levers, as do local authorities. I know that the
anti-poverty programmes are being examined carefully by the new
Minister, and I’d be very interested to see what happens with
those. I think they really need to be targeting child poverty, and
children’s experiences of that. We need to see it as a
cross-Government role. I want to see children featuring in thinking
right across the Government.
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[78]
I’m really pleased that we have a Minister for children in
this Government—it’s something I called for before the
election. I hope he’ll take a leading role in co-ordinating
the response to children across Government. Personally, I think
that could be well done by a Cabinet sub-committee on children,
which, I hope, would have child poverty at the top of its agenda.
We know that there’s a new committee, for example, on the
impact of Brexit. I can’t remember its formal name.
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[79]
Mr Dafydd: It’s an advisory group, I think.
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[80]
Dr Holland: An advisory group—so, an advisory group on
Brexit. I want to know what thinking that group’s going to
have on the impact of Brexit on children. You know, children
mustn’t lose out in any new settlements, post Brexit. I
wouldn’t want the Government to be using Brexit really as a
kind of get-out-of-jail card for saying, ‘Well, we
can’t do anything about child poverty, because
everything’s changed.’ Children must be visible. You
know, we can only pay due regard to children’s rights really
by having children really visible in our planning, and in our
delivery. I want to see children right up there in the budgets, to
know what’s being spent on children. I’d like to see
young people more involved in finding these solutions too.
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[81]
At a local level, the new public service boards—under the
Well-being of Future Generations (Wales) Act 2015—if done
well, do give an opportunity for public services to come together,
to really plan for tackling child poverty. Although we can see
great initiatives, like community-based schools, children’s
experiences of poverty aren’t going to be alleviated by one
sector or another. I’m working hard with the Future
Generations Commissioner for Wales, Sophie Howe, to help public
service boards understand how they can embed children’s
rights, through fulfilling the well-being goals of the new Act. So,
we’re doing some quite distinct work with the public service
boards, to get them to think about keeping children at the
forefront of what they’re doing, both in their delivery, and
in involving children in planning that delivery.
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[82]
Play has got to be a priority. The UN committee, interestingly,
singled out Wales for praise in terms of our play sufficiency
regulations. But, we need to make sure that they are properly
carried out and embedded throughout Wales. And you’re right,
play has got an important role in promoting physical health; there
are lots of other reasons why we should promote play, but one is
physical health. Children in the ‘Beth Nesa?’
consultation told me that they wanted to be able to play out more,
but they didn’t always feel safe to do so. So, we need to
find ways of making children feel safe to navigate our communities,
and play out; opening up facilities out of hours may be just one
way of doing that.
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|
[83]
But, I’m particularly concerned really that we need to keep
an eye on, under austerity measures, when local authorities are
inevitably making cuts, that we don’t lose some of the areas
that they don’t have to provide through statutory guidance.
So, if things are cut like free access to sports, play and
facilities, et cetera, then the children who are going to lose out
are going to be the poorest children. Middle-class parents can
compensate by buying their children music lessons, football
lessons, et cetera, but the poorest children are going to lose out.
So, I think that we need to be scrutinising the impact of cuts on
the poorest children, including play.
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|
[84]
In terms of my role, I’m expanding this year my community
ambassadors programme, which gives an opportunity for children with
all sorts of expertise—it might be experience of being
disabled or of living in a particular community, like
Gypsy/Traveller communities, or children living in poverty—to
both spread the word about rights in their community, but also to
make sure that I hear and I help other people to hear their
everyday experiences of poverty. I’m expanding that programme
this year to be more widespread throughout Wales and I’ll be
listening to those children’s experiences, particularly of
accessing some of the extra-curricular, you might say, or
enrichment activities that other children take for
granted—so, sport, leisure and play activities. So, I hope,
again, that I’ll have more to report on that in next
year’s annual report.
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|
[85]
Lynne Neagle: Thank you very much. Llyr, on safety
issues.
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|
[86]
Llyr Gruffydd: Yes, thank you. Child sexual exploitation is one area
that I think the committee needs to look at at some point, and the
Assembly more widely as well, I think, should do more in
deliberating that particular issue. Where would you see the
committee potentially making the greatest contribution around that
agenda?
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|
[87]
Dr Holland: Since I took up my role, I have seen some real
progress in this field. Following some of the events in England, in
Rotherham and Rochdale, et cetera, my predecessor set up a national
round table, which he chaired and which I’ve carried on the
work of over the last year and will continue to carry on. I’m
co-ordinating with the National Independent Safeguarding Board for
Wales on that, but they’ve asked us to carry on meeting
because they see it as a really valuable meeting. So, about four
times a year, I meet up with some of the most senior police and
members of local authorities and the voluntary sector and health
providers from right across Wales to share best practice, but also
to monitor progress being made. Welsh Government officials in
charge of this area attend that, and I and the group have been
pushing them to come forward with a national action plan, which did
come forward in the spring. All local areas should be working to
that now. I think it’s a good, comprehensive plan. You can
have all the plans in the world, but you need to make sure that
they make a difference to children’s everyday lives. So, the
next role of this round table will be to ensure that it is making
that difference.
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[88]
I’ve seen some quite creative
working, I think, across Wales. But, once again, I want to make
sure that that’s experienced by a child if they live in the
middle of rural Powys or in the centre of Cardiff or in Anglesey.
They must experience the same high-quality response, if
they’re at risk of CSE or have experienced CSE. But we have
seen some good initiatives. Most of the police forces now, for
example, are working with the third sector to bring in experienced
advocates who can work with children who they know have experienced
CSE or are at risk of it because of frequently going missing, for
example. Those child advocates, the police say, are much better at
working with those young people to keep them safe. So, that’s
been an encouraging thing.
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[89]
Sometimes it’s been, you know,
things that are just really good ideas and are spreading. So, in
Gwent, for example, they saw taxi drivers as a really key component
in spotting where young people were being transported,
unfortunately for the purpose of exploitation, by taxi. So, they
saw them as key potential informants. So, they reduced their
licensing fee, I think by 25 per cent, if they attended a CSE
awareness course. When that was brought to my round table, the
other police forces said, ‘Oh what a good idea; we could do
that too.’
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[90]
So, I think we’ve seen progress over the last year, but what
we will see with that progress is possibly a change in the
statistics that might look more worrying, because we’re
seeing more awareness; the police are identifying more young people
at risk, so the figures are likely to go up. So, I think
that’s important for the committee to be aware of when
you’re scrutinising those figures. I think the committee may
wish to look at whether the Government action plan and the local
action plans that should come out of that are actually making a
difference to children’s everyday experiences of being
safe.
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[91]
Llyr Gruffydd: That’s what I was getting at. So, you would see
value in us scrutinising the action plan and its implementation
particularly.
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|
[92]
Dr Holland: I would, yes.
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|
[93]
Lynne Neagle: Thank you. Hefin.
|
|
[94]
Hefin David: I had a very productive—. I’m coming back
to John Griffiths’s area of interrogation, looking at your
priorities, poverty and social inequalities, and particularly also
transitions to adulthood for all young people who require
continuing support in care. With that in mind, I had a very helpful
meeting with Action for Children this week, and they raised with
me—. I’d read their document, ‘A Fair Deal for
Young People in Wales’, in which they raised the issue of
young people in care struggling with budgetary issues, which then
lead in to difficulties in adulthood, and the need to intervene
appropriately, differently and, often, early or in a timely way.
Could you reflect upon that and give your opinion on what you think
the best way of tackling these issues is?
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|
[95]
Dr Holland: Absolutely. This is an area of absolutely essential
importance to me that I’m really stuck into at the moment,
actually. I highlighted the issue in my last annual report, but
I’ve continued to do more project work on it this year.
It’s something that came up strongly in my consultation.
I’m interested in transitions of all young people needing
additional care and support into adulthood. So, that might be for
health reasons or other social care reasons. But, this year,
I’ve decided to concentrate on the experiences of young
people in care as the highest priority, the highest at-risk group,
really, as they move into adulthood.
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[96]
Over the summer, I held two regional
assemblies for young people in care, which young people from 19 of
the local authorities attended, and we specifically discussed
issues of how they’re supported into adulthood. Finance comes
up a lot, and I think Action for Children are right to highlight
that as an issue. We’re bringing all those messages to a
national assembly now next month, which the Minister for children
is attending, where we’ll be continuing to further our calls
for a more secure move into adulthood for care leavers. This is a
long-term piece of work that I’ll be carrying on into the
next year and following it through with each local authority, but
I’m trying at the moment to bring forward the everyday
experiences of young people—and we’re doing that in all
sorts of creative ways—to Government’s attention, and
then I would like to see a much stronger commitment from
Government, and then each local authority, to these young
people.
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[97]
We need to make sure that every young
person leaving care has a secure place to live, and they will all
need something different. Often, they’re going into bedsits
or single flats where they are isolated and lonely, and vulnerable
to financial exploitation. They’re living in poverty, often.
So, they are living on, I think it’s £56 a week in
general, and that’s to pay all their bills, travel to
college, food, et cetera. You know, think of how much that is per
day; it’s not a lot to live on, and they’re paying
their council tax, et cetera, out of that as well. And too many of
them are not in education, employment or training. So, I think the
basic thing that corporate parents should be able to offer the
young people that we have taken into our care in Wales, as they
move into adulthood, is what any parent would offer: something
constructive in terms of a training place, an education place or a
job—an active offer of, anyway—and secure housing and
support. So, that social support needs to continue, because many
young people get into financial difficulties, and once you start to
do the sums with them, you can see why, and they are often
exploited by other people and are often vulnerable. We have to
remember, of course, these are amongst our most vulnerable young
people, and yet they’re moving into adulthood earlier than
most young people from birth families. There’s a lot
of work to be done in this area. But, actually, I think it’s
something that we can do as a nation. I don’t think
it’s one of these big issues that we will never solve. I
think it’s something that is entirely solvable. The numbers
are not too big for us to be able to provide properly for these
young people. It’s something that you’ll be hearing
quite a lot more on from me and my team over the next year.
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[98]
Hefin David: I, therefore—given that time is tight
today—look forward to talking about this more in the context
of your annual report.
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[99]
Lynne Neagle: Thanks, Hefin. Okay, well that concludes our session.
Thank you very much, both, for coming today. I’m sure we all
found it a really informative session and we’ll look forward
to seeing you again on 6 October. Can I just remind you that, as
you know, you will have a transcript of the meeting sent to you for
checking? Thank you very much for coming.
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[100]
Dr Holland: Thank you. Diolch yn fawr.
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10:30
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Cynnig o dan Reol
Sefydlog 17.42(ix) i Benderfynu Gwahardd y Cyhoedd o’r
Cyfarfod ar gyfer Eitem 4
Motion under Standing Order 17.42(ix) to Resolve to Exclude the
Public from the Meeting for Item 4
|
|
Daeth
rhan gyhoeddus y cyfarfod i ben am 10:31.
The public part of the meeting ended at 10:31.
|
|
Ailymgynullodd y pwyllgor yn gyhoeddus am 10:56.
The committee reconvened in public at 10:56.
|
|
Ysgrifennydd y Cabinet dros Iechyd, Llesiant a
Chwaraeon a Gweinidog Iechyd y Cyhoedd a Gwasanaethau Cyhoeddus:
Sesiwn Graffu
Cabinet Secretary for Health, Wellbeing
and Sport and Minister for Social Services and Public Health:
Scrutiny Session
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|
[102]
Lynne Neagle: Can I welcome the Cabinet Secretary for health and
the Minister to our meeting this morning? Thank you for attending
and for providing papers in advance of the meeting. Can I just ask
you to introduce your officials for the record, please?
|
|
[103]
The Cabinet Secretary for Health,
Well-being and Sport (Vaughan Gething): I’m Vaughan Gething. Thank you very much for
the invitation as the Cabinet Secretary for Health, Well-being and
Sport, and I’ll ask people to introduce themselves around the
table.
|
|
[104]
The Minister for Social Services and
Public Health (Rebecca Evans): Rebecca Evans, Minister for Social Services and
Public Health.
|
|
[105] Mr Heaney: Good
morning. I’m Albert Heaney, director for social
services and integration.
|
|
[106]
Mr Rees: Good morning. Irfon Rees, deputy director public
health.
|
|
[107]
Dr Watkins: Dr Sarah Watkins, head of mental health
policy.
|
|
[108]
Dr Payne: I’m Dr Heather Payne. I’m senior medical
officer for maternal and child health.
|
|
[109]
Lynne Neagle: Lovely. Thank you very much all. If it’s okay,
we’ll go straight into questions, then, and the first
question is from Llyr.
|
|
[110]
Llyr Gruffydd: Thank you very much, Chair. Good morning to you all.
I just want to start by asking a few questions about the way
responsibilities have been shared out across Cabinet Secretaries
and ministerial portfolios, really. I’m just wondering if you
could clarify a few particular areas for us first of all, maybe, in
terms of responsibility because it seems to be unclear from the
information that we have in the public domain. Who’s
responsible for safeguarding and child protection?
|
|
[111]
Vaughan Gething:
Well, can I—?
Generally—.
|
|
[112]
Llyr Gruffydd: Who leads, then, I should say.
|
|
[113]
Vaughan Gething:
Generally, you’d expect us, as we
will need to, to work across Government on a range of different
areas and as this particular committee has oversight for any of
those areas we do need to work together. We already work and
we’ve had a meeting between the two and three Ministers with
responsibility. Perhaps Rebecca could come back to you on the
specific areas that you’ve raised, but this is a new way of
working, working across Government, and the portfolios have been
deliberately designed by the First Minister to encourage and
require cross-Government working.
|
|
[114]
Rebecca Evans: So, with specific regard to safeguarding, Carl
Sargeant has responsibility for child safeguarding and I have
responsibility for adult safeguarding. As far as safeguarding is
concerned, our work is supported by the same team of officials
anyway, so it does have that consistency and co-ordination across
Government. Of course, officials are well used to working to
multiple Ministers across multiple portfolios anyway.
|
|
[115]
Llyr Gruffydd: What about disabled children?
|
|
[116]
Rebecca Evans: Different aspects of disabled children’s lives
will be in the responsibility of different Ministers. For example,
Carl Sargeant would be responsible if a disabled child needed
advocacy provision. He has Families First in his responsibilities
as well, whereas other aspects of disabled people’s lives,
for example, through the care and support plans that they would
have under the Social Services and Well-being (Wales) Act 2014,
would sit with me.
|
|
[117]
Llyr Gruffydd: This isn’t a very long list—.
|
|
[118]
Vaughan Gething:
Staying with your point on disabled
children, that is a good example of where you couldn’t
honestly say that only one Minister could or should have
responsibility, because that disabled child will have a whole life
where each aspect of that life would cross different parts of
responsibility. You’d have straight healthcare
needs—well, obviously, that could end up being with
me—and then their role within school and educational life as
well. So, I think, with some of this, it’s easier to talk up
the difficulties rather than say, ‘Actually, as long as we
have a focus on outcomes for the child and as long as Ministers and
officials work across the Government, then we should be able to
deliver on our responsibilities’. I think it will get easier
for Members to scrutinise as that becomes clear in the way that we
work.
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|
[119] Llyr Gruffydd: Yes, and I welcome this broader approach in terms
of—. Because, as you say, the danger always is that we end up
working in silos and that’s an easy criticism to throw at
Government, and I applaud the fact that there’s a
concerted effort to look at structures, but you do have to accept
that there would be inherent risks as well in introducing this kind
of system. Because where there is overlap and a decision needs to
be made pretty swiftly, do you have sort of understandings about
who would initially respond to certain circumstances?
|
|
11:00
|
|
[120]
Vaughan Gething:
Yes. I think there’s decisions to
do with the policy and regulations.
|
|
[121] Rebecca
Evans: Yes. I think probably the simplest way to consider it is
that Carl Sargeant would be responsible for the policy aspect of
children, and I’m responsible then for the legislation,
regulation, implementation and inspection side of things. So, a
simple example would be childcare. Carl Sargeant would be
responsible for the policy on childcare and delivering our
manifesto pledge in terms of childcare as well. I would be
responsible for the oversight of the regulation and inspection of
those childcare settings. So, that’s an example of how the
split would work in practice.
|
|
[122] Llyr
Gruffydd: Not easy, though, for stakeholders and the wider
public to know who to go to, then, in those kinds of
circumstances.
|
|
[123] Vaughan
Gething: I don’t think it’ll be that difficult. In
any reshuffle, people always say, ‘What does this really
mean?’ In any new way of working—. You talk about the
risks inherent in any structure, but in any structure there is a
risk that you self-identify, proceeding to your working in silos
and people falling between different responsibilities. I’m
confident that we’ll be able to make this work and the public
will understand who they need to go to for which particular either
individual issue or a challenge or problem, as well as lobbying and
scrutiny as well.
|
|
[124] Rebecca
Evans: I think this is about maximising our resources across
Government as well in order to support families and
children—so, maximising resources across housing, social
care, family support and so on. And having more than one Minister
with a deep interest in that portfolio, in that subject area, I
think is a good thing.
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|
[125] Lynne
Neagle: Thank you. Julie on this.
|
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[126] Julie Morgan: Yes, thank you very much. I
think it’s an excellent idea to work across Government, and
that’s something that we’ve been looking for for a long
time. Would there be any plan to have any forum where all of the
key players came together, such as a Cabinet sub-committee or some
area for children?
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[127] Vaughan
Gething: We already work on issues across the Government
already and there are good examples of where we do that. For
example, we’ve had a specific example in the Dylan Seabridge
case, where three Cabinet secretaries and the Minister worked
together on the response. And, as we’ve set out, we’ve
already had meetings, both with Carl and Rebecca, and we, as
Cabinet Secretary and Minister, have had meetings where myself,
Rebecca and Carl have sat down. There’ll be other times
where—for example, on working on the autism strategy—we
would need to, obviously, talk to colleagues in education. So, I
think, rather than wanting to have one, if you like,
superstructure, where people will turn up, it’s about making
sure that, as we deal with each issue, we have a proper
cross-Government approach so that the right parts of Government are
involved and are taking part in that discussion. That really is our
responsibility, ultimately, as Ministers: to make sure that we have
proper sight of who needs to be involved and engaged in that
decision-making and discussion process at ministerial level and at
official level as well.
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[128] Julie
Morgan: So, you would see it happening, according to the issues
as they arise, that the key people would come together.
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[129] Vaughan Gething: Yes. Looked-after children is a good example
as well.
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[130] Rebecca
Evans: Yes, as is adverse childhood experiences. We’ve
had a trilateral meeting on that to look at Public Health
Wales’s recent report—because that very much does cut
across the various different portfolios—to consider a joint
response to those challenges that are in that report.
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[131] Vaughan
Gething: And Albert’s team is working with a team on
housing on a range of these things as well, so it isn’t just
about health and social care working with a particular partner. But
it’s a good example of where we all have an interest,
there’s a lead Minister, but we then take part in the
discussion and the decision making as well. I hope that colleagues
are aware of the role that David Melding’s going to take.
Carl Sargeant, as the lead Minister, is involved in that, but
we’re both involved because we both have an interest as
well.
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[132] Rebecca
Evans: A final example would be the review that we’re
doing of the children’s independent reviewing officers. This
is something that Carl Sargeant’s leading on, but because it
would be my responsibility to instigate any changes that are
necessary to the legislation, then I’m very much being kept
up to date and in the loop and have early sight of documents and so
on in order to be able to contribute to those.
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[133] Lynne
Neagle: Okay. Thank you. Can I just clarify, then, in terms of
young carers, because you’ve got the lead responsibility for
carers: does that include young carers as well?
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[134] Rebecca
Evans: Yes, all carers.
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[135] Lynne
Neagle: Right. Okay. Lovely. Thank you. Okay, just before we
move on, then, just to ask Rebecca if she could maybe say something
about her priorities for the areas in social care that you are
responsible for.
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[136] Rebecca Evans: Certainly. Well, you
mentioned young carers. Young carers are a particular focus of
mine—a personal interest—but also as part of my
portfolio as well. The implementation of the Social Services and
Well-being (Wales) Act gives enhanced rights for all carers, and
that includes young carers. So, it’s my responsibility to
make sure that the implementation of that Act does benefit all
carers, including those who are under 18 as well. Carers are now
recognised as being carers without having to provide evidence of
providing substantial amounts of care. So, you can self-declare as
a carer if you know that that’s what you are. So, they have a
right to have their needs for support assessed. Young carers may
have a support plan integrated within their family plan, and
possibly a plan for the person that they care for as well. So, this
is all very much new under the legislation and something I’ll
be keeping a close eye on to make sure that it does have the impact
that we want it to have for young carers.
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[137] We’ve
developed our national outcomes framework, which underpins and
measures the Social Services and Well-being (Wales) Act, and that
really is about measuring the impact that it’s having. Young
carers were very much involved in that, and in the development of
those outcome measures. One of them actually specifically relates
to young carers. So, that’s one of the areas that I’ll
be certainly prioritising in my time in this post.
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[138] I’m also
keen to prioritise autism. As you know, I’ve got a background
in autism and a special interest there as well. So, it’s a
very important part of my portfolio. So, we’re currently
reviewing our autism strategy to make sure that it’s fit for
purpose for the next level of provision now. Again, that’s
very much done in close co-operation with people representing
people with autism and actually people with autism themselves.
I’m looking forward to meeting the National Autistic Society
later today to discuss this.
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[139] Lynne
Neagle: Okay. Thank you very much. We move on now to child
health. John Griffiths.
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[140] John
Griffiths: Yes. I wanted to ask, on child health, in terms of
getting our children and young people more physically active.
Obviously, Vaughan has responsibility for health and sport. You
have responsibility for public health, Rebecca. I just wonder how
your different responsibilities, and indeed responsibilities across
Government, will hopefully get our young people more active,
bearing in mind that quite a lot of developments have taken place,
I think, such as Tanni Grey-Thompson’s report on physical
literacy and the reform of the curriculum. Hopefully, we can get
those good habits embedded in young people that will stay with them
for life and help tackle things like the obesity crisis, for
example. Also, of course, community-focused schools, I think, is an
important development where, if we could get schools consistently
open to the community at evenings, weekends and holidays, I think
that would help.
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[141] So,
there’s quite a lot going on, as it were. Personally,
I’m involved in local initiatives trying to bring the health
service together with a leisure trust, registered social landlords
and sports organisations to encourage young people to become more
active. I just wonder if you could say a little bit about how we do
achieve this. I think it’s a really important goal: getting
our young people to be more physically active.
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[142] Rebecca
Evans: Thank you. Again, Chair, this is something that falls
within my explicit responsibilities under my portfolio. I think
there’s a role for all of us in this particular agenda. So,
the NHS, local authorities, ourselves as Ministers as well, schools
and so on. But in terms of the NHS, for example, we’ve got
Motivate 2 Move, which is our initiative to try and help healthcare
professionals to incorporate exercise advice routinely into their
patient consultations. So, that’s the role of the NHS. Of
course, Sport Wales is our main delivery partner for activity, and
that’s physical activity and sport because it’s
sometimes easy just to think of sport as a separate thing. But,
actually, we’ve got a much wider spectrum of interest, and
that includes physical activity as well. On our behalf
they’re delivering programmes such as the free swimming
initiative, Dragon Sport for primary school children, and the 5x60
programme, which is aimed at secondary school children as well. We
have also delivered our Change4Life programme, which is for
families—a focus on the whole of the family as well.
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[143] So,
there’s a great deal going on, not least to mention our
Healthy Schools initiative as well. I was really pleased to see an
example of that, myself, over the course of the summer as well. It
was good to see that in action. I would say, on the Healthy Schools
initiative, it is a whole-school approach. So, that’s about
physical, mental and social health, not only for the students or
the pupils, but the whole of the school family, which includes the
family members of the pupils as well. More than 99 per cent
of our schools in Wales are actually
actively engaged in this. So, the award will come as a result of
the work that they’re doing through the curriculum, through
leadership in the schools and through the work that they’re
doing on the school environment and the ethos of the school, as
well as family and community involvement as well. So, this is about
physical activity, but it’s also about mental and emotional
health, food and fitness, tackling issues of substance misuse, the
environment more generally and safety and hygiene and so on. So,
it’s very much about the wider public health agenda and
ingraining that very much in the minds of young children from the
youngest age.
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[144]
John Griffiths:
In terms of some of the exciting new
developments, such as, I think, the physical literacy aspect of the
curriculum reform—drawing on Tanni-Grey’s
report—and hopefully a push for more consistency in
community-focused schools, what role would you have in terms of
liaising with other Government Ministers and Cabinet Secretaries to
ensure that we make the sort of progress that really will take
forward public health and produce more physically active young
people in Wales?
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[145]
Rebecca Evans: My role is very much to be an advocate for public
health and for physical activity amongst my colleagues in
Government. The Public Health Wales ‘Making a
Difference’ report was published recently and that covers 10
different areas that Public Health Wales have identified as being
key to needing improvement to improve the public health of Wales as
whole, and it’s very much cutting across Government. So,
I’ll be having meetings with our various Ministers whose
portfolio responsibilities are reflected in that report.
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[146]
I also have a responsibility to
consider—. For example, you mentioned using our school
resources most effectively, so I’ll be meeting with the
education Minister on this as well because I’m very keen to
ensure that school governing bodies do take the opportunity to open
up their resource of an evening or on weekends and so on for the
whole of the community’s benefit. Because that sometimes is
the stumbling block, that the school perhaps or the governing body
of the school are a bit nervous or reluctant to open up the school.
Whereas, when you consider the great benefits that would be, not
only for the pupils of the school, but for their families and wider
community, I think that that’s something I really want to
encourage.
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[147]
Lynne Neagle: Thank you. Oscar.
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[148]
Mohammad Asghar:
Thank you very much, Rebecca. You
mentioned earlier childcare and adult care and everything. Very
recently, I’ve been a carer for my wife and my hat’s
off to Age Cymru and those who did a wonderful job of caring for my
wife for six weeks after the operation. I must give you credit
where it belongs. But, the fact is that there are still some areas
where there is a need for training and understanding of culture.
They were very punctual, but there are certain areas that still
need to be looked at. Again, as I said, they’ve done a
wonderful job and I don’t know which ministry they come
under, whether child, adult or age, so that is another area.
We’ve got an ageing nation, with a lot of people going
through operations and everything.
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[149]
But my question to you is on
maternity-ward qualified nurses. I think there are not enough
there. I think the First Minister has already said recently that,
in his words: the goal over the course of the next five years is
for every neonatal unit to be properly staffed in that time, in the
next five years. I would like to ask the Minister what his plans
are and how he is going to achieve that. Because it’s 20 per
cent and achieving the other 80 per cent is a long ask with the
funds available.
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[150]
Secondly, obesity in our children, which
is a very serious point. I need to know if there are sporting
events in college, schools or local government. I know one instance
in Newport, where they are demolishing a church to build housing
right in the middle of a housing area. I think that that is not
acceptable by the local council. Are you aware of that, that right
in the middle of residential areas, they’re demolishing
churches and other iconic buildings to build only housing or a
couple of flats there? That land could be used by our young
children as playgrounds to stop this obesity. So, that is another
area that I’d like you to tell us what measures you’re
taking through Government to stop obesity in our
children.
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[151]
Lynne Neagle: We were going to come on to neonatal as a separate
item and I—
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[152] Vaughan Gething: If you want, given that childhood obesity has been
raised, do you want us to deal with that point and then I’ll
happily deal with the neonatal lines as and when you want to
deal with them, Chair?
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11:15
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[153]
Rebecca Evans: Our childhood measurement programme suggests that
most children are of a healthy weight in Wales, and that’s
certainly to be welcomed. Our recent data also show the prevalence
of overweight and obesity amongst reception-age children is
remaining stable. Now, that presents a challenge to us, because
obviously we want to see the figures moving in the right direction.
So, we’ll be focusing some of our attention, certainly, on
that.
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[154]
We’re expanding our nutritional
standards to new settings. So, that will include early-years
settings. I think that’s positive. We’re also working
with the food industry in Wales on things like the substitution of
salt, fat and sugar and so on in their recipes—the
reformulation of those recipes—and we’re encouraging
the use of the UK Government’s front-of-pack labelling as
well.
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[155]
Of course, you’ll be aware that the
UK Government have recently published their UK childhood obesity
strategy. Whilst we welcome the moves on the sugar levy within
that, we’re certainly disappointed that they haven’t
taken on board some of the things that we’ve been calling for
in the Welsh Government for quite some time, such as tougher action
on the advertising of unhealthy foods before 9 o’clock, for
example. A concern of ours, again, is that unhealthy foods and so
on are being advertised within the new media, for example, so, on
social media and games, and so on, that young people are playing.
So, that’s a new avenue to influence young people, which I
think the UK Government does need to address. The Cabinet Secretary
has written to Jeremy Hunt in precisely those terms, in response to
the publication of the UK strategy.
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[156]
Vaughan Gething:
If you’d like, Chair, we’d be
happy to share the letter that’s gone to Jeremy
Hunt.
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[157]
Lynne Neagle: Thank you. Yes, I’m sure the committee would be
keen to see that. Is it on this?
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[158] Llyr Gruffydd: On this specifically, can I
just ask: the sugar tax has been well trailed, have you any
thoughts about expanding that to high-salt goods, or the high
levels of fat in foods? Are there any other areas that you’re
looking at or actively encouraging the UK Government, for example,
to address?
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[159]
Vaughan Gething:
I think our letter and previous
correspondence helped to set out that we do think there should be
more action that goes beyond voluntary. But the challenge is that
these are not powers that are devolved. So, it’s about us
urging the UK Government to try and do the right thing. It’s
part of our challenge and our disappointment that there
hasn’t been more robust action previously on these areas, but
we do know, for example, that action has been taken on salt. There
have been significant reductions made in salt in food, and it
doesn’t affect the taste, but you’ll see a reduction in
the salt in any event. So, there’s more that could and should
be done is our view, and if you want us to come back to this
subject after you’ve seen the letter, we’re more than
happy to.
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[160]
Llyr Gruffydd: Thank you.
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[161]
Lynne Neagle: Okay. Hefin, did you want to raise your points now on
this?
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[162]
Hefin David: I think it would be appropriate to come in under
public health later.
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[163]
Lynne Neagle: No, we’re going to do it now, because
it’s been brought forward.
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[164]
Hefin David: That’s fine. Just going back, you mentioned the
Healthy Schools scheme. To build to my next question, would you
reflect briefly on the success of the Healthy Schools
scheme?
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[165]
Rebecca Evans: I think it’s been very successful indeed. I
visited, over the summer, a school in Powys, which was the first
junior school in Powys to receive the very top-level award, and the
hundredth school in Wales to receive that top-level award. So,
it’s been tremendously successful in terms of changing the
culture in schools. It was launched back in 1999 and, in 2012,
Public Health Wales took responsibility for leading on this. Again,
it’s one of these programmes that is constantly under review
in order to make sure that it very much reflects the latest in
terms of the challenges within the community, the pressures facing
young people, and so on. It’s a fantastic way of engaging
children and, as I said, the wider school and families and the
school community in this agenda.
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[166]
Hefin David: Given the success of that programme, last year the
Government moved to healthy and sustainable further and higher
education as well. Is that within your responsibility,
too?
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[167]
Rebecca Evans: Yes, and healthy workplaces, for example, and
we’ll be looking at what we can do in childcare settings as
well. So, it’s right across all of the educational settings
and work settings. Again, over the summer, I visited one of our
healthy workplace award-winning workplaces, and the culture within
that workplace because of the work that they’re doing on
healthy living, not just through promoting good nutrition and so
on, but supporting their staff through access to counselling
and mental health services and so on, was really positive as well.
So, there’s a lot of good work going on.
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[168] Hefin
David: Yes. Declaring an interest, Chair, as a former
university lecturer and having experienced the programme for
healthy and sustainable higher education, the management at Cardiff
Metropolitan University certainly bought into that and were taking
steps to survey staff on these issues. However, with schools, there
is a certain amount of Government control there, isn’t there?
Through local authorities, you can ensure that schools are engaging
with this programme. It’s a little bit more difficult with
further and higher education and workplaces. So, how are you
ensuring sustainable long-term engagement across different
businesses and further and higher education?
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[169]
Rebecca Evans: Well, this programme is not a statutory programme. It
is a voluntary programme that organisations, schools and
educational settings and so on will sign up to. So, really
it’s about Government and others—Assembly
Members—promoting the benefits of it to the workplaces and
educational settings within our own areas, and also listening to
people who have actually benefited from this kind of approach
within the workplace or educational setting as well. We know that
when members of staff, pupils or students are well supported, they
perform better and are much more content and happy within their
workplace or educational environment as well.
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[170]
Vaughan Gething:
I have to say that healthy workplaces is
a significant programme, where just under a third of the working
population in Wales work for an employer who is engaged in that
programme. It’s got a range of levels for small, medium and
larger businesses, and it does make a real difference to the
culture within each of the organisations that take part in it. So,
we are looking at a range of different things, not just at, if you
like, public services, but also how we work alongside the private
sector as well on having a healthier workplace, as it ends up being
a positive advantage for the business as well.
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[171]
Hefin David: It hasn’t been 12 months yet, has it, that this
programme has—
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[172]
Vaughan Gething:
Yes, the healthy workplaces programme has
been running for a few years now.
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[173]
Hefin David: The further education—
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[174]
Vaughan Gething:
I ended up giving awards on healthy
workplaces when I was the Deputy Minister. It was one of the first
things I did, and one of the more enjoyable things I did as well,
actually.
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[175]
Hefin David: I understood that—
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[176]
Vaughan Gething:
The higher education programme is more
recent.
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[177]
Hefin David: Yes. I was looking at the healthy colleges and
universities framework document, and one of the things that’s
missing from it—and is signposted as missing from it—is
case studies. So, I wonder if it might be useful to quickly develop
some successful case studies in order to spread that message across
the higher and further education sector.
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[178]
Vaughan Gething:
Fair point.
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[179]
Rebecca Evans: Yes, and in reflecting on what you have said, I will
certainly write to educational settings in further and higher
education to inform them further about the programme and encourage
them to sign up and give some of those examples of the successes
that there have been.
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[180]
Lynne Neagle: Thank you. Darren, and then Michelle.
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[181]
Darren Millar: Thanks. It’s just a very brief question. I know
that both of you, as Cabinet Secretary and Minister, appreciate the
value that school nurses bring to assisting with the public health
agenda in our schools and, in fact, in terms of giving advice and
support to pupils and teachers sometimes in schools. Can you tell
me: how many school nurses are there in Wales?
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[182]
Vaughan Gething:
No. We can do a pop quiz if you like,
Darren.
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[183]
Darren Millar: This is not a pop quiz. It is not a trick question. I
am just trying to establish how many there are. I mean, does every
secondary school have access to a school nurse? Does every primary
school have access to a school nurse? They all have access to
school nurses.
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[184]
Vaughan Gething:
Heather, do you want to come
in?
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[185]
Dr Payne: Yes, certainly. I can’t give you the exact
number, but we can find it for you. Certainly, every secondary
school and primary school has access to a public health school
nurse. So, the public health messages, the immunisation and the
screening that is part of our overall health programme are
available to every school.
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[186]
Darren Millar: In terms of the hours that each school nurse is able
to commit to each school, as it were, are some parts of Wales
benefiting from school nurses more than others?
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[187] Dr Payne: The
chief nursing officer has under way an actual analysis of what is
the best model for school nursing. That isn’t yet completed
and published, but that’s been—. It’s a very
important question—to use this tremendously skilled resource
to support children and young people in the educational setting.
So, we don’t actually have the answer because it will be
coming in the next few months, when her review is completed. I am
sure that there are still opportunities to actually feed
significant questions. Those particular questions that you have
asked are absolutely the core of the review that’s happening
at the moment. So, if there’s anything else that you
want answered, then I’m sure that she’d be happy to
make sure it’s considered in that.
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[188] Darren
Millar: Thanks.
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[189] Vaughan
Gething: That will then feed into the Healthy Child Wales
programme, of course. I know you’ll be coming on to ask about
that, but we’re launching the programme at the start of
October. It’s been led by staff within the NHS working
alongside Government to try and have more consistency in health
visiting and school nursing in how we support families with young
children up to the age of seven. I think it’s really
important that this has been part of what we understand from the
last term as being successful, and recognising that we need to have
universal provision that actually takes an evidence-led approach
that will help support those families with young children in the
best possible way. So, it’s evidence-led and it’s quite
exciting. We have real and genuine buy-in from staff in the service
as well about how they really think it will make an even better and
more consistent difference for families with the greatest
needs.
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[190] Darren
Millar: Yes. I know anecdotally how much staff really
appreciate the ability to be able to call on the school nurse
sometimes, as part of the public health agenda, particularly in
schools and in terms of communicating with parents about the
importance of immunisation, where we’ve had some problems,
for example, in north Wales in the past—
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[191]
Vaughan Gething:
Not just north Wales.
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[192]
Darren Millar: Yes, but—
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[193]
Vaughan Gething:
You know, we’re thinking about the
measles outbreak and other things as well. Immunisation is hugely
important.
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[194]
Darren Millar: Yes, but can I just ask, I know that the Welsh
Government at one time had an ambition to have more school
nurses—I think at one time, it was a full-time school nurse
in each secondary school—do you have a clear ambition or goal
around that at the moment? Is that something that is still on the
agenda?
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[195]
Dr Payne: That’s very much the question that the chief
nursing officer’s review is addressing, and, again, rather
than looking at how many school nurses we have, it’s about
the extended public health role of the school nurse. So, what are
they there to do? What are they there to deliver for children and
young people? And, now, we’re talking about extending this
into young adults, as the proposals are—. You know,
we’re seeing this as a population group that has particular
needs and is particularly susceptible to certain influences, and
therefore we need to support them to make healthy
choices.
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[196]
So, it’s actually the model
that’s being looked at, not just the numbers. So, when there
is professional consensus within not just school nursing, but
public health as a whole and with our education colleagues and also
social services, where children and young people with specific
needs like looked-after children, travelling children, asylum
seeking, refugees and you know, disabled children—all
children—are reflected in the actual public health service.
Once the model is agreed and taken forward, then we’ll be
able to have a clearer idea of what we need for the future, but
that’s absolutely part of the review and the overall
strategy.
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[197]
Darren Millar: Just one final question on this.
|
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[198]
Lynne Neagle: Quickly then, Darren, please.
|
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[199]
Darren Millar: Obviously, we were all very concerned, and I know
that, across Government, there was concern, about the Dylan
Seabridge case—a young man who was home educated, who was not
having his rights fulfilled in terms of access to health
practitioners. Is that being considered as part of the scope of the
piece of work that the chief nursing officer is doing?
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[200]
Vaughan Gething:
No, I think we’re talking about
slightly different things here, Darren.
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[201]
Darren Millar: Well, with respect it’s
not—[Inaudible.]
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[202]
Vaughan Gething:
Let me explain, because we’re
talking about what school nursing could and should do where those
families are engaged in schools. There is a different question
about children and families where the children are home schooled
and how we make sure that health contacts do take place. The review
into Dylan Seabridge and the lessons we’re learning coming
from that is something that Carl Sargeant is leading. We do expect
that to be shared across Government, and Members will, of course,
be properly informed. I don’t want to try and cross into a
different subject and trying to join them up into the same
area.
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[203]
Darren Millar: Okay, I appreciate that.
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[204]
Vaughan Gething:
There’s a general point about
wanting to children to have the best access to support and to
ensure that they have it and that their parents are supported to
help them make better choices. That’s broadly there, but I
think trying to confuse the review the chief nursing officer is
doing with that particular case, I don’t think that’s a
helpful way to go.
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[205]
Darren Millar: I’m just raising it as an
issue—
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[206]
Lynne Neagle: No, Darren. Thank you. Right, maybe if the Cabinet
Secretary could update the committee when the work is completed,
because it does sound interesting and something that the committee
would want to look at in the future, if that would be
okay.
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[207]
Vaughan Gething:
Yes, we’d be more than happy to
update the committee.
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[208]
Lynne Neagle: Lovely, thank you. Julie.
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[209]
Julie Morgan: I don’t know whether it lies in the public
health area—I think it does—but obviously, right at the
very early beginning of life, the issue of breastfeeding is very
important, and I wondered if you could just tell us what progress
has been made on increasing the rates of breastfeeding and
particularly with different groups.
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[210]
Vaughan Gething:
Well, I’ll ask Heather to come in
shortly, but you’re right to point out the importance of
breastfeeding both for mothers and babies. It’s an area of
focus for us.
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11:30
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[211] We’ve
looked again at the work that Public Health Wales have done on how
we approach this effectively. It is also part of the Healthy Child
Wales programme that I mentioned in conversation with Darren Millar
early on, because this is about looking at all those areas so we
can make the biggest difference, with health visiting being very
much part of that programme from birth up to the age of seven, and
before, working with the family beforehand as well, to ensure that
we support parents to make informed choices about how they can do
the best thing for their children. That is a universal programme,
so there’s a universal message about the importance of
breastfeeding that is coming through that programme. I don’t
know if, Heather, you want to fill in the detail on that.
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[212] Dr Payne:
I think that’s basically the point. We have far lower rates
of breastfeeding than we want, but everybody appreciates that
it’s absolutely one of the 10 steps to a healthy future.
It’s what everybody can do, and some of the strategies that
we’ve asked Public Health Wales to be working on. Everybody
knows it’s what we want, but there’s not an absolutely
clear evidence base of how to get it. But that’s what Public
Health Wales is working on—a number of models, whether
buddying, whether it’s, kind of, much more education, or
whether it is actually social influences.
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[213] One of the
interesting things that’s come out of the research is that
the message, ‘Breast is best’ may not be that helpful.
‘Breast is normal’ should be the message, because
‘best’ means, ‘Oh well, everybody’s only
good-enough parents, so let’s go to the bottle.’
Sometimes, simple messages like that seem to undermine the ultimate
goal. So, again, Public Health Wales is looking at that.
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[214] We’ve
engaged with the universities—Cardiff and Swansea
universities, which have experts in this area. We have incorporated
it into a key aspect of Healthy Child Wales, starting with midwives
speaking with women as they book and as they make their plans for
delivery and puerperium. So, lots of things are happening and we
are carefully monitoring rates. Our data collection is now much
better than it was. Neonatal units also, which take about 10 per
cent of babies, have got a clear strategy to improve breastfeeding
or giving any breast milk to neonatal unit graduates. So, we have
distributed work across the piece, and we anticipate
that—well, we will be looking at the outcomes to look for
improvement.
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[215] Vaughan
Gething: There are consistent and positive messages, and we
recognise the importance of improving breastfeeding rates and
normalising—not just for women, but, actually, on a broader
societal point as well, because we do recognise part of the issue
is the reaction that somebody will get when they do breastfeed. So,
it’s all part of a wider picture.
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[216] Julie
Morgan: On that particular issue, does that scheme still exist
that encouraged mothers to breastfeed in cafes where you had a sign
up? I think it was led by Public Health Wales. But I haven’t
seen any of those signs recently. Do you—?
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[217] Dr Payne:
I don’t know in detail, but we can pass on details
to—
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[218] Julie
Morgan: The point the Cabinet Secretary is making is the fact
that people don’t always have a good reaction or a supportive
reaction, and I think it’s very important that we
do—
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[219] Mr Rees:
If I could just come in on that, there are various baby friendly
accreditation schemes in operation, one of which is Unicef’s,
and health boards continue to move towards those accreditations and
those standards, so those still are relevant.
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[220] Lynne
Neagle: Can I just ask on this: there was concern when Public
Health Wales lost the breastfeeding lead post, so I appreciate lots
of good work is ongoing, but how is that actually being driven
forward now without one person being responsible for it?
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[221] Mr Rees:
Again, it’s being driven forward by multiple people now being
responsible for that, because the approach they’re taking is
to embed it in a range of their programmes now, whether that is
their work with workplaces, with education settings or with NHS
settings. So, as to the example I just cited around the Unicef
accreditation, they’re working with health boards to support
them to achieve those standards. So, it’s very much
integrated into a far broader scope of work within the
organisation.
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[222] Lynne
Neagle: Is there is a mechanism in Government to actually
monitor that in terms of progress?
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[223] Mr Rees:
We have regular interaction with Public Health Wales on a range of
their programmes to keep track of progress.
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[224] Dr Payne:
And it’s reported by maternity boards, which happen every
year, and there’s a series of them led by the chief nursing
officer coming up, so—
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[225] Lynne
Neagle: Lovely, thank you.
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[226] Julie
Morgan: Can I ask: is the rate rising?
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[227] Dr Payne:
We haven’t actually had data quality that has allowed us to
be clear on that yet.
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[228]
Julie Morgan: When will you be likely to be able to say
that?
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[229]
Dr Payne: Well, there’ll be a round coming along in the
next three months, so we will have the data then.
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[230]
Julie Morgan: We’ll have an idea.
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[231]
Dr Payne: But again, Public Health Wales will actually be
verifying and co-ordinating the data.
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[232]
Lynne Neagle: Thank you. Can we move on now, then, to child and
adolescent mental health services? As the Cabinet Secretary will be
aware, the predecessor committee took a great interest in this area
because of the concerns over a number of years, and I hope that
this committee will continue to monitor progress in this area. Can
you tell us whether you feel that Welsh Government are on track to
deliver the step change that we know is needed?
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[233]
Vaughan Gething:
Yes, I think we are on track, but the
challenge is that, for all the progress that we have made on
reducing the numbers of people going into CAMHS, in appropriate
referrals and on reducing some of the waiting times and waiting
lists, there is still a significant challenge to be dealt with. So
I wouldn’t want to try and give the impression that the
Government thinks that this is an issue that’s been resolved.
It’s an issue that’s being resolved, and we should note
the progress that has been made and recognise where we still need
to go.
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[234]
I know you’ve had a briefing on the
Together for Children and Young People programme and again it
points at the progress that’s been made, the investment and
how it’s been used, the fact that recruitment is taking
place, staff are coming on stream, you can see some of the falls in
waiting times that are taking place, and the new work being done on
the neuro-developmental pathways—all really positive steps,
including on reducing the number of children requiring inpatient
care outside of Wales. But when I look at the figures I recognise
there are still too many people waiting, there are still too many
people being inappropriately referred, and in particular there are
still people who are just waiting too long as well. So,
that’s very much in our mind as a Government: that we know
that there is much more to be done, and I fully expect this
committee will take an interest in this area until the progress
that we have seen not just continues to a level that’s
acceptable, but it’s also then sustained, as well. So I fully
expect that there will be more questions from this committee and
Members in the Chamber and in this room as well.
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[235]
Lynne Neagle: Thank you. In our previous session with the
children’s commissioner, she was commending the fact that
Welsh Government has set these ambitious targets now for CAMHS, but
was querying when you think they’ll be deliverable. Have you
got a time in mind when you think that you’ll be able to
deliver these across Wales?
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[236]
Vaughan Gething:
The Together for Children and Young
People programme is three years, and it’s roughly halfway
through. I want to see how far we can get and how much progress
we’ll make once we’ve got the full complement of staff.
I don’t want to give a hostage to fortune about when we will
get to exactly where we want to be, but I do want to assure the
committee and the watching public that this is an area of real
priority and obviously we want as much progress made as quickly as
possible. Because I recognise it’s not just the impact on the
child themselves, or the young person themselves, but it’s
the impact on the whole family group as well, and that’s also
why you’ve got to focus on primary mental healthcare for
children and young people as well, because part of our challenge
has been with referrals into CAMHS—is there somewhere else to
go if it isn’t the specialist CAMHS service? That’s why
there’s been investment in that, and it’s also why this
features in the overarching Together for Mental Health strategy as
well. It isn’t just an issue to be seen on its own, and
that’s also helped to inform why we’ve changed the
waiting times targets. They are equivalent now to what we expect in
the adult world as well, rather than having longer waiting time
targets for the children’s sphere. So, as I said, I
won’t give you a hostage to fortune, but I will give you the
assurance that, a) it’s a priority, and we’ll also
report transparently on where we are with those waiting times and
waiting lists as well.
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[237]
Lynne Neagle: Thank you. On neuro-developmental waiting times, I
know that the Welsh Government has taken specific action to tackle
the sort of logjam that’s developed there. Are you able to
provide an update on progress specifically on those waiting
times?
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[238]
Vaughan Gething:
Yes, I’ll ask Sarah to come in and
provide you with some of the details, but you’ll know that,
within the £7.6 million that the previous Minister announced,
there was over £2 million of that allocated to this particular
area.
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[239]
Dr Watkins: I mean, I think neuro-developmental waiting times,
autism, ADHD, Tourette’s, conditions like that, were, in
almost all health boards, very unacceptable, and one of the first
things we needed to do was really assure ourselves that the health
boards knew exactly who was waiting and on what waiting list,
because it wasn’t appropriate to mix together what could be
lifelong conditions or certainly long-term conditions, such as
autism. The timescale to see those children is very different to
the timescale to see a child that’s acutely suicidal. So,
we’ve clarified the waiting lists. We now have
separate waiting times for specialist CAMHS and
neurodevelopmental disorders, and they have developed across Wales.
Every LHB now has a well-recruited—not fully recruited
everywhere, but well-recruited—neurodevelopmental team. What
I can say is that, in almost every area, waiting times have gone
down significantly. They are still too long. We have asked them to
be working as expeditely as possible and they are aiming for April
2017. Whether they will reach that point—. But we have made
it clear that we expect to see very dramatic improvements by that
time. For the first time, because we are now seeing clarity with
waiting lists, we are confident that significant improvements are
being made. We still do have a way to go, but we are absolutely
keeping a very close eye on that.
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[240]
Lynne Neagle: Okay, thank you very much. And just finally from me,
in terms of funding, the announcement of extra money was very
welcome. Would it be your intention, going into the budget round
now, to try and get a recurrent extra boost for CAMHS
funding?
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[241]
Vaughan Gething:
Well, the money that was previously
announced is recurrent and we’ll have to get through the
budget round on a reducing overall spend. But if we want to make
progress, we do need to maintain the investment we’ve already
made.
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[242]
Lynne Neagle: Okay, thank you. Anybody else on CAMHS?
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[243]
Darren Millar: Can I just ask—? One of the things that some
have advocated is ring-fencing child and adolescent mental health
spend within the overall mental health budget. I know there’s
been discussion and consideration of this is the past by the Welsh
Government, but given that the local health boards themselves
reduced spending on CAMHS in 2014-15 by around £3 million, do
you think that there is a need to ring-fence the amount
that’s being spent in order to deal with these capacity
issues in the system in the short term?
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[244]
Vaughan Gething:
I’m pleased you mentioned this,
actually, because we do understand now that one local health board
actually overstated its CAMHS spend in a previous year, so when it
then corrected that figure it looked as if there was a fall of
between £3 million and £4 million on CAMHS spend, which
isn’t actually true. So, if you look now, you’ll see
the figures are much more even. You will then see the bump in
resource that’s gone in to supporting the different areas
that I described earlier, and that the previous Minister set out on
a number of occasions, for the significant additional investment
that we have made in CAMHS. So we want to see the investments being
made—but, crucially, that we’re seeing improvements in
the services and in outcomes for children, young people and their
families.
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[245]
Darren Millar: Thanks for the clarification, I wasn’t aware of
the overstatement in the previous year. Can I just ask you then, in
terms of the progress that’s being made—? The
children’s commissioner was with us this morning; she
expressed some concern that the advisory committee had only met
once since the programme had started. We’re now halfway
through the three years. I know that she’s made a request for
a further meeting and has been advised, as I understand it, that
there’ll be a meeting of the advisory committee, which will
be convened before the end of the year. Do you think that
that’s regular enough?
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[246] Dr Watkins: Can
I clarify? There are several work streams. We’ve had close
scrutiny of our delivery plan for ‘Together for Mental
Health’ and that had a CAMHS work stream, which had a
national advisory group that was working for it; we also have Carol
Shillabeer’s steering group; and we actually also had another
group that were meeting. So, there were three groups. As people
will know, there was a discussion just before the end of the last
Assembly on the new delivery plan. There wasn’t a delivery
plan to assure at that point. We are aiming to launch the next
three-year delivery plan of ‘Together for Mental
Health’ on World Mental Health Day on 10 October, when the
assurance process starts again because there’s a new delivery
plan. So, there hasn’t been any hiatus in working. There have
been regular meetings of Together for Children and Young People,
including conferences that Ministers have spoken at. But, because
of where the delivery plan was—the assurance—we came to
an end of one and then we’ve developed another, which will
then have that same assurance process that we are meeting the
deliverables within that plan. So, that’s why there has been,
to be fair, a slight hiatus, but then everything will go back. So,
it will be four-monthly—we have three meetings a
year—of all the delivery assurance groups, as well as
three-monthly national meetings for older people, adult and
CAMHS. So, it is true, but there are specific reasons for
this at this point.
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11:45
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[247] Darren
Millar: And just one final question. Obviously, you’ve
mentioned the fact that the full complement of additional staff has
not quite yet been recruited. What sort of progress has been
made?
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[248] Dr
Watkins: By March, it was around 50 per cent. There were a lot
in process. However, we’ve written out, and we are expecting
at the end of the month—. I would anticipate that, as long as
they can find people, it would be 90 or 95 per cent, but we are
waiting for that formal confirmation from health boards, and we are
again keeping a close eye on the money to make sure that the people
are appointed.
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[249] Darren
Millar: Okay, thank you.
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[250] Lynne
Neagle: Thank you. Oscar briefly on this.
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[251] Mohammad
Asghar: Thank you, Chair, and thank you, Minister. My question
to you is—. It’s a traumatic period for the young
children and the family with these mental health problems and the
waiting time is so long; in some cases, for a year. I think the
Welsh Government is setting a target to achieve in the next five
years, in this Assembly term, that they would be reducing it to 14
per cent. This is the timeframe. What steps are you taking to
reduce year by year, and are you going to update us regularly on
this time?
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[252] Vaughan
Gething: I think we’ve broadly covered that in previous
answers. As I said, I don’t want to be a hostage to fortune
about timescales for that. We expect to see improvement; we’d
expect there to be significant improvement over the course of the
next year, particularly, as you’ll have heard, as more staff
are coming on board now. You’ll also have heard that we
recognise that current waiting times are not acceptable, so we
expect to see that progress to make the real difference that all of
us around this table would want to see for children, young people
and their families.
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[253] Lynne
Neagle: Okay, thank you. I’m sure we’ll return to
CAMHS.
|
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[254] Vaughan
Gething: I’m sure you will.
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[255] Lynne
Neagle: Can we move on now then to neonatal care? John
Griffiths.
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[256] John
Griffiths: I wanted to ask about the restructuring that’s
envisaged, specifically for south Wales, because I think it does
play to the general anxieties that exist around structural change
in the health service, as to whether the new services will be local
enough for all areas within south Wales. I’m particularly
concerned with Gwent as far as that’s concerned. I think
people understand the need to recruit the adequate level of
expertise and numbers in terms of those that staff these services,
but they’re not always convinced that it isn’t possible
to do that on a more local basis than structural change sometimes
delivers. I’m sure all of us are familiar with these issues
and concerns, and in terms of south Wales and neonatal services,
and, as I say, Gwent in particular, I wonder if you could say a
little bit about the process that’s in train, and will be
followed, to ensure that we can get the adequate provision as
locally as possible.
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[257] Vaughan
Gething: I know that it’s an issue of real concern for
people across the country about how we provide care to the sickest
babies, but I think it’s really important to recognise that
the neonatal network and the Welsh Health Specialised Services
Committee are looking at this; there’s work ongoing at
present. But, for me, I don’t think you can just see Gwent on
its own, because you’re looking at a system right across the
whole of south Wales and how the network actually works together.
For example, I have been on visits to west Wales, where I’ve
met parents whose children have ended up being in Cardiff, then
moving to Swansea, then moving back to Glangwili, before then being
able to go home to further west Wales as well, and not one of those
people said that they were unhappy about travelling for really
specialist care to save their child’s life.
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[258] The challenge
always is how we provide the very best care possible to deliver the
best outcomes possible, and within that, we recognise that
there’s the point about supporting the family. So, if your
child is being cared for a significant distance from your home, how
are you supported in being able to be near to your child as well?
So, we’re looking at both the impact of deanery proposals,
and we’re looking at, in any event, how we have a
concentrated enough, highly specialist service, and that’s
the work that both the neonatal network, and WHSSC are engaged in,
and I’m expecting there to be answers in the fairly immediate
period, as well as alongside us looking at our ability to meet the
neonatal standards that we have. So, there is likely to be change,
but it’s really important that change is driven by not just a
desire but the evidence on how we improve outcomes, which are
already good within Wales, but it’s about how we make sure
that we don’t just say ‘everything is fine now’,
and wait for the system to start falling over before we then start
to change it. It’s really important that the public are
engaged in a conversation around this and, in particular, that
clinicians working in the service take part in that conversation.
Because, often, clinicians themselves will say, ‘We
don’t think this is the right model of care for us to be
running, and we don’t think we’re doing the right thing
by our families and their children if we simply try to stay as we
are’. So, it’s difficult just to have a Gwent
conversation. It has to be seen in the whole south Wales context,
and any changes that are proposed have to be on that basis of
‘this is the right thing to do to improve outcomes for those
children who have the greatest need for the greatest level of
care’. Is that helpful? Does that deal with your point or is
there—?
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[259] John
Griffiths: Could you say a little bit more about the timescale,
then, for decisions and announcements?
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[260] Vaughan
Gething: Yes. I’m expecting that that work will be done
within this half of the term. So, there are then proposals to look
at what that actually means. This is thinking about the different
parts of how all the different things add up, both the deanery
decision on training, the work in any event that we need to do on
the workforce and getting the workforce in the right place at the
right time, and the capacity, really, that’s being done at
present. It might be helpful if Heather tells you about the
capacity review that’s currently being done and will inform
where we go with neonatal care.
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[261] Dr Payne:
Certainly. The neonatal network, which is, of course, an all-Wales
organisation that advises and leads on this for us, they undertake
regularly a capacity review. So, in other words, they look at all
the neonatal units and assess their compliance with the all-Wales
neonatal standards. They’re just about to send out a review
data collection at the end of this month, so we will have within
the next month or so a summary of exactly where we are so that we
can track our progress. Over the years, tracking our progress
against the all-Wales neonatal standards, we have shown across
Wales steady progress with improved compliance. No unit is
compliant with absolutely all the standards, but they are all much
closer than before we had the neonatal network. Again,
conversations with the neonatal network today: obviously, the
shortfalls in staffing, which, of course, have been a UK-wide issue
in terms of recruiting medical staff to specialist neonatal care.
That’s well-recognised, and that was recognised earlier on in
the year because the Bliss data is almost a year old. So, the
neonatal leaders told me there’s been really successful
recruitment to neonatal units across south Wales.
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[262] Just to say that
the sub-regional neonatal intensive care centre developments in
north Wales, again which come within the remit of the network, have
actually had very, very positive responses to all the preparatory
work for the development of the SuRNICC, with recruitment of
increased numbers of neonatal consultants. So, again, that model of
a central SuRNICC, with two less-specialised units peripherally
using it as a proper network to give surge capacity, that seems to
be—. Those plans are coming on very well.
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[263] Lynne
Neagle: Thank you. Darren, on the SuRNICC then.
|
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[264] Darren
Millar: Yes, it’s just on the SuRNICC in north Wales.
I’m pleased that you’ve made reference to it. I’m
pleased also, Cabinet Secretary, that you made reference to the
need to take the public with you on these debates. We know from
bitter experience in north Wales just how painful some of these
discussions can be, but, in terms of the SuRNICC development, Betsi
Cadwaladr University Local Health Board has obviously submitted its
full and final business plan and is awaiting now the decision of
the Welsh Government in terms of the funding for the construction
of the new sub-regional neonatal intensive care centre.
What’s the timescale by which you expect to be able to
determine their business plan and application?
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[265] Vaughan
Gething: Well, we’ve received the business case and, at
this point in time, I don’t think there’s any reason to
think that there should be a need to delay the target date of the
SuRNICC opening in 2018. It all depends on what’s—you
know, the review itself, which is why I’m not going to give
you a specific, ‘It will be done by x point’, but at
this point in time my advice from officials is that there’s
no reason to think that the SuRNICC won’t be able to be open,
up and running in spring 2018.
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[266] Darren
Millar: But what sort of timescale are your officials working
to to give you a recommendation as to whether the business plan can
be signed off or not? That’s all I’m looking for. A
rough timescale. Because, obviously, they’re not going to be
able to start work on the thing until the finance has been
released.
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[267]
Vaughan Gething:
Well, that’s the advice that
I’ve had—that we expect to be in a position for them to
give me a recommendation that I can approve to actually get on with
it and to open by spring 2018. I’m interested in getting the
whole thing up and running. If you want me to come back and give
you a timescale for when I expect to receive advice on the business
case, I’m happy to do that.
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[268]
Darren Millar: Yes, that would be helpful.
|
|
[269]
Lynne Neagle: Thank you. Julie.
|
|
[270]
Julie Morgan: Yes. In terms of transfers between units, could you
tell us how that is actually done and whether there have been many
transfers outside Wales recently?
|
|
[271]
Vaughan Gething:
Heather, do you want to explain the
process for how and why the transfers take place? There are
different reasons why transfers take place: sometimes it’s
about need and sometimes, for example, some units can’t
accept more children. There were infection-control issues in some
of our units. There have been different reasons as to how and why
within Wales and there have also been transfers on the basis of
need as well, so—. But, Heather, do you want to explain the
process we’re going through now?
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[272]
Dr Payne: Certainly. The cot capacity determines who you can
take in, obviously. If a pregnant woman with twins—so,
needing two neonatal cots—is somewhere where they’ve
only got one cot, then she’ll need to be transferred so that
she’s delivered in the place where the neonatal care takes
place, because that’s the recommended model and that’s
the safest way. So, we accept—. And that’s why
we’ve got a network that works across health board boundaries
in order to make sure that the women of Wales are catered for as
much within Wales as possible, not necessarily as close to home as
they would like to be, but so that it’s safe and guarantees
the best possible outcomes for the baby or babies.
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[273]
So, that’s a kind of given as part
of providing neonatal care. What we have had since we’ve had
to have a reduction in cot capacity in Cardiff, over the past year,
because of infection control—. And, as you know,
there’s the development of the new build and the new
cots—additional cots, additional space—which now meets
the building note, which is the space requirement, which reduces
the cross-infection risk in a neonatal unit. So, that’s all
going to be lovely, shiny and new when it comes on-stream in a few
months’ time. But, because of that reduction in cot capacity,
unfortunately, it has meant, over the past few months, that more
women have had to be transferred out of Wales. There has been a
slight increase in that number, although most have been
accommodated within Wales. Of course, when they’re
transferred out, they’ve got to be transferred back, and
women and babies can be transferred to step-down care. So, they can
be transferred. So, if they needed to come to Cardiff, for
instance, for specific care, including surgery, that is only
provided in Cardiff—or even Bristol, if it’s cardiac
surgery—then, when they are well enough, they’ll be
stepped down and they may step down back down to Carmarthen so that
they are nearer home.
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[274]
So, those happen for good reasons. There
are occasionally transfers for non-clinical reasons: in other
words, to make a bit of space so that you can stop a woman going
out of Wales altogether. Unfortunately, that does happen.
It’s discussed with families as much as possible and it is
managed in as sympathetic and caring a way as possible.
Occasionally, it has to happen for non-clinical reasons, but,
again, that is a measure that we keep an eye on because
that’s a measure of capacity and that goes into the capacity
review.
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[275]
Julie Morgan: Thank you very much for that. I’m delighted at
the development in Cardiff. When is that likely to actually be
fully operational?
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[276]
Dr Payne: It’s within the next few months. I don’t
have a precise date, but we can let you know what the most recent
plans are.
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[277]
Vaughan Gething:
Chair, to avoid having to write to the
committee, I’ve been reminded that I expect to have advice on
the business case on the SuRNICC within this calendar year, if
that’s helpful.
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[278]
Lynne Neagle: Thank you. Okay. That concludes our questions. So,
can I thank the Cabinet Secretary and the Minister plus the
officials for attending this morning and for answering all of our
questions? You will, as is normal practice, be sent a transcript of
the meeting for you to check for accuracy, but thank you very much
again for attending.
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12:00
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Papurau i’w Nodi
Papers to Note
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[279] Lynne
Neagle: Okay, we can move on now then to item 6, which is
papers to note. Can I just ask Members—? We’ve got a
number to note. The first is the letter from the Chair of the
Finance Committee regarding the approach to scrutiny of the Welsh
Government draft budget 2017-18. Are Members happy to note that?
Then there’s the letter from the Chair of the Constitutional
and Legislative Affairs Committee regarding the Wales Bill. Noted.
A letter from the Presiding Officer to the Chair regarding
committee statements in Plenary. Noted. A letter from the Chair of
the External Affairs and Additional Legislation Committee regarding
the committee’s remit, which we’re going to look at
next meeting. A letter from the Cabinet Secretary for Education
offering further information following the meeting on 13 July. A
letter from the Cabinet Secretary for Communities and Children, a
follow-up from the 13 July meeting. And, finally, the letter from
the Minister for Lifelong Learning and Welsh Language, following up
on our meeting of 13 July. Are you happy to note those? Excellent.
Thank you.
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12:01
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Cynnig o dan Reol
Sefydlog 17.42(ix) i Benderfynu Gwahardd y Cyhoedd o’r
Cyfarfod ar 22 Medi
Motion under Standing Order 17.42(ix) to Resolve to Exclude the
Public from the Meeting on 22 September
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Cynnig:
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Motion:
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bod y pwyllgor yn penderfynu gwahardd y cyhoedd o’r
cyfarfod ar 22 Medi yn unol â Rheol Sefydlog
17.42(ix).
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that the committee resolves
to exclude the public from the meeting on 22 September in
accordance with Standing Order 17.42(ix).
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Cynigiwyd y cynnig.
Motion moved.
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[280] Lynne
Neagle: So, can I then propose, in accordance with Standing
Order 17.42, that the committee resolves to meet in private for our
meeting on 22 September? Are all Members content with that?
Excellent. Thank you very much for attending.
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Derbyniwyd y cynnig.
Motion agreed.
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Daeth y cyfarfod i ben am 12:01.
The meeting ended at 12:01.
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