The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
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Dechreuodd y cyfarfod am 09:34.
The meeting began at 09:34.
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Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introduction, Apologies, Substitutions and Declarations of
Interest
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[1]
Dai Lloyd: Bore da i chi gyd a chroeso i gyfarfod
diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn
y Cynulliad. Ar ddechrau’r cyfarfod fel hyn, a gaf i groesawu
fy nghyd-Aelodau, a hefyd egluro bod y cyfarfod yma, fel pob
cyfarfod arall, yn naturiol ddwyieithog? Gellir defnyddio
clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg
i’r Saesneg ar sianel 1, neu i glywed y cyfraniadau yn yr
iaith wreiddiol yn well ar sianel 2. A allaf atgoffa pawb i
ddiffodd eu ffonau symudol ac unrhyw offer electronig arall a allai
ymyrryd â’r offer darlledu? Ac nid ydym yn disgwyl
tân y bore yma, ond, os fydd yna un, dylid dilyn
cyfarwyddiadau’r tywyswyr. A allaf hefyd bellach nodi ein bod
wedi derbyn ymddiheuriadau gan Dawn Bowden y bore yma? A oes unrhyw
ymddiheuriadau neu ddatganiadau o fuddiant eraill? Nac
oes.
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Dai
Lloyd: A very good morning to you all, and welcome to
this latest meeting of the Health, Social Care and Sport Committee
here at the National Assembly. I should, at the beginning of the
meeting, welcome my fellow Members and explain that this meeting is
bilingual, as are all other meetings. Headphones can be used for
simultaneous translation from Welsh to English on channel 1, or for
amplification on channel 2. Can I remind everyone to switch off
their mobile phones and any other electronic equipment that they
may have, which could interfere with the broadcasting equipment?
And we’re not expecting a fire drill this morning, but, if
you do hear an alarm, then please follow the instructions of the
ushers. Can I also note that we have received apologies from Dawn
Bowden this morning? Are there any other apologies or declarations
of interest? No.
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09:35
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Sesiwn Graffu
ar Adroddiad Blynyddol Comisiynydd Pobl Hŷn Cymru 2015-16 a
Rhaglen Waith y Comisiynydd ar gyfer 2016-17
Scrutiny
of the Older People's Commissioner: Annual Report 2015-16 and Work
Programme for 2016-17
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[2]
Dai Lloyd: Felly, symudwn ymlaen at eitem 2, sesiwn graffu
ar adroddiad blynyddol Comisiynydd Pobl Hŷn Cymru 2015-16 a
rhaglen waith y comisiynydd ar gyfer 2016-17. Felly, i’r
perwyl yna, a allaf groesawu Sarah Rochira, Comisiynydd Pobl
Hŷn Cymru? Diolch am eich gwaith a diolch am yr adroddiad.
Gyda’ch caniatâd, awn ni yn syth i mewn i gwestiynau,
a’r cwestiwn cyntaf gan Julie Morgan.
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Dai Lloyd: We’ll move on to item
2, a scrutiny session on the Older People's Commissioner for
Wales’s annual report and the commissioner’s work
programme for 2016-17. So, to that end, may I welcome Sarah
Rochira, the Older People’s Commissioner for Wales? Thank you
for your work and the report. With your permission, we’ll
move immediately to questions, and the first question is from Julie
Morgan.
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[3]
Julie Morgan: Diolch and bore da. We know from your report
the huge amount of contact you’ve had with older people. I
think it was very striking, the number of meetings you’ve
been to and your engagement with older people. So, you’ve
obviously got a strong grasp of what are the general issues that
come up with older people. So, could you tell us, roughly, what are
the main issues that come up when you meet older people?
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[4]
Ms Rochira: Well, you’re absolutely right: my
engagement is hugely important to me—my engagement with large
groups of older people, but I also do home visits as well. And I
guess they’ve taught me a huge amount about what it’s
like to grow older, the good and the bad, what good public service
looks like—they’re great critiquers of public
service—why rights matter. They’ve made me, in no small
part, the commissioner I am, and I still learn from them, and I
still remember and think about some of the people I have met. I
guess you can look at the themes in different ways. The big issues
that people raise are in terms of care, care in nursing homes,
residential care homes, care in hospitals, issues to do with
housing as well—no surprises there, in a sense—and
issues of health as well. There are no surprises, in a sense,
because those are the big services that people use. It’s very
difficult, I think, to extrapolate from that any sort of sense
check about the state of those services. The sorts of issues that
people raise vary enormously within that, from things that can seem
small but are not small in their own lives, to very significant
safeguarding and protection issues as well. I will just give you
maybe three examples of the sorts of cases, because I know that
people are always interested in them. It’s actually sometimes
difficult for me to talk about them because they are very personal
to people, and I don’t want to share, often, their grief and
their lives, but I’ll just share three examples. The
lady—and, in fact, we visited her together, Julie—on
the Gypsy and Traveller site whose home was really not safe. She
needed immediate safeguarding. She needed basic aids and
adaptations. It shouldn’t have taken me, as the commissioner,
to intervene. I think she was the victim of discrimination; I think
she was the victim of all sorts of assumptions about who she was
because of where she lived. I saw a vulnerable older person, and we
had to get her home made safe for her, and we did, and, as I say,
it shouldn’t have involved me or needed me as a commissioner,
but it did.
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[5]
A care home that we’ve been monitoring and tracking for a
number of years—a care home that’s had a significant
numbers of protection of vulnerable adults cases within it. The
agencies have, I think, on an integrated basis, been behaving and
acting appropriately. But we were, of course, tracking it from the
perspective of the older person. Part of my role was to ask at the
appropriate time, ‘When do you stop supporting and when do
you decide that you need to close this home?’ In fact, that
led to a wider piece of work in relation to care home closures
across Wales.
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[6]
Or the lady who was referred to us from another agency—and we
get many referrals from other agencies as well as directly from
older people—about the poor care that her partner had
received, appallingly poor care, and not just poor; she felt,
actually, that it constituted wilful neglect. The police and social
services didn’t agree with that view. We actually, with her,
instigated a POVA and helped her to complain to the police and get
a review of the decision not to prosecute.
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[7]
So, those are just three examples, and there are so many different
examples. Just finally, just to pick up on what I would say are
common themes, if you like, that underpin all of my casework, you
don’t see it, perhaps, in the first year, but you do over
time: people who get lost in the system; people who are treated
without dignity; people who become voiceless and unheard; and
people who are powerless. In a sense, all I do as commissioner is
help them navigate through, give them back their dignity, and give
them back some power as well.
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[8]
Just a final point on my engagement, because I try to make this
point all the time: I am a commissioner for all older people.
It’s what I call the glorious diversity of older age. It is
something that we should embrace and celebrate. So, not only do I
cover all of the 22 local authorities every year in Wales, about 75
per cent of my engagement, my visits, my meetings and my
conversations are with people who have a protected characteristic.
And, within that, I include carers, I include issues of poverty,
Welsh language and rurality, because I think those should be
considered protected characteristics.
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[9]
Julie Morgan: So, how do you actually determine who
you’re going to see, and what issues you’re going to
take up? Because, obviously, there’s a whole mass of contacts
that you make, and you say you do some individual visits. How do
you determine what you do?
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[10]
Ms Rochira: Well, in terms of who I meet with, I kind
of meet with everybody who asks to meet with me. But we also
actively seek out older people through the 50-plus forums
we’ve got across Wales. I often do joint visits with Assembly
Members. MPs can refer people to me. And we find people and meet
people through all sorts of routes. I’ve even done meetings
with people on buses, and those have been quite interesting, I can
tell you. If I had more hours in the day, I would do more visits
across Wales. They’re not actually hard to find, older
people, when you try. We have a big contact book, I guess, is what
I would say in relation to that.
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[11]
In terms of which cases we take, I’m not a casework
organisation. It’s just one of the ways I choose to discharge
my functions. So, we have a range of support, which can be from
tailored signposting. That’s actually really valuable,
because there are many other agencies who can help and support
people—community health councils, citizens advice bureau. But
we don’t just pass them on. We help them get to the right
people, and often, we check that they have had the support that
they need, all the way up to assisting them and providing them with
that sort of detailed, long-term case support—for example, in
making referrals to the Nursing and Midwifery Council. Some of our
work—the more complex ones—which involve a wide range
of agencies across the public sector, can go on for many years, and
will go on for as long as people need me to walk along their side,
hold their hand and give them some power back.
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[12]
Julie Morgan: And you talked about people who are
powerless and people with protected characteristics that you felt
you needed to reach. Is it easy to reach the powerless groups, the
voiceless groups?
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[13]
Ms Rochira: I don’t think it’s too hard if you
try really hard to reach people. I came from the third sector
before I became commissioner. I had many contacts anyway. But I was
determined from day one that I would reach out to those who are
most voiceless and most vulnerable. So, you know I have a
particular interest in areas of dementia, for example. I’ve
met with Gypsy and Traveller people, and we’re doing more
work, which I’m quite keen to bring back to the cross-party
group on older people and ageing, based on that
engagement—and people with sensory loss. I’m a
commissioner for all older people and that glorious—and it
really is glorious—diversity. But I’m particularly a
commissioner for those who are most voiceless. They can’t
raise their voice and find me, but I can, and I always will, go to
them.
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[14]
Dai
Lloyd: Trown nawr at
gwestiynau mewn manylder ar wahanol adrannau, a’r adran
gyntaf ydy gofal preswyl. Mae Caroline yn mynd i ddechrau’r
cwestiynau i ni. Caroline Jones.
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Dai Lloyd: We now turn to some detailed
questions on various different sections, and the first section is
residential care. Caroline is going to start the questioning here.
Caroline Jones.
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[15]
Caroline Jones:
Diolch, Chair. In your 2014 report and review of residential care,
‘A Place to Call Home’, you concluded that too many
older people living in care homes had an unacceptable quality of
life, and you imposed a series of requirements for action on care
provided. Could you tell us please what progress has been made on
meeting these recommendations, and can you also provide further
information on the follow-up review, including its scope, and what
actions you are taking to indicate that further work is needed by
providers, and that they are listening to your recommendations?
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[16]
Ms Rochira: Yes, I can. Thank you. This is actually a good
example of a major piece of work that arose from my engagement and
conversations with older people, because they kept talking about
this. And I thought, ‘Actually, if you keep talking about it,
it must matter.’ So, I went to look and then I decided that
the issues were big enough to warrant a formal statutory review.
You’re right; I found much good practice in my review, but it
made for hard reading, and I didn’t shy away from describing
it as it was, people’s day-to-day experiences. I laid out a
wide range of requirements for action, for a wide range of public
bodies, and I made it very clear that I wanted that action taken. I
was also clear that the publication of the review was just the
beginning, and I would stay on this for as long as I needed to. So,
I’ve had a number of approaches. First, I sought assurance
from all those public bodies that they would take that action. Some
of that assurance was easier to get than other pieces of it, but I
did eventually get to the stage where I had broadly the assurances
I was looking for. What I then said to them was, ‘I recognise
you need some time to do this, so I’ll support you through
that, but go away and get on and undertake that action’. But
I did say I would come back. In the interim, though, I have been
doing a number of things. I’ve been tracking what’s
been going on. I shared some of that with the previous Health and
Social Care Committee. I have to say, that’s been a mammoth
piece of work, and it’s been really hard to do to try and see
everywhere and everything that’s been going on. So, the best
I could get was a sense check behind that, but I was watching very,
very closely.
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09:45
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[17]
I also undertook a whole range of seminars with providers across
Wales to grow their knowledge as well. I was thinking, looking at
this—because I’ll come onto, in a moment, the follow-up
areas—what progress has been made. I thought I could share
with you some of the areas where I have, through that tracking and
my own continuing engagement, seen some progress. So, in no
particular order here, I think there’s a wide range of issues
that have already been picked up in legislation, or are planned for
in regs that underpin legislation. So, we’ve got the
registration of the workforce within residential care homes, which
is incredibly important—something the previous committee and
I pushed hard for. We’ve got what are called the new section
29 and section 27 regs that take us away from those—that
dreaded phrase—minimum standards to standards around
well-being. That change is fundamentally driven by the focus of the
review. We’ve got work being done by the regulatory inspector
in relation to rights. We’ve got work within the Regulation
and Inspection of Social Care (Wales) Act 2016,
particularly—I think it’s section 57; I might be
wrong—in relation to market stability and this point about
forward planning, which was one of the big observations from the
review. We’ve got something in Wales called the dementia and
learning framework. I don’t always use this phrase, but
it’s an outstandingly good piece of work. It would not have
been written in the way it was written if it was not for the
review. You only have to look at the language within it to see how
fundamentally we’ve changed our benchmark about what’s
good enough. Just to share a couple of words that were within
there—because I have a thing about language and words. We
give ourselves away by the words that we use. It’s a
rights-based document. It talks about things such as empowerment;
it talks about sharing power; and it talks about activism. I
don’t think I’ve ever seen ‘activism’ used
in the context of residential care homes before, but I really quite
like that phrase.
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[18]
Some of the other examples that I think are particularly good are
some of the Magic Moments work, which have been developed by
Swansea University with us and the Joseph Rowntree
Foundation—already changing practice across care homes. We
have enrichment programmes in relation to staff roles within
residential care, and career pathways taking place in the north.
Those are really good. We’ve got new occupational standards
for social care workers, which have rights within them. Through our
own care seminars that we have organised, we had about 420
providers engage, and I saw their appetite to change our approach.
There were two things that particularly stood out for me on those
that were indicative of change on a day-to-day basis—those
very small places. One was a provider who said, ‘I’m
going to go back and ask our residents what their dreams
are’. I nearly called my report ‘In search of life,
love and laughter’. Everyone should have a dream in their
life, regardless of their age. I remember that. The other one was a
care home manager who said, ‘I’m going to take people
out more. Actually, I don’t want the last day I see the sun
to be the day I go into my care home’. So, those are some big
examples and some kind of small examples within that.
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[19]
Another thing that I think is particularly good is the guidance
that the Welsh Government will be shortly publishing in relation to
mealtimes. We used to have nutritional standards before the review.
Nutrition is important, but actually, that’s nowhere near
good enough for older people living in care homes. I believe that
the last time I saw the draft, it was headed ‘The dining
experience’, because that’s what it should have been
about. It talks about the table and the menu; it talks about the
stuff that gives value to things. And, of course, we’ve had a
fairly rapid—I think, after the review was
published—investment from the Welsh Government in things like
dementia support, oral health, and we’ve got new and enhanced
primary care packages. There are many other things I could share
with you. But, you see, some of them are big and legislative, some
of them are fairly strategic, some of them are the tiniest of
things. A bit like St David says, it’s the little things that
make life big.
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[20]
So, I’m pleased to see all of those, and I firmly
believe—and I think the evidence is clear from the types of
things that those are—those would not have taken place
without the review giving us all a wake-up call. So, that’s
kind of in the interim on the mapping—and I’m going to
continue to work on the regs that obviously will sit under the
Regulation and Inspection of Social Care (Wales) Act 2016. But as
you rightly say, I did say I would be back. I said to people,
‘Here’s some time, get on and do it’, and
I’ve just written out to the bodies that come under the
review on the areas that I’m going to focus on. I’m
very happy, Chair, to write to you formally with those, because the
letters just went out yesterday. So, they are fairly hot off the
press. But I did say that I would do them in November. So,
I’ve written to bodies this week. It’s going to be
quite a considerable piece of work again, to look in depth at these
issues. So, I will report again next November, and I’ll say a
bit more about the reporting in a moment.
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[21]
These are the issues that I’m going to—excuse me if I
read from the letter, Chair, but this as I said, this is very hot
off the press—I’m going to look at the extent to which
specialist continence support is available in care homes.
It’s fundamental to people’s dignity and respect.
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[22]
I’m going to look at the extent to which older people have
access to specialist services and, where appropriate,
multidisciplinary care that provides rehabilitation support
following a period of ill health. If I have a stroke in a care
home, I do not want to be put to bed. I want to a rehabilitation
package to give me the best possible quality of life for the
remaining years of my life.
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[23]
I’m going to look at the prevention and management of falls,
including national monitoring and reporting in respect of falls. We
have a very strong concept in Wales of something called adverse
childhood events. I talked to the children’s commissioner
about these. Well, do you know what? There are adult adverse events
as well, and falls is one of those. And as someone who has had a
fall, I personally know how devastating they can be.
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[24]
I’m also going to look at—and this is one of the big
issues in my review and much of my work since then has been around
this—the training available to and undertaken by all care
home staff and managers in relation to understanding and caring for
people with dementia, including the extent to which this is built
in to ongoing supervision and skills assessment. The vast majority
of people living in our homes in Wales have a form of dementia.
They have a right to be cared for by people who have the right
skills, knowledge and competences.
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[25]
I’m going to be looking at the undertaking of medication
reviews and the use of antipsychotic medication within care homes.
I’m going to be looking at the extent to which—sorry
I’m nearly at the end, Chair—commissioners, local
authorities and health boards, including the regulatory inspector,
understand the day-to-day quality of life experienced by older
people living in care homes, and, just as importantly, the way in
which that is used to drive continuous improvement.
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[26]
Now, I was very clear during the last term of the Assembly, and the
last committee, that I wanted to see lay assessors going into care
homes. It was one of the areas where I didn’t win the
argument, and people said to me, ‘There are better ways to do
it’. So show me, prove to me that there are better, different
ways to do it. I’m not too big to say I was wrong on an
issue. But I want to see the evidence behind it.
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[27]
And then just the final few areas. I’m going to look at the
extent to which Welsh Government has ensured that there is an
integrated approach to the inspection of nursing homes, not just
social care but the quality of nursing care as well. This was one
of the big issues that I and the previous committee spoke about. It
was promised in what would be a forthcoming quality Bill. The
quality Bill seems at the moment not to be forthcoming. So, my
question is a simple one: What have you done? How have you ensured
there’s an integrated approach? And I’ve just read the
last report—or the latest report—of the former chief
inspector of social services—sorry, I’m not putting
that very well, but you get what I mean—the last report. And
actually, it didn’t answer the questions that I had: How good
is the quality of nursing care within nursing homes? It’s a
simple question; I do expect a simple, clear answer.
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[28]
I’m going to be looking at the extent to which steps have
been taken by local authorities to encourage the use of befriending
initiatives. Everyone should have a friend in a place they call
home. And I’m going to be particularly looking at the extent
to which people have access to faith-based support and cultural
communities as well. People have shared with me how much these
matter.
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[29]
And then the final thing that I’m going to be looking at
looks at the issue about forward planning. As you remember, it was
the last of my significant observations within the review. So,
I’m going to look at particularly the extent to which we now
have—because we should have by now—robust workforce
planning projections. That’s going to be an issue for Welsh
Government. But I’m also going to look at the extent to which
health boards have worked with the care homes sector to develop an
integrated, incentivised, attractive and supportive nursing pathway
as well.
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[30]
So, those are the areas that I’m going to focus on. I will,
as I did before, place all of my documentation in the public domain
and there’s likely to be quite a lot of that. I’ll be
issuing in January a pro forma to all of the bodies who are going
to be asked for further information. As I said, I’ll publish
my findings in November, and, by that stage, I consider that, on
those issues, sufficient time will have expired and I will be very
public and clear again in my views as to whether we’ve made
sufficient progress and as to whether a good enough job has been
done for some of our most important, vulnerable people.
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[31]
Dai Lloyd: Diolch yn
fawr. Lynne, did you have some issues here? And then you can
move on seamlessly to antipsychotic medication as well.
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[32]
Lynne Neagle: Thank you. Can I just say, Sarah, as you know,
I’m a very big fan of the work that you’ve done on care
homes and I’m also really, really pleased to see that
there’s going to be such rigorous follow-up? I’m
especially pleased to see the inclusion of the quality of nursing
beds in there, because I think if somebody is having a bed that is
funded by the NHS it should be the same quality as we would expect
to see in a hospital. I just wanted to ask, of course, as well as
the quality issues we’ve also got issues, I think, with what
I would describe as the fragility of the care home sector in Wales.
As you know, we’ve had quite a few home closures that have
happened at very short notice. We nearly had another one on my
patch the other day where we had three weeks’ notice, which
fortunately has been averted by prompt action by the health board.
I just wanted to ask if you think the Welsh Government, in
partnership with local authorities, is actually doing enough to
ensure that we have got more capacity in the sector so that
we’re not completely dependent on particular homes if
something happens. Of course, most of them are privately run and
some of them are really excellent private homes, while some of them
have got a lot of room for improvement, but we are dependent on
private businesses a lot of the time, which I think makes us very
vulnerable, really.
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[33]
Ms Rochira: Okay, thank you. The issue around care home
closures is one that I’ve always taken very close oversight
of, primarily because of the number of older people that came to me
and spoke to me about it. Just by way of backcloth before I come
directly to your question, I have already issued guidance to public
bodies in terms of how care home closures should be managed, so
that the rights and dignity of people is maintained during that
process—it’s not just what we do, it’s how we do
it. From time to time, I do take a very active
interest—that’s almost commissioner code, really, for
expectations—in terms of particular homes that are
closing.
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[34]
The point you raise, I think, goes directly back to the point I
made in my care home review about the need for a really robust
market plan. I do not think the current market we have is
sustainable. I’m not sure anybody thinks the current market
that we have is sustainable. We need a real root-and- branch review
about what sort of market we want—the role for the public
sector, the role for the private sector, the role for social
co-operative movements as well. I know that work has been
undertaken, and I’ve been able to track some of this through
my interim monitoring report in terms of those early market
position statements. I guess I won’t know whether that is
sufficient until I undertake that more detailed follow-up work. So,
there is work taking place but I think the big worry I have is that
we’re getting time-expired on this. That’s the
danger.
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[35]
Had we started this work in Wales—and I generously will use a
broad ‘we’ here—10, 15 years ago, when we should
have done, actually we’d be in a much stronger position now.
The biggest risk, I think, that we have and that we face is time.
So, yes, I see work going on across Wales and, in fact, I saw a
presentation recently through the Welsh Government care home
steering group, which looked at some of the numbers behind that.
But, actually, in some places we’ve got weeks and months
behind. That’s why managing the ‘how’ matters so
enormously to people. I think we are a very long way from where we
need to be in Wales in having a stable, high-quality market, where
we’ve got barriers to entry for those who shouldn’t be
in the market and where those who we want to see in the market can
come in and know that we’ll be able to invest in them to keep
them there for the long term.
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[36]
Lynne Neagle: Thank you.
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[37]
Dai Lloyd: Moving on.
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[38]
Lynne Neagle: Moving on then to antipsychotic use in care
homes, which is an area you’ve been concerned about
previously. Are you able to provide any update on—because,
you know, you’ve been exploring data with health
boards—what your concerns are in relation to the use of
antipsychotics in care homes? But also, can I ask about
inappropriate antipsychotic prescribing for older people more
generally, because in my experience it also happens in
hospitals?
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[39]
Ms Rochira: Well, as I touched on earlier and you’ve
seen this in my follow-up work, the wider issue of management of
medicines within care homes was something that was identified in
the review. I drew very heavily on advice from people such as the
Royal Pharmaceutical Society, who have real knowledge and
expertise. I have to be knowledgeable about many things as
commissioner, often in some depth, but I also know when I need to
go and talk to professionals and experts as well. The findings
through the care home review were quite stark. It doesn’t
take away from the good practice that we saw and that I know has
been developing over the last two years, but the whole issue of
medicines management—particularly in terms of staff skills,
meds reviews and the use of antipsychotics—was stark and
salutary in terms of the findings. Let’s not shy away from
it, in terms of language. There are people in care homes who are
being chemically coshed—that’s the reality of
it—inappropriately. I know, from one of the reports that I
read as part of that review, that about two thirds—I think
that’s the figure—of antipsychotic use is
inappropriate.
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10:00
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[40]
We are not complying with NICE guidance across Wales. I just want
to say this, because I keep saying this all the time: it is
completely inappropriate that antipsychotic drugs are used as a
substitute for things such as a lack of privacy, lack of staffing
levels, over-stimulation or under-stimulation, poor communication,
depression, anxiety or fear. This is one of the things that we
absolutely must address.
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|
[41]
I have leaked like a sieve on this. From the day I published the
report, I made it clear that I would be coming back to look at
this. Health boards absolutely know how much of a priority this is
for me. Many of them have spoken to me. I think that they are quite
keen to tell me what they have been doing in the interim in a range
of areas. So, in parts of Wales, we now have a consultant who
oversees all prescribing of antipsychotics, and I think
that’s a really good approach; additional use of prescribing
reviews by pharmacists—that’s a really good step
forward as well; better training of staff. But I won’t really
know, in a sense, until I go back and, in detail, do that review.
What I have been so pleased about is the extent to which so many
partners stepped up after I published my review, and one of them
was the Royal Pharmaceutical Society. They have made the focus of
their work over the last year the better management of medicines,
and that includes antipsychotics in care homes. They have been out
there, because, actually, they are the experts and they are really
knowledgeable on this, working with health boards and providers
across Wales, to grow and improve practice. Because they have been
doing that, I do expect to see a very significant step up when I
come back.
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|
[42]
Lynne Neagle: So, have health boards been able to provide the data
on the exact numbers of older people who are being prescribed
antipsychotics?
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|
[43]
Ms Rochira: I have not asked them for those data yet, but I
will be asking them for those data. I’m going to use things
like the NICE guidelines as the benchmark for that when I undertake
the formal part of the review. But they have had every opportunity
to do that, both in terms of what we found in the review and, I
think, the outstandingly good work done by the Royal Pharmaceutical
Society. If you’ve not seen their guidance, it is well worth
reading. I asked all bodies to step up. They absolutely did step
up. They have focused their work around this issue of medicines
management, and I am really grateful to them because I am not an
expert in medicines management or antipsychotic drugs. The thing I
know is that we are not getting it right. They have been helpful in
getting it right, and I expect to see that evidence from the health
boards when I go back. I am very rarely, I have to say, pejorative.
I am quite often critical in the public domain. I am very rarely
pejorative. There is a nuanced difference here. I can only say that
they best be getting this right now when I go back and do the
follow-up work.
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|
[44]
Dai Lloyd: Mae’r adran nesaf o gwestiynau ar
ffïoedd ychwanegol gogyfer â gofal preswyl—y
top-up fees—a Caroline sy’n mynd i ofyn y
cwestiynau hyn.
|
Dai
Lloyd: The next section of questions is on top-up fees in
residential care, and Caroline will ask the questions on top-up
fees.
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|
[45]
Caroline Jones: Diolch, Chair. Regarding the top-up fees
that families are being asked to pay to subsidise care home fees,
there were concerns that these fees were being misused and used for
other purposes, and even used to provide basic care. In March 2016,
you had occasion to write to all care home providers, stipulating
various recommendations that they shouldn’t be used to
provide basic care. Could you tell me, please, what responses you
have had regarding these recommendations and how far forward we are
with this forward planning and recommendation?
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|
[46]
Ms Rochira: This is another example of a piece of work that I did
because of my casework. I’d had a number of people come to me
raising concerns about top-up fees, which caused me to give pause
for reflection and thought. So, I
did write out to providers and commissioners as well. I
didn’t really issue new guidance to them, but I reminded them
about the existing guidance. Sometimes it’s important just to
do that. What I basically said to them was that top-up
fees—we use that as the colloquial phrase—should never
be used for basic care, for the care that people have through their
needs or to address their physical care or their wider well-being;
that people’s personal allowances should always be
protected—it’s all you’re left with and you need
to have some money in your purse or your wallet in the place you
call home; and that people should never, ever be threatened with
eviction because of issues around funding or top-up
fees.
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|
[47]
So, they were, if you like, reminders to
people that I was watching this area. And I was watching it really
because of the financial pressures on the system. So, providers
will say, ‘We’re not getting enough money’.
Commissioners will say, ‘We don’t have any more money
to give you.’ There’s a danger of cost shunting. So, I
hadn’t seen it as a huge issue across Wales, but enough maybe
to issue, if you like, an early warning to people. There were one
or two cases that came to me that were quite concerning and I
actually wrote to the specific commissioning bodies who
weren’t aware of the practice that was going on. Actually,
they were very grateful to me for having raised that, but, as I
pointed out to them, ‘You should have known this
anyway’, and they did take action on the back of
that.
|
|
[48]
So, I’m keeping it under what I
would call a watching brief. My engagement and my casework will
very particularly be the drivers behind that. If I see that this
starts to become more of a problem, then I may well go back and do
a more detailed piece of work. I can do that on a national basis or
I can do that in relation to one of the commissioning bodies, if I
needed to.
|
|
[49]
Caroline Jones:
So, was there a combination of your own
casework and your own observations, plus people telling you that
they had concerns about relatives and people in the care
homes?
|
|
[50]
Ms Rochira: I think it’s just sometimes you get a—.
My contact and engagement with older people—they’re my
eyes and my ears really, and sometimes you just start to hear
things on the edge, and what you don’t want them to do is to
grow and to snowball. So, I was just trying to remind people, and
it was particularly focused, I have to say, on the point that
people should never be evicted. I have once in the past had to
threaten legal action—a prohibitory injunction—to stop
a person being evicted, and I’m not beyond using that again.
It’s vigilance.
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|
[51]
Dai Lloyd: Ocê, symudwn ni ymlaen i’r adran
nesaf. Mae’r adran nesaf ar ddementia, eich adroddiad chi a
hefyd ar y strategaeth yn mynd ymlaen. Mae Lynne yn mynd i ddechrau
a wedyn Rhun yn ymuno.
|
Dai Lloyd: Okay, we’ll move on to
the next section and that section is on dementia, your report and
also on the strategy, moving forward. Lynne will start and then
Rhun will join in.
|
|
[52]
Lynne Neagle: Thank you. Can I just ask about your dementia report,
Sarah, and how you are following the recommendations in that up?
And then I did want to just ask a question about the
strategy.
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|
[53]
Ms Rochira: Thank you. The two are intrinsically linked for me. I
mentioned right at the beginning that I have a particular role.
I’m here particularly for those who are most vulnerable and
most voiceless. I’ve spoken many times about how dementia is
the game changer for all of us. If it doesn’t affect us all
now in some shape or form, it will, indirectly or directly. Some of
the people I’ve met with dementia have been the furthest away
from the well-being outcomes that we would aspire to here in
Wales—the most voiceless, the most disenfranchised, the most
powerless and the most lost. I have to say, however, people living
with dementia still have so much to tell us and so much that we can
learn from. Some of the people I’ve met with—Karen,
Chris, Nigel, Pat, who is no longer with us, and many
others—have taught me a huge amount about what needs to
change. They are still worth listening to, and not just listened
to, but taken seriously.
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[54]
When I published my report, at the heart
of it was something very simple. I asked people with dementia,
‘What are the big issues that you face? Tell me about your
lives, the good and the bad’. They were all different but
they spoke with one voice about being excluded from society, a lack
of emotional and family support, a reactive focus from
services—you get the help when a crisis occurs but not to
stop the crisis occurring—services that don’t meet
people’s need, a lack of basic information and advice, and so
the list went on, but they pretty much spoke with one voice. So, I
identified 13 areas that they had told me needed to improve. So, I
wrote out to partnership boards across Wales and I said,
‘I’ve listened to them, you need to listen to them as
well. I want you to tell me what you’re doing on this’.
They all wrote back to me in some detail and I’ve just
provided them all with a very detailed critique of their responses
to me. I’ve also provided them with what I hope will
be a helpful toolkit, if you like—what are the big outcomes
that people should be aspiring to? And a whole range of good
practice based on what people with dementia shared with me. And
that is designed to grow their knowledge, their thinking, their
practice. And what I’ve said to them is, ‘I want you to
reflect on this, take it back to your partnership boards, evaluate
yourselves in terms of how you’re doing against these, and
then go and discuss your progress with people living with
dementia.’ So, that piece of work was very much about growing
their ongoing work as partnership boards across Wales.
|
|
[55]
There were some systemic issues—and I’ll talk about
those in a second—but I also saw a wide range of good
practice developing across Wales. It is the usual story from
me—huge variability. But this was, I guess I would say, a
postcode lottery bar none, in terms of what I have seen. And
that’s not good enough, is it, because the basics should be
right across Wales? So, I will continue to work with them, to
support them to grow their knowledge, to push them to listen to
people with dementia, and that’s been a big piece of work.
And the feedback I’ve had already has been very positive.
People have said, ‘This is helpful. This is what we needed
from you in terms of growing our work.’
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|
[56]
And then we come to the strategy. The strategy is important,
because of the point I just made. We have 1,000 flowers blooming
across Wales, but it’s that uber-postcode lottery. We need a
strategic approach where we get the basics right across Wales. So,
regardless of where you live, there will be uniformity of support
for you. The best thing I can do is take my learning, my knowledge,
because that’s older people, people living with dementia,
their voices, and feed them into that strategy. And I’ve
already done that. I’ve shared all of my learning, all of my
strategic observations, all of the big issues that people with
dementia raise with me, with the Cabinet Secretary, and with Welsh
Government officials already. I’m already actively involved
in supporting them in terms of the development of that strategy,
because we need to get that strategy right.
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|
[57]
I thought it might be helpful to share with you what I think some
of the issues are, because there is a difference between a strategy
and a good strategy. Now, I’ve never yet heard an older
person ask for new legislation, strategy, policy or plan. I’m
not taking away from them—they’re really important, but
it’s not what people talk about. They talk about the stuff
that makes a difference to their lived lives, on a day-to-day,
hour-by-hour basis. So, my job is, in part, to advise Government.
Government’s job is to listen to me and people with dementia,
and make sure they pick up on these issues. So, this is what I
think makes for a good strategy. And I’m very happy to write
to you with more on this. So, I think there are some strategic
things. The first thing is that the strategy must take a
life-course approach. It’s right, of course, that we focus on
issues of diagnosis in the first couple of years, but then what do
you do for the rest of your life, the next 20 years, because
that’s how long people are going to live with dementia? How
do you make sure our well-being outcomes are made real for the rest
of your life? Twenty years and more. It’s got to be
measurable and have an outcome focus to it—measurable,
outcome focused, and reportable as well, both in terms of process,
but also what we’ve really changed for people.
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|
[58]
We need to strengthen partnership working, and I saw that in terms
of the responses—it’s hugely variable across Wales.
Some of it is really good. Some of it is nowhere near where it
needs to be. I’m not easily fooled as a commissioner, and
pages of pages of words don’t necessarily equate to evidence
of a strong partnership approach. We need to strengthen the
inclusion of people living with dementia. Those people I spoke
about earlier—you put them in a room for an hour, and,
actually, they’ll give you the heart of a really good
strategy, because they know what it’s like because they live
the life. We need to make sure we embed rights—a rights-based
approach. One of the things I’m particularly pleased that
Welsh Government is doing is that they’ve commissioned the
Dementia Engagement and Empowerment Project to lead on the
engagement with people living with dementia. DEEP are very strong
on rights, and, actually, so are people living with dementia. All
of those were observations from the critiquing and the reviewing
that I did, if you like, of those responses from the partnership
boards. And all of those, I think, sit at the heart of a good
strategy.
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|
[59]
But then there are practical things. I like practical things, and
so do people living with dementia—they like practical things.
These are the things that they’ve shared with me, and
I’ve shared. So, practical things around the skills,
knowledge and competencies of staff. Not just specialist, but
including specialist staff, ranging from GPs, but all the way up
across the breadth of public service. There is a fundamental
difference between having had some training and knowing what it is
like to live the life. Emotional support, relationship and family
support—we have this concept of family support for children
and young people.
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10:15
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|
[60]
People with dementia need us to take that concept and that learning
and apply it to them as well. The emotional devastation that
dementia wreaks on people can be brutal. Clear and flexible
pathways—one size does not fit all. In fact, one size will
probably not fit anybody. I’m not even sure
‘pathways’ is the word—life is not that clean or
not that linear—but clear and flexible; I think the word is
‘flexible’ approaches. Strengthened advocacy
support—that outcome that sits in the national outcomes
framework for social services, ‘I have an effective voice or
someone to speak for me’—when you can’t use your
own voice, someone who can. Single points of contact came up all
the time from people with dementia. Easier and earlier
diagnosis—no-one wants to be labelled, but people would like
to know what on earth is going on and how it’s going to
affect them. Challenge and support to wider society—and this
is a leadership role, I think, for Government. It doesn’t
matter whether you’re public, private or third sector. The
way that we address these issues now will define us as a society.
And one of the big issues that a lady called Karen shared with me
very eloquently was around employment and how she lost her job, I
think unfairly, because of her dementia, and the devastation that
wrought upon her and her family. So, those have all been directly
taken from the review and my ongoing engagement with people with
dementia.
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[61]
I just want to leave you with some things that Nigel told me,
because all I try and do is give a voice back, but, actually, when
you talk to people like Nigel, or Pat and others, they’re far
more eloquent. So, those are Nigel’s words about I think what
would make for a good strategy. This is what he wants to be able to
say, so in three, four, five years’ time, if we’re
getting the job right, people like Nigel and others, this is what
they’ll be saying: ‘I’ll be helped to live
independently for as long as possible.’ That’s a great
outcome. Only Nigel and others can judge that. ‘I’ll be
treated as an individual, with those looking after me knowing about
my life.’ That’s a great, nuanced, value-based outcome.
The next phrase that he uses I think is really moving, actually. He
says, ‘I will have the peace of mind that my family will be
helped to remember the person I was after my death.’ You just
see how the language is so resonant with value and meaning, and
legislation, strategies, plans and policies matter. Those are the
outcomes that people talk about.
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|
[62]
One of the things I am going to be quite focused on in my
conversations with Welsh Government is, ‘How are you going to
judge success?’, because I think that’s easier than
people think. It’s when we make the outcomes that sit at the
heart of the Social Services and Well-being (Wales) Act 2014 real
for everybody. I’ll just remind you of what some of those
are. I’m slightly biased—we heavily influenced what was
in them—but they say things such as, ‘Have an effective
voice for someone to speak for me’, ‘I can do the
things that matter’, or ‘I belong’. That’s
the job of that strategy—to make sure that that’s what
people with dementia say in years to come, and only they will be
able to judge whether a good enough job has been done.
|
|
[63]
David Rees: Okay. Lynne.
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|
[64]
Lynne Neagle: I don’t disagree with a word that
you’ve said—it’s all excellent—and we know
that the strategy is a work in progress. But you’ll have also
seen some of the proposals that are being mooted for the strategy,
and I just wanted to ask about things like 32 support workers for
the whole of Wales and the still relatively low targets for
dementia diagnosis. How satisfied are you that the plan is going to
be sufficiently ambitious to meet the challenge that you yourself
have also described as a game-changer in Wales?
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|
[65]
Ms Rochira: I’ve said for some time that I’ll
take a view on the final strategy, and whether I think it is a good
strategy. I will use the voices of people with dementia to help me
form that view, but I think that’s fundamentally part of my
role. I think we have seen significant progress, and we’ve
seen not insignificant investment from Government over the last few
years in dementia. I’ve been listening to debates recently,
as I would because they were about older people—well,
actually, one was about my work as well in the Senedd—and
actually we’re now talking about being a dementia-supportive
nation. All this is good stuff, but if this is a journey of 100
steps and it’s a journey that we will, in a sense, forever be
on, we’re maybe on the first few steps, and I don’t
think we should underestimate the scale of the challenge ahead of
us. Nor should we underestimate the impact on our future lives if
we don’t get this right. I think, though, the point I made
earlier was really important. The Government has a leadership role,
and it’s clearly that which they should do within that, but
there is also that which they should enable and cause to make
happen. So, the conversations with employers, for example, in terms
of keeping people in employment. The conversations that can be had
with small businesses across Wales in terms of how you make your
local newsagent shop dementia-supportive and friendly as well. We
all have to play a part within this. So, that leadership
role—that which they must do. The strategy will be their
opportunity to show what they’re going to change, but it has
to be a part of our wider roles.
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|
[66]
Dai Lloyd: Okay. Rhun.
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[67]
Rhun ap
Iorwerth: Rwyf innau, yn sicr, yn cyd-fynd â’r weledigaeth
rŷch chi wedi’i thanlinellu ar ein cyfer ni, ond buaswn
i’n licio eich gwthio chi ychydig bach ar sut y mae, neu sut
y bydd hi’n bosibl i fonitro llwyddiant y strategaeth yn y
pen draw. Rŷch chi’n sôn am bethau mesuradwy,
rŷch chi’n sôn am ‘outcomes’, ac
rŷch chi’n sôn am ganlyniadau. Beth ydych
chi’n gobeithio gallu ei fesur, a beth fydd eich rôl chi
yn monitro’r llwyddiant? Hynny ydy, ai dim ond—nid
‘dim ond’; mae hynny’n anghywir. Ai’r hyn
rŷm ni’n ei glywed gan Nigel a Pat, mewn blynyddoedd,
ydy’r KPIs, ynteu a oes yna fwy na hynny?
|
Rhun ap
Iorwerth: I certainly agree
with the vision that you’ve outlined for us this morning, but
I would like to push you a little further on how we could monitor
the success of the strategy ultimately. You’ve mentioned
measureable things, you’ve mentioned outcomes and
you’ve mentioned results, but what do you hope to be able to
measure, and what will your role be in monitoring the success? Is
it not only—I don’t mean ‘not only’;
that’s not right. Is it only what we’ll hear from Nigel
and Pat over the years? Are those the KPIs, or is there more to it
than that?
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|
[68]
Ms Rochira: No, Nigel and Pat are just some real people I
wanted to share with you who have very important things to say.
It’s nice to name people and give them that respect. I think
it’s a great question. I talk about outcomes all the time. In
fact, I’m increasingly becoming quite fixated on outcomes.
I’m doing quite a big piece of work next year, looking at
outcomes across the public service. So, what we have, I think, is
intent. So, it’s the intent in a whole range of legislation
and strategies and policies. I don’t take away from the vast
majority of that intent. It seems to be appropriate. Then we have a
whole range of things that we do, that public bodies do, that
Government does—an industry of activity; almost more than one
can possibly track. The big question, of course: what was the point
of it all? Did it deliver what it was intended to? That test back.
Just to give you an example, the social services and well-being
Act: I have a very dog-eared copy of the initial statement that the
Deputy Minister put out, and what was the intent behind the
legislation, to keep me rooted on what it was designed to do. One
of the things that strategy I think needs to do is define, in a way
that is relevant to people living with dementia, what a good job,
well done would look like. Now, I can give you some examples, and
that’s why I shared with you Nigel’s voice because,
actually—
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[69]
Rhun ap Iorwerth:
And that’ll be vital, of
course—[Inaudible.]
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[70]
Ms Rochira: He describes that. There will always be some
qualitative measures, but the quantitative measures—. But
those tend to be around process than input—that stuff that
has to be. It’s not a technical term, but all the stuff we
do. But it’s about those qualitative indicators. Ultimately,
only people living with dementia will be able to judge that. The
Welsh Government, though—I would respectfully suggest to
them—should also be asking themselves the question,
‘Are we delivering on our intent? Are we making a difference
in the day-to-day lives of people?’ I’m sure, at some
stage in the future, I will be asking that question. I suspect you
might be asking them that question at some time in the future. My
role is to help get that strategy right. I will continue, through
my casework and my ongoing engagement, and my work with partnership
boards, to track what I think that progress is. I’ll ask
those questions of Welsh Government in years to come. If I think
that sufficient progress hasn’t been made, but I think
it’s a particular area where older people are suffering real
detriment, then I do, of course, have the opportunity to undertake
a piece of work, and that includes a section review, as
commissioner. But, fundamentally, that question is one that Welsh
Government must be asking itself. It must be putting the answer to
that in the public domain. I think all of the scrutiny bodies
always make sure that they do ask those questions. They ask the
right ones and they get the right outcome indicators.
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|
[71]
Rhun ap
Iorwerth: Ond y qualitative a fydd yn bwysig i’r
comisiynydd, yn wastad, yn hytrach na’r quantitative,
ie? Achos mae’r hyn yr ŷch chi wedi’i ddweud yn
cadarnhau beth oedd yn fy meddwl i: mai’r unig beth yr oeddem
yn gallu ei fesur, o bosib, ydy beth sy’n cael ei roi i mewn
i’r system. Y peth pwysig ydy profiadau pobl a phrofiadau
pobl â dementia, ond mae’n rhaid hefyd cael rhyw ffordd
o weld a ydy’r strategaeth yn gweithio mewn ffordd
quantitative.
|
Rhun ap
Iorwerth: But it’s the qualitative that will
always be important to the commissioner, rather than the
quantitative. Because what you’ve said confirmed what was in
my thinking: that the only thing that we can measure, perhaps, is
what’s put into the system. The important thing is
people’s experiences—people who have dementia—but
we also have to have some way of measuring whether the strategy is
actually working in a quantitative way also.
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|
[72]
Ms Rochira: I’ve always thought there were. I’m
very happy to share with you next year the work that I’m
going to do around outcomes. How do you know whether a ‘good
job’ has been done? It’s just a simple question,
isn’t it? A good job well done. I’ve always thought
there are three levels: there’s the strategic level, and then
there’s the level of services, and then there’s the
level of the life you live; and I think it’s the combination
of all three.
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[73]
I’ll just give you an example from a completely different
context, where I have done some work around outcomes with health
boards, driven, again, by my learning from older people. So, I
reviewed for a number of years the annual quality statements from
health boards, because they’re designed to reassure the
public, and I thought, ‘Well, I am both a member of the
public and I represent many members of the public.’ I
realised that, the first time around, they didn’t really tell
me anything I actually wanted to know. They told me a whole range
of stuff, but none of it was what I really wanted to know. So, I
worked very closely with them—critique, advice—and then
I issued them some guidance last year, and I said, ‘I want
you to report on the following stuff. It’s really hard to do,
a lot of it is qualitative, but start.’ I’ll share one
example because it goes to the heart of what you were saying. One
was about continence care. I have an issue about continence care
across a whole range of care settings. It’s really important.
So, I would go to a health board, and I would say, ‘Tell me
about your continence care’, and they would tell me about
their continence bundle and their compliance figures. They’d
tell me about their new strategy—both really good.
They’d tell me about the specialist staff—really good.
I’ve met many of those specialist staff across Wales.
They’d sometimes send me their newsletter—that was a
bridge too far. But none of that was what I asked. What I asked
them was: ‘Are people losing their continence whilst in your
care?’ It was a simple question and I expected a simple
answer.
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[74]
So, I’ve been pushing public bodies really hard to answer
those simple questions—the questions that, if you were a
vulnerable person, you would want somebody at a corporate level to
be asking. So, it’s been a big feature of my work about
governance scrutiny across public boards, both in terms of working
with them, but also in terms of published guidance as well.
It’s about intent and it’s about outcomes, and then you
have the stuff that has to be done in the middle.
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[75]
Dai Lloyd: Reit. Mae’r ddwy adran nesaf o dan law
Angela. Y gyntaf ar unigrwydd ac unigedd, ac wedyn hefyd ar
ddiogelwch personol. Angela.
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Dai Lloyd: Right. The next two sessions
will be headed by Angela—first of all, loneliness and
isolation, and then personal safeguarding. Angela.
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[76]
Angela Burns: Thank you very much, Chair. May I take the
liberty of asking just one other question? I can’t see
anywhere else where it might fit in this.
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[77]
Dai Lloyd: Liberty taken and understood.
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[78]
Angela Burns: Good morning, Sarah.
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[79]
Ms Rochira: Good morning.
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[80]
Angela Burns: It kind of segues slightly into loneliness and
isolation from dementia. I’ve listened very carefully to what
you’ve been saying about your way of targeting more
vulnerable groups, and I absolutely applaud everything you’ve
done. I appreciate that you cannot do absolutely everything and
that this is an ongoing process. But, one of the areas I do have a
concern about is older people who have some kind of mental health
difficulty. They haven’t got dementia, necessarily, but they
might be autistic. They might have had learning difficulties. They
may not be able to read and write. They could be on various
spectrums. They could be, actually, just severely depressed. They
don’t live in a care home, they’re in their own homes,
and they’re not able to access support and services. I have
concerns about where, or who, is looking at that area, because they
don’t fit neatly into any of the boxes. I think on the
dementia story you’re absolutely right: we’re on the
early stages of it, but there is an intent and a recognition that
there’s an issue, and we have to find good outcomes and
solutions for that.
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[81]
But there’s that other little group of older people and they
tend to be very isolated, which is why I felt it came quite well
into this area. But they also tend to be incredibly voiceless. If I
can use one example, perhaps they are severely mentally
handicapped, but they’ve been going to the same day centre
for years and years and years. I’ve met these people. Their
parents are in their 80s and 90s, and these people are in their 60s
and 70s, but then, you know, social services are under pressure,
councils decide to close the day centre, and really change and
upset those people’s lives. They seem to have no recourse
anywhere. Would you perhaps be looking at that section of society
at some point—those older people with those kinds of
issues?
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10:30
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[82]
Ms Rochira: When I was interviewed for post, one of the
questions I was asked was, ‘What would keep you awake at
night?’ and the answer I gave then is the answer I’d
still give: it’s the things I can’t get to, or that I
can’t go into depth on. So, I guess the broader issue, the
mental health of older people, in its breadth, hasn’t been as
significant a piece of work as I would have liked if I had more
hours in the day. It’s not not been on my radar at
all—
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[83]
Angela Burns: No, I totally understand that.
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[84]
Ms Rochira: And I guess my work has probably been with
sister organisations, particularly in the third sector, in making
sure that I understand what the issues are, trying to get those
into things like ‘Together for Mental Health’, for
example, to make sure that older people are not forgotten, making
sure that I listen very closely to people with all sorts of
challenges in their lives. In fact, I have a phrase:
‘everyday heroes’. Some of my everyday heroes are the
golden oldies that I meet—older people with learning
difficulties who’ve still got a lot to share and to say. So I
guess my role has been very much to support other agencies, other
organisations, in every way that I can to shore them up in the work
that they do. If I find—well, it won’t actually be me
in years to come, but I’m sure the next commissioner, in
years to come, if they find that there are big systemic issues here
leading to significant detriment, that people are being ignored,
that rights are being overridden, then of course they have the
opportunity to look at any issue relating to older people in some
depth.
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[85]
Angela Burns: All right. Because a lot of those people are
very marginalised, and it goes into the loneliness and isolation of
older people. I’m sure all of us, you included, as people who
handle casework, will have seen many elderly people we’ve
come across who’ve just been completely ignored and are not
part of their communities. One of the things I always find slightly
surprising is that, sometimes, we are what we make ourselves, and
if you have an elderly person who has never been into social clubs,
has never been great at going out and meeting people, who is
actually very shy and finds that very difficult, how do you think
that we as a society might be able to engage with them and improve,
if you like, their lot in life and make sure that they do have a
sense of still belonging, albeit on their terms? I meet incredibly
well-meaning people who think, ‘Right, Mrs Jones is all on
her own, let’s drag her off down to this club and that
club’, and Mrs Jones is saying, ‘I am very lonely and I
am very sad, and I haven’t got a family, and Mr Jones has
just died, but actually I’ve never gone to a knitting club
and I don’t want to start knitting now because I’m 83,
or 72, and it doesn’t appeal to me.’ I just wonder what
your view is on how we might be able to start tackling loneliness
and isolation, because I do sometimes think we think the easy
answer is just to set up lots of clubs and get people involved.
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[86]
Ms Rochira: If I just speak for a moment about loneliness
and isolation in its breadth—
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[87]
Angela Burns: Yes, and your Ageing Well in Wales programme,
please.
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[88]
Ms Rochira: Oh yes, thank you.
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[89]
Angela Burns: That would be really great.
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[90]
Ms Rochira: In some ways, when I began as commissioner, I
think because of my background, I had a bit of a sense check about
what I would find. Some of these issues weren’t going to be
surprises. But, the one I think I hadn’t anticipated finding
out was about loneliness and isolation, about its breadth, its
scale and its impact. It’s called ‘the silent
killer’, and it destroys your soul as well, let alone the
physical impact it has on people’s health. You all know the
figure: it’s the same as smoking 17 [correction: 15]
cigarettes a day. We have all eyes on stopping smoking, yet
it’s just as devastating for people. It can happen to
anybody. I spend my life hoping there were more hours in the day,
as I suspect many of you do, and there comes a point when time
becomes your enemy, but for a different reason. It’s been
chilling—that’s actually the phrase I would use around
it.
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[91]
It is what I have called one of our modern public health issues,
and I want to see it actually recognised by Public Health Wales as
a public health issue, but I am pleased that Welsh Government
responded to my call and it is now going to be a feature of their
programme for government. We’ve got it also into the
well-being of future generations indicators—it’s
indicator 30, actually, within that. So, at long last, we’re
beginning to recognise it as a big strategic health and well-being
issue within Wales. Four years or five years ago, we just
weren’t talking about it at all, so that has been an
important step forward, that it is up there with the other big
issues—chronic health conditions, loneliness and isolation,
they’re both of equal status.
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[92]
I’ve seen evidence—. Well, ‘I’ve seen
evidence’ sounds too posh, to be honest. I have visited many
fantastic services across Wales and many delivered by the third
sector, but others delivered by local authorities as well, and
what’s really impressed me is how different and diverse they
all are. I think this goes directly back to your point. My point:
one size never fits all. There are two approaches that we can take.
One is to say to somebody, ‘Are you lonely? Are you without
friends? Would you like us to help you? Would you like to come to
our day centre?’ I’m not sure I’m ever going to
say ‘yes’ to any of those questions, because who wants
to put their hands up and say, ‘I have no friends, I have no
life’?
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[93]
Angela Burns: Absolutely.
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[94]
Ms Rochira: To paraphrase Oscar Wilde, it’s the modern
day version of the shame that dare not speak its name. Nobody says
that. Or you say to somebody, ‘Actually, we need your help.
Could you come and help us please?’ or ‘We’ve got
an exciting new thing happening down the road, would you like to
come?’ There are so many good examples. We have men’s
sheds. Apparently, according to the evidence, men make friends in a
different way than women do and that’s quite right.
We’ve got walking football as well. I’ve seen tea
parties and befriending services—they call them
‘befriending services’, but people are invited into
someone’s home to take afternoon tea. The afternoon tea is
the lead, but of course, someone is being brought back out into the
wider community. I’ve seen community connectors run by local
authorities—hugely powerful. I’ve seen
intergenerational clubs; I really like intergenerational
activities. I know I’m the Older People’s Commissioner
for Wales, I clearly have a vested interest, but it’s about
generational solidarity. So, we’ve got the Lewis School in
Pengam, for example, where there’s a fantastic
intergenerational event at lunch time, and you get bingo and lunch.
I mean, what’s not to love about it? Clwb Ni in west Wales: a
fantastic intergenerational approach. It’s about having those
1,000 flowers, those different offerings, but it’s about
taking an asset-based approach that says, ‘Could you help
us?’ So, saying to an older person, ‘Could you help us
and come and volunteer at our youth club,’ for example,
‘because, actually, our younger people would like to meet
you?’
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[95]
I think what’s been interesting in terms of all the many,
many services I’ve visited and the good practice examples
I’ve seen, I think what sits behind them for me is this idea
about an asset-based approach. I’ll just share with you one
example of how, when we approach the issue of loneliness and
isolation properly, it becomes such a rich offering to so many
people. It’s not a problem to be solved; it’s an
opportunity missed, I think is what I’m not saying very well,
but what I’m trying to say. I’ll share an example. I
visited an after-school club on the Gurnos estate. It was not a
formal visit; I go and have a cup of tea and chat to people.
You’ve got older ladies there, you’ve got younger
children there as well, and it’s just a very nice place to be
and I’m sure it’s great childcare for hard-working
parents as well. I was watching what was happening and chatting to
people and the older ladies were teaching the younger children to
knit, and I thought that was lovely. And then I sat and I watched
for a while—I often sit and watch and listen—and I
realised what was happening was skills transfer. So, the older
ladies weren’t just teaching the younger children to knit,
they were teaching them to focus, to concentrate, to practice. You
take those skills back into the classroom, for example; those are
good skills to learn in life. And what a rich model that was and
how different that was from offering a day centre: ‘Would you
like to come because you’re lonely?’ So, I’ve
seen so many examples of good practice and many of those are driven
by our phenomenally good third sector.
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[96]
But, I go back to the strategy from Welsh Government and this idea
about the postcode lottery. We need a much more strategic approach.
It is that public health issue; it’s epidemic, endemic in
proportion, and devastating in terms of people’s physical and
emotional health. I will work with Welsh Government to get that new
strategy right and get it right we need to, as well. I already have
a very clear sense of what I think needs to be in that strategy;
I’d be happy to advise Welsh Government on that. At the end
of the day, you come back to—. Rhun, you mentioned it in
terms of outcomes. There’s a lady I was told about who stays
with me in my memory, and I was told by a third sector organisation
how this lady goes every day to Swansea bus station and she sits
there for two hours so that she has someone to talk to. Do you know
what? That’s not good enough, is it? So, support our third
sector, support all those initiatives, have all sorts of different
offerings like sporting memories too—they’re
great—but focus on that strategic approach. It was good
enough and important enough to put in as a well-being outcome, so
let’s deliver on that well-being outcome.
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[97]
Angela Burns: But, do you know, in some ways, Sarah, that
lady who goes to the bus station for two hours is lucky, a bit like
the elderly gent who comes down to my office every Friday,
he’s lucky—he’s got no-one else—because
they’re mobile. The people who really break my heart are the
people who are stuck in their homes because they are not mobile.
They may have a carer who comes in for 15 brief minutes, gets them
up, puts them to bed at ridiculously early hours, all the rest of
it, and then they don’t see anybody else. I spent a day with
a gentleman in Deer Park View in Stackpole about four years ago,
and I’ve never forgotten it, because he had absolutely nobody
but a carer that came in for 15 minutes four times a day. I spent
the entire day there; nothing. The phone didn’t ring, the
bell didn’t ring, nobody knocked on his door, nobody walked
outside his window, and he just said that’s his life.
He’d been housebound for—already, I think, by the time
we got to him—three or four years. He can’t go
anywhere.
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[98]
So, earlier on in your evidence you talked about befriending
services, and I wonder if, when you look at this strategy, you
might look at or encourage Government, perhaps, to look at what we
can do to have another layer on top of carers who go in to look
after the social and mental well-being of these people. Because a
lot of them are very independent and they do want to stay at home,
but, as you say, it’s the loneliness and the isolation that
does for them in the end.
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[99]
Ms Rochira: I completely agree with you. I’ve visited
many people who are house bound. In terms of some of the things I
touched on earlier about strategy and good strategy, what will some
of the necessary ingredients be—absolutely, some of the
befriending schemes I’ve seen across Wales where people go
and visit people. I remember one gentleman, he said, ‘I just
like to sit and to music with somebody. That’s what makes my
week.’ People go into people’s own homes. But also
things such as the bus pass, the concessionary bus pass—it
is, rightly, called by me and many older people ‘a
lifeline’—it gets people out and about, particularly
the one in six who live in poverty. Issues around community
transport as well: we need to invest in our community transport,
it’s the stuff that keeps people connected, out and about,
being able to get to places. We have a phrase in my office, which I
coined, just based on my conversations with people, and it goes
like this, ‘We need to be careful we don’t become a
nation of people with great hips—we’re quite good at
hips—but nowhere to go, no way to get there, and no desire to
go on.’ That’s for me what underpins the whole
loneliness and isolation agenda.
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[100] Angela
Burns: And, of course, coming onto my next topic, if we could
have some kind of measure of being able to get into people’s
lives in a very kind way—I mean not in a dictatorial
way—we might be able to, perhaps, be better at safeguarding,
particularly older people who are subject to domestic violence and
abuse. I just wonder if you could perhaps give us a very quick
overview of your work in that area.
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[101] Ms
Rochira: In relation to safeguarding people?
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[102] Angela
Burns: Safeguarding, yes.
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[103] Ms
Rochira: Very happy to. If you want more
information—because it’s hard to do a quick overview on
this, because it’s huge—I’m very happy to write
to you afterwards. So, I guess I would say—. It’s one
of my five published priorities—and, just to remind people,
those priorities were based on what older people told me they
wanted them to be—standing up for and safeguarding older
people. A number of strands to that work: my casework, the work
we’ve done with partners in the Wales Against Scams
Partnership, the anti-scamming charter, and the work with trading
standards—it’s been really important work; I asked
everybody to step up, and they did—work we’ve done with
people such as the Office of the Public Guardian in relation to
powers of attorney—I have never known a booklet fly off the
shelf so fast, who knew it would be such a popular booklet, but it
is, with older people—and work I’m doing around the
criminal law. It’s not a devolved issue, but we are part of
the United Kingdom, and so I consider it part of my business.
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[104] You mentioned,
though, domestic abuse. This has been one of the big areas of my
work. I guess, when I started, five years ago now, we weren’t
talking about domestic abuse of older people. I lifted up a heavy
stone, and I had to shine a bright light into some really dark
places. We use the phrase ‘domestic abuse’, I used the
phrase ‘dark places’: call it out for what it is,
we’re talking about violence, we’re talking about
sexual assault and rape, we’re talking about coercion,
imprisonment, we’re talking about theft—the most
horrific of things. For many older people, this has gone on for
over a decade or more. Many older people don’t even recognise
it as domestic abuse. It beggars belief, actually, the scale and
impact of that. I mentioned the 40,000 figure; actually,
that’s fairly outdated now.
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10:45
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[105] So, I’ve
had a very strong focus on this, and, I think, so has Government as
well. So, we have the new domestic violence Act, for example,
we’ve got new safeguarding duties in the social services and
well-being Act—about time too; many of us pushed very hard
for those. I’ve seen a whole range of new services across
Wales as a result. I’ve visited—I don’t really
like to be told, I like to go and look, and I’ve seen them.
So, the Gwent victim support hub—really good work. An
integrated approach in RCT and Merthyr—a really good
approach.
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[106] But I’ve
had my own work as well, and I guess there’ve been a number
of aspects to my own work. The first in terms of seminars for
front-line professionals, growing people’s knowledge and
understanding about domestic abuse of older people, because, whilst
there are similarities that run across all age groups, there are
also fundamental differences as well. We’ve had, I think,
around 600 professionals attend, though the feedback has been
really good, and the early evidence is that we are now seeing
increased referrals into the domestic abuse helpline. That’s
been really important.
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[107] I’ve also
been providing advice and guidance to older people. My office
produced one of the only, if not the only, small booklets
specifically for older people, and you will only ever see one
poster with a picture of older people on. That’s produced by
my office, because, too often, the narrative is of a, I don’t
know, 30-year-old with a common-law partner and two children.
That’s not the paradigm that older people can associate
with.
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[108] The other big
piece of my work has been about working with Welsh Government to
develop specific guidance for front-line professionals, taking a
lot of my knowledge, the work that we’d commissioned from
Aberystwyth University, and turning that into front-line guidance,
and I understand that’s coming out, I think, in the new year.
So, those have all been important parts, but, again, they are only
a start.
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[109] There are, and
I’m very clear on this, areas we need to invest in in Wales.
The role of independent domestic violence advisers is incredibly
important for older people. It helps them slowly walk down the
journey of understanding and asking for and being prepared to
accept help. We don’t have enough of them, we don’t use
them enough. The role of MARACs—multi-agency risk assessment
conferences—and particularly the role of housing. I
don’t think I understood how important housing was in this
agenda until I met with three ladies recently in north Wales, and
they all told me how it was for the want of housing they
couldn’t escape. So, the role of housing within that—.
The role of getting risk assessment right—and we’ve
done a lot of work on this. One of the criteria that are sat within
the risk assessment, a kind of standardised approach, is,
‘Are you pregnant?’ There are better things to ask
older people in the limited time that you have, so much more
nuanced support—and many other issues as well besides
that.
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[110] But we
weren’t anywhere four years ago or five years ago in
understanding this. I think we now actually understand it. I work
very closely with a wide range of agencies—they have been
fantastically supportive. I think, together, we are now just about
beginning to recognise what we need to do, and do it we will.
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[111]
Dai Lloyd: Yr adran olaf, gan fod amser yn mynd ymlaen,
fydd ar ddeddfwriaeth i ddiogelu hawliau pobl hŷn, ac
mae cwestiynau gan Julie Morgan ar hyn.
|
Dai Lloyd: The final
section—because the clock is beating us slightly—will
be on legislation to protect the rights of older people, and Julie
Morgan has questions on this.
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[112] Julie
Morgan: Diolch. You’ve said, Sarah, that you do support
the rights-based approach for working with older people and that
you have called for legislation to create a duty on public bodies
to promote the rights of older people. Could you tell us why you
believe we need legislation and what stage are you at in promoting
this?
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[113] Ms
Rochira: Thank you. I’m so glad you asked me about this.
Well, I am a rights-based commissioner, because you made one when
you created me. I must, by law, pay regard to the UN principles,
and I’ve worked hard over the last four years to grow our
knowledge and understanding of rights and embed them across public
service. It’s been a big part of my work. So, we had the
Welsh declaration of the rights of older people—not legally
binding, but actually a big step forward to talk about rights, and
published by the former Deputy Minister on behalf of Government.
I’ve done work on integrated equality and human rights
assessments with public bodies across Wales and I’m just on
my second round of training on how we make the UN principles for
older persons due regard in the social services and well-being Act
real for people. We’ve had ageism training, we’ve
worked hard to embed rights in key documents—I spoke about
the dementia training framework earlier—professional codes of
practice, a rights-based approach to reporting from health boards,
for example, and, of course, the national outcomes framework, which
I spoke about earlier, is inherently a rights-based document in its
approach—and I was pretty determined from day one it would
be—and much, much more.
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[114] Why do I do
that? Well, I partly do it because of the legislation—. Well,
I suppose I do, but I don’t really do it because it’s
in the legislation, I do it because it’s the right thing to
do. A rights-based approach helps us to deliver better public
services, make better decisions. It
delivers—[Interruption.] Sorry?
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[115] Julie
Morgan: Why does it deliver a better approach?
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[116] Ms
Rochira: Because I think what it gives us is a lens through
which to look: a lens that is fairly fundamental, fairly clean,
fairly simple, that reminds us about what ‘good’ looks
like. I’ll just show you two examples in relation to the
declaration of rights for older people.
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[117] I was in
Llanidloes hospital, just on a visit, and they said, ‘We want
to tell you about our rights work and how we use the declaration of
rights as an everyday tool to help us in our decision
making’. I thought that was great, actually, a really good,
practical example. And I was in Fleur-de-lis nursing home and I was
in the lounge and it was lovely—there was just life going
on—and I saw the declaration of the rights on the wall. I
can’t tell you how excited I was—I said, ‘This is
the mantra by which we live’. And I already knew, but it
reinforced to me, how they’re a very practical tool for
public services to use. We already see ABMU health board use them
in terms of their children’s charter and they’re
developing an older people’s charter based around rights as
well, and we’ve seen work done with CSSIW as well.
They’re a moral compass, a lens, that reminds us about common
humanity, common decency, and that some things are right.
I’ve always found them so very practical.
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[118] Julie
Morgan: But you are planning actual legislation.
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[119] Ms
Rochira: Well, I am, and I’ll just share with you the
reason why. One of my functions within my Act, one of my duties, is
to:
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[120] ‘Keep
under review the adequacy…of law’.
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[121] I’ve never
called for legislation before. I don’t default to legislation
easily and I doubt I will call for legislation again, either. The
fact that I am this time is for two reasons. One is because it
would take me 1,000 years and I would need 100 of me to keep
rolling out the work I have done across Wales. I’d need to be
here, there and everywhere—I just can’t stretch that
far, as I said, not just in four or five years, but in 1,000 years.
But also because of the breaches l see, the everyday breaches I see
through my work that take place. It does not take away from good
practice and intent, but I’ll just share with you three
examples of the sort of breaches that I see.
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[122] An everyday
breach—and this is how common it is. I’m in Asda,
shopping for my children’s tea—an everyday
place—a lady comes up to me and says, ‘I need to talk
to you about my friend. She’s told to go the toilet in the
bed at night and they clean her up in the morning’. This was
not the needle in the haystack, this was an everyday example. Or
the lady referred to me by an advocate on a Welsh ward: she wanted
to go home—her home wasn’t really fit for purpose
according to the system, those powers that be. They wanted her to
go to a care home, but she didn’t want to go there. She
wanted to go back to her home. They did nine capacity assessments
on her, just waiting for the day when they could prove she
didn’t have capacity. That was, as far as I’m
concerned, state-condoned abuse. And so many other examples, such
as the gentleman in a housing sector, who had lived there all his
life, a frail elderly gentleman, cared for his wife. He
couldn’t get the repairs done to his house by his housing
provider because they were trying to force him, in my opinion, to
move 20 miles away, away from all his independence and his family.
Those are just everyday breaches. But think what’s behind
Tawel Fan, ‘Trusted to Care’, Operation Jasmine, and so
much more. That’s what a rights-based approach is all about.
A rights-based approach stops some of these awful things happening,
because it pulls us up at a much earlier stage.
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[123] Julie
Morgan: Well, I think you are absolutely convincing when you
explain the need for it. So, would you see this sort of duty put on
all public bodies—a duty that could be made in the Assembly,
like, I think, with the Rights of Children and Young Persons
(Wales) Measure 2011, which only covers the policies that the
Assembly does, but obviously there’s a call for that to cover
local authorities? Would you see this duty on all public
bodies?
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[124] Ms
Rochira: Absolutely. If public service is not about making
rights real, I don’t really know what public service is
about. It should be like a stick of rock. You break it, and it runs
through our very ethos and our value base, particularly here in
Wales. Of course, older people’s lives aren’t all about
social care. They aren’t all about health and social care.
They’ve got a much greater breadth to them. So, I thought it
might be helpful just to share with you what I think that
legislation should look like. Now, this isn’t just my view.
When I made the call last year, I was grateful to all the parties
for supporting my call because this has never been a party
political issue. This is just about the people of Wales. I got a
small group together of older people and legal experts, and they
worked with me. I’m really grateful for the advice they
provided. So, I think this is what it should look like.
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[125] You are
absolutely right: in no small part it mirrors the Rights of
Children and Young Persons (Wales) Measure 2011. This is not
something that we are uncomfortable with in Wales by way of
approach. It uses a due regard model, and it is well with our legal
competencies. So, the duty for Welsh Government to pay due regard
to the UN principles in exercising their functions: actually, they
are good enough for me and they are good enough for Government as
well. It is a concept that we are familiar with. There would be a
duty to review and report, as well as a duty to promote knowledge
and rights by Government and public bodies across Wales. We need to
reclaim rights. The people I represent fought for our rights, and
they fought really hard. Actually, we need to reclaim them and make
them something that we are comfortable with on an everyday basis
and that we are proud to talk about—everyday rights for
everyday people in the places that matter for them.
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[126] There would be a
provision within that to enlarge that due duty to Welsh public
bodies. What I propose is that we use the concept of public bodies
as outlined in the Human Rights Act 1998, which gives us
consistency. I’m not trying to change things, just bring them
home. And then there would be powers to issue guidance.
That’s of course where rights get really tangible. I will
just give you two examples of different ways of looking at things.
What makes for good care for people with dementia on a Welsh ward?
I could answer that. But what makes for a rights-based approach to
care for people with dementia on Welsh wards? Well, I tell you what
it doesn’t include: if you’re a carer, it doesn’t
include being asked to leave at 3 p.m. when you want to stay, and
not being able to stay. That’s where it becomes a really
practical lens.
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[127] I think
it’s right to take that approach, and I’ve been very
cautious in this. This is not a big bang. This is not something
that we can tell people. This is something that we have to learn,
and I would rather that we learned over the next decade to 15 years
how to do this properly, to focus on areas and get them right. But,
as I said, this is not something that we are unfamiliar with. We
use the due regard model. We already use the UN principles.
It’s not a big-bang approach. What it does is give older
people parity with other vulnerable groups. As I said at the
beginning, if there was a different way to do this other than
legislation, I would be doing it, because I passionately believe
that rights are good for public service, good for individuals and
good for staff as well.
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[128] I would also,
just finally, say on that—and I just touched on this a moment
ago—I have met the people who fought for our rights: people
like Walter and David and Stella. We exist in a free democracy
because of them. Actually, they paid a high price. We’ve let
go the sense check of value that we should have. These are not
esoteric issues. It is what I have called making rights real for
everyday people in everyday places—in their own homes, in
their care homes, in their streets. They’re a practical tool
for public service, and if Government and public service is not
about making rights real, meaningful and touchable by people, then
I don’t know what public service is about.
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[129] I am
discharging my function as commissioner. One of my functions is to
advise Government. This is my formal advice to them. I had a really
positive meeting with the First Minister, and a positive meeting
with the Minister, Rebecca Evans. I have
a further meeting with her next week. We all have a vested interest
in this because it is, of course, for me about older people,
but actually we all plan to grow older as
well.
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11:00
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[130]
It’s the ultimate aspiration for
all of us, and, one day, we won’t be there to protect our
children, and they will be older people. This will define the
nature of Welsh devolution for generations to come. This is what
big government looks like.
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[131]
Dai Lloyd: Grêt, diolch yn fawr am yr ateb yna.
Rwy’n credu ei bod hi’n amser priodol, gan ein bod ni
wedi rhedeg allan o amser ta beth, i ddod â’r sesiwn i
ben. A allaf i ddiolch yn fawr iawn i Sarah Rochira, y comisiynydd
pobl hŷn, am ei phresenoldeb, yn gyntaf, y bore yma a hefyd am
ei thystiolaeth raenus? Roeddwn i’n clywed eich cynnig eich
bod chi’n mynd i ysgrifennu atom ni efo rhagor o wybodaeth ar
gwpwl o adrannau. Fe fyddem ni’n gwerthfawrogi derbyn y
wybodaeth honno. Wrth gwrs, yn naturiol, fe fyddwch chi’n
derbyn trawsgrifiad drafft o’r trafodaethau'r bore yma er
mwyn i chi gadarnhau bod y ffeithiau yn gywir. A gyda hynny o
eiriau, diolch yn fawr i chi am eich presenoldeb y bore yma. Diolch
yn fawr.
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Dai
Lloyd: Great, thank you very much for that answer. I
think this is an appropriate point, as we have run out of time
anyhow, to bring the session to a close. May I thank Sarah Rochira,
the commissioner for older people, very much, first of all for her
attendance this morning and also for her excellent evidence? We
heard that you were going to write to us with a little more detail
on a few sections. We would appreciate receiving that information.
And of course, you will also receive a draft transcript of this
morning’s discussions so that you can verify that it’s
factually accurate. And with those few words, thank you very much
for your attendance this morning. Thank you.
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[132] Ms
Rochira: Thank you all very much. Diolch yn fawr.
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11:01
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Cynnig o dan
Reol Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd o’r
Cyfarfod ar gyfer Eitemau 4, 5 a 6
Motion under Standing Order 17.42 to Resolve to Exclude the Public
from Items 4, 5 and 6
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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 yn unol â Rheol Sefydlog
17.42(vi).
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that the committee
resolves to exclude the public from the meeting in accordance with
Standing Order 17.42(vi).
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Cynigiwyd y cynnig.
Motion
moved.
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[133]
Dai Lloyd: Fe wnaf i symud yn syth i eitem 3 a chynnig o
dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o’r
cyfarfod ar gyfer eitemau 4, 5 a 6—am yr awr nesaf. Pawb yn
hapus efo hynny fel Aelodau? Diolch yn fawr.
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Dai Lloyd: I will move to item 3 and
move, under Standing Order 17.42, to resolve to exclude the public
from the meeting for items 4, 5 and 6—for about the next
hour. Is everyone content with that as Members? Thank you very
much.
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Derbyniwyd y cynnig.
Motion agreed.
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Daeth rhan gyhoeddus y cyfarfod i ben am
11:01.
The public part of the meeting ended at 11:01.
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Ailymgynullodd y pwyllgor yn gyhoeddus am
12:30
The committee reconvened in public at 12:30
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Bil Iechyd y Cyhoedd
(Cymru)—Cyfnod 1, Sesiwn Dystiolaeth 1—Gweinidog Iechyd
y Cyhoedd a Gwasanaethau Cymdeithasol
Public Health (Wales) Bill—Stage 1, Evidence Session
1—the Minister for Social Services and Public Health
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[134]
Dai Lloyd: Croeso i bawb i’r sesiwn nesaf o’r
Pwyllgor Iechyd, Gofal Cymdeithasol, a Chwaraeon, yma yn y
Cynulliad. Mae’r sesiwn gyhoeddus y prynhawn yma, o dan eitem
7, i graffu ar Bil iechyd y cyhoedd yma yng Nghymru. Rydym ni yng
Nghyfnod 1 wrth ymdrin â Bil iechyd y cyhoedd, felly mae
gennym ni sesiwn dystiolaeth efo Gweinidog Iechyd y Cyhoedd a
Gwasanaethau Cymdeithasol. Felly, a gaf i yn gyntaf groesawu
Rebecca Evans AC,
Gweinidog Iechyd y Cyhoedd a Gwasanaethau Cymdeithasol; Chris
Tudor-Smith, uwch-swyddog
cyfrifol Llywodraeth Cymru; Rhian Williams, gwasanaethau
cyfreithiol Llywodraeth Cymru; Chris Brereton, prif swyddog iechyd yr amgylchedd
Llywodraeth Cymru; a Sue Bowker, cangen polisi tybaco Llywodraeth
Cymru.
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Dai Lloyd: I welcome everyone to the
next session of the Health, Social Care and Sport Committee, and
this afternoon’s public session under item 7 is scrutiny of
the Public Health (Wales) Bill. This is Stage 1 of the Public
Health (Wales) Bill and so we have an evidence session with the
Minister for Social Services and Public Health. So, first of all,
may I welcome Rebecca Evans AM, the
Minister for Social Services and Public Health; Chris
Tudor-Smith, the senior responsible officer for the Welsh
Government; Rhian Williams from legal services, Welsh Government;
Chris Brereton, Welsh Government chief environmental health
officer; and Sue Bowker, the tobacco policy branch of the Welsh
Government.
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[135]
Gyda hynny o ragymadrodd, bydd y
Gweinidog yn deall sut yr ydym yn cymryd tystiolaeth yn y pwyllgor
hwn erbyn nawr—hynny yw, rydym ni’n mynd yn syth i
gwestiynau. Felly, gyda chymaint â hynny o ragymadrodd, fe
wnaf fi ddechrau gyda’r cwestiwn cyntaf, sef cwestiwn
cyffredinol i ddechrau yn nhermau Bil iechyd y cyhoedd. Yn benodol
felly, yn nhermau y ddeddfwriaeth benodol yma, a ydy Llywodraeth
Cymru wedi manteisio i’r eithaf ar y cyfle i gyflwyno mesurau
i fynd i’r afael â rhai o’r materion mwyaf dyrys
yn y byd iechyd cyhoeddus—pethau mawr fel, dywedwch,
gordewdra?
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So, with those few words of introduction, the
Minister will understand how we take evidence in this committee by
now—that is, we move straight to questions. So, having said
that, I will begin with the first question, and that’s a
general question to begin with in terms of the public health Bill.
Specifically in terms of this legislation, do you believe that the
Welsh Government has taken full advantage of the opportunity to
introduce measures to tackle some of the more significant public
health issues—major issues such as obesity?
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[136]
The Minister for Social Services and
Public Health (Rebecca Evans): Well, the Bill responds to some very significant
public health issues, particularly regarding smoking and the
potential public health harms of intimate piercings and special
procedures if carried out in an unhygienic fashion, for example.
But it also takes forward some policies that benefit the whole of
communities as well, so, our actions within the Bill on pharmacies,
on access to toilets and particularly our health impact assessments
as well. So, public health is, as you’ll all be aware, a
really far-reaching agenda, and one piece of legislation I
don’t think can necessarily address all of those challenges.
The Bill is one part of an important broader suite of measures that
we have, so, our campaign activity for example, policies, existing
services, various programmes, all designed to tackle the underlying
causes of poor health.
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[137]
In developing the Bill, you’ll be
aware that there was a great deal of consultation in the last
Assembly and, during that consultation, no particular ideas came
forward in terms of tackling obesity that specifically required new
legislation that would be in the competence of the Assembly to
deliver. Ideas did come forward for policies, and we’re
taking forward some of those ideas in other ways, but, with regard
to legislation, there wasn’t anything particular that came
forward. That doesn’t mean that we don’t attach great
importance to that particular agenda; it just means that
there’s nothing specific in terms of legislation. I would say
many of the levers in this regard are actually either at UK
Government level or European level, because most food manufacturers
and retailers operate on a UK, EU or even global basis as well. So,
we do work very closely with the UK Government and others, for
example, on front-of-pack labelling and other measures as
well.
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[138]
Dai
Lloyd: Diolch yn fawr i’r Gweinidog am yr ateb cynhwysfawr yna.
A gaf i hefyd groesawu Huw Irranca-Davies i’r cyfarfod, sydd
yn dirprwyo y prynhawn yma ar ran Dawn Bowden? Mae’r
cwestiynau eisoes wedi cael eu dosrannu, ond teimla’n rhydd,
Huw, os wyt ti’n cael ambell feddwl gwyrthiol, i ofyn
cwestiwn. Diolch yn fawr. Rhun sy’n mynd i ddod i mewn
nesaf.
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Dai
Lloyd: Thank you very much,
Minister, for that comprehensive answer. May I also welcome Huw
Irranca-Davies to the meeting, who is substituting this afternoon
for Dawn Bowden? The questions have been pre-allocated, but do feel
free, Huw, to ask a question you might have in order to share any
prodigious thoughts. Thank you very much. Rhun will come in
next.
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[139]
Rhun ap
Iorwerth: I barhau i drafod gordewdra, ac mi gysylltwn ni efo gordewdra
anweithgarwch corfforol hefyd, rydych chi’n hollol iawn, rydw
i’n siŵr, i ddweud na allwn ni ddisgwyl i Fil iechyd
cyhoeddus ddelio efo pob agwedd ar iechyd cyhoeddus. Ond, o
ystyried bod gordewdra ymhlith y mwyaf o’n heriau iechyd
cyhoeddus ni ar hyn o bryd, oni ddylai’r darn yma o
ddeddfwriaeth gynnwys camau
tuag at daclo gordewdra, ac o ystyried bod cymaint o’r camau
sydd wedi cael eu cymryd efo ysmygu, er enghraifft, dros y
blynyddoedd wedi dod drwy ddeddfwriaeth?
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Rhun ap
Iorwerth: To continue with the
theme of obesity, and we will link obesity and physical inactivity,
you’re entirely right to say that we couldn’t expect a
public health Bill to deal with all aspects of public health. But
given that obesity is among the greatest challenges in terms of
public health at the moment, shouldn’t this piece of
legislation include steps towards tackling obesity, and
given that so many of the steps that have been taken with smoking,
for example, over the years have been brought about through
legislation?
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[140]
Rebecca
Evans: Well,
obviously, I am keen to listen to any ideas that the committee
might have with regard to how legislation could help us with this
particular agenda, but we are using the levers that we do currently
have in Wales. For example, we recently—well, in 2014, we
introduced the food information regulations. They create stricter
requirements for mandatory nutritional labelling to allow consumers
to have access to the information that they need in order to make
healthier, informed choices about food. But we are also using
guidance, for example, and secondary legislation. Our nutritional
standards, for example, that we have in schools and hospitals are
already in place. We are also seeking to extend those now to early
years settings and to care home settings as well. So, there are
things that we can already do within our existing powers. I know
that the issue of nutritional standards was something that was
looked at previously, but it didn’t come through this piece
of legislation because, actually, it doesn’t need
legislation. This is something that we can just get on with and
do.
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[141]
Rhun ap Iorwerth: Beth sydd yn y
ddeddfwriaeth yma sy’n hwyluso’r ffordd i’r
Llywodraeth gyflwyno rheoliadau mewn meysydd eraill? Os nad
deddfwriaeth ynddi ei hun, beth sy’n bodoli yn y Bil yma
sy’n mynd i hwyluso pethau i’r Llywodraeth?
|
Rhun ap Iorwerth:
So, what is there in
this legislation that facilitates the Government in introducing
regulations in other areas? If it’s not legislation in and of
itself, what is there in this Bill that will facilitate things for
Government?
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[142]
Rebecca
Evans: With
specific regard to tackling obesity, this Bill, I suppose, beyond
the—. The main thing would be the health impact assessment
section of the Bill, which puts health at the heart of all policy.
So, the public bodies covered under the Well-being of Future
Generations (Wales) Act 2015 will, under certain circumstances, be
required to have a health impact assessment—for example,
major schemes, projects and so on. Clearly, there will be
opportunities there to deal with physical inactivity, which you
have mentioned, and obesity as well. So, that is covered in that
part of the Bill. But, as I said in response to the Chair’s
initial question, the Bill is only one part of a wider suite of
measures, and not everything is necessarily appropriately dealt
with in legislation. However, having said that, I would just repeat
that I am open to ideas. So, if there are specific concerns that
you have as a committee, I would be happy to listen to
them.
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[143]
Rhun ap Iorwerth: Mae yna lot ohonom ni
yn meddwl—a lot o bobl y tu allan i’r ystafell yma yn
meddwl—am beth ellir ei wneud. Ond rwy’n sicr yn
croesawu’r cyfeiriad hwnnw at yr asesiadau effaith iechyd.
Rwy’n meddwl bod gennych chi bwynt da yn y fan honno. Beth am
yr elfen o’r Bil yma rŷch chi’n meddwl sy’n
mynd i allu taclo anghydraddoldebau iechyd, sydd yn un o’n
problemau dwysaf ni yng Nghymru? Mae llawer o’n problemau
iechyd cenedlaethol ni yn deillio o anghydraddoldeb.
|
Rhun ap Iorwerth:
Many of us here, and
many outwith this room, are considering what could be done. But I
certainly welcome that reference to health impact assessments. I
think that’s a good point well made. What about the elements
of this Bill that you think will assist in reducing health
inequalities, which is one of our gravest problems in Wales? Many
of our health problems at a national level do stem from
inequality.
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[144]
Rebecca
Evans: Well,
there are a number of aspects of the Bill that are specifically
designed to address health inequalities. Health inequalities and
the health of children are very much, I think, at the heart of this
particular Bill. If you take the efforts within the Bill to lower
rates of smoking, for example, that has a particular health
equality issue because we know that smoking prevalence is higher in
areas of deprivation. So, this Bill will have greater impact in
those particular communities. Also, improving the planning of
pharmaceutical services will also enable us to take a more
responsive approach to the needs of particularly disadvantaged
communities, again, to ensure that assessed local need is being met
by the pharmaceutical provision available. And, again, health
impact assessments have health at their core, and would again seek
to benefit more deprived communities where those gradients in
health inequalities are most well observed.
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[145]
Rhun ap Iorwerth: Un cwestiwn olaf gen
i: dechrau’r siwrnai ydy’r Bil yma mewn llawer o
ffyrdd. Bydd angen is-ddeddfwriaeth a chanllawiau pellach i
gyflawni amcanion y Bil. Pa fath o amserlen sydd gennych chi yn
eich meddwl ar gyfer hynny?
|
Rhun ap Iorwerth:
Just one final question
from me: this Bill is the beginning of the journey in many ways. We
will require subordinate legislation and further guidance to
achieve the objectives of the Bill. What kind of timetable do you
have in mind for that?
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[146]
Rebecca
Evans: We
already have detailed or preparatory work ongoing at the moment in
terms of the statement of policy intent, a copy of which we have
provided to the committee. Some very detailed work will need to be
undertaken in terms of developing the secondary legislation and the
guidance. But, as I say, we are very much aware of that, and
consideration has been given to those parts of the Bill that will
need that to come forward. It’s the intention to publish a
detailed implementation of the Bill in due course as well, and that
will give certainty and clarity to those
bodies that are subject to the Bill, but also to members of the
public and stakeholders with an interest, because obviously
there’s going to be a process of consultation and engagement
with stakeholders as we move to develop those regulations. I
don’t know if Chris or anybody would like to add anything on
that.
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[147]
Mr Tudor-Smith:
I think the different elements of the
Bill will require a different time frame, because some have more
complex issues to deal with. So, for example, with setting up the
retail register for retailers of tobacco and nicotine products,
it’ll take some time, actually, to develop the register and,
similarly, setting up the work on special procedures. So, as the
Minister said, we will develop a time frame so that people can see
how these are developing at the time.
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[148]
Dai Lloyd: Angela, gyda chwestiwn ar y mater
yma.
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Dai Lloyd: Angela has a question on
this issue.
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[149] Angela
Burns: Yes, absolutely, thank you. Minister, the chief medical
officer, in his report that we looked at earlier this week, stated
very clearly that through their plans, health boards and NHS trusts
must present health needs analyses that clearly show how
communities differ and how unequal social factors impact on the
need and inequality of health. Now, it goes on to say that some
health boards are doing this, but a lot aren’t, and I
wondered if the Public Health (Wales) Bill might be the right
vehicle to put some kind of benchmark in place on top of the health
impact assessments, and I just wanted to take your view on that so
that you might be able to benchmark those health inequalities,
because they very clearly say, the chief medical officer, that if
there was better measuring of the social gradient fractions the NHS
takes—. So, I just wanted to have your view on that,
please.
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[150]
Rebecca Evans: I think this is something that I will have to give
some further consideration to as to what might be possible and
practical in terms of what could be achieved beyond legislation,
but also if there would be a need to introduce this as part of the
Bill. So, perhaps we could have a more detailed discussion as to
what precisely would be required under the Bill or, I suppose, more
importantly, what the outcomes are that need to be achieved and how
we go about doing them. So, is it through this piece of legislation
or is it something that we can just take forward in terms of
seeking a more consistent approach across health boards. It might
be that we need to issue guidance to health boards, it might be
that we need to stress this in our regular meetings with the chairs
and chief executives of the health boards and so on as well. There
are always various ways of achieving the same aims, so it’s
about choosing what the most appropriate might be.
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[151]
Angela Burns: Well, we would be—the Welsh Conservatives would
be very grateful if you would actually look at this specific issue,
because it was a recommendation, or a commentary, in his report,
and I do appreciate that there may be the facility under different
pieces of legislation to issue that guidance, but I think one would
have assumed that, if there had been, they might have already
issued that, because he was saying he just can’t get those
data, and that’s why we wonder if the public health Bill
would be a vehicle that we could use, as it’s coming through
and it would affect a huge section of public health.
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[152]
Rebecca Evans: Well, if I may, Chair, I will explore this idea
further and then write to the committee. The committee might want
to provide more information as to your thoughts on this as
well.
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[153]
Dai Lloyd: Diolch yn fawr. Rwy’n mynd i symud ymlaen
at yr adran nesaf. Rydym ni wedi bod yn trafod y cyffredinol, ond
fe awn ni i mewn i fanylder nawr ar wahanol rannau o’r Mesur
yma, a’r rhan gyntaf ydy sôn am dybaco, ac mae Lynne yn
mynd i ofyn y cwestiynau nesaf, ac wedyn efallai Rhun.
|
Dai Lloyd: Thank you very much.
We’ll move on to the next section. We’ve been talking
in generalities, but we’ll go into detail now, into the
various parts of this Bill, and the first part talks about tobacco
and nicotine products, and Lynne is going to ask the next question,
and then perhaps Rhun will come in.
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|
[154]
Lynne Neagle: Thank you, Chair. The Bill seeks to make certain
areas smoke free, such as playgrounds, hospital grounds, school
grounds, but you haven’t chosen to go down the road of
including other areas in the smoke-free list, such as outdoor cafes
et cetera, which would also have an impact on public health. Can
you just explain the rationale as to why you’ve chosen those
particular settings?
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[155] Rebecca Evans: Well, the three particular settings that have been
described in the Bill were identified as priority areas in our
tobacco control action plan for Wales, and these areas have
continued to be highlighted by stakeholders as particular areas of
concern, mostly because of the health message that you have in
hospitals, but also of sending the right message to children and
not making children be surrounded by tobacco and smoking in areas
that are designed for them and so on. But there’s strong
public support for those particular measures. There’s another
reason as well, and that’s because voluntary measures have
been in place in these areas for some time, but we know
there’s been significant difficulty in enforcing these things
on a voluntary basis. So, including these in the Bill will enable
us also to issue guidance and so on afterwards and provide
clarity and consistency, and also provide managers of these
particular facilities with the ability to engage with enforcement
officers to make sure that enforcement does take place as well. We
recognise, though, that there might be further areas that might be
desirable to bring into the scope of the Bill in future, and the
Bill does allow for that. It would require stakeholder engagement
and consultation, and the agreement of the Assembly as well. Again,
I’m open to ideas as to what we could look at in a practical
way in future.
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12:45
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[156] Lynne
Neagle: You referred to enforcement. We know that there have
been difficulties enforcing the ban on smoking with children in the
car, and we also know that, when the previous Bill went through,
environmental health officers were worried about the implications
of enforcing further restrictions on smoking. Can you tell us what
consideration you’ve given to the challenges of enforcing the
Bill, particularly in relation to any resource implications
locally?
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[157] Rebecca
Evans: In terms of the issue of smoking in cars with children,
first of all, this is the same as with other smoking legislation
previously. It’s been the case that a light-touch enforcement
has been undertaken, certainly in the initial stages of it, and
just as was the case with wearing seat belts in cars, for example,
this is really about creating a shift in culture, a shift in
behaviour; so, a cultural change rather than being heavy-handed in
terms of enforcement. We do know, however, that the police forces
and local authorities, as enforcement bodies, have issued warnings
and letters, for example, with regard to smoking in cars with
children, and it’s something that officials, I know, continue
to monitor regularly.
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[158] In terms of
enforcing this provision and the other provisions in the Bill as
well, we’re really keen to make sure that we’re only
asking local authorities to do what they’re able to do within
the resources that they have. Parts of the Bill will allow local
authorities to have an income stream, in terms of licensing and so
on, where they’re able to charge for the application in order
to cover those costs and also to charge people who are licensed as
well, and that will give a further income stream to help them
enforce as well. So, we’re really keen not to create a Bill
that is overly burdensome on local authorities and would be a
barrier to effective enforcement of it.
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[159] Lynne
Neagle: One final question on smoking—further provisions
to restrict smoking in vehicles is included. Can you give us your
thoughts on that and under what kind of circumstances you would be
looking to introduce that?
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[160] Rebecca
Evans: This part of the Bill—sorry, these provisions are
in the Bill because it’s restating what’s already in
existing legislation, and I might ask Sue to give you some of the
details in terms of what that means in practice.
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[161] Ms
Bowker: Currently, we have the restrictions on smoking in
vehicles that are workplaces or that carry passengers, and we have
restrictions on smoking in cars carrying children, as you said.
Those regulations were made under the Health Act, so because
we’re restating the Health Act, we have to go back to those
regulations and look at them all over again. So, that’s why
it’s there: to allow us to do that.
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[162] Lynne
Neagle: So, it’s not your intention to further extend
that then at this stage.
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[163] Ms
Bowker: No.
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[164] Lynne
Neagle: Thank you.
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[165]
Dai Lloyd: Rhun, a oedd gyda ti gwestiynau yn fan
hyn?
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Dai Lloyd: Rhun, did you have questions
here?
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[166]
Rhun ap
Iorwerth: Buaswn i’n licio gofyn cwestiwn, efallai dau, ar y
bwriad i wahardd ysmygu ar dir ysbytai. Mi wnaf i ddweud ar y
dechrau fy mod i’n cytuno efo’r egwyddor. Mae’n
gas gen i weld pobl yn nrws ysbytai yn ysmygu ac ati, ac o bob man,
mi ddylai ysbyty fod yn rhywle sy’n cael ei weld fel bod yn
ddi-fwg, ond mae o’n gonsýrn gen i ar ambell i lefel. Un, nid oes
gan bobl ddim dewis i fynd i rywle arall pan maen nhw mewn ysbyty,
a hefyd mi fydd pobl mewn ysbyty, p’un ai’n gleifion
neu yn ymwelwyr, mewn sefyllfa o fwy o straen, o bosib, nag mewn
unrhyw ran arall o’u bywydau. Mae yna ddwy ffordd rydw i wedi
meddwl amdanyn nhw ymlaen. Un, y gellid caniatáu neu hyd yn
oed annog e-ysmygu fel ffordd o gwmpas hyn, ond rydw i’n
ymwybodol, o bosib, ein bod ni ddim eisiau dod ag elfennau o
e-ysmygu i mewn i’r Bil y tro yma. Y ffordd arall o’i
wneud, o bosib, fyddai mynnu bod ysmygu allan o olwg y cyhoedd ar
dir ysbyty, gan gydnabod bod yna sefyllfa unigryw mewn ysbyty. A
fyddwn i’n gallu cael eich ymateb chi i hynny a’ch
syniadaeth chi ynglŷn â hyn?
|
Rhun ap Iorwerth: I’d like to ask
a question, perhaps two, on the intention to ban smoking on
hospital grounds. I will say at the outset that I agree with the
principle. I dislike seeing people smoking outside of a hospital
and at a hospital door—a hospital of all places should be
somewhere that should be seen as smoke free, but I do have a few
concerns. Firstly, people don’t have any
choice—they’re not able to go elsewhere when
they’re in hospital, and that’s people, patients or
visitors, when they are perhaps under greater pressure or strain
than at any other time in their life. There are two ways ahead that
I’ve thought about on these things. First, perhaps we could
permit or even encourage e-smoking as a way around this, but I am
aware that we might want to avoid bringing e-cigarettes and such
issues into the Bill this time around. Another possible thing that
we could do would be to state that smoking outside of the
public’s view on hospital grounds would be okay,
acknowledging the unique circumstances in hospitals. Could I have
your response to those suggestions and your ideas about this
issue?
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[167]
Rebecca Evans: Thank you. I know you’ve had a particular
interest in this part of the challenge of addressing smoking, and
the idea of having vaping rooms in hospitals we’ve previously
discussed, as well. Hospital managers are already able to designate
rooms in which e-cigarettes would be able to be used, because the
Bill restricts smoking in public places and workplaces, but it
doesn’t restrict the use of e-cigarettes. So, hospital
managers can already do this if they want to.
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[168]
Rhun ap Iorwerth:
But they’re also able to completely
ban vaping, which has been done in ABMU, I think. Am I
right?
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[169]
Angela Burns: Yes.
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[170]
Rebecca Evans: But the point would be, for us to have anything in
the public health Bill, it would have to demonstrate the public
health benefits of doing it. On the public health benefits of
e-cigarettes themselves, I think the jury is out, to say the least,
on this at the moment. If anything, I think the evidence is
weighing in the direction of caution at the very least, but perhaps
that e-cigarettes are not necessarily a healthy choice.
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[171]
Rhun ap Iorwerth:
We don’t know that, but as I said,
I recognise why we wouldn’t want, perhaps, to seek to put
e-cigarettes in any form in this Bill this time round. But the
second half of the question is that you have people who
aren’t able to make choices about where they are; that they
are at a hospital, whether visiting or as a patient, at a very
stressful time in their lives, and it may actually not be good for
their health or their mental state if they were to be forced at
that time to come off nicotine. The second suggestion I made there
was to have designated—totally out of the view of the
public—smoking places allocated in hospital
grounds.
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[172]
Ms Williams: The Bill does already allow hospital managers to
designate areas in the grounds where smoking is permitted.
That’s already covered by the Bill.
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[173] Rhun ap Iorwerth: Okay, and that is clear
in the Bill—within hospital grounds.
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[174]
Ms Williams: Section 8.
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[175]
Rebecca Evans: Is that what you were going to say?
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[176]
Ms Bowker: Yes. There would be regulation-making powers under
which we can specify those conditions. We could consider, as
you’re saying, that those areas where smoking is allowed are
out of view of the general public.
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[177]
Rhun ap Iorwerth:
But it’s up to the health boards,
of course.
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[178]
Ms Bowker: Yes.
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[179]
Rhun ap Iorwerth:
And that’s the problem.
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[180]
Dai Lloyd: Ocê, symudwn ymlaen at y mater nesaf,
a’r gofrestr o’r sawl sy’n gwerthu tybaco.
Mae’r cwestiynau hyn o dan law Caroline Jones.
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Dai Lloyd: Okay, we’ll move on to
the next issue, and that’s the register of retailers of
tobacco products. Caroline Jones.
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[181] Caroline
Jones: We all agree it’s of paramount importance that we
protect people under the age of 18 from obtaining nicotine and
cigarettes illegally. But can you tell me how retailers being
placed on a register will help reduce underage sales, and how will
this measurement be monitored? How will it be measured and
monitored, this register?
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[182]
Rebecca Evans: Well, the creation of the register of retailers
restates, really, the importance of ensuring that under-18s
don’t have access to tobacco and nicotine products. The
creation of the register will give local authorities for the first
time a full picture as to which retailers are selling nicotine
products. They don’t have that information at the moment.
This will help them in their enforcement duties, because they know
where these retailers are, but it will also help them in supporting
retailers as well, in terms of giving them information and advice
to prevent them being in a position where they’re selling to
under-18s.
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[183]
Caroline Jones:
Okay. I had noticed that there is a
£30 suggested fee for registering, to cover admin fees. Could
you tell me how this has been decided? Are we penalising very
responsible traders and retailers for the actions of those who
continually break the rules, and so on? The registration in
Scotland is free. So, can you tell me how, again, this register is
going to be measured?
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[184] Rebecca Evans: Well, consultation responses to the public health
White Paper that we had—I was about to say that there was a
divergence in views as to whether or not we should be charging a
fee for retailers to register. So, they were split between those
who thought that retailers should be charged in order to ensure
full cost recovery for the register and those who thought that
retailers shouldn’t be charged anything at all. But,
following the consultation, the fee structure was reviewed and the
requirement to re-register with the payment of re-registration fees
was removed from the proposals as a result of that
consultation—so, listening to a very similar argument to the
one that you’re making in terms of being fair to
retailers.
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[185] We’re not
putting the fee structure on the face of the Bill. They’ll be
set through regulations and, obviously, we will consult on those
regulations, including the level of the fee as well before those
regulations are laid. The application fee, though, will be
calculated to cover only the administration costs, and that keeps
us within the recent Hemming judgment, as well, which we discussed
at the recent legislation committee.
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[186] Caroline
Jones: Is that a one-off charge, then, or is it annual
charge?
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[187]
Rebecca Evans: It’s a one-off charge, and that covers both
nicotine devices and tobacco.
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[188]
Caroline Jones:
Thank you.
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[189]
Dai
Lloyd: Diolch, Caroline. Symudwn ymlaen i’r adran nesaf, hefyd
efo tybaco, ac mae Jayne yn mynd i ofyn y cwestiynau
hyn.
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Dai
Lloyd: Thank you, Caroline. We
move on to the next section, which is also on tobacco, and Jayne
will ask the questions for us.
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[190]
Jayne Bryant: Thank you, Chair. The Bill aims to reduce the risk of
young people under 18 accessing nicotine products through the
internet and phone sales, for example. How will this part of the
Bill be enforced?
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[191]
Rebecca Evans: Local authority enforcement officers will need to
undertake test purchasing, and perhaps Sue might like to say a
little bit more about the practicalities of that as well.
Enforcement officers will use the intelligence that they also
gather to select which retailers to test, as they do with current
tests, for example, with alcohol—it’s based on those
retailers who they believe pose a particular risk in terms of
potential sales to young people. They’ll also be able to use
the retail register to identify retailers who offer remote sales
and delivery of tobacco and nicotine products. Again, that’s
access to information that local authorities don’t have
access to at the moment.
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[192]
Ms Bowker: We have examples of test purchases where a vacant
house, for instance, is taken and orders are made to that house
with a young person who has agreed to do the test purchasing. So,
we have examples of that already having happened, so that’s
how we would envisage this being measured if there were complaints
and we needed to follow that up.
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[193]
Jayne Bryant: Okay, so it puts the onus on the individual who is
handing over the product. Will there be extra support or training,
for example, for perhaps supermarket delivery people?
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[194]
Rebecca Evans: An offence is only committed if the tobacco is
knowingly handed over by the delivery driver to a person who is
under 18. Supermarkets should already be really familiar with these
kinds of offences anyway and with age verification processes,
because they should have similar processes in place already to deal
with sales of alcohol. For example, when a delivery driver delivers
an order containing alcohol, whether that alcohol is visible or not
to the driver, there’s a legal requirement under the
Licensing Act 2003 and statutory guidance under that Act requiring
them to verify the age of the person they’re handing the
delivery to. So, delivery drivers themselves are already very aware
of the need for age verification before handing over age-restricted
products.
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[195]
Part of the guidance that we will issue
following the Bill will be highlighting the importance to
supermarkets and other retailers of alerting their drivers if any
of their deliveries contain tobacco or nicotine products, and there
are various ways in which they can do this. For example, in handing
over age-restricted products at the moment, some supermarkets put a
note at the top of the receipt for the driver, and so on. So, there
are various different ways in which supermarkets could make sure
that they are supporting their drivers to act within the
law.
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[196]
Jayne Bryant: Thank you. Just a last question: how will the impact
of this part of the Bill be measured?
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[197]
Rebecca Evans: We’ve heard about the role that trading
standards will play in terms of monitoring complaints and the
intelligence gathered in terms of handing over cigarettes or
nicotine products to people under the age of 18. This will be
continually monitored and tracked over time, so that we’ll be
able to be aware of any trends. These provisions, of course, will
work as a package in terms of the revised tobacco products
directive, the regulations on the sale of nicotine products, proxy
purchasing of nicotine and tobacco products and the standardised
packaging that we have as well. So, all of these things together
will seek to stop young people taking up smoking.
So, it’s a package of
measures.
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13:00
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[198]
Ultimately, how will we know if
it’s working as a package? Well, if we see the number of
people smoking falling over time. We’ve got the aim of 16 per
cent by 2020. Young people at the moment are smoking less and less,
and fewer young people are taking it up, which is really to be
welcomed. Levels are lower now than they have been since records
started.
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[199]
Jane Bryant:
Brilliant. Thank you.
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[200]
Dai
Lloyd: Diolch, Jayne. Symudwn ymlaen nawr i’r darn yna
o’r Mesur sydd yn ymdrin â thriniaethau arbenigol, fel
aciwbigo a thatŵio. Ac mae’r cyfres o gwestiynau nesaf o
dan ofal Angela.
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Dai Lloyd: Thank you, Jayne.
We’ll move on to the part of the Bill that deals with special
procedures, such as tattooing and acupuncture. And the next series
of questions is from Angela.
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[201] Angela
Burns: Thank you, Chair. Good afternoon, Minister. I was very
interested to see that on the Bill you’ve identified
tattooing, piercing, acupuncture and electrolysis as key
body—not modifications—procedures, that you would like
to have banned. And I don’t disagree with that for the age
group that you’re talking about. What I would like to just
explore is why you feel that body modification should not be part
of that. I noted that the previous time the public health Bill came
for scrutiny, the then Minister stated that greater exploration of
associated risks or harms was needed before considering adding them
to the legislation. But, if I just take one example, I would have
thought that piercing a tongue would be a type of risk, but then
cutting that tongue to provide
a—tongue-splitting—sorry, I’m not up with the
jargon on this—would be an even worse process, and could have
even greater harm. So, I’d just like your view on why those
kinds of things aren’t involved in this as well.
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[202] Rebecca
Evans: Well, the four processes that have been introduced in
the Bill at this time—so, tattooing, piercing, electrolysis
and acupuncture—were chosen particularly because they pose a
harm to human health if not performed in a hygienic manner, but
also because they are currently regulated by local authorities.
These are things that local authorities are familiar with, so
they’ll be able to hit the ground running in terms of this
new rule. And the Bill does replace what has been an outdated
registration system that only required a one-off registration for a
fee, whereas this modernised system will give us greater surety in
terms of the standards and so on. But, the previous Minister did
signify his intention to consult early in terms of adding other
procedures to the list of special procedures covered by the Bill,
and I would be happy to keep that commitment.
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[203]
A working group has already been
established to consider other potential additions to the list of
special procedures, and the scope of that includes body
modifications—so, tongue-splitting and other similar
procedures, Botox injections, dermal fillers, colonic irrigation,
and wet cupping—so we’ll be engaging at the earliest
opportunity in terms of exploring whether these things should be
added to the list. The object of the earliest consultation will be
to gather and assess information on these procedures and their
prevalence in Wales, to thoroughly explore the legal and ethical
questions that could arise in terms of deciding whether to make
them licensable by way of affirmative regulations in the
future.
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[204] Angela
Burns: Thank you for that. I must admit that when I came to
this Bill, I was really surprised to see, for example, acupuncture
included, because I had always assumed that it was a kind of
quasi-medical process and that it had its own set of regulations,
like many other healthcare professions who have their own
regulations and their own body that ensures that standards are
applied et cetera. How do you think this Bill will be able to go
and deal with the underground, the people who are never going to
get licences and who go and do tattooing down the back streets, and
on people who are inebriated and are doing it for a laugh, and wake
up the next morning and think ‘Oh my goodness, what have I
done?’? I just wondered how useful you think this Bill will
be in trying to capture, or prevent that from happening.
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[205] Rebecca
Evans: Before I address that, can I ask Chris to say a little
something in response to the comments on acupuncture particularly,
and the discussions we’ve had with the industry?
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[206] Mr
Brereton: We’ve had several discussions with the British
Acupuncture Council, who represent acupuncturists, and there is an
ability in the Bill to exempt certain organisations, and the BAC
may well be one of those, because they’ve received
accreditation. So, there’s a way of doing that. But,
you’re quite right in saying that, in theory, anyone could
set up as an acupuncturist tomorrow, and what this Bill does is say
‘You can’t do that unless you’re competent and
meet the relevant criteria.’ For those organisations that are
trained and professional and then meet those professional standards
and achieve those accreditations, there is the ability to exempt
them. [Interruption.]
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[207] Angela
Burns: I do hope that’s not me. If so, I will eat the
humblest pie I can possibly find. It’s not me. Phew.
[Laughter.]
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[208] Dai
Lloyd: Carry on with your—
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[209] Rebecca
Evans: Shall I just say something about illegal tattooists and
piercers?
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[210] Angela
Burns: Yes.
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[211] Rebecca
Evans: The aim, really, is for this legislation to make it even
more difficult than ever for people to be operating outside the law
because this Bill will make sure that people who are operating
legitimately have a licence. They’ll be able to display that
licence. If they don’t have a licence to display,
they’ll be operating outside the law. It will be that simple.
So, in that sense, we’re rewarding good tattooists and good
piercers who offer their services in a hygienic environment and are
able to support their customers with appropriate advice and so on
before they leave. But also, it will be easier then for customers
to spot those people who are operating in a way that doesn’t
have those hygienic sureties and so on provided by the
legislation.
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[212] Angela
Burns: Of course, this obviously would be a question of law,
and we all know that the police are busy doing what I call
‘big crime’, if you like. So, what we’re going to
have to do is rely here upon council officials, local standards,
trading officers, the local Health and Safety Executive. Do you
feel confident that we have enough human resource within our local
government to be able to enforce another set of regulations? That
almost applies not just to this but also to the tobacco licensing
et cetera. Do you think we’re at that place yet?
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[213] Mr
Brereton: Minister, perhaps I could respond. As the Minister
said, the four procedures currently on the face of the Bill are
regulated by local authorities, but the system of regulation is
under what I think is outdated legislation—back to 1982. If
you were to set up as an acupuncturist, a body piercer or a
tattooist, you’d pay a one-off registration for life, and
that registration is as of right. You would be granted it, unless
you’d previously been convicted under that legislation. So,
that doesn’t provide much resource for local authorities
currently. Now, all of those current practitioners will have to be
re-licensed and their premises approved under a new system, which
will attract a continued cycle of funding. That funding will
provide the capacity for local authorities to work with those
regulations to ensure compliance.
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[214] In relation to
the problem of the underground tattooists and piercers you
mentioned—illegal activity—at the moment it’s
quite hard for local authorities. They have to gather the evidence,
go to a magistrate, and convince the magistrate that this activity
is happening and that there is a serious risk to public health
before a Part 2A Order is granted under the Public Health (Control
of Disease) Act 1984. They have to use that and go to the premises,
whereas this provides a much more streamlined way of designating an
individual, bringing them within the licensing regime and stopping
that behaviour at a much faster pace than before. So, I think it
will actually assist local authorities who do have a greater
capacity as a result of the infrastructure of a cycle of funding,
due to the new licensing system being put in place.
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[215] Angela
Burns: Thank you. I take on board that point. I think
it’s a point very well made. My final sort of area that
I’d just like to talk about briefly, Minister, would be your
view on the right age for prohibition of some of these activities.
For example, I understand now that you cannot get a tattoo, or you
shouldn’t be able to get a tattoo legally if you are under 18
years of age, but I think that your intent is to look at 16 for
some of these areas. I know we’ve talked before about child
protection and about ensuring that, actually, it’s not just
the child who’s protected but also the practitioner, because,
of course, they could be vulnerable. So, I just wanted to hear your
views on whether all of the age limits should be 18 rather than
having a two-tier system.
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[216] Rebecca
Evans: Well, we have put 16 as the age for intimate piercing
because we feel that it strikes a balance, really, between the
human rights of children and young people to decide what to do with
their own bodies, but also the safeguarding of those children and
young people as well. We feel that it fits as well with the kind of
other decisions that people are able to make at the age of 16. I
know this was subject to quite some discussion in the previous
Assembly. So, we’ve kept 16 for intimate piercings for that
reason.
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|
[217] Angela
Burns: Could you just explain to me, perhaps, the difference
between an intimate piercing, which I understood could be a stud
through a belly button and somebody going to have a tattoo on their
bottom, which is more intimate, and therefore exposes both the
young child—or the young individual, young person—and
the practitioner?
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[218] Mr
Brereton: The belly button wouldn’t be intimate within
the definition of the Bill, but a young person under the age of 18
wouldn’t be able to have a tattoo at all. A young person
under the age of 16 wouldn’t be able to have an intimate
piercing. They could have another piercing—between 16 and 18
they can have other piercings as well.
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[219] Angela
Burns: But that was my point—so we’re saying that
you can’t have a tattoo, and you can have a tattoo in any
part of your body, because we want to protect you until
you’re 18, but we’re actually saying you can go and
have another procedure that could be even more invasive and even
more intimate but we’re only going to protect you up to 16.
So, I just don’t quite see the illogicality of that
position.
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[220] Ms
Williams: It’s mainly for historical reasons because the
age of 18 for tattooing is set out in the Tattooing of Minors Act,
which dates from the 1960s, so I think you have to look at that as
a product of its time. The age of 16 for intimate piercing was
arrived at after detailed consideration of the human rights
implications, as the Minister has already said. I think any
disparity in the age, which you’ve drawn out, can be
explained by reference to the fact that the Tattooing of Minors Act
is a relatively old piece of legislation.
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[221] Angela
Burns: Right. Thank you.
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[222] Dai
Lloyd: Huw.
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|
[223] Huw
Irranca-Davies: Thank you, Chair. Just a point of clarification
following up on Angela’s point about the interplay with
organisations such as whatever the governing authority is for
acupuncturists and so on. Is it the design and intention of this
Bill that if there was an authoritative, reputable organisation
within a particular area, that that would, in effect, allow them to
be recognised as a bona fide premises that could deliver this?
Would the very membership of such an organisation allow them to be
a registerable organisation here—a licensed organisation?
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[224] Mr
Brereton: The Bill provides that—. There are a number of
exemptions on the face of the Bill and exemptions for organisations
could be created by regulations, but the governing thing would be
that that organisation, the voluntary registry if you like, is
accredited by someone like the Professional Standards Authority for
health and social care. That’s where people like the
acupuncture council are already accredited by that organisation and
therefore would be allowed to be exempt by way of regulations. So,
there is the ability to do it, but they have to show they have
adequate safeguards in place and that those safeguards have been
accredited and are monitored under a system of robust
regulation.
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[225] Dai
Lloyd: Trown ymlaen i’r
adran nesaf o’r Mesur ac asesiadau iechyd—health
impact assessments—ac mae gan Rhun gwestiwn am
hyn.
|
Dai Lloyd: We’ll move on to the
next part and this is health impact assessments. Rhun has a
question here.
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[226] Rhun
ap Iorwerth: Diolch. Yn sicr,
rwy’n meddwl bod yna gefnogaeth—cafodd cefnogaeth ei
dangos gan y pwyllgor iechyd diwethaf i roi sylfaen statudol i
asesiadau effaith iechyd, ond atgoffwch ni o’r dystiolaeth a
berswadiodd y Llywodraeth bod yna le i ddeddfu yn fan hyn i wneud
asesiadau o’r fath yn statudol yn hytrach na’r drefn
bresennol.
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Rhun ap Iorwerth: Thank you. Certainly,
I think that the previous health committee showed its support for
providing a statutory basis for health impact assessments, but
remind us of the evidence that persuaded the Government that there
was room to legislate here in order to make such assessments
statutory rather than adopting the current system.
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[227] Rebecca
Evans: Well, you’re right, it was the work of the
previous committee’s scrutiny and the evidence and
campaigning by organisations such as BMA Cymru and others that led
to the adoption of this particular part of the Bill. The benefits
of health impact assessments I think are well recognised
internationally. I point you to the World Health Organization, for
example, which has noted a number of benefits for them including
their role in improving health but also reducing health
inequalities and promoting co-operation across sectors as well and
across communities. They also say that health impact assessments
can provide high-quality evidence to policy makes in terms of
helping policy makers take good decisions as well. So, the World
Health Organization certainly said that by—it has recognised
the value of them in terms of allowing policy makers to make good
evidence-based decisions.
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[228] Rhun ap
Iorwerth: Would you expect that over time there would be an
increase in the numbers of health impact assessments that were
taking place? I think currently there’s not an intention to
have an explosion even after legislating.
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13:15
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[229] Rebecca
Evans: They already take place across Wales in various
different situations at the moment. What this Bill does is, again,
help improve clarity and consistency of approach across Wales.
It’ll also complement the well-being of future generations
Act as well, because it will help public bodies use health impact
assessments to demonstrate how they are making a contribution to
the healthier Wales well-being goals.
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[230] Rhun ap
Iorwerth: What about financial implications? Clearly, the more
HIAs that are done, the more public money, in some way, perhaps,
will have to go towards conducting them. What sort of assessment
has been made of the value-for-money element of the
post-legislation set-up compared with now?
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[231] Rebecca
Evans: For this part of the Bill, as all other parts of the
Bill, the regulatory impact assessment looks at the necessity for
legislation, as opposed to other options to achieve the same goal.
The estimated costs and benefits of a legislative approach in
comparison to a non-legislative approach in the RIA demonstrate
that the legislative approach is a cost-effective way in which to
take this forward. It says that it will achieve benefits without
incurring significant additional costs.
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[232] Rhun ap
Iorwerth: Okay, thank you. Diolch.
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[233]
Dai Lloyd: Os gallaf i jest sôn ar gefn hynny, mae yna
bryder allan yn fanna, wrth gwrs, am yr holl fater o lygredd yr
awyr rŷm ni i gyd yn ei anadlu. Rwyf i wedi gweld nifer o bobl yn ddiweddar
sy’n pryderu ynglŷn â hynny. Sut fuasai
hynny’n ffitio i mewn i’r Mesur yma? A oes unrhyw
fwriad o dan unrhyw un o’r asesiadau iechyd yma i edrych ar
sut mae llygredd yn digwydd o ganlyniad i beth bynnag sy’n
cael ei ddatblygu yn ein trefi a’n pentrefi ni?
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Dai Lloyd: If I could just mention on
the back of that, there is some concern out there on this whole
issue of air pollution—it’s the air that we all
breathe, of course. I’ve seen a number of people recently who
are concerned about that. How could this fit into this Bill? Is
there any intention under any of these health impact assessments to
look at how air pollution happens as a result of anything
that’s developed in our towns and villages?
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[234] Rebecca
Evans: Well, there’s already work being undertaken
elsewhere in Welsh Government on the issue of air quality. The
Cabinet Secretary for Environment and Rural Affairs is currently
consulting on changes to the way in which local authorities and
other public bodies manage the effects of air pollution. So, that
consultation relates to the changes in Welsh Government about the
local air-quality management regime, so that very much fits in with
what you’re talking about today.
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[235] I think
it’s important that the public health Bill doesn’t cut
across other work that the Welsh Government is doing, so in that
sense I wouldn’t want to pre-empt anything that came out of
the consultation with regard to air quality. I know that the
National Institute for Health and Care Excellence, today, have
launched a consultation on this particular issue as well, so
we’ll be watching closely in terms of what that NICE
consultation determines.
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[236]
Dai Lloyd: Diolch yn fawr. Mae’r adran nesaf o
gwestiynau ar wasanaethau fferyllol, ac mae hynny o dan law
Lynne.
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Dai Lloyd: Thank you very much. The
next section deals with pharmaceutical services, and Lynne’s
going to lead on that.
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[237] Lynne
Neagle: Thank you, Chair. We know that there’ve been
difficulties expanding the additional pharmaceutical services that
are offered. Can you just tell us how you feel that the Bill will
address those challenges and make sure that community pharmacies
are actually able to meet the needs of the community?
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[238] Rebecca
Evans: I think that it is fair to say there has been
significant progress in recent years in terms of expanding the
services provided by pharmacies. For example, the improved access
to emergency contraception, increased provision of the flu jab, for
example, and increased commissioning by the NHS of smoking
cessation services. So, it is the case that services that are being
provided by pharmacies are improving, but I think that this Bill
recognises that we can certainly do a lot more.
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[239] The Bill will
change the way in which pharmaceutical services are identified as
being necessary locally. The current regime, actually, is 25 years
old, so this brings it very much up to date, and it’s not
looking particularly or singularly at the dispensing of
prescriptions; it’s looking at the wider services that
pharmacies can provide, particularly in response to the
pharmaceutical needs assessment that local health boards will be
able to undertake. So, it is a step change in terms of the status
of community pharmacies within the provision of health services in
Wales, and also an opportunity, I think, to realise the huge
potential of community pharmacies as well.
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[240] Lynne
Neagle: And in relation to the pharmaceutical needs
assessments, how will the Bill ensure that they are applied
consistently throughout all health boards in Wales? And also, how
will we ensure that there isn’t duplication with the other
assessments of well-being that health boards are having to
conduct?
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[241] Rebecca
Evans: Well, Part 6 of the Bill provides Ministers with powers
to make regulations, and that will include the detail regarding how
and when pharmaceutical needs assessments must be undertaken, and
the extent to which an assessment is to take account of other
matters, the preparation of that assessment, and the consultation
that must be carried out in connection with an assessment, as well
as any procedural requirements as well. We will be providing a
standard suggested template for a pharmaceutical needs assessment
in guidance as well in order to support the delivery of this part
of the Bill, and I think that will enable us to deliver a more
consistent approach to pharmaceutical needs assessments across
Wales.
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[242] Lynne
Neagle: And what assessment have you made of the implications
of the Bill on the pharmacy workforce in Wales?
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[243] Rebecca
Evans: The Bill doesn’t have any immediate impact for the
pharmaceutical workforce in terms of the provisions in the Bill.
But the Bill will obviously have an impact on the workforce in
terms of providing increased opportunities for the workforce by
widening the services that pharmacies provide. And, obviously, that
will lead to training opportunities, and the opportunities for
pharmacists to work in the spirit of prudent healthcare, providing
and working at the top end of the talents and skills and knowledge
that they have.
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[244] Lynne
Neagle: Thank you.
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[245]
Dai Lloyd: Reit. A’r adran nesaf ydy toiledau. Felly,
ar y pwynt yna, Caroline.
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Dai Lloyd: Okay. The next section is in
relation to toilets. So, on that point, we’ll turn to
Caroline.
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[246] Caroline
Jones: Diolch, Chair. Could you tell me please how the Bill
will ensure that a consistently robust approach to identifying and
planning for the needs of communities is taken by local authorities
across Wales?
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[247] Rebecca
Evans: Well, similar to my answer to Lynne in terms of
consistency, the Bill will require statutory guidance to be made in
terms of the provision and the assessment of needs for toilets to
be available by users of highways and active travel routes,
significant transport facilities, and sites of particular
significance—cultural, sporting, historic, popular or places
of national interest. So, all of these will be included, and the
guidance will also cover the assessment of needs for toilets
located in premises that are publicly funded, and for promoting
public awareness of toilets available for the public as well. So,
in that sense, we’re setting out clearly a framework that
would be consistent for all local authorities.
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[248] Caroline
Jones: Okay. Also important is how will the Bill ensure that
the specific needs of people with disabilities, and baby changing,
be taken into account, and how will adequate information regarding
location and access be issued to the public.
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[249] Rebecca
Evans: The Bill also puts a duty on local authorities to have
regard to guidance issued by Welsh Ministers, and that guidance
will set out that local authorities should engage users to ensure
the assessment of need accurately reflects the needs of the local
and the visiting population. So, that includes consulting
residents, visitors, and different groups with specific needs, such
as children, older people, people with disabilities, homeless
people, mothers with children, and so on—all different groups
who you would normally expect to have a particular interest in
access to public toilets.
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[250] Caroline
Jones: And how are we engaging with the wider community, for
example, a range of organisations, private entrepreneurs and
businesses, and how will the local authorities’ performances
be measured in this? Because there are people that could provide
toilet facilities that have private businesses, so how can we
engage more with the public to find out what’s around us,
basically, and how we can use it?
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[251] Rebecca
Evans: The statutory guidance will recommend local authorities
consider whether there are opportunities to work with others: so,
working with other local authorities, working with public bodies,
commercial and private entities, when assessing the need for, and
the availability of, toilets in the local area. So, the toilets are
deliberately referred to as ‘toilets for public use’
rather than ‘public toilets’, because ‘public
toilets’ conjures up a very narrow idea of what that might
involve, whereas ‘toilets for public use’ really opens
up the facilities that are already there. And you’re right
that it is about also encouraging users to understand what’s
available as well and to have the confidence—. Again, this is
about a culture change, because I know many people are
uncomfortable about perhaps going into a cafe or a pub, or a
library even, or a public building in order to just use the toilet
without engaging with any of the other things that are going on in
that particular place. So, it is about making the public aware that
actually this is an okay thing to do and it’s encouraged and
it’s welcomed by the people who are offering that
service.
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[252] Caroline
Jones: And, finally, how will the local authorities’
performances be measured on this?
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[253]
Rebecca Evans: Local authorities will be providing a report.
It’s an annual report or—. Can you remind me when the
reports are due?
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[254]
Mr Brereton: There’s a timetable for the production of the
strategies and a review process in it as well so that local
authorities would have to review it within the year following an
election. There will also be an interim review during the progress
of that where they look at what they set out to do, what
they’ve achieved and where the gaps are. It will also be
subject—. Through the guidance, we’ll be encouraging
local authorities to subject their strategies to their own scrutiny
process where they can be held to account. Local authorities will
also have a duty to consult on their strategies and the review of
those strategies with representative persons, people who would be
interested in the strategy, and provide them with access to a copy
of that strategy as well.
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[255]
Caroline Jones:
Thank you.
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[256]
Dai Lloyd: Lynne.
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[257]
Lynne Neagle: Last time round, the issue of public toilets was
quite contentious. Lots of people felt that the Bill should have
gone further in actually ensuring that local authorities had a duty
to provide public toilets. Did you give any consideration to
strengthening the Bill this time round? If not, why not?
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[258]
Rebecca Evans: I think the arguments were well discussed in the
previous Assembly as well. But, again, I’ve referred a few
times throughout the discussion and in the Plenary sessions as well
about the need to give a Bill that’s realistic in terms of
what local authorities are able to deliver and not to make
something that’s so burdensome on them that it’s going
to be very difficult for them to deliver or be financially
impossible for them to deliver, which is why we’re taking
this view about ‘toilets for public use’ rather than
‘public toilets’, which will require a change in
thinking, I think, from users but also from providers as
well.
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[259]
Dai Lloyd: Ar gefn hynny, a allaf i jest gofyn—? Yn
naturiol, mae’r holl fusnes yma o gyfleusterau cyhoeddus yn
allweddol bwysig i rai categorïau o bobl sydd efo gwahanol
glefydau sy’n golygu eu bod nhw angen toiled ar fyrder yn
eithaf aml. Weithiau, mae hyn yn eu hatal nhw rhag gadael y tŷ
yn aml. Felly, beth mae nifer o’r bobl yma yn gofyn
ydy—maen nhw eisiau gwybod yn union le mae’r toiled
agosaf gogyfer defnydd y cyhoedd. Byddai’n help cael bas data
o union leoliad rhain mewn tref, mewn dinas, a gogyfer Cymru i gyd.
Rwyf ar ddeall nad oes y fath fas data ar gael.
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Dai Lloyd: On the back of that, can I
just ask—? Naturally, this whole issue of public facilities
is particularly important to certain people who have various
conditions that mean that they need toilets as a matter of urgency
quite often. Sometimes, that prevents them from leaving the house.
So, what many of these people ask is—they want to know
exactly where the nearest toilet for public use is. It would be
good to have a database of the exact location of these toilets in a
town, in a city, and on an all-Wales basis. I understand that there
is no such database available.
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[260]
A fyddai’n syniad felly, fel
rhan o’r Mesur yma, i dynnu’r holl wybodaeth at ei
gilydd fel ein bod yn gallu dweud wrth bobl lle yn union
mae’r toiled agosaf er eich defnydd pan fyddech chi allan,
fel eich bod chi’n gallu sicrhau bod yna gyfleusterau
cyhoeddus ar agor, ar gael, ac na fydd pobl yn ofni gadael eu
cartrefi wedyn? Mae yna nifer o glefydau sydd yn golygu fod pobl yn
gorfod chwilio am doiled, dywedwch, bob chwarter awr. Y rhan fwyaf
o’r amser, os nad ydy pobl yn gwybod lle maen nhw, nid ydyn
nhw yn gadael y tŷ. Mae hyn yn elfen allweddol bwysig.
Wedyn, os nad oes
casglu’r wybodaeth o le mae’r toiledau yma ar hyn o
bryd, fe fuaswn yn eich annog i gael gafael ar y fath fas data a
gweithio arno fel rhan o’r Mesur yma. Nid wyf yn gwybod a oes
gennych chi ymateb i hynny.
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Would it be an idea therefore, as part of this
Bill, to draw all that information together so that we can inform
people exactly where the closet toilet for public use is, so that
you can ensure that there are public facilities that are open and
available and people won’t be fearful of leaving their homes
then? There are a number of conditions that mean that people have
to seek a toilet every 15 minutes or so. Very often, if people
don’t know where those toilets are, they simply won’t
leave the house. That’s a crucially important element. If we
don’t have that information as to where those toilets are,
then I would encourage you to get hold of that kind of information
and work on it as a database as part of this Bill. I don't know
what your response is to that.
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[261]
Rebecca Evans: Well, the Bill does require local authorities to
publish their local toilet strategies, so they should be available
for the public to consult. The guidance that Welsh Ministers will
set out will say that published strategies should provide for
signposting, dissemination, and publication of information on the
availability of toilets for the public use within its area. Do you
want to add anything?
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[262]
Mr Brereton: We have, during the development of the Bill, looked
at national data bases and toilet apps such as SatLav, the Great
British Toilet Map. There is a growth in that type of mapping and
app development. It’s something we would encourage local
authorities, through the guidance, to engage with to make sure that
those toilets that are being made available as a result of their
strategies and are signposted to in as many accessible forms as
possible.
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13:30
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[263]
Dai Lloyd: Diolch am hynny. A allaf i jest gofyn i
orffen—? Roeddem ni’n cael tystiolaeth oddi wrth
comisiynydd pobl hŷn y bore yma—tystiolaeth fendigedig,
mae’n rhaid i mi ei ddweud—ac un o’r pethau a
oedd yn achosi pryder i’r comisiynydd oedd y syniad yma o
unigrwydd, unigedd—loneliness and isolation, felly.
Mae hynny yn berig bywyd hefyd, ar y fath raddfa hefyd sy’n
gallu lladd yr un nifer o bobl ag ysmygu rhywbeth fel 15
sigarét y dydd. A ydych chi felly yn cytuno y dylid trin
unigrwydd, unigedd, fel mater o iechyd y cyhoedd?
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Dai Lloyd: Thank you for that. Just to
conclude, we received evidence from the older people’s
commissioner this morning—it was wonderful evidence, I must
say—and one of the things that caused the commissioner
concern was this issue of loneliness and isolation. That can be
extremely serious, and can exist at a degree that could kill as
many people as smoking 15 cigarettes a day. So, would you agree
that we should treat loneliness and isolation as an issue of public
health?
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[264]
Rebecca Evans: Yes, I certainly would agree that there are
significant public health implications of loneliness and isolation,
certainly given the evidence that seems to be emerging about it
being as bad for you as smoking and other evidence of that sort.
You’ll be aware that Welsh Government’s committed to
tackling loneliness and isolation. It was a manifesto commitment to
take a refreshed approach to this. We’ll be partly doing that
through our older people’s strategy, but obviously it will
have to be cross cutting, and no doubt will be part of our
‘healthy and active’ approach, as well. But whether or
not there are things that we could do in this Bill in order to
address that would be another question. Certainly, it is something
we are committed to dealing with.
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[265]
Dai Lloyd: Diolch yn fawr. Yn absenoldeb unrhyw gwestiynau
eraill, a allaf i ddatgan felly bod y sesiwn dystiolaeth yma ar
ben? A allaf i ddiolch yn fawr iawn i’r Gweinidog am ei
phresenoldeb, a hefyd am ei thystiolaeth, a hefyd diolch i’r
swyddogion am eu cyfraniad hwythau hefyd?
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Dai Lloyd: Thank you very much. In the
absence of any further questions, may I declare therefore that this
evidence session has come to a close? May I thank the Minister very
much for her attendance and also for her evidence, and also thank
the officials for their contributions?
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[266]
A allaf i ddatgan y bydd trawsgrifiad
o’r cyfarfod yma ar gael i chi i gadarnhau bod y ffeithiau yn
gywir? Ond, gyda hynny o eiriau, a allaf i ddiolch yn fawr i chi
unwaith eto am eich presenoldeb a’ch tystiolaeth? Diolch yn
fawr.
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I declare, therefore, that a transcript of
this meeting will be made available for you to confirm that
it’s factually accurate. With that, may I thank you very much
once again for attending and for your evidence? Thank you.
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