The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
|
Dechreuodd y cyfarfod am 09:30.
The meeting began at 09:30.
|
|
Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
|
|
[1]
Dai Lloyd: Croeso yn ffurfiol i gyfarfod diweddaraf y
Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad
Cenedlaethol Cymru. A gaf i estyn croeso i’n tyst—mwy
am yr Athro Williams yn y foment—a hefyd estyn croeso
i’m cyd-aelodau o’r pwyllgor, gan gyhoeddi y bydd Jayne
Bryant ychydig yn hwyr y bore yma? Rydym ni wedi derbyn ei
hymddiheuriadau hi am hynny. A allaf i egluro yn bellach fod y
cyfarfod yma’n ddwyieithog? Gellir defnyddio clustffonau i
glywed cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar
sianel 1 neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar
sianel 2. A allaf i atgoffa hefyd pobl i ddiffodd eu ffonau symudol
ac unrhyw offer electroneg arall sy’n debygol o ymyrryd
â’r offer darlledu byd eang? A allaf i yn bellach
hysbysu pobl nad ydym ni’n disgwyl tân y bore yma,
felly dylid dilyn cyfarwyddiadau’r tywyswyr os bydd y larwm
yn canu?
|
Dai
Lloyd: Welcome to the latest meeting of the Health,
Social Care and Sport Committee here at the National Assembly for
Wales. Can I please welcome our witness today—more about
Professor Williams in a moment—and can I also welcome my
fellow members of the committee? Jayne Bryant will be a little late
this morning. We have received apologies from her. Can I explain
that the meeting is bilingual? Headphones are available for
simultaneous translation from Welsh to English on channel 1 or for
amplification on channel 2. Can I please remind you to turn your
mobile phones off and any other electronic equipment that may
interfere with the broadcasting equipment? Also, can I let you know
that we’re not expecting a fire alarm? If you do hear the
alarm, please follow the directions of the ushers.
|
|
09:31
|
|
Ymchwiliad i Recriwtio
Meddygol—Sesiwn Dystiolaeth 1—yr Athro Robin
Williams
Inquiry into Medical
Recruitment—Evidence Session 1—Professor Robin
Williams
|
|
[2]
Dai Lloyd: Felly, symudwn ni ymlaen at eitem 2 a’n
ymchwiliad ni i recriwtio meddygol. Dyma’r sesiwn dystiolaeth
gyntaf a’n tyst cyntaf ni ydy’r Athro Robin Williams.
Croeso mawr ichi—awdur, wrth gwrs, ‘Health Professional
Education Investment Report on the Single Set of
Arrangements’. Mae pawb wedi darllen pob manylyn yn drylwyr
iawn. Wrth gwrs, mae gyda ni gyfres o gwestiynau sydd yn mynd i
mewn i fanylder y pwnc—rhyw 15 ohonyn nhw dros yr awr nesaf.
Felly, bydd angen cwestiynu tyn ac efallai atebion tyn, Robin.
Felly, gyda chymaint â hynny o ragymadrodd, a chroeso
i’r Athro Robin Williams, a gaf i ofyn i Rhun
ddechrau’r cwestiynu? Rhun.
|
Dai
Lloyd: So, can we move on, please, to item 2, our
inquiry into medical recruitment? This is the first evidence
session and our first witness is Professor Robin Williams. Welcome
to you—the author, of course of, ‘Health Professional
Education Investment Report on the Single Set of
Arrangements’. Everyone has read every detail of your report.
Of course, we do have a series of questions that look at the detail
of the subject—some 15 questions in all, over the next hour.
So, we will need to be succinct in our questioning and, perhaps, in
the answers as well, if I may say so. So, can I move on now,
please, and welcome Professor Williams? Can Rhun please begin the
questioning?
|
|
[3]
Rhun ap Iorwerth:
Bore da iawn ichi. Croeso atom ni'r
bore yma. Os cawn ni ddechrau’n eithaf cyffredinol a mynd yn
ôl at y dechrau—dechrau eich rhan chi yn hyn—mi
oedd eich gwaith chi’n deillio, wrth gwrs, o adolygiad Evans,
ond beth oedd eich dealltwriaeth chi ar y dechrau yna o’r
themâu a’r cwestiynau yr oedd disgwyl ichi fynd
i’r afael â nhw?
|
Rhun ap Iorwerth: Good morning and welcome. If we could start quite
generally and go back to the beginning—the beginning of your
part in all of this—your work stemmed, of course, from the
Evans review, but what was your understanding during that initial
period of the themes and questions that you were expected to
address?
|
|
[4]
Yr Athro Williams:
Diolch yn fawr. Yr adroddiad Evans
ydy’r canllawiau go iawn, ac mae’r adroddiad yna yn un
drylwyr, yn ofalus ac mae wedi gwneud ei waith cartref yn hynod o
dda. Un o’r argymhellion oedd bod y Llywodraeth yn—y
gair ydy ‘refresh’ eu strategaeth; rydw i wedi
clywed geiriau eraill—a hefyd y dylai fod yna ryw fath o
gorff a fyddai’n edrych ar y gweithlu yn y dyfodol ac yn
comisiynu, oherwydd yr hyn sydd o’u blaenau nhw. Ar hyn o
bryd, rydw i’n meddwl bod y comisiynu yn dibynnu mwy ar beth
sydd wedi digwydd yn y gorffennol nag ar yr hyn sydd yn
angenrheidiol. So, mi ddylai fod y comisiynu wedi’i wreiddio
mewn tystiolaeth yn fwy na hanes.
|
Professor Williams: Thank you very much. The Evans report would be the
guidelines, and that report is very detailed, carefully considered,
and his homework was done excellently. One of the recommendations
was that the Government should ‘refresh’ their
strategy—I’ve heard other words used—but also
that there should be some kind of body that would look at the
workforce required in the future and also would commission training
guided by future needs. At present, the commissioning work depends
more on what has happened in the past, rather than what is
required. So, the commissioning work should be based on evidence of
need and not historical figures.
|
|
[5]
Dyna oedd y dechrau. Wedyn fy meibl i
oedd adroddiad Evans ac roeddwn i’n edrych ar y rhan fach yna
o’r posibilrwydd o gorff hyd braich—arm’s
length—i edrych ar yr holl agweddau yna.
|
That was the
starting point. Then my bible was the Evans review, and I was
looking at that particular part of the report on the possibility of
having an arm’s-length body to look at all those
aspects.
|
|
[6]
Rhun ap Iorwerth:
Mi wnawn ni drafod manylion y
casgliad y daethoch chi iddo fo, ond, os caf i rŵan neidio i
ben draw eich gwaith chi, mi wnaethoch chi argymhelliad ynglŷn
â’r corff newydd roeddech chi yn ystyried y
byddai’n ateb gofynion yr argymhelliad a gafodd ei wneud yn
adroddiad Evans. Yr ymateb, wedyn, i’r casgliad a ddaethoch
chi iddo—a oedd hwnnw’n cyd-fynd â’r ymateb
cyffredinol a ddaeth yn sgil adroddiad Evans am yr angen am yr un
corff?
|
Rhun ap
Iorwerth: We’ll discuss
the details of the conclusion that you reached later, but, if I
could jump to the other end of your work, you made a recommendation
regarding the new body that you considered would meet the
requirements of the recommendation made in the Evans review. The
response, then, to your conclusion—did that correspond to the
general response that came from the Evans review on the need for a
single body?
|
|
[7]
Yr Athro Williams:
Diddorol. Roedd yna gonsyltio ar
ôl adroddiad Evans ac mi oedd yna nifer anferth o
atebion—ffeil y seis yna. Gwnes i ddarllen y rheini bob un,
ac roedden nhw’n mynd o un pegwn, mewn gwirionedd, i’r
llall, fel byddech chi’n disgwyl—lot o bobl yn hollol
gefnogol, ac eraill ddim mor
gefnogol; rhai reit yn erbyn, a dweud y gwir. Wedyn, un o’r
jobs a oedd gen i i’w wneud oedd trio cael consensws,
trio cael un model y byddai pawb yn ei gefnogi ac yn ein galluogi
ni i symud ymlaen. Wedyn, un o’r pethau pwysicaf i’w
wneud, mae’n debyg, oedd siarad efo cymaint o bobl â
phosibl, ac mae’n rhaid i mi ddweud yr oedd yn anferth o
bleser gwneud hynny, achos roedden nhw i gyd eisiau dweud eu barn,
ac roedden nhw’n gwerthfawrogi cael y cyfle i fynd
trwy’r hyn yr oedden nhw yn ei feddwl efo fi.
|
Professor
Williams: Interesting
question. There was consultation following the Evans report, and
there were very many answers—a huge file of responses was
received. I read them all, and opinions basically went from one
extreme to the other, as you might expect—many people were
very supportive, and others not quite as supportive, and
some quite strongly against the idea. One of the jobs I had was to
try to get to some sort of consensus on the matter, and have one
model that everyone would support that would then enable us to move
forward. The most important thing, perhaps, to do was to talk to as
many people as possible, and I must say it was a great pleasure to
do so, because they were all very keen to give their opinions and
they very much appreciated the opportunity to discuss the issues
with me.
|
|
[8]
Yn y diwedd, cawsom ni bawb at ei
gilydd i drio cael consensws a phawb tu ôl i’r model,
a’r teimlad roeddwn i’n ei gael yr adeg honno oedd bod
pawb rŵan yn gefnogol ac yn barod i fynd. Roedd llawer iawn yn
dweud, ‘Os gwnewch chi plîs symud yn fwy cyflym, achos
mae’r amser yn mynd’. Ond rydw i’n gobeithio ein
bod ni wedi cael pawb, mwy neu lai, i’w gefnogi. Nid
yw’n 100 y cant, ond rwyf i’n meddwl ar y cyfan bod yna
gefnogaeth, a chonsensws, go dda.
|
In the end, we got everybody together to try
and reach a consensus, and get everyone to support the model, and
the feeling I had at that time was that everyone is by now
supportive and ready to move on with this. Many people said,
‘Please can you move more quickly on this, because time is
passing by?’ But I do hope that we have, more or less, got
everybody’s support. It’s not 100 per cent, but I think
on the whole we have consensus.
|
|
[9]
Rhun ap
Iorwerth: Diolch.
|
Rhun ap
Iorwerth: Thank
you.
|
|
[10]
Dai Lloyd: Symud rŵan i statws cyfredol eich adolygiad
chi, a hefyd casgliadau eich adolygiad chi, mae gyda Caroline Jones
gwestiynau ar hyn.
|
Dai Lloyd: Moving now to the current
status of your review, and also to the conclusions of your review,
Caroline Jones has questions on this.
|
|
[11]
Caroline Jones: Diolch, Chair. Could you tell me the current
status of the review in terms of formal agreement, and the
implementation of the proposals against the timescales suggested in
the report?
|
|
[12]
Professor Williams: One of the issues was what kind of body
there should be formally. I think what I did, and the panel that
helped me—and I must pay tribute to them, because, as I said
in the introduction, I’m a novice in NHS matters, so I needed
a lot of help—. But what we did was to come up, first of all,
with what kind of body is needed. Once we’d done that, then
we looked at what kind of structure is in place for that to happen.
By far the most suitable in our view was a special health
authority, because that can be established without primary
legislation, if I’m right—you’ll know a lot more
about this than I do. So, that was the reason for doing it that
way. As I understand it, this can be done by the Welsh Ministers,
and, in terms of the target date, I think April 2018 was the date
in the report, perhaps with something in shadow form 12 months
earlier than that. I think the current situation is that there is
now a project director. There’s a system in place to look at
the various components of setting this up, and it’s quite
complex because you can’t do some things until you’ve
done other things. So, I would be hopeful that it would be in place
and fully operational by April 2018.
|
|
[13]
Caroline Jones: Okay. Thank you very much. I’ll ask
you a couple of questions now. Can you tell me what the key
conclusions are of the report, and the suggested areas for
prioritising, and how they’re going to be—different
parts of—and, in different parts of the UK, looking across at
the health education teaching in a positive and negative way for
the workforce planning, could you tell me please is there anything
that has been learnt from this and the increased emphasis on
multidisciplinary teams?
|
|
[14]
Professor Williams: Thank you very much for that. So, let me
start with the main part. I’m a physicist, so I tend to put
things in order, but it starts with: we’re all ageing. The
health needs are changing. The health service is so good—we
have all kinds of things now—we’re living longer and
longer and we have multiple issues. So, the question is: 15 years
down the line, what kind of healthcare need will there be? Is the
workforce that exists now, the pattern of that, adequate for
what’s coming down the line? Now, the view we took is that,
to judge that—. By the way, the health boards and workforce,
education and development services are very good on the short-term
workforce planning. The first year is good, second year less, third
year—. Now, long-term workforce planning is a difficult thing
to do. You can’t be accurate. But, for sure, you can be more
accurate if you have experts looking at it—if you have people
who know what kind of health facilities, treatments and so on are
down the road. So, that’s where it starts. Then, of course,
that needs to feed back into the training of the workforce, bearing
in mind that, for doctors, it takes a long time before the training
is complete. For some others, unlike health [Correction: medicine],
it’s shorter, so they can respond a lot more quickly. So,
that’s the main consideration.
|
|
[15]
Now, part of the problem, I think, in Wales is this. There is a
group called the strategic education and development group, which
you will know about, where the participants are involved. There is,
I thought, often a silo mentality—you know, if you are around
the table to defend your own profession, that’s not the best
way of allocating resources and gaining confidence of the whole
community. So, I took the view that this body needs to be
independent, not representing silos. You need experts. You need
them to be independent. I would suggest that the trawl for members
is wider than just Wales. The chairman is crucial, and the chief
executive is crucial. The body would work with—not instruct,
work with—the health authorities and the universities and all
the other stakeholders—the royal colleges, the regulators,
and so on. It is vitally important that the people who deliver have
confidence in that body. If they don’t have confidence, then,
you know—. So, that’s a crucial thing.
|
|
[16]
We looked at Northern Ireland. I won’t say a great deal about
that, because the nurse training is done directly through
university, and there is a body that looks after the doctors.
England—it’s a different situation in England.
It’s so big. Even the smallest, I think, of their local
health authorities is bigger than Wales. So, they had a system
where quite a number of things like workforce planning are done
centrally, but the delivery is done through the local boards. We
had a good look at that, and some of these have worked better than
others. Some have worked quite well, others not. The workforce
planning arrangements—WEDS in Wales—used to make use of
that, but it’s been discontinued, and I’m not sure now
what has replaced it. But that’s a different scene in England
to what it is in Wales.
|
|
[17]
Now, the one that we really liked was Scotland. I went up there and
spent quite a bit of time with them. They took us through the way
that they do things. The interesting thing about Scotland is that
they don’t look at other people. They decide what Scotland
needs and do it. This kind of arrangement, which we suggested in
the report, is what actually works in Scotland and works very well.
They’ve reduced the deaneries from four to one; they’ve
got integrated operations. It’s taken time, and it’s
been difficult. They are aware of the difference between the rural
needs and the urban needs and, in fact, the different urban needs;
Edinburgh and Glasgow are very, very different. They have the
confidence of the delivering bodies—the health boards and so
on—and the confidence of the Government, which is also
vitally important. So, broadly, that’s the model we’ve
gone for here—not altogether, because they don’t
actually do the workforce planning through the Scottish body;
that’s done separately. But, other than that, the functions
are quite similar.
|
|
[18]
Caroline Jones: Thank you very much.
|
|
[19]
Julie Morgan: Can I just ask on that?
|
|
[20]
Dai Lloyd: Julie.
|
|
[21]
Julie Morgan: How long ago did the Scottish model start
working; and have we got any results that have been researched and
quantified?
|
|
09:45
|
|
[22]
Professor Williams: Don’t take my word for this, but I
think it is something like—is it 10 years? It’s that
kind of scale. And, yes, there is evidence now that, for example,
they’ve been able to do major changes in the area of
dentistry—again, don’t ask me for the details, my
memory isn’t that good—and also I understand that they
are training more doctors now in Scotland than they need, which is
a change in the situation from when they started. But everybody I
talked to said they had confidence that this body was doing a
really good job.
|
|
[23]
Julie Morgan: Thank
you.
|
|
[24]
Dai Lloyd: Ymhellach at hynny, cyn inni symud ymlaen, a
allaf i ofyn: mae yna rai pobl wedi dweud wrthym ni fod yna
wendidau yn y ffordd y mae’r ddeoniaeth, y Wales Deanery, yn
gweithio ar hyn o bryd yn nhermau bod Cymru’n cael ei chyfrif
fel un lle mawr ac wedyn bod anhawster denu meddygon ifanc yn
ôl i mewn i Gymru, yn enwedig pan maen nhw’n gyplau
sydd wedi priodi ac ati, rhag ofn bod un yn diweddu lan ym
Mangor—gyda phob parch—a’r llall yn
Nghaerdydd—eto gyda phob parch. Wrth gwrs, y system flaenorol
oedd eich bod yn gallu gwarantu y buasai’r ddau efo’i
gilydd yng Nghaerdydd, neu o leiaf yn y de, neu’r ddau
efo’i gilydd yn y gogledd ac ati. A ydy pethau fel yna yn
mynd i ddod i mewn i strwythur y corff newydd yma, fel eich bod
chi’n gallu gwarantu bod newidiadau fel yna’n gallu
cymryd lle?
|
Dai Lloyd: Further to that, before we
move on, can I ask: some people have told us there are weaknesses
in the way the Wales Deanery works at the moment in terms of Wales
being counted as one big location and then there’s a
difficulty in attracting young doctors back to Wales, especially
when they maybe have married in the meantime, or something, in case
they end up with one in Bangor and one Cardiff, which, with all
respect, wouldn’t be very workable. In the previous system,
you could guarantee that the two could be together in Cardiff or in
south Wales, or in north Wales, for example. Are things like that
going to come within the structure of the new body, so that you can
guarantee that those changes can happen?
|
|
[25]
Yr Athro Williams:
Yn sicr. Rydw i wedi clywed hynny dro
ar ôl tro am y ddeoniaeth. Mae ganddyn nhw swydd anodd, anodd
iawn i’w wneud, oherwydd ar yr un llaw mae cyrff iechyd
eisiau gweithwyr ac, ar y llaw arall, mae angen rhoi’r addysg
iawn i’r myfyrwyr. Ond, yn union, rwy’n meddwl bod yna
gyfle i fod yn llawer mwy innovative—nid wy’n
gwybod beth ydy’r gair Cymraeg—ac edrych ar ddulliau
eraill o sut i ddelio gyda’r broblem yna.
|
Professor Williams: Certainly.
I’ve heard that time after time about the deanery. They have
a very difficult job to do, because on the one hand, there are the
health bodies who need workers and then, on the other, there is a
need to provide the right education for students. But, exactly, I
think there’s an opportunity to be much more
innovative—I don’t know the Welsh word—and look
at other methods of how to deal with that problem.
|
|
[26]
Dai Lloyd: Bendigedig. Dawn.
|
Dai Lloyd: Excellent. Dawn.
|
|
[27]
Dawn Bowden: Thank you, Chair. Again, I was really
interested to hear your comments about the strategic education and
delivery group. I used to be a member of SEDG, and you’re
absolutely spot on, in terms of the competitive nature of that
organisation, between different organisations representing
different professions. And I think one of the things that you
alluded to was the that there was very much a vying process and a
competition between the different professions for how many training
places they would get for each—
|
|
[28]
Professor Williams: And the hierarchy.
|
|
[29]
Dawn Bowden: And the hierarchy. And so there was a lot of
tension between the medical commissioning arrangements and the
allied professionals and support staff commissioning arrangements.
Now, under your proposals, you’re going to be bringing these
two bodies together. How do you think you—? What do you think
are going to be the key challenges in overcoming not only the
competition between the different professions, but between the
medics and everybody else?
|
|
[30]
Professor Williams: It’s vital. I think you’re
absolutely right about these issues, so that’s why it’s
so important to bring them together. But just to bring two groups
together and let them operate as they are now, you might as well
not bother. It’s got to be a proper integration, and
there’s got to be a rethinking of the roles. Now, putting
them together in one building is absolutely crucial, and what they
told us in Scotland was: have an open plan place, where they have
to have cups of coffee together. A lot of it is to do with that.
Now, that’s where the chair and the chief executive of this
are so vitally important, because if you get that right at the
beginning—and it will be a challenge and will take some
time—I think it’ll work, but if you’re moving
towards more inter-profession working, which I think is
what’s inevitably going to happen, then those barriers really
need to be, not broken down, but bridged for them to be
effective.
|
|
[31]
Dawn Bowden: So, have you got any thoughts
about—following on from that, really—about how this new
body really is going to engage with all of the—? How can they
successfully engage with the stakeholders, really?
|
|
[32]
Professor Williams: It’s crucial that the chief
executive of this body sits with the other chief executives of the
health boards in Wales, so that the workforce issues and
commissioning and training is there right from the beginning, so
that the chief executive can listen to the needs of the health
board, the way they’re thinking for the future, and can
respond early. The same for the chairman—I think he needs to
be around the same table as the chairs of the health
authorities.
|
|
[33]
So, the interface between this board and the health authorities is
crucial, and needs to be well defined. We were told that very
clearly in Scotland and in England, so that would be one of the
first challenges. Then the body needs to work with, again, the
education providers. I suggested here that when they hold meetings,
they go around—we do that with the higher education funding
council and it work very well—to listen to what
people’s needs are, both from the health boards and from the
educational providers, for example Bangor in north Wales and
Glyndŵr. Then there’s a need to interact with all the
royal colleges and the regulators and so on, and that’s
something that will have to be done, I guess, on a one-to-one
basis.
|
|
[34]
Dawn Bowden: Interesting.
|
|
[35]
Professor Williams: Yes, it’s a challenge.
|
|
[36]
Dawn Bowden: Okay, thank you, Chair.
|
|
[37]
Dai Lloyd: Julie.
|
|
[38]
Julie Morgan: Just following that up, from what you’ve said,
the relationship between the different bodies seems to be
absolutely key, whether that’s from an open-plan office to
the structures that you’re proposing. Do you think anything
more is needed in order to make that working together
happen?
|
|
[39]
Professor Williams: It’s difficult for me to say, but
it will be the duty of the body itself to look at those issues. If
they’re able to appoint the right people, I’m sure they
will look at how things are operating elsewhere and what are the
key things that need to be introduced in order to ensure that.
I’m sure they would want to look at the Scottish system, and
they’d want to look at the successful local area boards in
England, for example. I’d be a bit out of my depth if I were
to go into that too seriously.
|
|
[40]
Julie Morgan: So, you saw your role as the structure,
setting it up—
|
|
[41]
Professor Williams: I think the structure would be right in
order to come up with the solutions.
|
|
[42]
Julie Morgan: Thank you.
|
|
[43]
Dai Lloyd: Dawn, did you want to come back now?
|
|
[44]
Dawn Bowden: Yes, thank you, Chair. You may not be able to answer
this, actually, just because, as you say, this wasn’t really
your remit, but I’m just wondering how you would see the role
of the new body in developing workforce planning, which is going to
be crucial to what we eventually end up with. What do you see the
role of the new body in that?
|
|
[45]
Professor Williams: I think the workforce planning needs to
be well defined to start with. If you’re going on an exercise
of finding out what is needed, you must define, at the beginning,
what it is that you need. Then you need to be able to interrogate
the output of that. The workforce planning that’s done
now—. WEDS produced an excellent document—they do it
very well—but, as far as I can see, there’s nobody
really questioning that and analysing it. What can you really learn
from it that will translate into commissioning? The new body has
got to get on top of that. My suggestion would be—but it
would be for them—that they would probably have a sub-group
that addresses workforce planning issues, and they may wish to
bring in some experts. For example, there are experts in Whitehall
who would be delighted to help, who have been through the middle of
that. There are some very good experts in our universities in
Wales. It would be for the new body to decide how they do things,
but that would be one of the ways that they could function. I would
suspect that the body will have different sub-groups: workforce
planning, perhaps; education commissioning, perhaps; et cetera.
|
|
[46]
Dawn Bowden: Okay, that’s fine. Thank you.
|
|
[47]
Dai Lloyd: Dal ar gynllunio’r gweithlu, mae cwestiwn
gyda Caroline Jones—cwestiwn 10.
|
Dai Lloyd: Still on the topic of
workforce planning, Caroline has a question—question 10.
|
|
[48]
Caroline Jones: Diolch, Chair. Regarding workforce planning
again, could you tell me: are you confident that the information
and skills were available to support the workforce planning work,
and are there gaps that need to be addressed, and what are the
gaps?
|
|
[49]
Professor Williams: I’m confident that the structure
could be put together with the right expertise, whether it would be
on the board itself or a sub-committee. They would be expert to a
certain degree, but it may be that they need to look at who the
best people are to advise in order to do this, and how you get the
information and what substructures you need for that.
|
|
[50]
Caroline Jones: Okay, thank you.
|
|
[51]
Dai Lloyd: Mae’r cwestiwn nesaf o dan law Julie
Morgan—cwestiwn 11.
|
Dai Lloyd: The next question is from
Julie Morgan—question 11.
|
|
[52]
Julie Morgan: Thank you very much. Could you talk some more
about how you think the new body will impact on the deanery?
|
|
[53]
Professor Williams: As I said, the deanery has a very
difficult job to do, and I saw some of the challenges they had when
I talked to them. And there are a lot of things they do very well.
But you probably know that the deanery is actually part of Cardiff
University. There’s nothing wrong with that—Cardiff has
been a very good host for them—but I think it’s the
only one left in the UK that’s not in the NHS. And if things
went awry, who actually carries the can? And it is the chairman of
the council, I guess, of Cardiff University, and the chief
executive. Now, it should be in the NHS, I would think.
|
|
[54]
And then, in the deanery, whether they could be more innovative by
being part of a body that involves more professions and so
on—maybe it’s not for me to say, but that’s the
feeling I had when I was—
|
|
[55]
Julie Morgan: But its focus was too narrow in terms of the
professions.
|
|
[56]
Professor Williams: Yes. I think what they do, they do very
well, but there’s a lot more, I think, that could be done by
a larger body of the kind that I mention here. My feeling is that
if they co-located and if they’re talking all the
time—if the communication within is good—that that will
come because they’re excellent people and they’re doing
their very best. The General Medical Council have great faith in
them. So, that’s what I think—co-location, I think,
will lead to a lot of the kind of things that you might be looking
for.
|
|
[57]
Julie Morgan: Yes, and, obviously, there’s a huge
range of medical specialties—primary care all the different
types of medical specialties—and, of course, there’s
community care, which is so important. So, we really need all those
areas to have at least equal consideration, as well as the hospital
care. So, what are your comments about that?
|
|
[58]
Professor Williams: My thinking is that’s exactly why
I’m proposing this body be a body of experts, so they can
talk—
|
|
[59]
Julie Morgan: Will it include people who are expert in all those
fields?
|
|
[60]
Professor Williams:
No, but they will include people who
understand what is required in those fields and who to go and talk
to—you know, where to get advice from.
|
|
[61]
Julie Morgan: So, is that linking back to what you said in the
beginning that you didn’t want people who were professionals
from the field because that would mean they would fight their own
corner?
|
|
[62]
Professor Williams:
Not in silos, but you do want people who
have an awareness, I think, of—. But, you know, this is peer
interaction. You really need experts to talk to experts. It’s
very difficult for, I guess, people like us to question the experts
when they are giving advice, whereas other impartial experts can do
that very effectively. So, I think that’s a way. And also, in
terms of looking more broadly at the deanery’s involvement,
the body would be in a good position to do that, if you can get the
right people.
|
|
[63]
Julie Morgan: You’ve said quite a lot about the right people
in the right places, and I think that’s—.
|
|
[64]
Professor Williams:
Absolutely, yes.
|
|
[65]
Julie Morgan: Then, the other issue I wanted to cover was trying to
reach out to Welsh schools and to make pupils aware of the
opportunities that there are, and to try to sell the professions
that there are. Have you got any views on that?
|
|
10:00
|
|
[66]
Professor Williams: I’d better answer in terms of the
report I’ve written, rather than in terms of my personal
views.
|
|
[67]
Julie Morgan: Yes. What can the new body do?
|
|
[68]
Professor Williams: It can look at those issues.
|
|
[69]
Julie Morgan: And would you see it as something that it
should look at?
|
|
[70]
Professor Williams: Absolutely. It’s got to look at
the pipeline, I think, of health-related people coming through,
right from the schools. And there’s a lot that can be done at
that level—at every level, in fact. I would have thought that
would be one of the tasks of the new body.
|
|
[71]
Julie Morgan: Because one of my impressions from the schools
when I go round is that many people don’t aspire to the
medical profession and some people see it as something that’s
not for them, or it requires too much academic knowledge. So, I
think there are quite a lot of barriers and a lot of work to be
done in that area. So, would you see this body as having this as
one of the priorities?
|
|
[72]
Professor Williams: Absolutely. Particularly so in rural
areas, I suspect. I’ve seen some figures from the Welsh
schools, which, you know—there’s quite a bit that can
be done there. But, I think this would be a very important part of
the work. It’s interesting that Scotland seem to be producing
the numbers they need, if not more.
|
|
[73]
Julie Morgan: And are Scotland producing the home-grown
numbers?
|
|
[74]
Professor Williams: That’s right. Yes, largely. So,
yes, a lot to be done. And then there’s issues of retention
and all that, which you are so familiar with, which I
couldn’t comment on. But the new body, I hope, would be in a
position to do that, because I’m sure one of the tasks it
would be given would be how do you increase the numbers, how do you
encourage retention and all the rest of it.
|
|
[75]
Dai Lloyd: Ar y pwynt yna, cyn symud ymlaen, Julie, mae gan
Rhun gwestiwn.
|
Dai Lloyd: On that point, before you
move on, Julie, Rhun has a question.
|
|
[76]
Rhun ap Iorwerth:
Jest eisiau rhoi senario bach ichi
oeddwn i, a meddwl sut fyddai ymyrraeth y corff newydd yma yn
dylanwadu ar y senario yma. Senario sydd wedi cael ei dynnu
i’m sylw yr wythnos yma ydi o. Mae’n stori rwyf
wedi’i chlywed llawer iawn yn rhy aml: bachgen 17 oed o
Gaernarfon, canlyniadau TGAU rhagorol, rhagolygon ei fod o’n
mynd i gael lefel A ardderchog, yn gwneud cais i goleg meddygol
Caerdydd i fynd yn feddyg—mae o eisiau gweithio yn y Gymru
Gymraeg fel meddyg—mae o’n cael llythyr yn dweud nad
ydy o’n cael cyfweliad. Beth fyddai’r dylanwad gan y
corff newydd yma i drio atal y math yna o sefyllfa?
|
Rhun ap Iorwerth: I just wanted to put
a scenario to you, if I may, and think about how the intervention
of the new body would influence this scenario. It’s something
that’s been brought to my attention this week, and it’s
a story that I’ve heard very many times: a 17-year-old boy
from Caernarfon, fantastic GCSE results, his predicted grades for A
levels were excellent, made an application to the medical school in
Cardiff—wanting to be a doctor and wanting to work in Wales
through the medium of Welsh—and had a letter to say
he’s not having an interview. What sort of influence, now,
could we have under this new body to try and stop this kind of
situation?
|
|
[77]
Yr Athro Williams:
Rwy’n mawr obeithio y
byddai’r corff yma yn edrych ar yr holl agweddau yna. Ar hyn
o bryd, mae’n ddigon posib bod nifer o fyfyrwyr israddedig
sy’n dod i mewn i Gymru—mai’r peth sydd fwyaf
pwysig iddynt ydy league tables y Russell Group. I mi, nid
yw hynny’n iawn, ond barn bersonol ydy hynny, ac mi
ddylai’r corff yma edrych arno: os ydych chi eisiau meddygon
i ardaloedd gwledig, pa fath o bobl sydd eu hangen? Nid lefelau A a
TGAU, o reidrwydd, yw’r peth mwyaf pwysig. Dyna’n union
y math o beth rwy’n meddwl y dylai’r corff edrych arno.
Sut y byddai o’n gallu gwneud gwahaniaeth? Wel, os oes
ganddyn nhw’r arian comisiynu,
mae’n bosib gwneud drwy hynny, achos mae’n bosib cadw
rhan o’r arian i wneud pethau newydd, er
enghraifft.
|
Professor Williams: I really hope that
this body would look at all of those aspects. At the moment,
it’s quite possible that the number of undergraduate students
coming into Wales—that the most important things for them are
the league tables of the Russell Group. To me, that’s not
right, but that’s a personal view, and this body should look
at it: if you want doctors for rural areas, what sort of people are
required? The A levels and GCSEs aren’t necessarily the most
important issue, and this is exactly the sort of thing that the
body should be looking at. How could it make a difference? Well, if
they have the funding for commissioning, it’s possible to do
so through that. Because it’s possible to keep part of that
funding to do new things, for example.
|
|
[78]
Rhun ap Iorwerth:
Y sefyllfa ddelfrydol fyddai pe bai
pob person yng Nghymru sydd eisiau astudio meddygaeth yng Nghymru
yn gallu gwneud hynny, neu o leiaf yn cael y cyfle.
|
Rhun ap Iorwerth: Well, an ideal
situation, of course, would be that every person in Wales who
wishes to study medicine in Wales can do so, or at least have the
opportunity to.
|
|
[79]
Yr Athro Williams:
Ac nid yn unig yn israddedig, ond
post-grad. Mae yna nifer o rai ardderchog o Gymru a
fyddai’n gallu dod yn ôl a dechrau cyrsiau byrrach,
efallai, ac a fyddai’n gallu gweithio dros Gymru ac yn y
gorllewin gwledig.
|
Professor Williams: And not only on
undergraduate level, but also post-grad. There are a number of
excellent students from Wales who could return and do shorter
courses, perhaps, and would be able to work all over Wales,
including west Wales.
|
|
[80]
Rhun ap Iorwerth:
Fy nghasgliad i—ac mae’n
ymddangos bod eich casgliad chi’r un fath—ydy bod y
system addysg feddygol yng Nghymru wedi anghofio, rywsut, mai ei
phrif ddiben ydy darparu ar gyfer gweithlu’r NHS yng Nghymru
mewn blynyddoedd i ddod.
|
Rhun ap Iorwerth: My
conclusion—and I think yours is perhaps the same—is
that the medical education system in Wales has forgotten, somehow,
that maybe its main purpose is to provide the NHS workforce in
Wales in the future.
|
|
[81]
Yr Athro Williams:
Fe wna i ddim rhoi comment,
ond dyna y byddai’r corff newydd yn gallu rhoi ystyriaeth
iddo.
|
Professor Williams: I won’t
comment, but that is what a new body would be able to consider.
|
|
[82]
Dai Lloyd: Julie, wyt ti am gario ymlaen ar y
thema?
|
Dai Lloyd: Julie, are you going to
carry on with this theme?
|
|
[83]
Julie Morgan: That’s the sort of area that I think
it’s very important to look at.
|
|
[84]
Professor Williams: I couldn’t agree more
|
|
[85]
Julie Morgan: I won’t say any more than that.
|
|
[86]
Dai
Lloyd: Mae’n
bwysig dweud pethau felly, Julie.
|
Dai Lloyd: It’s important to say
that, Julie.
|
|
[87]
Julie Morgan: I’ve had lots of examples similar to
Rhun, where very high-qualified students have not been able to get
into Cardiff medical school, and are extremely disappointed, and
have also had these high grades, so it’s very hard to
understand. But I think the reason is that there are just far too
many applying, and because it has got a very good reputation, and,
as you said, because of the Russell Group—and that’s
what people look at—it’s vastly
oversubscribed—and, obviously, from all over the UK and
elsewhere. So, that’s a very important issue. Is that
something that you think should be looked at?
|
|
[88]
Professor Williams: Absolutely. I was told as part of this
review, by some people, that they prefer an all-graduate entry.
|
|
[89]
Julie Morgan: All graduates.
|
|
[90]
Professor Williams: Yes, that medical students come in as
graduates and get trained.
|
|
[91]
Dai Lloyd: Like in Swansea.
|
|
[92]
Professor Williams: I wasn’t going to say that,
but—
|
|
[93]
Dai Lloyd: That’s all right, you didn’t. I said
it. [Laughter.]
|
|
[94]
Professor Williams: Because they’re mature and they
know what they want to do. They’ve decided, and they are much
more likely to stay. I think, if you look at the figures, that that
may be right. So, I think this body would need to look at
undergraduate versus graduate entry, how do those suit Wales, can
you have schemes that bring people back, and how do you bring our
Welsh kids back from over the border—all kinds of things, in
my view, that can be done, and are a very important part of the
duty.
|
|
[95]
Dai Lloyd: Cyn inni symud ymlaen a mynd off y pwynt yma,
wrth gwrs, efo ysgolion meddygol yr Alban, mae nhw’n llwyddo
i gael dros 50 y cant o’u myfyrwyr nhw yn dod o’r
Alban—pob un o’r pump neu chwech ysgol feddygol sydd
gyda nhw. Un sydd gyda ni, wrth gwrs, yn israddedig, yn y fan hyn,
ac un yn Abertawe. Ac, wrth gwrs, efo ysgol feddygol Caerdydd, fel
mae pobl wedi dweud wrthyf, nid ydych yn cael pwyntiau ychwanegol
yn y system gyfweld os ydych chi un ai yn dod o Gymru neu yn gallu
siarad Cymraeg. Hynny yw, nid yw’r sgìl yna
ddim yn cael ei gydnabod, na’r ffaith eich bod chi’n
dod o Gymru. Hynny yw, gallwch chi ddod o unrhyw le. Dyna pam, wrth
gwrs, rwy’n credu bod canran y myfyrwyr meddygol rywle o dan
20 y cant a rhywbeth yn nes i 10 y cant yn ysgol feddygol Caerdydd,
ac yn Abertawe y dyddiau hyn. Felly, byddwn yn licio ein gweld
ni’n dynwared yr Alban, a dweud y gwir, mewn nifer o
ffactorau. Ac, wrth gwrs, mae yna ffyrdd o gynyddu’r canran o
fyfyrwyr o Gymru sy’n astudio meddygaeth, heb orfod tanseilio
unrhyw safonau, achos mae nhw’n llwyddo i’w wneud yn yr
Alban heb orfod delio efo’r ddadl yna. Nid wyf yn gwybod beth
ydych chi’n teimlo am y math yna o beth.
|
Dai Lloyd: Before we move on and go off
this point, with the Scottish medical schools, they succeed in
getting 50 per cent of their students from Scotland—all the
five or six medical schools they have in Scotland. We only have one
undergraduate in Cardiff, and one in Swansea. But with Cardiff
medical school, as people have told me, you don’t have any
additional points in the interview system if you either come from
Wales, or if you can speak Welsh. That skill isn’t
recognised, nor the fact that you come from Wales. You can come
from anywhere. That’s why, of course, I think the percentage
of medical students is somewhere under 20 per cent, and closer to
10 per cent, in Cardiff medical school, and in Swansea these days.
Therefore, I’d like to see us imitating Scotland in a number
of factors, and there is a way of increasing the percentage of
students from Wales who study medicine, without having to undermine
any standards, because they succeed in doing so in Scotland without
having to deal with that argument. I don’t know how you feel
about that.
|
|
[96]
Yr Athro Williams:
Rwy’n cydweld yn union
â’r ddadl, a dyma un o’r pwyntiau a ddaeth i fyny
yn y drafodaeth gyda’r gwahanol royal colleges, yn
enwedig y BMA. Y teimlad yw nad y lefelau A sy’n cael
pwyntiau uchel, o reidrwydd, yw’r pethau ddylai fod ar dop
pob math arall o bethau, fel siarad Cymraeg a gallu gweithio mewn
gwahanol rannau o Gymru.
|
Professor Williams: I do agree exactly
with what you’re saying, and this is one of the points that
came up in the discussion with the royal colleges, especially the
BMA. There is a feeling that the A-levels that have high points are
not necessarily the issues that should be the overriding concern,
and come above everything else such as being able to speak Welsh
and to work in different areas of Wales.
|
|
[97]
Dai
Lloyd: Julie, sori,
roeddwn i wedi amharu ar—
|
Dai Lloyd: Julie, sorry, I
interrupted you—
|
|
[98]
Julie Morgan: Just following on with this theme, I
don’t know whether it’s anecdotal, but it does seem
that a large number of medical students come from families where
the parents have been in the medical schools. And I just wondered,
in your investigations, whether you felt there was anything
operating that meant it was easier for somebody to get into the
medical school who had a—
|
|
[99]
Professor Williams: No. That wasn’t part of the remit
at all. It’s the kind of thing the body should look at.
Bearing in mind now that, if the Diamond review is implemented and
the funding situation is going to change, the body will need to
consider whether those changes can help the situation that we have
in Wales.
|
|
[100] Julie
Morgan: The other issue I wanted to ask you about was female
recruitment, which I believe is—. Often, in medical schools,
for example, going back to medical schools, there is a higher
percentage, maybe, of women. I don’t know if that’s
true.
|
|
[101] Professor
Williams: That’s right, it’s quite high.
|
|
[102]
Julie Morgan: But, in terms of some of the prestige jobs in the
medical profession afterwards, they don’t get them, and in GP
practice, women are very often much more interested in having the
salaried posts rather than taking on the partnership. Is this the
sort of area that is important to look at?
|
|
[103]
Professor Williams:
Again, I’d better not comment on my
personal views, but one thing that did come over very clearly is
that—thankfully, there are more women, certainly, in the
Cardiff medical school than men, and that’s great to
see—the pattern of work of young people is changing. A lot
take time off to travel the world after graduating. A lot now share
jobs because of it being more family friendly and so on. Those are
issues that need to be looked at in detail because, if that’s
the case, then you need to train more. You might say that training
more is going to cost a lot of money, but bear in mind that the
Diamond review now changes that situation. Then, it comes back to
things like SIFT, which I don’t fully understand. But
absolutely; that needs to be looked at. So, not only are the health
needs changing, but the medical workforce also. I’m not sure
it’s as true of the health profession generally, but
certainly in the medical profession it’s changing.
|
|
[104]
Julie Morgan: I also wondered, when you were doing this
work—I don’t know whether you were looking at the
implications of the Brexit vote or whether this didn’t bring
that in. Is that something that this new body is going to have to
look at—the implications?
|
|
[105]
Professor Williams:
It is, yes. The Brexit vote came after I
finished this.
|
|
[106]
Julie Morgan: Yes, I thought it might have.
|
|
[107]
Professor Williams:
However, I have seen
figures—particularly through HEFCW, which is a very important
body from this point of view—and there is an implication,
certainly, that if we lose European students, then that could be
detrimental. Although, the numbers that I saw were significantly
less than the numbers of overseas students from outside
Europe—those numbers are quite high. The numbers from Europe,
I think, are substantially less, but will have an effect and will
need to be considered.
|
|
[108]
Julie Morgan: I think they said today they were down 7 per cent
overall—students from Europe. There was something on the news
today.
|
|
[109]
Professor Williams:
I saw some figures for the home students
today, but I hadn’t realised that the European ones were down
that much.
|
|
[110]
Julie Morgan: I think so. You mentioned HEFCW. Could you say some
more about HEFCW and how its role will operate and how it will work
with the new body in the future?
|
|
[111] Professor Williams: It’s very interesting, the new body, and
it’s one I personally fully approve of. In fact, HEFCW also
put forward that there should be a body of that kind. The further
education and higher education interface is a very interesting one.
It’s blurring. It’s vitally important from the health
point of view, because one of the things I’m sure you are
giving a lot of thought to is social care—the caring side. I
didn’t touch on that because that’s handled largely
through the local authority and FE, but I think the new body
that’s been proposed to replace HEFCW could have a key role
to play. It will need to work, therefore, very closely with the
body that I’m proposing. I think there are great
opportunities for trying to rationalise and make bridging
that boundary more effective.
|
|
10:15
|
|
[112]
Julie Morgan: Thank you.
|
|
[113]
Dai
Lloyd: Dim ond i bwysleisio cyn inni orffen beth oedd Julie
wedi’i ofyn ynglŷn ag ysgolion, a Rhun hefyd, ac,
wrth gwrs, yr angen i gydweithio neu i annog ein hysgolion ni yng
Nghymru i feddwl am iechyd yn y lle cyntaf ac i feddwl am
feddygaeth a nyrsio yn lle jest gadael y peth i fyny i deuluoedd
unigol felly. A hefyd, mae angen rhyw fath o hyfforddiant o ran
cyfweliadau meddygol achos pan mae’n dod i’r
‘crunch’, mae ein pobl ifanc talentog ni weithiau ddim
yn gallu sgleinio cweit yn ddigon hyderus yn y fath amgylchiadau.
Nid mater o a ydy eich rhieni chi’n feddygon ydy’r
peth, ond y ffaith, os ydych chi’n teimlo’n hyderus
eich bod chi’n mynd i fod yn llwyddiant fel person ac fel
meddyg.
|
Dai
Lloyd: Just to emphasise,
before we finish, what Julie has asked about schools, and Rhun
also, and of course the need to collaborate or to encourage our
schools in Wales to think about health in the first place and to
think about medicine and nursing rather than just leaving it to
individual families. And also, we need some kind of training in
terms of medical interviews because when it comes to the crunch,
our talented, young people sometimes can't shine and are not
confident enough in such situations. It doesn’t matter if
your parents are doctors or not; you need to feel confident in
yourself as a person and to feel that you could succeed as a
doctor.
|
|
[114]
Mae ysgolion
bonedd Lloegr yn gallu gwneud hyn a dyna beth maen nhw’n
treulio eu holl amser yn ei wneud, rwy’n credu, ond mae yna
le, buaswn i’n meddwl, i’n hysgolion uwchradd fod yn
rhan o hyn, neu o leiaf fod rhywun yn cyfeirio atyn nhw a bod yna
rhyw fath o strwythur. Buaswn i efallai’n meddwl bod y corff
newydd yma mewn lle arbennig i alluogi hyn ac o leiaf i bobl
ddechrau meddwl am y peth, achos mae’n rhaid derbyn yr
hyfforddiant yna y mae pobl ifanc eraill yr ynysoedd hyn yn ei
dderbyn er mwyn gallu disgleirio yn y cyfweliadau meddygol
yma.
|
Private schools in England
can do this, and I think they spend all of their time doing it, to
be honest, but I think there’s perhaps scope here for our
secondary schools to do something like this, or at least that
somebody can work with them on it to have some sort of structure.
Maybe this new body would be in a very good place to do this, so
that people can start thinking about it, because having that
coaching that other young people in these islands have in order to
shine in these medical interviews is very
important.
|
|
[115]
Yr Athro
Williams: Mae hynny’n hollol wir ac rwy’n meddwl y gall y
corff yma wneud gwahaniaeth cyn belled ag y mae hynny’n y
cwestiwn. Mae’n ddigon posibl y byddai’r pwyllgorau o
dan y bwrdd yma yn gallu delio gyda’r math hwnnw o
broblemau.
|
Professor
Williams: That is absolutely
true and I think this body could make a difference as far as that
is concerned. It’s quite possible that the committees under
the board could deal with those kinds of issues.
|
|
[116]
Dai
Lloyd: Grêt, bendigedig. Rwy’n credu ein bod ni ar ben
â chwestiynau oddi wrth fy nghyd-Aelodau. A allaf i ddiolch
yn fawr iawn i chi, Robin, am eich ymddangosiad a hefyd am yr holl
waith clodwiw sydd wedi mynd gerbron i baratoi’r ffordd,
achos rydym ni wedi bod yn meddwl am yr adolygiad yma ers cryn
dipyn o amser? Roedd yna bryder o sawl ochr ynglŷn â sut
oedd pethau’n gweithio neu ddim yn gweithio, ac yn enwedig
rôl y ddeoniaeth. Felly, rydym ni’n falch i gydnabod
bod yna ffordd amlwg ymlaen yn fan hyn. Felly, diolch yn fawr iawn
i chi am eich gwaith caled iawn yn y maes yna a hefyd am eich
ymddangosiad y bore yma ac am ateb yr holl gwestiynau mewn ffordd
mor raenus ac aeddfed. Diolch yn fawr iawn i chi.
|
Dai
Lloyd: Great, excellent. I
think we’ve come to the end with regard to our questions from
fellow Members. Can I thank you very much, Robin, for your
appearance today and for all the excellent work that has been done
in order to prepare the way here, because we’ve been thinking
about this review for some time? There was some concern from
several quarters about how things were working or not working,
especially the role of the deanery. So, we are very happy to see
that there is a clear way forward here. So, thank you very much for
your very hard work in this area and also for your appearance today
and for answering all our questions in such a polished and mature
manner. Thank you very much.
|
|
[117]
Yr Athro
Williams: Diolch i chi a phob hwyl gyda’r gwaith. Mae’n
amserol dros ben.
|
Professor
Williams: Thank you and good
luck with all the work. It is extremely timely.
|
|
[118]
Dai
Lloyd: Diolch yn fawr. Fe wnawn ni dorri am egwyl breifat rŵan,
gyda’ch caniatâd.
|
Dai
Lloyd: Thank you very much. We
will have a private break now, with your permission.
|
|
Gohiriwyd y cyfarfod rhwng 10:18 a
10:47.
The meeting adjourned between 10:18 and 10:47.
|
|
Ymchwiliad i Recriwtio
Meddygol—Sesiwn Dystiolaeth 2—Panel
Hyfforddeion
Inquiry into Medical Recruitment—Evidence Session
2—Trainee Panel
|
|
[119]
Dai Lloyd: Croeso i chi i gyd. A allaf i alw cyfarfod y
Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon i drefn am yr ail
sesiwn y bore yma? Eitem 3 i’w nodi i fy nghyd-Aelodau ydy
ein bod ni’n parhau efo’n hymchwiliad i recriwtio
meddygol. Hon ydy’r ail sesiwn dystiolaeth, ac o’n
blaenau ni mae panel hyfforddeion—pum meddyg ifanc, addawol
yn amlwg. [Chwerthin.]
|
Dai Lloyd: Welcome to you all. Can I
call the meeting of the Health, Social Care and Sport Committee to
order, please, for the second session this morning? Item 3, to note
to my fellow Members, is that we are continuing with our inquiry
into medical recruitment. This is the second evidence session, and
before us we have a trainee panel—five young doctors who are
very promising, of course. [Laughter.]
|
|
[120]
Nid oes angen poeni am ddim byd, yn
naturiol, yn fan hyn. Mae gennym ni restr o gwestiynau i’w
gofyn i chi dros yr awr nesaf. Nid oes yn rhaid ichi deimlo
rheidrwydd fod yn rhaid i bob un ohonoch chi ateb pob cwestiwn, neu
mi fyddwn ni yma tan yn hwyr yn y nos, ond, os oes rhywbeth wir yn
llosgi ac rydych chi’n teimlo’n danbaid ynglŷn ag
ef, ewch amdani. Ond, nid oes angen teimlo rheidrwydd i ateb pob un
wan jac cwestiwn.
|
You don’t have to worry about anything,
of course. We do have a list of questions that we’d like to
ask you over the next hour. You don’t have to feel that every
one of you has to answer every question or we will be here until
late this evening, but, if there’s anything that you feel
very strongly about, please go for it. But you don’t have to
answer every single question.
|
|
[121]
Felly, byddwn ni’n clywed eich
safbwyntiau chi. Rŷm ni wedi clywed oddi wrth yr Athro Robin
Williams eisoes. Yn naturiol, mewn sesiynau tystiolaeth eraill ar
recriwtio meddygol, mi fyddwn ni’n clywed cyfraniadau gan
arbenigwyr eraill yn y maes. Rŷm ni wedi derbyn un adroddiad
yn fan hyn gan Dr Huw Lloyd Williams, a diolch yn fawr iddo fe. A
gaf i groesawu chi i gyd, felly: Dr Zahid Khan, Dr Huw Lloyd Williams, Dr Abby Parish, Dr
Bethan Roberts a Dr Llion Davies? Fel yr wyf i wedi crybwyll
eisoes, mae gan ein Haelodau ni restr o gwestiynau, felly mi awn
ni’n syth mewn i’w gofyn nhw, gyda’ch
caniatâd. Felly, a gawn ni ddechrau efo Caroline
Jones?
|
So, we’re going to listen to your
opinions. We’ve already heard from Professor Robin Williams.
Of course, in other sessions on medical recruitment, we will be
having contributions from other experts in the field. We have had
one report from Dr Huw Lloyd Williams, and thank you very much for
that. Can I welcome you all here: Dr Zahid Khan, Dr Huw Lloyd
Williams, Dr Abby Parish, Dr Bethan Roberts and Dr Llion Davies? As
I’ve already mentioned, our Members have a list of questions,
so we will make a start on those, with your permission. Can we
begin with Caroline Jones, please?
|
|
[122] Caroline
Jones: Thank you, Chair. Good morning. I wonder whether I could
ask what it was that made you want to train and work in Wales.
|
|
[123]
Dai Lloyd: Nid oes eisiau ichi fod yn swil. Fe ddywedais i
nad oes raid i bawb ateb, ond mae’n rhaid i rywun ateb.
[Chwerthin.]
|
Dai Lloyd: Don’t be shy. I said
that not everyone has to answer, but somebody has to answer.
[Laughter.]
|
|
[124] Dr
Parish: I’ll go first then. I’m from
Bridgend—it didn’t really enter my mind to leave Wales.
It’s not the best sort of answer, but that’s where
I’m from. I did apply to other universities, but I got into
the one I wanted, which was Swansea.
|
|
[125] Caroline
Jones: Thank you.
|
|
[126]
Dr Davies: A ydw i’n gallu siarad Cymraeg?
|
Dr Davies: Is it okay for me to speak
Welsh?
|
|
[127]
Dai Lloyd: Wyt—caria di ymlaen.
|
Dai Lloyd: Yes, of course.
|
|
[128]
Dr Davies: Echo i hynny, really. Rwy’n
dod o Gymru ac roeddwn i am ddod yn ôl i fyw yng Nghaerdydd,
felly dyna beth wnes i.
|
Dr Davies: I can just echo that.
I’m from Wales and I wanted to come back to live in Cardiff,
so that’s what I decided to do.
|
|
[129]
Dai Lloyd: Diolch yn fawr. Jayne, wyt ti eisiau cario
ymlaen efo’r cwestiwn nesaf?
|
Dai Lloyd: Thank you. Jayne, do you
want to carry on with the next question?
|
|
[130] Jayne
Bryant: Brilliant, thank you. So, what was your initial
undergraduate medical education training in Wales like? Two of you
have said that you’re from Wales—what about the rest of
you?
|
|
[131] Dr
Roberts: I can’t actually answer that question because I
trained in England, so—[Inaudible.]
|
|
[132] Jayne
Bryant: Okay. [Laughter.]
|
|
[133] Dr
Roberts: Because Cardiff wouldn’t have me.
|
|
[134] Jayne
Bryant: Ah, yes.
|
|
[135] Angela
Burns: That’s interesting.
|
|
[136] Dr
Roberts: Just to get that in there.
|
|
[137] Dr
Parish: Cardiff didn’t let me in either. I applied to the
Swansea graduate medicine programme, and I applied to Cardiff
undergraduate. Swansea let me in; Cardiff didn’t. So, after
my first two years in Swansea, I joined the fourth year at Cardiff.
I just thought that it was quite funny that they wouldn’t let
me in.
|
|
[138] Dai
Lloyd: I think Angela’s got a burning issue.
|
|
[139] Angela
Burns: It’s just very interesting that you say that
because I’ve had a very bright constituent come to me, with
exactly the same thing—he went to one of these fairs and
Cardiff said, ‘Don’t even bother’, and he’s
just going to Cambridge now. That’s such a shame because
we’re losing our talent, and it does seem to centre around
the Cardiff medical school. So, I’d quite like us to bottom
that out because we don’t want to lose people. We want to try
and encourage as many people into Wales, and I think people do tend
to stick where they train.
|
|
[140] Dr
Roberts: Yes.
|
|
[141] Dr
Parish: Yes.
|
|
[142] Dr
Williams: They definitely do. On my experience at Cardiff
medical school, I started there in 2003. I think the course has
changed an awful lot since then. There’s a new C21
curriculum, which I’m sure you’re aware of. I think
that’s probably changed for the better. It was very good back
then, from my experience, anyway. So, I think it’s definitely
going in the right direction.
|
|
[143] Dai
Lloyd: Anybody else’s experience? Dr Khan?
|
|
[144] Dr Khan:
I haven’t trained over here. Basically, I’m from
Afghanistan, so I can’t basically comment on the
undergraduate training, but, before coming to Wales, I worked in
England for about 18 months. The main reason for coming to Wales
for training was that I had heard from a colleague, basically, that
the Wales training is a bit more supportive in terms of training
than England and Scotland. That was the main reason for which I
came over here, to Wales.
|
|
[145] Dai
Lloyd: Okay. Caroline, do you want to press on with the same
sort of theme?
|
|
[146] Caroline
Jones: If you like. What, do you think, are the most important
factors that influence where you train and where you work, and what
you want to get out of the place where you train and work?
|
|
[147] Dr
Davies: I think the factors change as you change with age. So,
the factors are important. In your 20s, you know, you can work long
hours, and it doesn’t matter that you’re not going to
be home on time, if you haven’t got children to pick up.
It’s very different to when you hit your mid 30s, when you do
have to do those things. So, for me, I graduated in 2004 from
Cardiff. It’s hugely changed in that time. I think that
working somewhere where you are in a supported environment is
probably the most important thing—and career prospects.
|
|
[148] Caroline
Jones: Yes.
|
|
[149]
Dai Lloyd: A oes unrhyw un arall eisiau dweud
rhywbeth?
|
Dai Lloyd: Would anyone else like to
add something?
|
|
[150] Dr
Roberts: Well, I think, if you’re from Wales, you kind of
have an idea of what things are like, but I think the big issue for
us—. I’m the Chair of the Wales Junior Doctors
Committee with the British Medical Association, and it’s the
perception that, for people who are not from Wales, that was a big
deal. People don’t quite understand how things work here, or
they don’t want to understand. There’s a perception
that things aren’t quite as good here. It’s actually
the perception that’s the battle, not the reality.
|
|
[151] Dr
Parish: One of my colleagues is from Cardiff. She’s a
Welsh speaker. She went to an English medical school, and she did
her—. When you finish medical school, you do your F1 and F2,
as I’m sure you know—the foundation year
programme—and then you start applying for some specialities.
So, she did her first two years as a doctor—the F1 and
F2—I think, in London and she actively chose to come home for
her paediatric training, to become a paediatrician. When she told
people that she was coming back to Wales, people had the attitude
of, ‘Oh, didn’t you get in to London?’
That’s what they were saying to her. They genuinely felt
sorry for her even though it was her, actively—. I obviously
think that the training here is great, but that attitude
isn’t across the border.
|
|
[152] Caroline
Jones: It isn’t. That’s unfortunate, because the
training is of a high spec in Cardiff.
|
|
[153] Dr
Williams: I’m not too sure whether you can take training
as an issue that brings people here or keeps people here.
You’ve got to look at a different speciality at a time. I
think training from one speciality to another can be extremely
different, and the experience that you get. And the reputation that
comes from that can be very different too.
|
|
[154] Dr
Parish: Elin is a Welsh speaker, but a lot of people said
things to her, like, ‘Oh, I can’t go and work in Wales;
I don’t speak Welsh’. Some people think you need to
speak Welsh. It’s clearly an advantage, but I don’t
speak Welsh. As a country, I think people are almost discounting
ways, even though the training is good and people might come. She
had a lot of people actively saying things to her, like, ‘Oh,
I can’t go there; I don’t speak Welsh. I wouldn’t
be able to do it’. It’s sad. It’s a really sad
attitude.
|
|
[155] Dr
Williams: There’s a misunderstanding.
|
|
[156] Dr
Parish: Yes, but maybe people don’t want to look for the
information and clarify anything. They just think, ‘Okay,
fine; there are 16 other deaneries. I’ll look at
those’.
|
|
[157] Dr Khan:
I think these points and then beside that—. You are
definitely looking for the working environment, like what sort of
environment you are working in. Then, definitely, another factor is
lifestyle—the work-life balance. You are definitely looking
for work, but you want some social life as well at the same point.
Another important thing that I have noticed is, for example, if you
work in a certain hospital and set-up, you want to look at the
amount of paperwork and the computer software that they use. Some
of them can be really demanding and they really waste a lot of
time, but others are quite feasible and they make life easy for
you.
|
|
[158] Caroline
Jones: You said you did 18 months in London, didn’t
you?
|
|
[159] Dr Khan:
I was in Peterborough.
|
|
[160] Caroline
Jones: Right. So, how does the London environment compare with
Wales then, if I may ask?
|
|
[161] Dr Khan:
If I talk about working environments: I think it’s a bit more
social and more interactive in Wales compared to Peterborough.
There, even on the same ward, we didn’t know each other.
Although we were colleagues, we didn’t know each other, but
here, everybody knows each other. Even if they’re not in our
department, we know each other. Regarding IT, I think the software
in England is a bit more sophisticated and a bit more supportive
than the one we use in Wales. A lot of things in England, in
Peterborough, we used to do online, but here we have to fill in
paperwork and then we send it. Sometimes it goes missing and then
things get difficult for the patient and we have to struggle to get
things sorted.
|
|
[162] Caroline
Jones: Thank you.
|
|
[163]
Dai Lloyd: Rhun, roedd gennyt ti gwestiwn
atodol.
|
Dai Lloyd: Rhun, you had another
question.
|
|
[164]
Rhun ap
Iorwerth: Yn dilyn i fyny ar beth ddywedoch chi, Bethan—rydym yn
ddiolchgar iawn eich bod chi wedi dod yn ôl i Gymru, yn
amlwg—pwy wnaeth ofyn i chi ddod yn ôl? Pwy wnaeth eich
tracio chi i lawr a dweud, ‘Come on, Bethan,
rwy’n gwybod eich bod chi wedi methu â chael i mewn
i’r coleg yng Nghaerdydd, ond rydym eich angen chi yn
ôl yn yr NHS, felly dyma pam ddylech chi ddod yn
ôl’? Rwy’n ‘guess-io’ beth
ydy’r ateb.
|
Rhun ap Iorwerth: Following on from
what you said, Bethan—we’re very grateful that you have come
back to Wales, clearly—who asked you to come back? Who tracked you down
and said, ‘Come on, Bethan, I know you didn’t get into
the college in Cardiff, but we need you back in the NHS, so this is
why you should come back’? I’m guessing the
answer.
|
|
[165]
Dr
Roberts: Ni wnaeth neb ofyn i mi ddod yn ôl.
|
Dr Roberts: Nobody asked me to come
back.
|
|
[166]
Rhun ap
Iorwerth: Diolch yn fawr.
|
Rhun ap Iorwerth: Thank you.
|
|
[167]
Dr
Roberts: Gwnes i raddio yn 2004 ac aros yn Llundain am bum mlynedd cyn
dod yn ôl. Gwnes i psychiatry training yn Llundain a
dyna pam rwy’n ffaelu cymharu gweithio yng Nghymru a gweithio
yn Lloegr achos mae’r training programmes mor wahanol.
Nid oes cymhariaeth. Gwnes i fynd am swydd yn Llundain a chefais
gyfweliad ond chefais i mo’r swydd. Roeddwn yn gwybod na
fyddai swyddi ar ôl ar gyfer yr ail rownd yn Llundain, so
dyna pam des i yn ôl. Gwnes i fynd am yr un swydd, core
medical training, yng Nghymru.
|
Dr Roberts: I graduated in 2004 and
stayed in London for five years before coming back. I did my
psychiatry training in London and that’s why I can’t
compare working in Wales with working in England because the
training programmes are so different. There is no comparison. I
went for a job in London and I had an interview, but I didn’t
get the post. I knew that there wouldn’t be any jobs left in
the second round in London, so that’s why I came back. I went
for the same job, core medical training, in Wales.
|
|
[168]
Rhun ap
Iorwerth: Pe byddech chi wedi cael y swydd, mi fyddech yn gweithio yn
Llundain ar hyn o bryd. A oedd hi’n ddymuniad gennych chi,
serch hynny, i ddod yn ôl i Gymru ac, eto, a oedd y cyfleon
hynny’n cael eu dangos i chi ar unrhyw bwynt fel opsiwn i
ddod yn ôl?
|
Rhun ap Iorwerth: If you had had that
job, you’d be working in London at the moment. Did you want
to come back to Wales, however, and, again, were those
opportunities shown to you at any point as an option to come
back?
|
|
[169]
Dr
Roberts: Na. Gwnes i fyth meddwl y byddwn i’n dod yn ôl, a
dweud y gwir. Byddwn i’n dal i fod yno pe bawn i wedi cael y
swydd, siŵr o fod.
|
Dr Roberts: No. I never thought that I
would come back, to be honest. I would still be there if I’d
had the job, probably.
|
|
[170]
Rhun ap
Iorwerth: Mae hyn yn allweddol: pam na fyddech chi wedi dod yn ôl,
o gofio mai fan hyn yn wreiddiol yr oeddech wedi bwriadu a
gobeithio gallu gwneud eich hyfforddiant?
|
Rhun ap Iorwerth: This is a key issue:
why wouldn’t you have come back, remembering that originally
you had intended and hoped to train here?
|
|
[171]
Dr
Roberts: Roedd e jest achos fy mod wedi sefydlu yna, roedd ffrindiau
gen i yna. Mae teulu gen i yng Nghaerfyrddin ac maen nhw’n
bell i ffwrdd o Lundain, ond roeddwn i’n yn hapus yn byw yna,
roedd digon yn mynd ymlaen ac roeddwn yn mwynhau gwaith. So, wnes i
ddim ‘really’ meddwl am ddod yn ôl.
|
Dr Roberts: It was just because I was
established there, I had friends there. I’ve got family in
Carmarthen, so they’re far from London, but I was happy
living there, there was a lot going on and I enjoyed the work. So,
I didn’t really think about coming back.
|
|
[172]
Rhun ap
Iorwerth: I’r lleill ohonoch chi, faint ohonoch chi sy’n
ymwybodol o fyfyrwyr sy’n dod o Gymru sydd wedi mynd i ffwrdd
i gael hyfforddiant ac sydd un ai wedi dod yn ôl, a beth yw
eu stori nhw, neu heb ddod yn ôl, a beth yw eu stori
nhw?
|
Rhun ap
Iorwerth: For the rest of you,
how many of you are aware of students who come from Wales who have
gone away to be trained and either have come back, and what is
their story, or haven’t come back, and what is their story?
|
|
[173]
Dr
Davies: Rwy’n adnabod llawer sydd wedi mynd dros y blynyddoedd.
Gwnaeth llawer o bobl adael ar ôl y rhaglen modernising
medical careers. Gwnaeth llawer ohonynt fynd i lefydd fel
Awstralia, bryd hynny. Y peth yw, roeddent yng nghanol eu 20au. Nid
oeddent yn mynd i benderfynu mynd am byth, ond wedyn roeddent yn
cwrdd â phobl mas yna ac wedyn yn aros. So gwnaeth grŵp
fyth dod yn ôl o fy cohort i. Wedyn, mae gen i lot o
ffrindiau sydd wedi symud. Roedd tri ohonom yn y tŷ tra
roeddem yn yr ysgol feddygaeth. Mae un nawr yn Oxford ac mae un ar
y south coast ac ni wnaethant ddod yn ôl. Fe wnaethant
symud a chael gwaith ac yna y gwnaethant aros ac wedyn cwrdd
â phobl ac aros.
|
Dr
Davies: I know many who have
gone over the years. Many people left after the modernising medical
careers programme. Many of them went to places such as Australia at
that time. The thing is they were in their mid 20s. They
weren’t deciding to go forever, but then they were meeting
people out there and then staying there. So, a group from my cohort
never came back. Then, I have many friends who’ve moved.
There were three of us in the house when we were in medical school.
One is now in Oxford and another is on the south coast and they
didn’t come back. They moved and had work and stayed there
and met people and stayed.
|
|
[174]
Dr
Roberts: A gaf i jest ddweud nid oedd lot o bobl—? Roedd tua
phump neu chwe pherson o Gymru yn fy mlwyddyn i ac maen nhw i gyd
wedi aros yn Llundain. Daeth un person yn ôl jest dros dro.
Mae e wedi cael swydd ymgynghorydd yn Llundain nawr. Fi yw’r
unig berson sydd wedi dod yn ôl.
|
Dr
Roberts: Can I just say that
there weren’t many people—? There were about five or
six people from Wales in my year and they’ve all stayed in
London. One person came back temporarily. He has had a
consultant’s post in London now. I’m the only one who
has come back.
|
|
[175]
Rhun ap
Iorwerth: Os ydych yn cofio yn ôl i’r flwyddyn gyntaf, faint
o’r rheini oedd yn meddwl, yr adeg yna, y byddai’n dda
mynd yn ôl a gweithio yng Nghymru, tybed?
|
Rhun ap
Iorwerth: If you remember back
to the first year, how many of those were thinking at that point
that it would be good to come back and work in Wales?
|
|
[176]
Dr
Roberts: Nid wyf yn siŵr. Mae’n amser maith yn
ôl.
|
Dr
Roberts: I’m not sure
about that. It’s a long time ago.
|
|
[177]
Dai
Lloyd: Yn dilyn o hynny, mae gan Jayne gwestiwn olaf.
|
Dai
Lloyd: Following on from that,
Jayne has a question.
|
|
[178] Jayne
Bryant: Do you think you’re likely to stay in Wales and
what would make you stay here? Abby’s mentioned, you know,
you didn’t want to leave.
|
|
11:00
|
|
[179] Dr
Parish: But I might have to. I’m a paediatrician, so
I’m a registrar—I’ve been a paediatrician for a
few years now. I want to subspecialise in neonatal medicine, and we
go through an application process, which I’ll be doing in
September this year. It’s a national programme. There are
three jobs in Wales to specialise as a neonatologist each year, and
I know at least five or six people who are applying for it. So
then, if I don’t get it and I want to continue my career,
I’m going to have to move. Wherever you end up moving, you
then make your contacts; you settle in. If you get on with them
then, I can see a lot of people—you basically want to stay
where you are. If I move, then I’ve got two small children,
they’ll be coming with me,
obviously—[Laughter.]
|
|
[180] Jayne
Bryant: I’m glad you clarified that one.
|
|
[181] Dr
Parish: So, I’ll probably take them and maybe my husband,
but he’s going to have to change his job. He’s not a
medic, so he’ll have to get a job somewhere else.
They’ll have to go to a different school. They’re in a
Welsh-speaking school, so they’re going to struggle to go to
an English school anyway—well, one’s only two. So, I
might not be able to stay here. I might have to leave to follow the
career I want, and a lot of people I know who have left—.
I’m on about paediatricians now. It’s because when we
subspecialise, a lot of the speciality jobs are either mixed with
England or you have to go to England. This is a national process;
I’m not going to have any choice. If other people are ranked
higher and they want to come to Wales, then I’m not going to
be able to stay.
|
|
[182] Dr
Williams: I’ve got the exact opposite experience of that,
I think, because in emergency medicine, we’re a very small
community—small in number in Wales and, actually, even though
Wales has a large deanery, the numbers in emergency medicine
training are quite small. There’s a lot of flexibility within
our training scheme, so we’re able to ask for certain things
and, normally, because there’s that small number,
they’ll be able to be very flexible—bend over
backwards, almost—to make sure you are able to do what you
want to do. So, taking it out of programme training, et cetera, is
something that’s very achievable in emergency medicine, I
would say.
|
|
[183] Dr
Parish: It used to be like that with us. If you wanted to
specialise in neonates—. As paediatricians, obviously, we can
specialise in cardiology—there are lots of different things
we can do. For neonatal, there are three tertiary neonatal units in
south Wales, so there are more than an adequate—.
They’re very woefully understaffed, as most of the paediatric
units are, so there are jobs for us. If I went, there’d still
be gaps on every single rota, but, because of this new national
programme for training, it’s out of my hands. I won’t
be able to be a working neonatologist if I don’t do the grid
training, even though I could have exactly the same jobs if I
stayed. But I wouldn’t be able to get a job in a tertiary
unit such as Cardiff, Swansea or Newport.
|
|
[184] Dai
Lloyd: Angela.
|
|
[185] Angela
Burns: Abby, could I just ask you: is the national programme
what the royal college has put together?
|
|
[186] Dr
Parish: Yes, it’s the royal college national
programme.
|
|
[187] Angela
Burns: I just wanted to check. It’s not a deanery-driven
thing, it’s a royal college—
|
|
[188] Dr
Parish: No, it’s the royal college.
|
|
[189]
Dai Lloyd: Mwy ar hyfforddiant nawr. Dawn, rwyt ti’n
arwain ar hyfforddiant ac wedyn cawn ni Julie.
|
Dai Lloyd: More on training now. Dawn,
you are leading on training, and then we’ll have Julie.
|
|
[190] Dawn
Bowden: Yes, thank you. I just want to take you back to the
initial questions about training and, really, about your
experiences of training in Wales, and in particular the kind of
level of support that you’ve received, either from senior
colleagues or from the training bodies themselves. What’s
actually been your experience? So, your experience here and if
you’ve got some comparative experiences with England as well,
that would be helpful to know.
|
|
[191] Dr
Roberts: I’ve worked in two specialties in Wales, so I
did core medical training and then I switched to GP, and I think
the way that the core medical training was set up at the time I was
doing it wasn’t very good. So, you had an odd collection of
jobs that, maybe, didn’t quite set you up to be the medical
registrar who was often the most senior medical person in the
hospital at night—
|
|
[192] Dawn
Bowden: And where was this, sorry?
|
|
[193] Dr
Roberts: It was all across south Wales. I worked at Neath Port
Talbot, Bridgend, Royal Glam and UHW as well. So, I think that
there needs to be a bit more thought about how jobs are put
together and what you produce at the end of that core training,
whereas my experience in GP training then has been the complete
opposite. They took into account my previous experience, I
didn’t have to repeat any jobs that I’d done before and
I got to do 18 months of hospital specialties that I’d never
worked in before. There were very supportive seniors who wanted to
know where we wanted to work, what we’d done before and
planned our programmes in a fairly bespoke way. And that was on the
Gwent scheme. I think most schemes run in a fairly similar way.
|
|
[194] Dawn
Bowden: Okay. At that stage you were working out of the Gwent
area on that.
|
|
[195] Dr
Roberts: Yes.
|
|
[196] Dawn
Bowden: Anybody else?
|
|
[197] Dr
Davies: I’ve worked in two specialties in Wales as well.
I did general surgery for 10 years, and I was very well supported
by people whom I consider to be mentors, and I still keep in touch
with some of them now. And then I did make a career change, and
there was a multifactorial reason behind that—I won’t
go into that, but I did make a career change—and I found the
same again. I’m very well supported by, basically, the
consultants.
|
|
[198] Dawn
Bowden: Okay. Is that the general experience?
|
|
[199] Dr
Williams: I think that the vast majority of the emergency
medicine trainees in Wales find that they’re very well
supported by senior colleagues and also the bodies. I think there
is one issue in emergency medicine with our north Wales trainees.
There are quite a few north Wales trainees and their access to
training is, perhaps, a bit more complicated than for us in south
Wales. So, for instance, if they come for a training day down in
south Wales, it normally would mean taking two study days to come
down to do it. There’s also the cost of coming down.
Therefore, we don’t tend to see our north Wales trainees as
much on our training days.
|
|
[200] Dawn
Bowden: Because that’s not provided in the north?
|
|
[201] Dr
Williams: There is some training provided in the north, but not
as much. We get regular monthly training, where they don’t.
So they’ve had to go over to the Mersey deanery to have their
training done there. I think that’s one of the issues that
our north Wales trainees are finding, but for south
Wales—
|
|
[202] Dawn
Bowden: It’s okay in the south.
|
|
[203] Dr
Williams: Yes, there’s a bit of a difference there. I
think that’s probably the only issue within our speciality,
in terms of training.
|
|
[204] Dr
Parish: Our north Wales trainees go to Mersey for their study
days as well. We’ve tried video-conferencing and other
things, but it just doesn’t work.
|
|
[205] Dr
Williams: It doesn’t work.
|
|
[206] Dawn
Bowden: Not for something like that, no.
|
|
[207] Dr
Williams: The other issue with their study is that the study
budget that they have to be able to come down here is the same as
what we get, but, for instance, they’ve got a lot more
expenses to come down to south Wales. So, they spend a night down
here, et cetera—
|
|
[208] Dawn
Bowden: It eats into their budget much quicker.
|
|
[209] Dr
Williams: Yes, absolutely.
|
|
[210] Dr Khan:
I think that the level of support is more here, in a way, compared
to England. It’s definitely more supportive, and the senior
staff especially are more supportive in terms of training and other
issues in Wales than England. However, there are a few things,
like, for example, the level of teaching or the sessions of
teaching: I think there were a bit more in Peterborough in England,
compared to Wales, but I think that varies from hospital to
hospital. In the previous hospital I worked in in Wales, there was
not much teaching for core medical trainees, but now I’ve
moved to Prince Philip Hospital, the level of teaching is a bit
more. So, we have regular sessions over there.
|
|
[211] And then the
other issues that I’ve noticed is, for example, if I’m
going for some training or if I’m doing an exam, if I need
annual leave or study leave for that time period, it becomes a bit
difficult to get it over here. And the reason being that, in
England, I think, there are more trainees and there are a lot of
non-trainee doctors in England, so they can adjust, somehow, the
rota, but over here, if you want to take some leave, it becomes a
bit difficult because they can’t find someone to fill that
rota.
|
|
[212] Dawn
Bowden: To fill the gaps, yes. So, if I can—
|
|
[213] Dr
Roberts: Sorry, can I just say—?
|
|
[214] Dawn
Bowden: Yes, please.
|
|
[215] Dr
Roberts: I wonder if it’s slightly simplistic to be
comparing England and Wales. I think it’s very specialty
dependent. Having done psychiatry in London, I was very well
supported and it was a very well-organised scheme. So I think the
problem isn’t the comparison between Wales and England, I
think it’s the comparisons between specialities within
Wales.
|
|
[216] Dawn
Bowden: Sure, I understand. That’s a good point. And I
wasn’t really trying to draw direct comparisons between
England and Wales, what I was trying to establish from you is if
you were satisfied that the level of training, the type of training
and the support you get is adequate to do what you do, and I think
you were saying, by and large, it is. So, if I can summarise then:
the training per se doesn’t seem to be a problem, but there
does appear to be a problem from outside Wales with the perception
of what they might get in Wales, and that is a bit of a barrier. Is
that—?
|
|
[217] Dr
Roberts: Sorry, just to disagree with that point, I did have an
issue with my core medical training, because it was so badly put
together. Because of rota gaps, I was doing the work of three
people. So I was on my own, on a ward, as a senior house officer
equivalent.
|
|
[218] Dawn
Bowden: Which specialty was this?
|
|
[219] Dr
Roberts: Well, the specialty itself was gastroenterology, but
it was within a core medical training programme. And I
couldn’t even get off the ward to go and see my educational
supervisor, go to teaching sessions, or anything. So I would say
that training in some specialties isn’t that good.
|
|
[220] Dawn
Bowden: It depends what you—
|
|
[221] Dr
Roberts: Yes, it depends what you do.
|
|
[222] Dr
Williams: It also works the other way around. As people might
not know what training is like in a certain specialty in Wales, I
don’t know what the training is like in Mersey, to be honest
with you. So it works both ways.
|
|
[223] Dawn
Bowden: Sure. I was just interested to hear the comments you
were making about apparent perceptions from outside of Wales as to
what it’s like in Wales, and that might be something we need
to reflect on. Thank you.
|
|
[224]
Dai Lloyd: Julie, a oedd gen ti gwestiwn?
|
Dai Lloyd: Julie, do you have a
question?
|
|
[225] Julie
Morgan: Yes, that was one of the things I was—
|
|
[226] Dawn
Bowden: Sorry, Julie.
|
|
[227] Julie Morgan: No, that’s fine. I was
thinking about the perception that you’ve referred to, and I
wondered if the issue of the rurality of a large amount of Wales
featured in the perception of people who were thinking of whether
to come to Wales or not.
|
|
[228] Dr
Parish: We’re a deanery—there are seven deaneries,
and they’re all a fair size, but we’re a massive
geographical area. So, I think if somebody was going to—. A
lot of people in medical school I remember saying, ‘Oh my
God’—and even I thought it as well, you
know—‘I’m going to stay here but I’m going
to have to go to north Wales for a year and then I’m going to
have to move back.’ I mean, that’s a massive move.
I’m sure I would have enjoyed it, and I would have done it,
but in the back of my mind then I had, ‘If I’m going to
have children, what would I do with them, as it’s uprooting
the whole family?’ Equally, I’m no more special just
because I’ve got children—just because I’ve got
them, why should I stay down more than somebody who has and has to
go up there instead of me? It’s quite difficult, but what
they’ve done—and I don’t think it’s very
well advertised—for paediatrics and, it sounds like, for
emergency medicine, means that I’ll never leave south Wales
now unless I actively ask to go to north Wales. So, I’m
guaranteed to be able to commute from wherever I live, and I think
that’s a big thing and could be advertised a lot better.
|
|
[229]
Julie Morgan: And that’s quite recent, is it?
|
|
[230]
Dr Parish: For paediatrics, it’s maybe three or four years
ago that they changed. So all their tertiary things are going
to—like a tertiary neonatal unit that takes 24-week babies et
cetera—they go to Alder Hey and another hospital up there,
whereas I can go to Cardiff, Swansea or Newport. Well, not Newport
anymore, as they’ve taken us out of there, but, you know,
that, for people to come, in is probably quite a significant thing.
Obviously, I don’t want to divide Wales—we’re one
big nation—but as a geographical deanery, we are massive, and
I think that might put people off if they don’t know that you
can stay in an area. It would put me off, anyway.
|
|
[231]
Dr Williams: I don’t think in emergency medicine
there’s a guarantee that you can say south Wales and south
Wales and north and north, but on the whole, if you ask to be in
south Wales then you probably will get most of your placements in
south Wales, and vice versa; it’s not written down, but
it’s effectively what happens.
|
|
[232]
Dr Roberts: There are some specialties where people have to move
between north and south Wales for the experience, and often it
becomes a problem when people are given two weeks’ notice
that they have to move, and that is a problem that
we—
|
|
[233]
Julie Morgan: Two weeks’ notice?
|
|
[234]
Dr Roberts: Yes. So, people have to wait until their end-of-year
reviews to see what they’ve already done and what they need
to be doing. So, one of my colleagues was potentially having to
move to north Wales at two weeks’ notice.
|
|
[235]
Julie Morgan: And what about family circumstances? Is that taken
into consideration at all in that?
|
|
[236]
Dr Roberts: No.
|
|
[237]
Julie Morgan: So, have any of you experienced this at short
notice?
|
|
[238]
Dr Davies: I’ve experienced going to the ARCP, which is
like the annual review process, and not knowing where I’m
going to be sent. Usually, it’s a bit more notice than two
weeks, but it can be about four to six weeks and I’m coming
home to my wife and my wife’s saying, ‘Well, where are
you going?’ But I do get used to it. I just got to the point
where I accepted that to a point. And then at one point I was told,
‘You need to go to Liverpool for a year, and then
you’ll need to go somewhere else in England for a
year’, and then I come home and my wife said, ‘Well,
you’re not going and that’s that.’
[Laughter.]
|
|
[239]
Julie Morgan: So, you didn’t go.
|
|
[240]
Dr Davies: No, I didn’t. She said, ‘You’re
not’.
|
|
[241]
Dai Lloyd: Angela, you had a point here.
|
|
[242]
Angela Burns: I just wanted to clarify this training. Having read
the responses in your paper, it’s really interesting what
people are putting up as either barriers or pluses or minuses. But
this is your training that would take place in a
hospital—those were, in the main, all of these responses,
rather than people’s views on the training that they would
receive within a medical school.
|
|
[243]
Dr Williams: Those responses there are purely for people on the
emergency medicine specialty training. So, it’s people from
ST1 or CT1—core training 1 or specialty training 1—up
to ST7 or ST6.
|
|
[244]
Angela Burns: So, they’re already in the hospital
environment.
|
|
[245]
Dr Williams: They’re in hospital. And then, normally, you
get notice of being within a group of hospitals for lower training
and for higher training; it’s normally split up.
|
|
[246]
Angela Burns: And because of the geography, is there—? What
would be your views on either—? Can we keep all of our
training in north Wales across our band of hospitals there, or
would it be more feasible for us to look at trying to create
properly integrated training between north Wales and the lower
Merseyside hospitals?
|
|
[247] Dr Williams: I
think it’s probably got to be a multi-angle attack to that,
and so you’re probably going to have to look at trying to
encourage more training locally. You’re probably going to
have to look at creating more links with Merseyside, and
you’re probably going to have to see whether more could be
done to bring our north Wales trainees down to south Wales. I think
it has to be that, because I don’t think there are enough
trainees up there—nor trainers, in terms of that we’ve
got only 64 consultants in our speciality in Wales, and the vast
majority of them are in south Wales. So, those in north Wales who
are interested in training—it’s actually quite low for
it to be provided up there. I think that’s probably
something I can’t answer, but something I think probably our
head of school could answer instead.
|
|
11:15
|
|
[248] Angela
Burns: Would any of you be prepared to give a view on what you
think about the current geographical location of our medical
schools in Wales?
|
|
[249] Dr
Williams: I think if you were to look at the number of
placements—. One of the things that we’ve had problems
with in our new emergency medicine degree is that we had to look to
where we can place the students. You’ve got to bear in mind
that the vast majority of placements would be in south Wales across
the south Wales M4 corridor. So, having a medical school in Swansea
and Cardiff, to me, makes sense. I know there’s the question
about maybe a medical school in north Wales.
|
|
[250] Angela
Burns: I didn’t want to put the words into your mouth,
but I just wondered what you thought.
|
|
[251] Dr
Williams: I think you’ve got to look quite carefully
there at whether or not there’s enough clinical placements
available, because one thing you don’t want to do is to
overload a department or overload a speciality with too many
medical students, because the quality of the teaching would then
reduce, and the quantity as well. But, that’s not to say that
that can’t be done in north Wales, but I think that’s
got to be looked at quite carefully.
|
|
[252] Angela
Burns: But if we were to look at it in conjunction with
building that integrated service with the Merseyside area, would
that work? Or do the medical schools up there already suck
up—
|
|
[253] Dr
Williams: Are you referring to undergrad medical or are you
referring to speciality?
|
|
[254] Angela
Burns: The undergrad.
|
|
[255] Dr
Williams: When I was talking before about Merseyside, that was
just with postgrad, with Merseyside taking some of our trainees
from north Wales. ‘I don’t know’ is the answer
for undergrad. I would be guessing.
|
|
[256] Dr
Roberts: I wonder actually if the issue is looking at how many
Welsh-domiciled students are actually accepted into the existing
medical schools we have. As someone who had to go elsewhere to
train, my form tutor was very angry about this and looked into the
figures. I think the intake was under 20 per cent, that year, of
Welsh-domiciled students. So, if there were to be an extra medical
school in Wales, if it’s not actually attracting
Welsh-domiciled students into it, then it may have no impact on
recruitment, ultimately, in any case. In Scotland, I’m told
that they have a sort of ring-fenced number of places for local
students. I’m not quite sure how that works, but I wonder if
that would be worth looking at.
|
|
[257] Angela
Burns: Funnily enough, because of my constituent, I’ve
already started this hare-chasing, because it does concern me. I
know that, when we talk about these issues in the Chamber, one of
the big pieces of evidence that’s always cited is the fact
that people tend to, because of all the reasons you’ve said,
settle where they train because, by then, you’ve started to
build up your networks. So, if we can keep more of our people who
want to stay in Wales in Wales, then we might have more of a
chance, going forward.
|
|
[258] Dr
Parish: I think that’s the one thing that needs to be
done.
|
|
[259] Dr
Williams: Over the last two years, there’s been roughly
around 60 per cent—from both Cardiff and Swansea graduates
who are then going into F1 positions—that stay within Wales.
That’s the figure that I’ve heard.
|
|
[260] Angela
Burns: About 60 per cent, okay.
|
|
[261] Dr
Williams: Yes, which I thought, personally, was quite
reasonable, if that figure’s right—I’d have to
check.
|
|
[262] Dr
Davies: I wonder whether Swansea would make a natural
experiment for what might happen in Bangor, because I think a few
years ago the degree changed fully to Swansea. It’d be
interesting to know where those students go. Do they go across to
Hywel Dda now, because that’s potentially commutable from
Swansea, a lot of it, or do they still want the bright lights of
Swansea? They may already be settled there because of their
postgraduate course. They may be coming towards the end of their
actual medical student training, already settled, buying houses,
with families, and not in that period of life where you do tend to
want to go elsewhere. That may be an experiment that’s worth
looking at and seeing if that is successful. Potentially, that
could be replicated in Bangor, and supply and demand in those
regions in north Wales as well.
|
|
[263] Dr
Parish: I’m a Swansea graduate. In my first year in
Swansea, there were only 35 students, and then it went up to 70. I
don’t know what it is now, but 70 is probably a manageable
number to have in north Wales without overpowering the universities
there. I did stay—literally, with my first pay check,
that’s when I bought my house, because I was 26. I was a bit
older than all the 23-year-olds in Cardiff that were graduating. My
life was in a slightly different place. It would be interesting to
see where everyone’s settled. A lot of people ended up going
back to where they were before, that’s the only
thing—the people I knew.
|
|
[264] Dr
Williams: Even though I’ve mentioned that 60 per cent
figure, I’m pretty sure that, in 2012 there was—. When
we choose which deanery we’re going to, we don’t just
say, ‘We want to go to this deanery’. We have to rank
the deaneries. Even though that sounds like quite a high percentage
coming into Wales, I think that in 2012 we were twentieth out of
twenty-one deaneries on the ranking list for first choice. So, even
though we might retain a few, it might be that people put it down
as second or third and tend to get it because you get fewer
applicants to Wales, which is a problem.
|
|
[265] Dr
Roberts: Even with foundation training, there’s a huge
drop-off at the end of your second year. So there’s a
compulsory two years after qualification and foundation training,
and we’re now seeing a huge drop-off after F2—that
people then don’t go into specialty training. So you could
finish your foundation training in Wales and then not stay here.
People take career breaks and go off to Australia and do lots of
different things. We’re seeing that, actually, big numbers in
foundation training do not necessarily translate into specialty
training.
|
|
[266] Angela
Burns: Can I just—? It kind of comes onto the career
development, is that all right? I just wanted to pick up on the
point about Hywel Dda and Swansea and stuff. Because, again, some
of the evidence we hear is that for the more rural health
boards—. And you’re talking about this; at least three
of you specialise in particular—you are not generalists, but
are obviously highly trained specialists. People don’t want
to go to the more rural health boards because they don’t
see—. And I only say that because I don’t know what
your specialities are. They don’t want to go to the more
rural health boards because they don’t have the numbers to
keep the speciality training up. So if you’re a paediatrician
you’ve got to be able to see a certain number of babies every
year. If you want to be a neonatologist you’ve got to be able
to see a certain amount of that. So, that’s why we struggle
so much in the more rural environment. When we talk about career
development and where people want to settle, how much of a factor
does that play on you? If you’re settling in an area, do you
think, ‘Well, actually, in four or five years’ time I
think I want to go down this speciality route, or that speciality
route’? You look at the lovely area that you’re in but
you think, ‘Actually, these hospitals are not going to
provide me with enough of the practice that I need in order to
achieve that’. I just wondered how much of that really
factors into your thinking at an earlier stage.
|
|
[267] Dr
Williams: It’s factored into my thinking. Within our
training, in lower training we have six-month placements and then
we have year placements—or they tend to be around
that—for higher training. It’s made sure, and I’m
sure probably in most specialities as well, that we are in tertiary
hospitals for some of it, so we see our traumas and we see the
types of cases that come in there, and then we’re also in a
DGH as well, so we get an experience of both. Then, I suppose,
it’s all down to your personality, isn’t it, so
I’m not sure I can really answer that, because whether you
want to work in a DGH with a different caseload and different types
of cases coming through, or whether you want to be in a tertiary
hospital, is all down to the person. Along with that, after working
six months in an area, you know the area, so you build that kind of
impression up, so I think it’s very much a personal
choice.
|
|
[268] Dr
Davies: I think you’re not going to know that at the age
of 23 either, and that’s one of the problems. Not only do you
change, but also the job can change. When I started general
surgery, it was still a mentorship and a firm-based structure,
which was great and I loved it, and then when I left it became
shift work. I didn’t know that was going to happen when I was
23. So you’ve got that thing as well. But I think what you
said about that was right; you get some experience in the tertiary
centres and different experience in DGHs. Also, sometimes in
tertiary centres you may actually do less operating, for example,
in a surgical specialty, while you might do a lot more in the DGHs,
but in tertiary centres you might have access to the research and
academic side. For example, if you’re going to do a higher
degree—and that might be another way of attracting people to
Wales: offering those high-quality higher degrees at the
established universities. There’s no reason why you
can’t be working somewhere, for argument’s sake, in
Hywel Dda, but do a degree linked to Swansea or Cardiff if you had
some freedom to attend some sessions. That might be quite
attractive to people, depending on what they wanted to do.
Obviously, the GP workforce would be a very different story again,
but for hospital-based—.
|
|
[269] Angela
Burns: I think what I’m trying to slightly bottom out is
the tension between what you as careered professionals want to try
and achieve and what the denary and the royal colleges are all
saying, because they’re all sort of coming in, but
they’re not quite matching up. So, if we were to take the
Hywel Dda scenario, and if we were to look at paediatrics, then
what the royal colleges say is that in order to complete your
paediatric training—I think it’s you’ve got to
deal with a minimum of 2,500 births a year, or you’ve got to
be in a hospital setting that deals with 2,500 births a year. And a
hospital could be over a couple of sites, maybe; it depends how far
apart they are. So, Hywel Dda has really struggled and is
struggling to keep maintaining that paediatric training.
|
|
[270] Dr
Roberts: They don’t go there.
|
|
[271] Angela
Burns: No, because it doesn’t fit that criteria.
That’s something the royal collages have said. In order for
you to be the best you can possibly be, you must have this
experience, so then it hits against the health board that says,
‘With the best will in the world, we can’t make more
people have more babies more quickly.’ So, we’re stuck.
We can’t do the training. But then you might have a person
that says, ‘Actually, I really want to have that environment,
I want to be able to settle down here and bring my kids up
here.’ So it’s just trying to marry all those tensions.
And, of course, who loses out is you lose out, because you’re
not where you want to be, and the public loses out because
they’re not getting the services they want because of all of
these developments in medicine, developments in attitudes,
subspecialisations. So, how we marry it all together I
haven’t got a clue, but it’s trying to understand what
impact it has on you guys.
|
|
[272] Dr
Roberts: New Zealand have rural medicine as a specialty, so
I’m not sure how that could translate to all the different
specialties that we have to provide training for within Wales. I
know of someone who trained in Birmingham as an undergraduate, did
her foundation years there, and was specifically attracted to Wales
on the basis of a rural GP course that she went on. So, it is
something that you can make quite a big deal of. How it then maps
out to provide training in every single different specialty is a
bit of a tricky issue, and I think, also, when you’re
thinking about who wants to go to the rural areas you also need to
think about who they bring with them as well. It’s often
difficult for people, when they want to go and work in the middle
of Powys, for example, if they have an other half whose job
isn’t so transferrable. Yes. It’s quite difficult.
|
|
[273] Dai
Lloyd: Dawn, you had an issue.
|
|
[274] Dawn
Bowden: It was only just picking up, I think, on Huw’s
point about the choices of deaneries, and you were saying that, in
general, you get to choose. You rank the order that you’d
like to—so, one, two, three. You said Wales Deanery comes
usually twentieth out of the 21 deaneries, in terms of choices.
|
|
[275] Dr
Williams: From some work I did a little while ago, I’m
sure it was twentieth out of 21 in 2012. I’m just pulling
that from the memory banks.
|
|
[276] Dawn
Bowden: So, forgive my ignorance in how this works. So, you
choose, or you make a choice of your preferred deaneries, at what
point—.
|
|
[277] Dr
Williams: So, as you graduate from medical school,
you—
|
|
[278] Dawn
Bowden: So, as you’ve graduated from medical school. So,
are the deaneries, then, all vying for you at medical
school—
|
|
[279] Dr
Williams: Are they all what, sorry?
|
|
[280] Dawn
Bowden: Are they vying for you, are they advertising their
wares at the medical schools or not? How do you get to know about
them, is, basically, I suppose, what I’m asking. How do you
come to your choices?
|
|
[281] Dr
Williams: I can’t remember—
|
|
[282] Dr Khan:
Online, I think they have the NHS website—
|
|
[283] Dai
Lloyd: It’s an all-UK application process, isn’t
it, for further training—
|
|
[284] Dr Khan:
Oriel—it’s called the Oriel website. There are all
these different sorts of rotations. So, then you select each and
every one, wherever you want to go, but there is a
mixture—you can’t jump from one to another. For
example, if you’re going for core training, they offer you
four rotations of different sorts. So, you select them, and then
you go to that—
|
|
[285] Dawn
Bowden: I see. I was just wondering why it was that Wales was
so low on the choice, which may come back to some of the earlier
points that you were making.
|
|
[286] Dr
Roberts: In the old days, you used to have jobs that were
linked to your medical school. So, I qualified before foundation
training, so you had specific jobs that you would just apply to
that were linked to your medical school. I’m sure Cardiff
would have had exactly the same thing. That’s slightly
different now. But I wonder if the application system for specialty
training also hinders recruitment in rural areas, because of the
way that you rank your preferences. I applied to the big deaneries
to begin with, and then when you have your interview—so, I
had an interview in the Wales Deanery—you then rank your
scheme and where you want to go within Wales. But you can
jump—so, they might be struggling to recruit in
Pembrokeshire, but if you rank somewhere else above that and your
ranking gets bumped up as people drop out of the scheme, you
completely bypass those rural schemes. So, the places that are
struggling to recruit, you then can’t opt in to going there,
because you kind of jump over them. It’s really difficult to
explain how badly organised the system is—but, yes,
it’s possible to completely bypass these schemes that are
struggling to recruit because of the way the application process is
set up.
|
|
[287] Dr
Williams: I think that system has changed since I’ve come
from medical school as well. Going back to that twentieth out of
21; that was back in 2012. That’s not to mean—I’d
imagine that might have been a lot of people putting their home,
where they grew up, as the place to go to as their first choice,
perhaps, and Wales very well might have been second choice for an
awful lot of people. I’m just talking about the first choice,
and that was, as I said, a long—it was five years ago.
|
|
[288] Dawn
Bowden: Okay. Thank you.
|
|
[289] Dai
Lloyd: Lynne, did you have a question?
|
|
[290] Lynne
Neagle: It’s not No. 11, is it?
|
|
[291] Dai
Lloyd: No, it’s not. They’re not numbered, Lynne.
It’s the one about—
|
|
[292] Lynne
Neagle: That’s what I thought. Sorry. No, I’ll
leave it. I’ll pass on this one, thank you.
|
|
[293] Dai
Lloyd: There we are. Let me pipe in while people are thinking.
In terms of, at the present time—. Going back to earlier
times in your careers, when you were still at school, i.e.
secondary school, nowadays less than 20 per cent of the medical
students in Cardiff and in Swansea come from Wales, whereas medical
schools in Scotland universally have more than 50 per cent or 55
per cent of their medical students coming from Scotland, and
medical schools in England also have similar or higher percentages.
What do you think about those statistics for Welsh medical schools,
as regards developing the next crop of junior doctors for this
nation? I don’t know who wants to take that on.
|
|
11:30
|
|
[294] Dr
Davies: When I was in school, we had careers advice, and the
careers adviser told me, and I quote, ‘You’re not going
to be bright enough for medicine—you should go into NHS
management’. That’s what I was told in school. But, if
that’s—. There need to be some links with the schools
to get people from a diverse background, definitely, and those
people are more likely to stay because they’ve got family
locally, childcare arrangements in future life, and all of the rest
of it, but how do you do that?
|
|
[295] The other side
of that is that there’s a massive, massive financial
implication of sitting medicine in the first place, not only to put
yourself through five years of student life with no grant and build
up a massive student loan, which may well be as high as
£40,000 coming off, even in Wales—you know,
£40,000—but then supporting your postgraduate training
thereafter, depending on what you’re going to do. If
you’re going to do a surgical speciality, for example, every
training course is, basically, £1,000. I think that, at the
last count, the deanery allowance was £450 or £500 per
annum. Every course is £1,000, and that’s without
accommodation and all of the rest of it. You pay yourself. To begin
with, you pay yourself. But, then, when you have a family, that
becomes harder because you’re not giving away your money,
you’re giving away your family’s money, and that
becomes much, much harder. So, I think the only problem with that
recruitment in schools is are people are going to be scared of that
financial implication, and with the political way things are at the
moment, the price of fuel and all of the rest of it, there’s
a massive—. I don’t know. That’s a real
worry.
|
|
[296] Dai
Lloyd: That’s fair enough. Lynne has now got a
question.
|
|
[297] Lynne
Neagle: I have, yes. I’m not asking you to be party
political, and this isn’t a party political point for the
sake of it.
|
|
[298] Angela
Burns: I can take it. [Laughter.] I know exactly what
you’re going to ask. Funnily enough, I was going to ask it as
well, because I am brave.
|
|
[299] Lynne
Neagle: Right. Okay. Obviously, there is a very different
approach to public services and the NHS in England and in Wales. As
I say, I’m not asking you to be political, but the Welsh
Government has made much of the fact that we haven’t had a
junior doctors’ strike here, et cetera. There’s been
different legislation in England—the Health and Social Care
Act 2012—and there’s a different ethos here. How
important is that to you, or even how important do you think it is
to people who are thinking of where to train and where to work,
that kind of ethos about public services?
|
|
[300] Angela
Burns: Before you answer, can I just build on that slightly, as
well, to say that, the differences in the contracts between the two
countries, do you think the divergence will carry on growing, and
would that then become an impediment to the flow? Because we see it
in education, where it’s slowed down that flow between the
two countries of professionals, because we’re forming quite
different systems. Would you ever see that happening in medicine,
or do you think that medicine is, excuse me for saying
this—I’ll sound such an amateur, but I am an
amateur—‘a body’s a body, there’s a lot
more stuff that joins rather than separates’? And you can be
political—I can take it. [Laughter.]
|
|
[301] Dr
Roberts: I think the contract issue is particularly relevant at
the moment. The BMA Wales junior doctors committee recently
conducted a survey, and we had—I can’t quite remember
the figure, but it was well over half of our respondents who said
that the contract issue had been a significant factor in their
decision to come and work in Wales. As things stand, there is a lot
of frustration in England at the way that the contract imposition
has been handled. We’re very pleased that we’re not
facing the same imposition in Wales, and I think, as things stand,
the way that our contract is working currently, and the same for
Scotland and Northern Ireland—we all still have the same
existing contract—that is a very positive thing to get people
into Wales.
|
|
[302] Dr
Williams: One of the questions that we asked in our survey to
the All-Wales School of Emergency Medicine trainees, of which we
had quite a high response rate of around 90 per cent—we asked
the question, ‘Have the recent changes in medical contracting
discouraged you from completing your training in England—i.e.
did you want to move across to finish your training?’ Two
thirds said that yes, it had discouraged them, and one third said
‘no’. Personally, for me, I haven’t considered
it, because I would want to stay here.
|
|
[303] Angela
Burns: Going back to your comments, Abby, about wanting to
develop your neonatal skills, would that be a barrier to stop you
from then going off to do your career development and your
subspecialisation? And, with the other hat on, if you were in an
English health board and you were signed up to the English
contract, I’m assuming that that obviously means, in fact, it
makes transitioning to Wales easier, mentally.
|
|
[304] Dr
Parish: I would never actively choose to go to England. I do
not want to be a part of the English NHS or the junior doctor
contract. If I have to go, though, to be honest I’m just
going to have to go and, basically, suck it up and just do it, and
that’s kind of what we have to do. We all have jobs that are
a poor experience and we can try and fight for whatever cause
we’ve got during that point, but we rotate jobs so often, and
we have to put up with various things in different jobs, that I
think we’re quite a resilient bunch, and that’s what
they’ve relied on with the imposition, that we’ll just
go, ‘Fine. We’ll just have to do it, then’. I
don’t know anyone in England who’s left medicine
because of it. I know some people who have actively chosen to come
here for the subspecialty process. One girl, who’s coming for
emergency medicine, actually, in Cardiff, she said she chose to
leave London because of the contract. So, she’s coming in
September. There are quite a few people who’ve come because
of it.
|
|
[305] In
paediatrics—this is obviously all paediatric-specific from
me, but, the deanery, there’s been a lot of improvement in
our training, our exam pass rates and our morale over the last few
years. So, from the General Medical Council surveys that come out
every year, we get ranked. I can’t remember what Wales
Deanery were—I think it was quite high—but
Wales’s paediatrics deanery was the highest deanery. And, for
the second year running, for the first time in a long time,
recruitment at ST1 level, which is the first year of paediatric
training, has been filled both times. They haven’t offered
the places this time, but enough applicants applied to take all the
jobs, whereas, in previous years, they weren’t filling
jobs.
|
|
[306] Angela
Burns: That’s good, then, isn’t it?
|
|
[307] Dr
Parish: That’s not all junior doctor contracts—that
was starting beforehand—but it does put you off wanting to
leave.
|
|
[308] Dr
Davies: Interestingly, the person you’re talking about
who’s come back to do emergency medicine here is actually
someone who was a Cardiff graduate, who’d gone to England and
has come back. So, this is someone who is coming back.
|
|
[309] Dr Khan:
I had many colleagues in Peterborough who left. Some of them came
to Wales and some of them went to Scotland. But I think they were
quite—. About 10 per cent or 15 per cent of them stayed in
England. The rest of them left because of the new contract. They
didn’t want to stay where they were.
|
|
[310] Angela
Burns: So, obviously there’s the big difference in the
contract—the terms and conditions of employment, et cetera.
Is there any sort of difference or divergence happening—?
You’ve talked about the fact that in Wales you’ve felt
that you’ve had more support in your training. Because of the
royal colleges, does that mean, then, that there’s actually
no difference though in training? So, if you’re going to be
trained in this speciality, whether you’re being trained in
Peterborough, or whether you’re being trained in Swansea,
you’re going to get the same kind of training, so that the
essence of the training and the practice of medicine in Wales,
England, Scotland and Northern Ireland will always stay pretty much
the same, but it’s the underpinning underneath it, the terms
and conditions, the support, the delivery of it, that will change
within countries.
|
|
[311] Dr
Williams: The competencies for a speciality, whether
you’re in England or Wales, are dictated by the royal college
and therefore you are trained to a certain level, but your
experience could be vastly different, and how easy it is to gain
those competencies could be vastly different as well. And
that’s not just a vast difference between the deaneries, but
a difference between the different departments you might be in.
|
|
[312] Dr
Parish: So, if we were both paediatricians or ED, our training
could be the exact opposite because we’d been in different
places, as with any sort of job, really, isn’t it? In my
experience, I think the training here is great; I’ve got
people who don’t think it’s so good, you know, and
we’re on the same training programme. It’s about our
expectations and our experiences, isn’t it?
|
|
[313] Angela
Burns: I’ve just got one more question.
|
|
[314] Dai
Lloyd: One more question, Angela.
|
|
[315] Angela
Burns: Thank you. It’s totally different, because I
understand that you are all hospital professionals, or all
specialising in hospital practice.
|
|
[316] Dai
Lloyd: Apart from one—a GP.
|
|
[317] Angela
Burns: Oh, a GP. Great, because this is—. General
practice—the face of general practice is obviously changing
enormously, and I just wondered if, through either your own
evidence or anecdotal evidence from people who you know
who’ve trained and gone down the GP route, there’s a
difference about whether people are happy to buy into and become
part of a practice, or whether, actually, people would much prefer
to go down the salaried GP route.
|
|
[318] Dr
Roberts: From my cohort—. So, I qualified two days
ago—that’s when I started; I qualified in August,
because I took an extra six months—
|
|
[319] Angela
Burns: Congratulations.
|
|
[320] Dr
Roberts: Thank you very much. And none of my cohort are
partners. Two people became salaried GPs out of 14 of us, I think.
So, two became salaried GPs in August. The rest have been locuming,
and that is my plan as well. I’m not going to make any rash
decisions about committing to anything at this stage.
|
|
[321] Angela
Burns: And do you think there’s a trend within the GP
workforce for more and more people to say, ‘Actually, we
don’t want to have the practice element. We would much prefer
to be locums or salaried GPs’? What I’m really trying
to drive at—I just wonder if in 10 years’ time, when we
look at the landscape, we will actually see a real dwindling of
practices because of the enormous costs of investing in a
practice—buildings et cetera. It’s not just your core
function; it’s everything else that you have to have as
well.
|
|
[322] Dr
Roberts: I have a slight bee in my bonnet about this. I think
it comes down to training, and if trainees feel abused during their
training—because a lot of people tell me that they see
themselves being used as an extra pair of hands—. So, there
is a GP trainee contract and you’re contracted to work 40
hours a week. When I was full-time, I wasn’t—I was
working closer to 50 hours a week, and that’s particularly
irritating when you have a contract that says that you should be
doing 40 hours a week. The problem is that lots of senior GPs see
your training as an opportunity to get to know the real GP. So, it
doesn’t matter what your contract says, you do what the GPs
do, and that’s that, because, otherwise, you have no idea
what it’s like to be a GP. So, I think there is a creep in
how much service we’re expected to provide.
|
|
[323] I dropped down
to less than full-time working after three months in my final year
of training, and I think if I hadn’t done that—. It was
for British Medical Association work, but the BMA work was partly
an excuse to go less than full-time because I would have just been
burnt out with 50 hours a week of working every single week, and a
lot of my colleagues feel the same. So, you come out of training,
you have a significant number of assessments to do in your final
year of training, there’s a very expensive exam to
sit—it’s £1,600 to sit and you pay for that
yourself, and if you fail, you have to pay an extra £1,600 to
sit it again—and the number of patients you’re seeing
are increasing as well. So, the day-to-day work gets busier, you
have more assessments to complete and you have difficult exams to
do. So, people finish their training and they feel a bit burnt out,
and I think that’s what’s contributing to the working
patterns—that people are just tired of being bossed around
and they kind of want to be their own bosses for a little while.
So, people will then eventually drift into becoming salaried GPs,
but I don’t know anyone on my scheme who is even talking
about becoming a partner.
|
|
[324] Angela
Burns: Wow, thank you.
|
|
[325] Dr
Davies: Can I just add that my wife became a partner about a
year and a half ago, and she was straight off a training scheme and
did go into a partnership. There are benefits to that because you
don’t have to drive somewhere different every morning. So,
actually, there’s a bit of peace of mind. We moved house
because of her job, so the only problem now is if I don’t get
a job in Wales then we might have to move again. So, some people do
still do that.
|
|
[326] Dai
Lloyd: Lynne.
|
|
[327] Lynne
Neagle: I just wanted to ask Bethan, really—so, if the
Welsh Government was going to, say, have a big strategic push
towards really increasing the number of salaried GPs, as opposed to
investing so much in the contractor model, you don’t think
that would put people off coming to do their training and working
in Wales?
|
|
[328] Dr
Roberts: I’m not sure whether there needs to be a big
push towards salaried GPs particularly. I think if there could be a
focus on optimising the training and making sure that trainees were
working within their contracts, because, initially, coming up now
in England, GP trainees in practice will be able to submit
reports—. If they’re working beyond their hours, they
will be able to submit reports that will be scrutinised by an
external agent who can then either authorise extra payment, or say
to the practices, ‘Stop doing this’. There is no
mechanism for that now in Wales. So, hospital doctors can do this
exercise to monitor their hours, but GP trainees in practice
don’t have that. I think, probably, what needs to be fixed is
how trainees are treated, particularly during their final year of
training when it’s very intense, to make them more likely to
want to work in independent contractor models or as salaried GPs
rather than coming to the end and thinking, ‘I’ve had
enough of this; let me just go and be my own boss.’
|
|
[329] Dr Khan:
Can I just add, regarding the training hours, like in hospital
training, we definitely really work more than the recommended hours
of 40 hours? But whenever the exercise timesheet comes out, even if
I work until 7 o’ clock, at the end of that time period, you
get an email that the time period, the working hours, have been met
and nobody’s worked extra hours. That was the same in
Peterborough—literally, I used to go home by 7.30 p.m.
instead of 5 p.m. It’s the same here in Wales, so I think it
hasn’t changed much. It’s still the same for hospital
doctors as well as GPs.
|
|
[330] Dai
Lloyd: Rhun.
|
|
[331] Rhun
ap Iorwerth: A gaf i ddod yn
ôl at y testun sydd wedi cael ei godi’n gynharach
ynglŷn â pha bryd i dargedu pobl? Fe gawsoch chi eich
perswadio—fe aethoch chi i mewn i feddygaeth—ond ym mha
gyfnod yn yr ysgol a ddylai pobl gael eu targedu yn bennaf
i’w cyfeirio nhw, gobeithio, tuag at nid yn unig meddygaeth
ond gyrfaoedd eraill o fewn y proffesiynau iechyd?
|
Rhun ap Iorwerth: Could I just go back
to a subject that has been raised already on when we should target
people? You were persuaded—you went into medicine—but
at what stage in school should people be targeted to refer them,
hopefully, not only to medicine but also careers within the health
professions?
|
|
11:45
|
|
[332]
Dr
Roberts: Siŵr o fod lot cyn TGAU, achos mae angen lot o waith i
gael y graddau i fynd mewn i feddygaeth. Fe wnes i benderfynu pan
oeddwn i’n 11 fy mod i’n moyn gwneud meddygaeth, so fe
wnes i’n siŵr fy mod i wedi gweithio i gael beth oedd
angen ei gael. So, ie, fe ddylai fod yn gynnar.
|
Dr
Roberts: Probably a lot before
GCSE level, because a lot of work is required in order to get the
grades you need to go into medicine. I decided when I was 11 that I
wanted to do medicine, so I made sure I worked hard to get what I
needed. So, yes, I think it definitely should be very early
on.
|
|
[333]
Dr Parish: I decided when I was 20 to become a doctor, because
when I was 14 in school I said to my biology teacher, ‘My
grandad said I should be a doctor’, she was pretty
much—. And my careers advice—I mean, this was in 2000
or 1999—was, ‘Oh, Abby, just go to university, get a
good degree and you can get a job in anything.’ I think it
should probably be year 9, so you can choose your right GCSEs and
start getting involved in things like the Duke of Edinburgh Award
and all these other projects, and get some good quality careers
advisers in.
|
|
[334]
Dr Williams: Same reason—it was year 9 when I roughly
decided, just before GCSE level.
|
|
[335]
Dr
Davies: I fynd nôl at beth wnes i ddweud am careers
advisers yn yr ysgol o’r blaen, efallai eich bod chi
actually angen pobl o healthcare neu o
medicine i fynd mewn i’r ysgolion i siarad
gyda’r plant, achos nid yw careers advisers yn gwybod.
Nid yw’n deg iddyn nhw wybod, efallai. Ond, ie, cyn TGAU,
achos rydych chi’n gorfod cael digon o bwyntiau TGAU
anyway i gael yr A-level courses cywir.
|
Dr
Davies: Going back to what I
said about the careers advisers in school before, perhaps there is
actually a need for people from healthcare or medicine to go into
schools to speak to children, because careers advisers just
don’t know. Perhaps it’s not fair for them to know
either. But, yes, I would say before GCSE, because you have to have
enough GCSE points anyway to have the right A-level
courses.
|
|
[336]
Rhun ap
Iorwerth: Ac mi fyddai roadshow o ryw fath sy’n mynd o
gwmpas ysgolion Cymru yn gwerthu’r proffesiwn
iechyd—bells and whistles, gwneud iddo edrych yn secsi
i’r plant sy’n meddwl i ba gyfeiriad i fynd—a
fyddai’r math yna o beth yn gweithio?
|
Rhun ap
Iorwerth: And maybe a roadshow
of some kind that goes around schools in Wales would be a way of
selling the heath profession—bells and whistles, and make it
look sexy to the children who are trying to think what direction to
go in—do you think that would work?
|
|
[337]
Dr
Davies: Y math yna o beth, ac efallai links i’r ysgolion
sydd efallai yn yr ardaloedd mwy deprived fel eu bod yn
gallu gwneud work experience, achos mae hynny yn gallu bod
yn anodd iawn heb gael y links i mewn, ac efallai bod y
services i wneud hynny yn fwy anodd i bobl sydd yn yr
ardaloedd mwy deprived nag efallai i’r ysgolion
sy’n gwybod beth maen nhw’n ei wneud—sydd gyda
system ‘target Oxbridge’ o’r dechrau. Ond
nid wyf yn siŵr sut i wneud hynny.
|
Dr
Davies: That kind of thing,
and perhaps links to the schools that are perhaps in more deprived
areas so that they can do work experience, because that can be very
difficult without having the links, and perhaps the services to do
those are more difficult for those in areas that are more
disadvantaged than for the schools who know what they’re
doing—who have a ‘target Oxbridge’ system from
the beginning. But I’m not sure how to do that.
|
|
[338]
Dai
Lloyd: Grêt. Wel, dyna’r hyn rydym ni’n mynd
i’w awgrymu i bobl sydd gyda’r arbenigedd yna i ddatrys
yr union broblem yna, felly diolch am amlygu’r
peth.
|
Dai
Lloyd: Great. Well,
that’s what we’ll suggest to those people with that
expertise to solve that very problem, so thank you for highlighting
those issues for us.
|
|
[339]
Byddwch yn falch
o nodi bod y sesiwn gwestiynu yma ar ben nawr. Diolch i chi gyd am
fod yma yn y lle cyntaf, a hefyd am rai papurau sydd wedi cael eu
paratoi ymlaen llaw. Diolch yn fawr i Dr Williams, a hefyd diolch
yn fawr am ateb y cwestiynau mewn ffordd mor raenus ac mor aeddfed.
Yn amlwg, mae yna ddyfodol disglair o’ch blaenau chi i gyd yn
y byd meddygaeth, a thrïwch aros yn fan hyn, nid fel rhai
ohonom ni sydd efallai yn trosglwyddo dros ambell i ffin arall.
Felly, diolch yn fawr iawn i chi am eich presenoldeb, a hefyd fe
allaf gyhoeddi y byddwch yn derbyn trawsgrifiad o’r sesiwn
yma er mwyn i chi gael ei wirio i wneud siŵr ei fod yn
ffeithiol gywir—nid eich bod chi’n gallu newid eich
meddwl am ddim byd, ond jest gwneud yn siŵr mai beth rydym ni
wedi ei gofnodi ydy beth roeddech chi’n bwriadu ei ddweud yn
y lle cyntaf. Felly, diolch yn fawr iawn i chi am eich presenoldeb,
a phob lwc am y dyfodol yn eich gyrfa yma yng Nghymru. Diolch yn
fawr i chi.
|
You’ll be glad
to know that the questioning session is at an end. Thank you all
very much for coming here, and also for some papers that have been
prepared in advance. Thank you very much, Dr Williams, and also
thank you also for answering our questions in such a mature way.
Clearly, there is a very bright future for you all in the world of
medicine, maybe not like some of us who have transferred to other
areas. So, thank you very much for coming, and can I also let you
know that you will receive a transcript of this session so that you
can check it for factual accuracy—not that you can change
your mind about anything, but just to make sure that what
we’ve noted was what you intended to say? So, thank you very
much for coming today, and good luck for the future in our career
here in Wales. Thank you.
|
|
[340]
Dr
Roberts: Diolch yn fawr.
|
Dr
Roberts: Thank you.
|
|
11:48
|
|
|
Ailymgynullodd y pwyllgor yn gyhoeddus am
13:01.
The committee reconvened in public at
13:01.
|
|
Ymchwiliad i
Strategaeth Genedlaethol Ddrafft Llywodraeth Cymru ar Ddementia:
Sesiwn Dystiolaeth 5—Cydffederasiwn y GIG
Inquiry into the Welsh Government’s Draft National Dementia
Strategy: Evidence Session 5—NHS Confederation
|
|
[342]
Dai Lloyd: Prynhawn da ichi i gyd. A allaf i alw’r
cyfarfod diweddaraf yma o’r Pwyllgor Iechyd, Gofal
Cymdeithasol a Chwaraeon i drefn, o dan eitem 6: parhad efo’n
hymchwiliad i strategaeth genedlaethol ddrafft Llywodraeth Cymru ar
ddementia? Hon ydy sesiwn dystiolaeth Rhif 5, prynhawn yma,
a’r sesiwn dystiolaeth gyntaf o ddwy. Rydym ni’n
croesawu Cydffederasiwn y Gwasanaeth Iechyd Gwladol o’n
blaenau ni. Rydym ni wedi gofyn cwestiynau i dystion o’r
blaen, ac rydym ni wedi derbyn eich papur chi hefyd a’r
dystiolaeth sydd gerbron—papur bendigedig, os caf ddweud.
Mae’r Aelodau wedi darllen eich papur chi, wedyn fe awn
ni’n syth i mewn i gwestiynau’n seiliedig ar eich papur
ac, yn naturiol, yn seiliedig ar strategaeth ddrafft y
Llywodraeth.
|
Dai Lloyd: Good afternoon to you all.
I’d like to call this latest meeting of the Health, Social
Care and Sport Committee to order, and under item 6 continue with
our inquiry into the Welsh Government’s draft national
dementia strategy. This is evidence session No. 5 this afternoon,
and the first evidence session of two. We welcome the NHS
Confederation, appearing before us. We have asked questions of
witnesses before, and we’ve also received your papers and the
evidence that is before us—a great paper, if I may say so.
Members have read the paper, so we’ll go straight into
questions based on your paper and, naturally, based on the
Government’s draft strategy.
|
|
[343]
Felly, gyda chymaint â hynny o
ragymadrodd, a allaf i groesawu i’r bwrdd Lin Slater,
cyfarwyddwr cynorthwyol nyrsio bwrdd iechyd prifysgol Aneurin
Bevan; Dr Suzanne Wood, ymgynghorydd mewn meddygaeth iechyd
cyhoeddus, bwrdd iechyd prifysgol Caerdydd a’r Fro; a hefyd
Nick Johnson, arbenigwr hwyluso gofal dementia, bwrdd iechyd
prifysgol Abertawe Bro Morgannwg? Croeso i’r tri ohonoch chi.
Fe wnawn ni ddechrau â’r cwestiynau, felly, ac mae
gennym ni ryw dri chwarter awr. Mae nifer helaeth o gwestiynau,
felly cwestiynau byr ac atebion byr a fyddai’n handi. Felly,
y cwestiwn cyntaf—Jayne Bryant.
|
So, with those few words of introduction, may
I welcome to the table Lin Slater, the assistant director of
nursing, Aneurin Bevan university health board; Dr Suzanne Wood,
consultant in public health medicine, Cardiff and Vale university
health board; and also Nick Johnson, dementia care specialist
facilitator, Abertawe Bro Morgannwg university health board? I
welcome the three of you, and we’ll start with the questions.
We have about three quarters of an hour. We have a number of
questions, so short answers and succinct answers, therefore. First
question—Jayne Bryant.
|
|
[344] Jayne
Bryant: Diolch. In the Wales NHS Confederation evidence that
we’ve had, you say that the crucial role of carers—and
I think it’s so important that we’re looking at the
work of carers. I think in it you mention that
|
|
[345] ‘we need
to support people to participate in planning, designing their care
with health and social care professionals’.
|
|
[346] Do you think the
draft strategy does enough for carers and citing the role of
carers?
|
|
[347] Mr
Johnson: I’ve got to say we need to appreciate their role
hugely, and I think we need to involve them as partners within the
whole process. I think we need more engagement with them. I
don’t know whether you are having representatives from
carers’ associations giving evidence here as well, but,
personally, no, I think they need to be more involved and given
more support.
|
|
[348] Jayne
Bryant: Any other comments? Okay, that’s really helpful
to hear. There are other parts of the evidence that say
|
|
[349]
‘investment in the skills, capacity and well-being of carers
should be prioritised’.
|
|
[350] Is that
something that you feel is important?
|
|
[351] Ms
Slater: Sorry, can I just make a comment for a moment? I
don’t think this is our evidence. We’ve provided
evidence on behalf of our own health boards, but I think the Welsh
confederation are providing evidence to you separately, and
that’s their paper.
|
|
[352] Jayne
Bryant: Right, sorry. I was looking at the NHS
Confederation.
|
|
[353] Ms
Slater: We are NHS bodies, but I think—
|
|
[354] Jayne
Bryant: Would you agree with the evidence?
|
|
[355] Ms
Slater: Yes, indeed, I would agree with the evidence. I think
what the strategy does is give us the opportunity to develop an
integrated dementia care pathway. I think, on that, in the
development of a pathway, what we need to include are the services
and support that we can provide for carers. That’s obviously
a range of things that we need to do, from supporting our families
when there is concern about a loved one having dementia, through to
supporting them through a diagnosis, getting that early support,
and also, as you’ve said, helping people to develop,
sometimes, skills that they might need in order to look after
people at home. So, there’s a whole raft of things, but, of
course, they’re all different, because people are different,
dementia is different, and circumstances of families are different.
So, it’s about having that person-centred approach. In terms
of what the confederation has said, I think it is important to have
services that wrap around not just the individual with dementia,
but also family members and carers too.
|
|
[356] Jayne
Bryant: How do you think that would progress when, obviously,
people who have dementia, and their families, might start after a
diagnosis of dementia with certain needs, but then, obviously, the
carers’ situation can deteriorate as well, later on into
that, when dementia deteriorates?
|
|
[357] Dr Wood:
If I could take that question, that would be great. So, locally,
we’ve developed a carers education pathway, and it involves
the Alzheimer’s Society’s Carer Information and Support
Programme—CrISP 1 and CrISP 2. So, it follows the carers
through both the beginning stages of a diagnosis and right through
to end-of-life care to support them in the process. Locally,
we’ve developed an education pathway to make sure that carers
really do have the education needs that they would need through
that journey.
|
|
[358] Jayne
Bryant: Thank you.
|
|
[359] Mr
Johnson: I would agree. If we can educate carers and families
around the progression of dementia and things that we absolutely
know are going to happen—. We know that, at some point
throughout that journey, there are going to be hospital admissions.
We know, throughout that journey, there is going to be a need for
support and respite care that is meaningful to that family.
That’s not necessarily two weeks in a care home. That is what
they need—‘What do you need?’ We need to have
those discussions. But I think that educating families and carers
to be able to cope with those changes as they come, in a timely
fashion, is something that we would definitely be welcoming.
Because I think, ultimately, that will end up preventing, or
delaying certainly, inappropriate referrals into a hospital
setting, for example.
|
|
[360]
Dai Lloyd: Julie Morgan, efo’r ail
gwestiwn.
|
Dai Lloyd: Julie Morgan, with the
second question.
|
|
[361] Julie
Morgan: Right. Good morning. Do you think anything should be
done to the strategy to strengthen access to care and help from
groups with protected characteristics or groups who have different
language needs? Could you give us your views on that?
|
|
[362] Ms
Slater: I think one of the most important things is that people
have access to their own language. For us, obviously, in Wales that
means Welsh. So, we need to do more to make sure that people who
work in public-facing bodies—certainly the health
service—have access to Welsh speakers so that people can
speak fluently to people, especially when they’re in hospital
and often distressed and need to speak in their native language.
So, I think that’s particularly important. We also need to be
mindful of those people with sensory impairments as well,
particularly loss of sight, and also those who have hearing
difficulties, because, again, those people will have needs in
relation to those things as well as to their dementia. We need to
think sensitively how we can properly meet those needs.
|
|
[363] Dr Wood:
I’d like to add to that, if I could. So, within Cardiff, for
example, the black and minority ethnic population constitutes 16
per cent of the population. Therefore, not only would the Welsh
medium be important, but other first languages in that context. So,
wherever possible, they do offer a translation service in memory
clinics and community mental health teams in order to support
people in that way. So, not only do the language needs need to be
supported, but also the cultural needs of that community.
|
|
[364] Mr
Johnson: I think we need to do more as a society to engage,
certainly with people not just from the BME environment but also
lesbian, gay, bisexual and transgender as well. I think the real
truth of the matter is that, at the moment, although there is a lot
of evidence out there in terms of published reports, I don’t
think we really know what those needs are. I think there were a lot
of myths around groups being difficult to engage with. I think that
that really is a bit of an excuse. I think we need to make more of
a concerted effort in that regard.
|
|
[365] Julie Morgan: Do you think there needs to
be a specific effort towards specific groups?
|
|
[366] Mr Johnson: I believe so, yes, I do.
Otherwise—
|
|
[367]
Julie Morgan: And how do you think this strategy could be
strengthened in relation to that?
|
|
[368]
Mr Johnson: I think it needs to refer back to successful—.
There have been other successful programmes within the UK, where
people have managed to reach out to those communities and develop
those links, and I think perhaps we could link to that evidence or
those schemes.
|
|
[369]
Julie Morgan: Yes. You don’t have any particular ideas of
anything, because I’m sure things have been done in Wales as
well.
|
|
[370] Mr Johnson: I think we need to have
engagement events and reach out and find out what those issues are,
because I think there are a lot of myths in that respect.
|
|
[371] Dr Wood: I concur with Nick. So, in terms
of LGBT groups, definitely, engaging with that community is
essential. Evidence suggests that, as you get older in the LGBT
group, you’re more likely to be alone, and also you’ve
got a fear of prejudice and discrimination against your sexuality
that may interfere with the care that you receive. So, it’s
important we do engage people honestly in that discussion.
|
|
[372]
Dai Lloyd: Ocê. Symudwn ni ymlaen. Jayne, y cwestiwn
nesaf.
|
Dai Lloyd: Okay. We’ll move on.
Jayne, the next question.
|
|
[373] Jayne
Bryant: Thank you. Suzanne, you mentioned memory clinics, so
what more do you think—? What do you see as the role of
primary care in identifying people with dementia?
|
|
[374] Dr Wood:
I see the role of primary care as being absolutely critical in
identifying cases of dementia. Locally, we’ve actually
commenced GP diagnostic clinics, funded through intermediate care
fund moneys, to ensure that GPs are more skilled up and aware of
dementia and they can make the diagnosis, with the supervision of
the memory team, following the consultation, to ensure that, using
the Addenbrooke's cognitive examination III diagnostic tool, they
can make a good and proper diagnosis, and there shouldn’t be
any misdiagnosis, or anything like that, in that instance.
|
|
[375] Ms
Slater: Just to add to that as well, I think it’s
important to understand in the strategy what’s meant by
‘a competent clinician’ as well, in terms of making a
diagnosis, because that could be within the memory clinic, it could
be primary care, GP services, but could that be others as well?
Could that be a competent clinician who is also a mental health
nurse, for example? So, we just need to, I think, think that
through a little bit more so that we can perhaps expand our
experienced clinicians to provide that service, too.
|
|
[376] Mr
Johnson: I’m not convinced that the primary care setting
is the correct setting in which to diagnose people with dementia. I
don’t think that the GPs have the time that’s needed to
conduct those sorts of assessments, and I don’t necessarily
feel that, actually, the skills and knowledge are there. I’ve
had a lot of discussions with people who’ve felt quite
dismissed by their GPs and, perhaps, didn’t understand the
issues. I have a family member who has dementia, and he was
undergoing some psychotic symptoms at home, and the GP suggested
that he needs to behave for his wife. Now that does show an
alarming level of ignorance, I think, around the condition itself
and it doesn’t help anybody.
|
|
[377] I think, to
improve access to memory clinics, we could open that up and say,
‘Well, why is it that, at the moment, in some health boards,
it is only accessible through GP or consultant referrals?’ I
think, if we’re going to develop the workforce in line with
the ‘Good Work’ framework, we’re going to have
more skilled individuals who can identify the early signs. And some
professions are very, very good at identifying those early, subtle
signs, but they’re not necessarily GPs.
|
|
[378] Jayne
Bryant: That was going to be next question, really, because
we’ve had evidence from some other organisations saying that
GPs may be reluctant to diagnose dementia because of the lack of
support services out there, but you think it might be knowledge and
skill as well as—
|
|
[379] Mr
Johnson: Yes. I think, professionally, I couldn’t
disagree with that more; and personally I couldn’t disagree
with it more. I saw the evidence that was given, and one of the
suggestions was around, ‘Well, this person just has a little
bit of anxiety and memory loss’. That could be quite a
significant, worrying factor, and particularly worrying, I think,
in males, for example, where the fear of becoming a burden could
lead to suicidal ideation—becoming a burden. So, no, I just
don’t agree with that at all; I think we need to take it very
seriously and, perhaps the services will develop once we know the
need. But I think we need to get as early a diagnosis as possible,
absolutely.
|
|
[380] Dai
Lloyd: Okay, turning to diagnosis rates, then, Caroline.
|
|
[381] Caroline
Jones: Diolch, Chair. Good afternoon. The draft strategy sets a
target for increasing the diagnosis of dementia by 3 per cent per
annum. Can I ask your view on this, and also on the issues
surrounding the collection and collation of data of diagnosis,
regarding transparency and frequency of the collection of data?
|
|
13:15
|
|
[382] Dr Wood:
I’m happy to take that question. So, I think 3 per cent is
quite an ambitious target for per annum increase because, in
Cardiff and Vale for example, I know, year on year, using the
Alzheimer’s Society figures for dementia diagnosis, its
increase is between 1 and 2 per cent per annum. So, of course,
it’s great to be ambitious and to continue to have
aspiration, but I think more resource would be required to ensure
you get a timely diagnosis within certain areas.
|
|
[383] Caroline
Jones: That’s valuable, thank you. Anyone else?
|
|
[384] Mr
Johnson: I think it’s important to ensure that it’s
a robust system of diagnosis and done in a proper fashion, like we
just said with the issue around GPs diagnosing. I think it needs to
be managed carefully to ensure that we’re not getting a lot
of false positive diagnoses, because that can be equally as
damaging, if not more so. I think it’s ambitious, and I would
echo what my colleagues are saying.
|
|
[385] Caroline
Jones: What about the collection of data then, and the
collation of it so that we’ve got an audit trail?
|
|
[386] Mr
Johnson: I do think health boards should be doing that. I think
we should be collecting that data and scrutinising data in terms of
the numbers of admissions into the acute setting. Do we really know
what those numbers are? I’m not convinced we do at the
minute.
|
|
[387] Ms
Slater: I think just one other thing to add is that the
strategy mentions presumptive or working diagnoses, and I think,
probably, that’s quite helpful as well for people who are not
ready to receive a diagnosis yet, or that it would be helpful in
terms of meeting their needs that we begin to understand their
presentations. So, I think that’s helpful.
|
|
[388] Caroline
Jones: Okay. Leading on to my next question, what is your view
on the proposed waiting time targets of 28 days for the first
assessment and 12 weeks for a working and preliminary
diagnosis?
|
|
[389] Dr Wood:
Presently, in Cardiff and Vale, the waiting time is 17 weeks for a
new patient appointment at the memory clinic. I would certainly
advocate for the four-week target, because it does mean that people
get that timely diagnosis. Clearly, more resource is required to
ensure that the capacity of a memory clinic is expanded in order to
deliver on that target in the future.
|
|
[390] Caroline
Jones: Okay.
|
|
[391] Ms
Slater: I would agree. It’s about increasing our
resources so that memory clinics are more accessible.
|
|
[392] Mr
Johnson: I definitely agree with that. I’d also echo what
Dr Aziz—the evidence he gave last Wednesday I think, where he
was talking around that subject. I think it’s a very tight
timescale, and it doesn’t necessarily allow for
investigations to take place within those timescales, as well.
|
|
[393] Caroline
Jones: Okay, thank you very much.
|
|
[394] Dai
Lloyd: Angela.
|
|
[395] Angela
Burns: I just wondered if I could press you slightly on the
target time—the 3 per cent. Is your view that the 3 per cent
is ambitious enough because of a recognition of where we are in
terms of resources, or would you feel that if we had more resources
going into dementia diagnosis, dementia support and all the
aftercare, that we’d be able to up that? Is it because we
don’t have enough people? Because we’re quite far
behind on being able to diagnose people, full stop, with dementia.
So, is it purely that we don’t have enough people, we
don’t have enough money, or is it something else that makes
you think that 3 per cent is the credible target?
|
|
[396] Dr Wood:
I think it does come down to resources at the end of the day. I
think, with further resource, we could be more ambitious with the
target, looking into the future. So, as you’re aware,
it’s the complete pathway that needs to have resource added
to it. So, it starts with having a dementia-friendly community,
people being able to recognise that perhaps they may have a
dementia or cognitive impairment in the first instance, then going
to their GP, who need to have the skills and knowledge and
education to be able to then refer appropriately on to the memory
team, which needs to have the capacity to deliver on that
diagnosis, and then they have to have it registered back then to
the GP practice to add to the statistics, as such. So, it’s
the whole pathway that needs to be seamless and timely in order to
deliver on an increased target.
|
|
[397] Angela
Burns: If the GP isn’t the gateway—you were
suggesting that other people might be the gateway—what kind
of other people would they be?
|
|
[398] Mr
Johnson: Physiotherapists, occupational therapists, speech and
language therapists, nurses—
|
|
[399] Angela
Burns: So, other medical professionals.
|
|
[400] Mr
Johnson: Yes. So, I think the education and training of the
workforce is key, because the strategy talks about case finding and
the early signs can be very subtle. So, it’s having people
who are able to identify and refer on. There shouldn’t be any
barriers to referral in my view, and I think there are at the
minute.
|
|
[401] Angela
Burns: Yes. Thank you.
|
|
[402]
Dai Lloyd: Ocê. Yn nesaf, Dawn.
|
Dai Lloyd: Okay. Dawn is next.
|
|
[403] Dawn
Bowden: Thank you, Chair. The strategy is very much focused on
trying to keep patients with dementia at home as long as possible,
and I think that’s a direction everybody seems to agree with.
The confederation’s evidence to us is suggesting that
that’s likely to mean that we’ve got to have a kind of
realignment of the existing resources, and it talks about
supporting new models of care and possibly a regional integrated
strategy and all these buzz phrases that seem to be used at the
moment. But, from your point of view, what is needed, do you think,
to develop those kinds of integrated packages that will help
dementia patients stay at home for longer and what would be needed
to support that?
|
|
[404] Mr
Johnson: That’s a massive question. Yes, it’s very
difficult to give an answer to that in a few lines, isn’t it?
I think it’s so multifaceted, ranging from our housing stock,
you know, the ability to adapt housing and have lifetime
housing—I mean, that’s one element of it. I think
it’s supporting the families and carers within that home
setting; it’s about trying to avoid what we know—we
know that acute admissions to hospitals are dangerous for people
with dementia. So, it’s about helping to, not delay it, but
manage that, and move away from a crisis-management
system—that’s what we have at the minute. So, I think
we need stronger community teams. Again, it’s going to come
back to a lot of education and training. If you can teach the
skills to avoid that admission or deal with those problems, then
we’re all in it together.
|
|
[405] Dawn
Bowden: Okay, I’ll ask the others if they’ve got a
view on that as well, but can I take it from that that you
recognise the importance of dementia support workers and the need
for the way in which dementia support workers are utilised to be
more consistent across the board?
|
|
[406] Mr
Johnson: I think we need to accept that, as a society, again,
this is one of the biggest health and social care challenges that
we’re going to face and finally we’re waking up to
that. I think this isn’t just about dementia support workers.
I think if we can train our workforce up to be competent in
dementia skills—it’s not rocket science—
|
|
[407] Dawn
Bowden: So it’s the whole workforce you’re talking
about.
|
|
[408] Mr
Johnson: Yes. Well, if we adopt the ‘Good Work’
framework, that’s what I’m saying. Actually, that
document has a lot more descriptors and direction in it than
perhaps the strategy denotes around certain areas. So, I think if
we do that—because two dementia support workers within a GP
hub, covering a certain area, I just think they’re going to
be sinking. They need that support.
|
|
[409] Dr Wood:
I couldn’t agree more. I think integrated models of care are
essential in this field because of the package of care that’s
needed to wrap around the person with dementia and their loved ones
and carers. So, already, community mental health teams locally are
integrated, but it’s trying to make the whole pathway more
integrated and also aligned with third sector organisations, such
as the Alzheimer’s Society. On the dementia support workers
issue, locally there are three dementia support workers and they
have the capacity to see only the newly diagnosed currently. So, in
order to enhance the support after a diagnosis, I do believe there
need to be more dementia support workers or their equivalents to
follow up their care right to the end of their journey.
|
|
[410] Dawn
Bowden: So, it’s not just the consistency, it’s the
number of them as well.
|
|
[411] Dr Wood:
Absolutely. The capacity to deliver on their care.
|
|
[412] Ms
Slater: Indeed, I would just echo what my colleagues have said.
It is about making sure that all the workforce are trained and
we’re thinking about occupational therapists and social
workers, physiotherapists and everybody, really, who’s
available for people with dementia who are in the community. It is
about developing those integrated teams that families can call upon
to support them at home. As I said, we are looking at different
roles, as well as the support workers, so that we can provide that
additional support and assistance, but it will take some time to
build up that critical mass, I think—
|
|
[413] Dawn
Bowden: A dementia-friendly workforce.
|
|
[414] Ms
Slater: Exactly: a dementia-friendly workforce. Absolutely.
|
|
[415] Mr
Johnson: Can I just make one more point? I think the medical
model is something that absolutely does not work within dementia
care.
|
|
[416] Dawn
Bowden: What do you mean by that?
|
|
[417] Mr
Johnson: The medical model, so, dealing with the signs and
symptoms rather than looking at the whole person, rather than
looking at environment, their support network—
|
|
[418] Dawn
Bowden: So, diagnosis is one thing, but then
it’s—
|
|
[419] Mr
Johnson: Yes. I think when we’re looking at that, we need
to move away from a medical model to more of that person-centred
approach, because actually providing the services that person needs
may cost us a lot less than giving people what we think they need.
I do believe that there are other professions that are very willing
to step up and take those roles to co-ordinate and manage those
teams. I think we need to look at the person rather than the
profession and move away from psychiatrist-led teams, if there are
other people who are more suited to that role and that service.
|
|
[420] Dr Wood:
If I could add a further point? Locally, we’ve conducted a
dementia-needs assessment, which will feed into our local dementia
strategy, and one of the top things that was noted was that
kindness and compassion was the thing that service users wanted to
see and feel more of in their day-to-day dealings with health and
social care and the third sector. So, it really is about that
person-centred model that’s required. I concur with my
colleagues about the ‘Good Work’ framework. It’s
an excellent framework. It looks at informed, skilled and
influencer levels, so it goes right across the pathway. It really
is a good guide for influencing the workforce development going
forward.
|
|
[421] Ms
Slater: Can I just add one other thing that you reminded me of?
It isn’t about—well, it is about helping people to have
their needs met, living in the community, but it is all about
trying to live as normal a life as possible. I was talking to
somebody the other day who is a person who had dementia diagnosed
at quite a young age. What he wanted was the opportunity to go to a
rugby match or to go down the pub with somebody, not necessarily to
go to a craft class, but to have the opportunity to do things that
other people do and he sometimes needs support to do, to have
someone to go with him who shared those interests. It’s about
what we can do in the community to make those things happen.
|
|
[422] Dawn
Bowden: Sure. That makes sense, okay. Thank you, Chair.
|
|
[423]
Dai Lloyd: Yn ôl i’r strategaeth ddrafft.
Julie, mae’r cwestiwn nesaf gyda ti.
|
Dai Lloyd: Back to the draft strategy.
Julie, you have the next question
|
|
[424]
Julie Morgan: Yes, I was going to ask you about the role of
community mental health teams, but obviously you’ve covered
that. Is there anything more that you’d like to say about
that?
|
|
[425]
Mr Johnson: Yes, I personally feel and I professionally feel that
that’s not necessarily the right place to turn to for
specialist care and support because, again, going back to that
‘Good Work’ document, if we are going to train up our
workforces to that level, we have other community teams as well
that should be well placed to provide that advice and support. I
think there is a misconception that mental health teams have the
specialist skills to deal with dementia care, and I’m sure
that is the case in silos—I’ve no doubt of that at
all—but I would say that’s quite a sweeping
view.
|
|
[426]
Dr Wood: I concur in a way that dementia really is
everybody’s business, so it’s really about skilling up
the workforce to be able to manage people better in the
surroundings they would like to be cared for. So, it’s really
about getting the skill levels up, across the board.
|
|
[427]
Julie Morgan: You’ve mentioned some of the things that are
important for people with dementia. You mentioned going to the
football match. Do you think there should be the inclusion of a key
action in the draft strategy on reablement that would include
access to reablement services that would include that sort of
initiative?
|
|
[428]
Ms Slater: Absolutely, I would agree with that. We’ve
talked about loneliness a lot in respect of older people just
recently, but we need to think about that particularly for people
with dementia who may be perhaps more lonely than others. So, what
can we do to help people to live stimulating and active lives as
well as they’re able to? So, yes, we do need to think about
how we bring that into this. That needs to be part of the
integrated care pathway.
|
|
[429]
Dr Wood: I couldn’t agree more. Reablement is absolutely
critical in the process. I think being able to maintain hobbies and
friendships and relationships with people is absolutely critical to
living the best life that you can do. For example, I know some
agencies have put on Singing for the Brain, which people do love if
they like to have a singalong, and other hobbies that they’d
like to keep going with, essentially. So, reablement is absolutely
critical.
|
|
[430]
Mr Johnson: It’s not just reablement, but enabling as well.
‘Reabling’ suggests getting back to something;
‘enabling’ means making the most of what we’ve
got.
|
|
[431]
Dai Lloyd: Gan symud ymlaen i’r rhan yna o’r
strategaeth ddrafft sydd yn ymwneud â gofal dementia yn ein
hysbytai ni, mae gan Rhun gwestiynau.
|
Dai Lloyd: Moving on to the part of the
draft strategy that relates to dementia care in our hospitals, and
Rhun has questions.
|
|
[432]
Rhun ap
Iorwerth: Prynhawn da i chi. Gan edrych ar beth sy’n digwydd pan
fydd pobl hŷn, a hefyd pobl sydd â diagnosis dementia yn
barod, yn cyrraedd yr ysbyty, mae’r strategaeth yn sôn
am sgrinio ar gyfer dementia a deliriwm pan fydd pobl hŷn yn
cael eu ‘admit-io’ i ysbyty. Mae’r
conffederasiwn, er enghraifft, yn sôn am y pwysigrwydd o gael
y sgrinio hefyd. Beth ydy’ch barn chi ar hynny?
|
Rhun ap
Iorwerth: Good afternoon.
Looking at what happens when older people, and people who already
have a diagnosis of dementia, get to hospital, the strategy talks
about screening for dementia and delirium when older people are
admitted to hospital. The confederation, for example, also talks
about the importance of having that screening. What is your feeling
on that?
|
|
13:30
|
|
[433] Ms
Slater: Absolutely, I would agree with that. In Aneurin Bevan
university health board we’re in the process of developing a
cognitive impairment pathway. Because, as I’m sure
you’re aware, people can come in to hospital—older
people—and they’re confused, and it may be because
they’re suffering from an infection and we need to be quite
clear about what that confusion is, and to treat people
appropriately. So, we’re developing this cognitive impairment
pathway to support clinicians in making that assessment and
diagnosis, so that people can be treated properly.
|
|
[434] I think
there’s a second part to your question as well, I suppose, in
terms of screening. I think, probably, I would go back to the
public health message about making every contact count. So, when we
meet with people in a healthcare setting, whether that’s
within the community, in primary care, or within a hospital, then
we do need to make that contact count in terms of understanding not
just their illness if they’re presenting with one, but also
their health needs. That may include undertaking some screening for
dementia—early screening—if that seems to be
appropriate. So, it is using all of those opportunities to support
early diagnosis, but also to make sure that people are treated
appropriately.
|
|
[435] Dr Wood:
I couldn’t agree more. So, case finding is obviously quite
different from population screening, which I wouldn’t
advocate for. But case finding, in particular settings where
you’ve got high-risk groups is critical to the care pathway.
So, I would advocate for that, absolutely. And from a public health
position, I would definitely advocate the ‘making every
contact count’ messages as well, and ensuring that people
have those healthy lifestyles to prevent and delay the onset of
cognitive impairment and dementia.
|
|
[436] Rhun ap
Iorwerth: What about when a dementia patient finds themselves
admitted to an acute hospital setting, and the need to ensure that
both their mental and physical well-being are taken care of and are
recognised by that hospital? What needs to change?
|
|
[437] Dr Wood:
I think, speaking from a local context, we do use the Butterfly
scheme to identify people who have a diagnosis of dementia or a
delirium. Underneath that you’ve got the Research in Ageing
and Cognitive Health team tool, which is really a person-centred
tool to ensure that the person with dementia, when they go from one
ward—say from the emergency unit, to one ward to another
ward—that their paperwork follows them and people get to
understand that person much more. Also, it encourages people to
think about the triggers that may cause behaviour that challenges,
so they’re going to be able to better manage in that setting.
So, I think having that broader scale approach, using either the
Butterfly scheme or ‘This is me’, or an equivalent tool
that’s person centred, in that environment, is
essential.
|
|
[438] Mr
Johnson: I think there’s a big gap at the minute between
looking after someone’s mental health in terms of dementia
and their physical health. I think what people tend to see is the
dementia, and they don’t see beyond that and see what might
be contributing to the signs and symptoms of dementia. I have a
very strong belief that dementia is not a mental health condition,
and so it should not be treated as such. This is a physical health
condition that manifests itself here in these signs and symptoms.
In terms of developing the workforce and making sure that graduates
are being trained at the right level before they come out of
universities, not doing a project that involves three hours’
work, but, ‘This is going to be your bread and butter, this
is what you’re going to be doing on a daily basis, so
let’s skill you up now and that way then, in the long term,
that will help.’ It will help save time in terms of training
costs. But, dementia is not a mental health condition and
there’s a big gap at the minute. Physical nurses, I think,
believe that it’s a mental health condition—‘I
don’t know, I’m not trained’—and mental
health nurses tend to not, perhaps, look at the physical aspects of
care. Again, a very sweeping statement. In silos, I’m sure
that’s not the case, but in my experience.
|
|
[439] Rhun ap
Iorwerth: Okay. Just back to Dr Wood, briefly, you mentioned
examples of good practice and what should be happening. What is
your impression of whether good practice is widespread?
|
|
[440] Dr Wood:
I can only talk about the local context, really. Certainly,
locally, we’d like to advocate to have that more widespread
than it currently is. But, again, it’s a kind of resource
issue, because it does require training and development to make
sure it’s applied appropriately because it’s an opt-in
scheme for the Butterfly scheme. So, it’s important that the
staff are using it appropriately and that it follows the patient
through their journey in the hospital setting. So, I think it is a
resource and training issue as well.
|
|
[441] Rhun ap
Iorwerth: Are they real barriers? Are you unable to do things
because of resource issues?
|
|
[442] Dr Wood:
It can be a real barrier. But, also, it’s a cultural change
as well. People have to recognise the importance of seeing that
someone may have dementia or a cognitive impairment to be able to
manage them appropriately in that setting.
|
|
[443] Mr
Johnson: I think there are big resource problems, like
environment, and hostile environments—that’s one of the
biggest factors that I believe feeds into disorientation,
confusion, and can also cause delirium as well. I think there needs
to be investment in that. We’re not talking about millions of
pounds. We’re talking about changing the colour of paint from
magnolia to something that’s a bit more soothing and natural,
perhaps. You know, it’s about appropriate signage. These
things can help, and they’re not massive investment issues. I
think there are areas of good practice that can be taken and used
as a model and replicated elsewhere. We had a ward in Tonna
hospital, where one of the occupational therapists went in and did
a project around environment, training up the staff and looking at
meaningful activities. All the negative markers that the hospital
would’ve looked at, in terms of violence, aggression,
sickness absence and stress levels, all came down. It is possible.
It requires a small investment, but we’re not talking
millions and millions of pounds.
|
|
[444] Dr Wood:
I agree, and what might be useful for strategy: there’s a
King’s Fund toolkit that looks at dementia-friendly
environments, both in the ward setting and generically in the
hospital setting, that could aid people to progress that even
further. As Nick said, it talks about things such as lighting,
contrasting colours, wayfinding signage—that kind of thing
that ensures that people, from the front door, will have a
dementia-friendly environment.
|
|
[445] Dai
Lloyd: Lynne, you’ve got the next set of questions.
|
|
[446] Lynne
Neagle: I wanted to ask about older people’s mental
health wards. One of the things that the predecessor committee
looked at when we scrutinised the Nurse Staffing Levels (Wales)
Bill was whether the Bill should be extended to other settings, and
I am personally very keen to see it extended to older
people’s mental health wards. Would you see that as a
priority?
|
|
[447] Ms
Slater: I think the number of staff and the skill mix of staff
is clearly crucial wherever patients are cared for within a
residential setting, particularly a hospital setting, and clearly
we need to have that right skill mix to meet the needs of patients.
My understanding is that, yes, that’s what we will be looking
at. As you know, in terms of the Nurse Staffing Levels (Wales) Act
2016, we’re looking at acute medical and surgical wards
first, but we’re rapidly developing models to think about
community nursing but also mental health nursing, particularly in
older adult mental health units.
|
|
[448] Lynne
Neagle: Thanks.
|
|
[449] Mr
Johnson: In my role, I do a lot of training of nurses, physios
and OTs, and the consistent factor that comes back amongst nurses
is the lack of appropriate staffing on the wards. Now, some of that
is about education as well, and like they were saying, the right
skill mix, because if you’ve got two individuals who are very
skilled, it’s a lot easier, so it’s finding that right
level there. We have massive problems recruiting nurses at the
minute, and applications have fallen by, I think, a quarter because
we’re losing bursaries, and that’s not going to be good
news. So, I think we do need to think about that.
|
|
[450] Lynne
Neagle: Okay, thank you.
|
|
[451] Dai
Lloyd: Moving on, because we’ve got four questions and
seven minutes.
|
|
[452] Lynne
Neagle: Antipsychotics—we know that they are being
inappropriately prescribed. You’ve said that you think the
strategy should go further in that area, but we also know that
there aren’t the alternatives. How do you propose that the
Welsh Government tackles that, because there isn’t the access
to talking treatments and the staff issues are difficult and what
have you?
|
|
[453] Dr Wood:
I think in certain settings such as care homes, which I think the
strategy does mention in particular for the antipsychotic use, the
non-pharmacological methods do need to be embraced and enhanced and
go a bit further to ensure that that care is appropriately managed
without the use of medication. That can also be applied in the
hospital setting as well, but really I think what does
happen—and there’s recognition locally—is that
sometimes in the hospital environment, an antipsychotic is started
due to behaviour that challenges, and then it may not be stopped on
discharge. So, locally, we’ve implemented guidance that
ensures that that now should not be happening. So, in a way,
you’re turning off the tap, if you like, of the antipsychotic
and then going on into the community.
|
|
[454] Mr
Johnson: We’ve developed an audit tool to ensure that
antipsychotic use is being reviewed regularly, but, yes, I
agree—I think the non-pharmacological options that are
available are well-evidenced. There are reams and reams of evidence
around meaningful activities and the reduction of psychotic
behaviours, so it’s a question of, ‘Why aren’t we
putting this into practice?’ Again,
I think it comes back to education and training, ultimately, as
well.
|
|
[455] Lynne Neagle: Okay. And just on palliative care, you’ve
suggested that the strategy could do more on that, in
relation to drawing a distinction between palliative and
end-of-life care—what would you like to see included
then?
|
|
[456] Dr Wood:
I think that the recognition of advanced care planning, when a
person has capacity to make those right decisions for their
end-of-life care, is absolutely essential. So, it starts with being
diagnosed, and from that stage onwards, because it is a chronic and
progressive illness, people would have insight at that stage to
work out what they would like for their end-of-life care. As
described in the confederation’s response, the palliation
phase essentially starts almost from diagnosis, but end of life is
actually towards those last days. So, planning for that eventuality
is really essential, and I’d like to see that enhanced more
in the strategy as well.
|
|
[457] Mr
Johnson: I think clear definitions of what constitutes
palliative care, end-of-life care and palliative care at the end of
life—those are three separate things. Actually, the
‘Good Work’ framework describes them in far greater
detail and better detail. I think one of the key things is that
we’re not giving carers, families and the people themselves a
clear indication that it is a terminal condition—‘This
is a terminal condition, let’s accept that.’ How we
deliver that news—it needs to be done sensitively, of course,
but we must accept it. The survival rate for Alzheimer’s is 0
per cent, so that’s the fact.
|
|
[458] Ms
Slater: I’d like to add to that that palliative care can
be needed for a number of years. I think that’s the other
thing to say.
|
|
[459] Mr
Johnson: And that’s my point. End of life—is that
the last two weeks? Is it the last four weeks? That’s what we
need the definition for, but palliative care could be years.
|
|
[460] Dai
Lloyd. Okay. The last couple of questions—Angela,
you’ve got five minutes.
|
|
[461] Angela
Burns: The 3 per cent target—in order to achieve that, I
wondered what your views were on not just the resources, but how,
if we’re going to deliver that, we can measure along the way
the progress that we’re making. What would be the best
measurements to put in place as to how close we are getting to
achieving those outcomes that we’re looking for? When I look
through the draft dementia plan, I’m not seeing outcome
monitoring featuring very highly, and I wondered what outcome
monitoring for knowing what success looks like and whether
you’re achieving it in your particular areas—what do
you use?
|
|
[462] Mr
Johnson: Is that purely on diagnosis rates, or just services as
a whole?
|
|
[463] Angela
Burns: Diagnosis rates, because that 3 per cent is tangible, so
how do you measure that, and then all of the services—are we
actually providing the step change in service that we say that we
want to?
|
|
[464] Mr
Johnson: I think we need to be asking service users that
question, and we need to be asking people living with dementia that
question. I’d be interested to note—will you be talking
to people with dementia as part of this committee? This is about
them, ultimately—well, it’s about all of us, but we
need to involve them in that question. In terms of the diagnosis
rate, I’d say that Dr Wood could probably—
|
|
[465] Angela
Burns: That’s about qualitative responses, isn’t
it?
|
|
[466] Mr
Johnson: Yes.
|
|
[467] Angela
Burns: I’m just wondering whether, when you’re
actually trying to scrutinise the effectiveness of a policy and
you’re chasing the money through the system, this money is
actually delivering the outcome that you hope it would. You also
need some quantitative stuff. I absolutely take on board your point
that unless we talk to the carers and the people with dementia, we
won’t know the quality of it, but we also need quantitative
measures. I wondered whether you thought that there were sufficient
quantitative measures built into the delivery plans.
|
|
[468] Ms
Slater: We’re trying to do that in Gwent. We’re
trying to develop an outcome measures action plan. So, we have a
dementia board, and that’s a multi-agency board with carer
representatives. We’re hoping to have somebody with dementia
also being part of that board. So, we’ve developed now a
framework that takes account of the skills of staff, training about
dementia-friendly communities—all of those things that we
want to put in place that we know—. They’re proxy
measures, really. They’re not outcome
measures—they’re proxy measures. But if we’ve got
proxy measures in place, if we know that the five local authority
areas in Gwent are dementia-friendly local authorities, if we know
that our hospitals are working towards dementia-friendly status, if
we know that our staff are trained and skilled, and we’re
hoping that we’ll have 75 per cent in Aneurin Bevan by March,
then that gives us some confidence that we’re developing
better outcomes for people.
|
|
[469] Dr Wood:
If I could add something: locally within Cardiff and Vale, we do
have a dementia three-year plan, which is coming to its end in
March of this year. We’re going to develop a further strategy
after that. But throughout the lifetime of the plan, we’ve
had a monitoring and evaluation sub-group, which tracks performance
measures over time. It’s measured on a quarterly basis, so
that we can see whether we’re going in the right direction.
They’re flagged using a red, amber or green status so we can
see the direction of travel and whether we need to actually take
action in certain areas. So, the domains that were used were
actually taken from the Welsh Government dementia vision document
that was produced I think in 2009-10.
|
|
13:45
|
|
[470] So, it’s
those four domains. We track the indicators of outcomes and proxy
measures aligned to those locally, so we do actually monitor
dementia diagnosis levels, but they’re only currently being
able to be extracted on an annual basis, as I’m sure
you’re aware. We would welcome more frequent data on that but
obviously, again, they need to be resourced. As I said, we’re
monitoring the waiting time for memory clinic and the number of
dementia friends, and we’re proud to say that we’ve
skilled up over 7,000 people locally as dementia friends. So,
we’re really starting to get traction on the
dementia-friendly communities initiative, but there are other
markers as well that we’re using and utilising to ensure that
we are monitoring progress. So, if something like that were to be
taken nationally, that would be great, because we could then have
the benchmarking data to use across the seven health boards and the
22 local authorities across Wales.
|
|
[471] Angela
Burns: Thank you.
|
|
[472] Dai
Lloyd: Thank you. Spot on time, Angela.
|
|
[473]
Diolch yn fawr. A diolch yn fawr am
eich tystiolaeth y prynhawn yma. Diolch yn fawr am ateb y
cwestiynau mewn ffordd mor raenus ac mor aeddfed. Gallaf bellach
gyhoeddi y byddwn yn anfon trawsgrifiad o’r cyfarfod yma i
chi er mwyn i chi gael ei wirio er mwyn gwneud yn siŵr bod
pethau yn ffeithiol gywir. Felly, gyda hynny o ragymadrodd, gallaf
ddatgan bod y darn yma o’r sesiwn ar ben. Felly, diolch yn
fawr iawn i chi gyd. Ac i’m cyd-Aelodau, awn i egwyl nawr a
dod yn ôl am 2 o’r gloch.
|
Thank you very much. And thank you very much
for your evidence this afternoon. Thank you for answering the
questions in such a polished and mature fashion. I can now let you
know that we will be sending you a transcript of the meeting today
so that you can check it for factual accuracy. Therefore, with
that, I can state that this part of the session is now closing.
Thank you very much for coming. And to my fellow Members, we will
now go into a break and then come back at 2 o’clock.
|
|
Gohiriwyd y cyfarfod rhwng 13:46 ac
13:58.
The meeting adjourned between 13:46 and 13:58.
|
|
Ymchwiliad i
Strategaeth Genedlaethol Ddrafft Llywodraeth Cymru ar Ddementia:
Sesiwn Dystiolaeth 6—Cymdeithas Llywodraeth Leol Cymru a
Chymdeithas Cyfarwyddwyr Gwasanaethau Cymdeithasol
Inquiry into the Welsh Government’s Draft National Dementia
Strategy: Evidence Session 6—Welsh Local Government
Association and the Association of Directors of Social Services
|
|
[474]
Dai Lloyd: Croeso i sesiwn ddiweddaraf y Pwyllgor Iechyd,
Gofal Cymdeithasol a Chwaraeon yma yn y Cynulliad. Rydym wedi
cyrraedd, rŵan, eitem 7 yn ystod ein dydd o gyfarfod. Eitem 7
ydy parhad efo’n hymchwiliad i strategaeth genedlaethol
ddrafft Llywodraeth Cymru ar ddementia. Hwn ydy sesiwn dystiolaeth
Rhif 6, ac o’n blaenau mae Cymdeithas Llywodraeth Leol Cymru
a Chymdeithas Cyfarwyddwyr Gwasanaethau Cymdeithasol. Hwn
ydy’r sesiwn dystiolaeth olaf yn ein hymchwiliad byr ni i
strategaeth genedlaethol ddrafft Llywodraeth Cymru ar ddementia.
Mae yna gyfarfodydd eraill i ddilyn ar yr un thema, ond yn
sylfaenol gogyfer â’r prynhawn yma, rydym wedi derbyn
tystiolaeth ysgrifenedig gan ein tystion, sydd o’n blaenau
ni, ac wrth gwrs, rydym ni ar fin mynd i mewn i’r drafodaeth
ar lafar. Mae yna broblem
efo’r cyfarpar cyfieithu, efallai. A ydy’n gweithio
rŵan?
|
Dai Lloyd: Welcome to the latest
session of the Health, Social Care and Sport Committee here at the
Assembly. We have now reached item 7 during today’s meeting,
and that item is a continuation of our inquiry into the Welsh
Government’s draft national dementia strategy. This is
evidence session No. 6, and before us we have the Welsh Local
Government Association and the Association of Directors of Social
Services. This is the final evidence session in our short inquiry
into the Welsh Government’s draft national dementia strategy.
There are other meetings to follow on the same topic, but primarily
in relation to this afternoon, we have received written evidence
from our witnesses, who are before us, and we are about to discuss
this issue. Sorry, I think we have a problem with the equipment. Is
it working now?
|
|
14:00
|
|
[475] Mr
Ayling: Sorry, I lost the English translation for a minute. So
I just missed the last 20 seconds of what you said.
|
|
[476] Dai
Lloyd: Worry not. We’re always complaining about the lack
of powers in this place. [Laughter.]
|
|
[477] Mr
Ayling: Okay.
|
|
[478] Dai
Lloyd: We’re about to lose some more, but that’s a
separate issue. We’ll muddle through.
|
|
[479]
Felly, o’n blaenau ni—ac
rwy’n falch o’u croesawu—Naomi Alleyne,
cyfarwyddwr gwasanaethau cymdeithasol a thai, Cymdeithas
Llywodraeth Leol Cymru, Neil Ayling, llywydd Cymdeithas
Cyfarwyddwyr Gwasanaethau Cymdeithasol Cymru a phrif swyddog
gwasanaethau cymdeithasol Cyngor Sir y Fflint, a hefyd Julie
Boothroyd, pennaeth
gwasanaethau oedolion Cyngor Sir Fynwy—gyda dau begwn Cymru
wedi’u cynrychioli, felly. Fel rwy’n dweud, rydym ni wedi darllen eich papurau
gerbron, ac awn yn syth i mewn i gwestiynau ar y strategaeth
ddrafft. Felly, Angela sydd i ddechrau.
|
So, before us we have—and I’m very
glad to welcome—Naomi Alleyne, director of social services
and housing, the Welsh Local Government Association, Neil Ayling,
chief officer of social services at Flintshire and president of the
Association of Directors of Social Services Cymru, and also Julie
Boothroyd, head of adult services at Monmouthshire. So we have two
polar, separate ends of Wales represented here. So, as I’ve
said, we’ve read the papers before us and we’ll go
straight into questions, if we may, on the draft strategy. Angela
is going to start.
|
|
[480] Angela
Burns: Thank you. Good afternoon. Thank you very much indeed
for your evidence. In your paper, you refer to the development of a
strategic action plan as
|
|
[481] ‘a golden
opportunity to set out our aspirations for what the NHS, local
authorities and our partners’,
|
|
[482] stakeholders,
could do, going forward. What contribution do you think this draft
strategy plan might make to the integration of health, social
services, or social care and social services, and third sector
organisations?
|
|
[483] Mr
Ayling: Thank you for the question, and thank you, Chair, for
the introduction. We’re very pleased, as a professional
organisation, to be asked to give evidence. I think a key issue in
terms of integration and partnership working between health and
local authorities and the wider communities is how we work together
to actually improve outcomes for people in relation to people with
dementia. Clearly, one of the key areas we’ve covered in our
evidence is what we all can do, as partners, to make sure that the
outcome for the individual is as positive as it can be through that
joint working. Quite clearly, some of the key issues that the local
authority needs to get right—and social services as part of
that local authority—is how we work with health to make
issues such as early diagnosis work as sensitively as possible for
people, how we can actually seek to remove some of the stigma in
relation to dementia to actually ensure that it is something that
people don’t need to see as something that they should be, in
any way, ashamed of. I think we’ve made great strides over
the last two years with that. I know, from just hearing the end of
the evidence in the previous session, the actual approaches within
local communities to actually develop dementia-friendly approaches.
I know Julie has experience in her authority of actually seeking to
get memory clinics working in a more effective way. I think those
are the opportunities that we can do jointly with health
colleagues. I think all of us have this particular group of our
community—both people who have dementia, their carers and
their families—as a key priority that we need to respond to.
So, in a sense, those are some of the reasons why we had said that
the actual strategy is a golden opportunity for the service.
Certainly, the aims, aspirations and visions espoused by the
strategy are ones that we would support.
|
|
[484] Angela
Burns: Given that integration between the two sectors is
something that’s talked about a lot, do you think that, in
the current climate, this is deliverable, or do you think that we
actually need to try to use this to lever in a lot more
collaboration? Are we very far away from that goal?
|
|
[485] Mr
Ayling: I think there is very effective collaboration in
authority areas with health board colleagues on this agenda. I have
many examples from my authority of where there’s been really
rapid progress in this. I actually think that all partners need to
be together on this journey in relation to development. I
wouldn’t personally think we need to bring about another
systematic integration process to achieve benefit. I think
what’s important are the outcomes for individuals and whether
that working is joined on the ground to actually ensure that people
don’t fall through the net.
|
|
[486] Ms
Boothroyd: Can I just add to that, really? I agree with Neil,
largely, but there was a little bit in terms of—. I think
there is a cultural difference between health and social care,
which everybody will be aware of. Actually, sometimes, bringing
this together can be quite difficult. I suppose that I can
illustrate that with an example that Neil mentioned, which is
moving memory assessment services out of a psychiatrist hospital
into a community setting. We had to use quite a lot of influence, I
think it’s fair to say, to persuade our health colleagues
that this was the right thing to do. And it was very much about
addressing the issue of stigma. It was actually quite a long, long
way from anywhere, and people were very frightened and worried
about going into a psychiatric hospital for that assessment.
Actually moving that into a community facility with a community
cafe, with other resources—third sector and support for
carers around that—has, I think—. I think we’ve
acted as a lever of change to the health authority locally to say,
‘Actually, this looks better, feels better, and the outcomes
are going to be a heck of a lot better, and are, for
individuals’.
|
|
[487] So, I do agree,
but I do think there is some shifting of cultures that does need to
be done to achieve more, I think.
|
|
[488] Angela
Burns: Thank you. Naomi.
|
|
[489] Ms
Alleyne: Just quickly as well, I think the strategy is aiming
to develop that pathway for people with dementia that looks at the
interaction between health, social care, housing and other parts of
the sector at different stages as well—so, having that
pathway that people will understand. We often talk about seamless
services, so it doesn’t really matter which agency is
delivering to the citizen but, actually, that they get that
comprehensive approach there. There’s also reference within
the strategy to the role of regional partnership boards, which,
obviously, are made up of health and social care, under the Social
Services and Well-being (Wales) Act 2014, but, obviously, possibly
a role for public services boards where you bring in some other
public sector partners to take that work forward. So, some of the
structures are there so that that integration is happening. The
strategy is very much around making sure that that integration
happens on the ground in terms of—. And including carers,
third sector, and independent sector within that. Again, I think
the aim would be having those seamless services that actually meet
the needs of individuals. So, it’s a very broad aspiration; I
think it’s certainly one that we support, but there’s a
journey, if you like, for us to get there.
|
|
[490] Angela
Burns: And if I was just to build on that commentary, one of
the areas you really identify in your paper as there being very
little reference to is housing, and you talk about the need for
housing to link—you use that word ‘link’ quite
effectively. Perhaps you could just highlight a little bit more
your concerns over the issue of housing within the draft dementia
strategy.
|
|
[491] Ms
Alleyne: There are very few references to housing within the
strategy, but there’s a lot of work ongoing across Wales,
both at the strategic level, but also locally, in ensuring that,
actually, housing is an integral part of that discussion, because,
obviously, people are saying that their preference would be to
remain in their homes. That means that we need to develop homes
that will meet those specific needs, but also that can be adapted
according to people’s needs. There are opportunities out
there, but I don’t think they’ve been drawn out enough
within the strategy. It’s probably just one of those areas
where you’d need to look at and strengthen what the
contribution of housing can be, both from local authorities, but
also from the housing associations as well.
|
|
[492] Mr
Ayling: One specific area around supporting people with
dementia is in relation to extra-care housing, which has been very
successful in my authority, with two schemes that support people
with needs across a spectrum, but including people with dementia as
part of a community around extra care. We have two such schemes in
Flintshire, and we’re developing two more. One of the key
issues I would raise with you is that having a sustainable funding
way of actually making extra care develop and not actually stop at
a certain level is a concern that some of us have. It’s not
the only issue around housing—far from it—but
it’s an example of a new, very popular and innovative way of
provision that has been really successful at supporting people with
dementia as part of the community.
|
|
[493] Angela
Burns: Can I just very quickly, on the housing issue, just ask:
have you seen any sort of spike in older people as they develop
dementia who might be in either the private rented sector or
private owned sector actually coming over and asking for not just
help to make their homes more friendly for themselves, but actually
saying they need to have a completely different kind of home and
can you provide it?
|
|
[494] Ms
Alleyne: I’m not aware of anything, unless—
|
|
[495] Mr
Ayling: No. I think in some communities in north Wales,
particularly Conwy, a very popular retirement community,
there’s been quite an influx of people of retirement age, and
I’m sure it’s the case in other authorities.
|
|
[496] Ms
Boothroyd: Just from a—[Inaudible.]
|
|
[497] Dai
Lloyd: [Inaudible.]
|
|
[498] Ms
Boothroyd: I keep seeing you pressing it, and I
think—
|
|
[499] Mr
Ayling: I’ll stop pressing it.
|
|
[500] Ms
Boothroyd: What I can add to that is that some of the RSLs
locally have been carrying out quite a bit of useful research in
trying to forward plan what provision might be needed for the
future, and the learnt wisdom was always that people needed
different accommodation, but, actually, we were finding that people
weren’t taking up certain types of accommodation. So, they
carried out some very interesting research that proved a different
model was needed. I agree with the extra care approach, and that is
something that we want, because we’re trying to keep people
in their own homes for as long as possible, whatever that home is.
But this desire market was very much about people needing to be
near things that they need to access, for transport or for
facilities, but also having that was a little bit more than just
perhaps an older person’s bungalow, and wanting something
that anybody might desire—a two-bed, nice, lifestyle-type
property.
|
|
[501] So, actually,
this RSL has taken a very different approach and said, ‘We
need to build and design very differently for the next 10/20 years,
because, actually, there is a desire that’s different
that’s coming up from the one that we’ve, perhaps,
previously planned for.’ So, I think there’s some very
interesting work that is looking at forward planning around that.
It’s just then trying to make that happen.
|
|
[502] Angela
Burns: Thank you.
|
|
[503]
Dai Lloyd: Ocê. Symud ymlaen i rannau eraill
o’r strategaeth ddrafft, a Dawn yn gofyn cwestiynau
nawr.
|
Dai Lloyd: We’ll move on, then,
to the other parts of the strategy. Dawn, please.
|
|
[504] Dawn
Bowden: Thank you, Chair. A couple of areas I wanted just to
explore with you—one is around the value of dementia support
workers, and I know in your evidence you talk particularly about
the social care workforce in general terms, and you talk about
addressing the low pay issue, and that’s an ongoing—.
That’s a work in progress, shall we say? But I just wanted to
ask you, really, about the value of dementia support workers, as I
said, whether you believe that the current level that we have
available to provide support is sufficient, and, if not, where you
think that needs to be pitched. And then, obviously, the $64,000
question is: where is the money going to come from?
|
|
[505] Mr
Ayling: Go on, have a go.
|
|
[506] Ms
Boothroyd: I’d like to have a go at this one, just
because I’m very passionate about this particular issue. I
think it’s fair to say, across local authorities and across
health, we are facing a crisis in the workforce of social care,
particularly at that front end. This winter has been particularly
hard and is not getting any easier, and it’s taking longer. I
think there is a real issue around there not being a good enough
image of what caring today is about and that people have an
image—perhaps some of us may have that image; I don’t,
but some people might—which is that it is not very well paid,
the terms and conditions aren’t very good, and, actually,
you’re doing quite hard work spread across a big geography.
Actually, the reality, when you talk to the front line and the
workforce—it isn’t like that at all. There are some
wonderful stories; there are great things happening. But
we’re not managing to attract more people, and I think
there’s a real opportunity to give care a facelift and really
promote it in a different way and create a structure around
workforce development that values that front-line support.
|
|
[507] I’d just
add, from a personal perspective from Monmouthshire—and I was
saying to Neil earlier—we actually took some evidence from
some front-line staff who were saying, ‘I don’t think
we can do this anymore; it’s too hard. We’re being
spread too thinly. We’re wanting to do things that you might
not think that we should be doing, but we are doing them
anyway’—you know, taking people out and about, whereas
it was very much task and time. We listened to them and said,
‘Okay, what can we do differently?’, and created a very
different approach that has now been rolled out. That’s a
small example of how you can train, value, pay differently, and
give different terms and conditions, to enable the workforce to
feel like $1 million—those are their words, not mine. I do
think we have a bit of a crisis, and we’ve got to address it
if we want to manage care into the future and for people with
dementia—I’m talking about the whole workforce, but,
certainly, around people with dementia.
|
|
[508] Mr
Ayling: Just to add to that just three things—and I
completely support what Julie said—firstly, one of the really
positive things in relation to the agenda around dementia is the
growth of dementia cafes in my area. We’ve had seven that
have developed in Flintshire, supported by local towns, and they
are supported mainly and overwhelmingly by volunteers who are
people of the local community who are actually coming in to support
their friends and their families in local communities.
|
|
14:15
|
|
[509] That’s
bringing some new groups of people into, potentially, the health
and social care workforce. One example is young parents, young
mothers. It’s their first major exposure to that and
it’s potentially a way of getting into the health and social
care workforce in the long term. So, I think, when we’re
talking about the dementia workforce, it is a very broad
element.
|
|
[510] The second thing
I wanted to say is, quite clearly, our care homes—our
independent and local authority sector care homes—all need to
be seen as part of that workforce. I was speaking to the chief
inspector, Gillian Baranski, earlier today, who was
saying—she obviously goes to see care homes—she went to
a care home, a nursing home, and I think she said 47 people were
there and all but three of them had dementia, so 44 out of 47. That
is replicated throughout Wales. So, in a sense, we need to be
thinking about that wider workforce and investing in that. Quite
clearly, you would expect me to say there’s an element of
resources that’s needed to pump-prime and invest that on a
community basis, with our third sector partners as well as in
hospital care.
|
|
[511] Ms
Alleyne: I think the final point I would make is—. I
think you asked about resources. I think, if I recall, they were
looking for 32 support workers with an investment of £800,000
across Wales. I think it’s probably a view that the third
sector would be able to give, particularly around whether
that’s spread too thinly in terms of the roles that they
undertake, because, looking at the strategy, it’s not only
around diagnosis, but advice and information in the broader sense,
to help people come to terms with the diagnosis, to react to it and
to start the preparations that are needed for how the illness will
degenerate, probably, over time. So, there is investment in there.
I think I tried to work out how much each of those would cost in
terms of on costs, but it’s making sure that some of those
support workers are able to signpost to other forms of advice and
information that will be there that people can take advantage of.
One of the initiatives we’ve developed is Dewis, which is an
online website. I’ve asked my colleagues to look at what
information is available around access to dementia support services
on Dewis and how we can develop that so there are clear
opportunities for people to dip in and dip out of getting the
information and signposting to services that they need as well.
We’d certainly welcome the role that the support workers take
in that broader support for people following diagnosis.
|
|
[512] Dawn
Bowden: I’m assuming you have less control over how that
is developed in the private and independent sector compared to
directly employed staff, services and so on. The point you were
making, Julie, earlier on about the terms and conditions et
cetera—again, that’s something you can control from a
local authority perspective, but there’s no control over that
in the independent and third sectors, and they’re critical to
the whole strategy. I’m not asking you to be able to respond
to that because, in a sense, I’m not sure that you can, but I
think we just need to put that out there in terms of the
difficulty. Just on the issue of funding, I don’t know
whether you’ve seen the proposal from Age Cymru, who talk
about having a national strategic approach to funding dementia to
help the short-term funding difficulties. I’m not quite sure
what they mean by that, but I think what they mean by that is
everybody pooling the resources. Have you got any thoughts on
that?
|
|
[513] Mr
Ayling: I haven’t seen that specific proposal, I must
say, but I think we have to pool resources, virtually and in every
way, to actually impact change in relation to this agenda. You
mentioned the relative lack of control that we might have in
relation to independent sector colleagues. Quite clearly, one of
the areas we’ve taken forward is looking at culture change
for their staff in relation to this, which takes some pump-priming
in terms of training materials, in terms of awareness, and in terms
of, particularly, projects to actually work with us. But, we can
achieve a lot. One of the examples we’ve had in north Wales
is we’ve worked in partnership with Bangor University, which
is an acknowledged centre of expertise around dementia care, to
actually encourage homes to come forward with projects in relation
to improving the care of people with dementia in their homes. That
was an incredibly affordable way of actually achieving quite a lot
of good outcomes for people. There are issues in relation to the
wider health and social care sector and the pressures in that are
well canvassed and in a sense we probably can’t go into that
today. But, quite clearly, dementia is one of the main challenges
around that. Again, I don’t want to go on, but in local
authorities in many ways we’ve sought to specialise our care
for our in-house provision and actually work around dementia
reablement services and maybe support specialist schemes such as
extracare but we actually need that wider sector to work with
us.
|
|
[514] Ms
Boothroyd: If I could just add to that briefly in terms
of—. I wouldn’t want people to think that we
don’t have—the word ‘control’ feels a bit
funny but I know what you mean.
|
|
[515] Dawn
Bowden: Influence.
|
|
[516] Ms
Boothroyd: Yes, influence, that’s the word. I think
certainly the approach that we’ve taken, given that
we’ve remodelled everything in-house like Neil is describing,
is that we’ve gone on a journey with our market, with our
providers, who are independent and private individual businesses,
and actually brought them to the table and said ‘How can we
solve this problem?’ Surprisingly, to us as well, they have
the answers, which I knew they would have, but actually
they’re willing to contribute and co-operate together. So,
actually, we’ve been able to make quite a lot of progress. I
wouldn’t want people thinking we don’t have influence,
because we do. It’s about an approach to working together.
The word co-production is the one we use.
|
|
[517] Dawn
Bowden: You basically buy their services in, don’t you?
So, you are the customer. You’ve got a bit of control over
that haven’t you?
|
|
[518] Ms
Boothroyd: Absolutely. But it’s about how we solve this
problem together, and that’s proving to be very useful.
|
|
[519] Mr
Ayling: There are various elements of that control. As well as
the co-production, we also have contract monitoring staff that
actually enforce those standards. So, there is a carrot and stick.
But it’s about working with partners on this agenda. Again, I
don’t want to—. We have engaged a lot more partners on
this agenda than traditional ones—local communities,
businesses, shops, town councils—and that has been really
powerful in terms of taking forward a really positive change.
|
|
[520]
Dai Lloyd: Mae amser yn carlamu ymlaen ac felly mae
cwestiynau eraill i ddilyn. Julie Morgan sydd nesaf.
|
Dai Lloyd: Time is moving on and there
are other questions to follow. Julie Morgan is next.
|
|
[521] Julie
Morgan: I think you say in your evidence how important it is to
have the person at the centre of the planning. What would
opportunities do you think there are for the dementia sufferer to
have a say on what the treatment should be or what that person
needs? If you could say what opportunities there are now and
whether you think the strategy should be doing more along those
lines.
|
|
[522] Ms
Boothroyd: Definitely more. We could always do more. I do think
that the approach around the person is where we have to get to.
Actually, often there has been a little bit too much ‘doing
to’ people and not ‘doing with’ or enabling
people. We’ve taken a very different approach, which is about
actually having the person at the centre, who is in a sense—.
We meet the person with dementia where they’re at. The
training programme certainly that we’ve used is about
skilling our workforce up in a very deep way so that actually they
do have the skills to be able to do that, and I think that’s
quite an important part. We’ve actually invested in a six-day
programme for 350 staff, both front-line and professional staff,
who can actually manage that interface with people in a more
successful way. Certainly, the early evidence is that the outcomes
are far better: people are calmer and happier and, actually,
counter-intuitively it costs a little less money, often, because
that upfront investment—we took that investment on
ourselves—has made a massive difference. But in terms of the
impact for individuals, if I can just give you a tiny example, a
case that we often talk about is a lady who had withdrawn from
life, really. She was behind her door and had dementia. Everybody
had moved away in terms of any contact. Our traditional approach
before might have been, ‘She’s not answering the door,
she’s not answering the door a few times, we’d better
call the police and get the door broken down.’ The person
might be admitted into hospital or residential care. Because the
workforce was empowered to say, ‘Actually, what is going on
for this individual?’ they spent about four or five days
talking to her through the letterbox: ‘Let’s see
what’s happening.’ Bit by bit—and I’ll go
to the end now—this lady actually reconnected with her
community, she got a mobile phone, she got a microwave, and she
started being very, very independent. She spent three years before
she sadly passed away being connected to what she thought were
friends. Actually, it was our workforce, but they had taken this
intentional approach. So for me, it’s always the example that
I use because I think it shows the difference between what we might
have done before and what we’re empowered to do now. But
it’s all about having the person at the centre and being
really clear about who they are, what their identity is, and how we
can—. So that, for me, is a very—. And it needs to be
much stronger.
|
|
[523] Mr
Ayling: I can’t improve on Julie’s example, because
I think it’s very powerful, but I think on the broader front
in terms of person-centred care, for me that is partly about
removing the stigma around dementia, as I said earlier. I know
you’ve had evidence from others in relation to the importance
of the Dementia Friends initiative, and I would really support
that. It’s so powerful, with quite a small targeted element
of training. Again, speaking locally, my corporate management team
in Flintshire have all had the training around Dementia Friends.
There are 270 staff within the authority, 300 within schools, and
400 people wider within the community of Flintshire who all have
significantly more awareness around dementia as a result of that
training, and that all adds to the ability to actually treat people
in a respectful, person-centred way.
|
|
[524] Dai
Lloyd: Okay. Moving on to Caroline, because you’re
building on the same sort of theme here, aren’t you?
|
|
[525] Caroline
Jones: Yes. Thank you, Chair. Good afternoon. When a person is
suffering from dementia, obviously the care that they receive and
the planning for their journey ahead is of paramount importance. I
wonder if you could tell me if the draft strategy promotes the
involvement of families and carers during this process.
|
|
[526] Mr
Ayling: I think it does, but I think we all acknowledge, as
Julie said earlier, that there’s more that we can do to
support the involvement of families and carers in the process. I
mean, again, like all strategies of a similar vein, we’re
heavily reliant on our families and carers, and in this instance
many of us are families and carers of people who have dementia. So,
I think it’s incumbent on us to improve that further. I do
think we can help that by having those services in communities,
rather than in institutions, in the main. Julie spoke about an
example in Monmouthshire where that’s happened. Again,
we’ve had real success in that in terms of working with third
sector colleagues, with local churches and with local businesses to
actually make sure those services are there in ways that are
accessible to people. Interestingly, the issue around resources is
one where sometimes you see interesting trends, because we’ve
actually, in my county, seen a reduction in some of the demand for
traditional day services as a result of there being popular
community-led dementia cafes and other community-led approaches
that support families. So, hopefully that starts to answer your
question.
|
|
[527] Caroline
Jones: Yes. And with regards to the voluntary sector then, as
well—regarding the voluntary sector’s involvement.
|
|
[528] Mr
Ayling: The Alzheimer’s Society and carers organisations
are an absolutely—for ourselves—fundamental part of
that approach. In terms of resources, I would say that we as a
community are going to get the best possible value out of
investment by supporting those colleagues in this area around
dementia support and dementia care.
|
|
[529] Ms
Boothroyd: I do think, just adding to that, there is a
real—. It’s very important, I think, that we recognise
that carers may not always be equipped for the journey ahead. I do
think there is—. Certainly, our learning through training
staff—often staff have said to us we need to give this
training to people who are supporting and caring for people,
because they need to have that same level of knowledge to feel
supported to be able to continue. So that’s something that I
think we’ve got to invest in: what would support and training
look like for informal carers, so that they actually have—?
It often is a shock, and it’s often something that people are
not equipped for. So, it’s how we can build some resilience
for people to be able to know where to go—whether it’s
a dementia cafe, whether it’s a level of training. I think
that would be really useful.
|
|
14:30
|
|
[530] Caroline
Jones: Thank you.
|
|
[531] Ms
Alleyne: Just quickly to reinforce Julie’s point. We
recently undertook some research with the sector, looking at the
improvement priorities moving forward, and one of the key messages
that came back was around, in certain ways, seeing carers not as
part of the formal workforce, but seeing them in the workforce and
providing not just support but training opportunities. One of the
issues picked up, I think, within the strategy, is training around
dealing with aggressive behaviour, for example. So, how do we equip
our carers to ensure that they’ve got the right experience or
skills in that? So, it’s just reinforcing that that was a
message that came from the whole sector in terms of supporting
carers not only in terms of dementia, but more broadly moving
forward as well.
|
|
[532] Caroline
Jones: Thank you.
|
|
[533] Dai
Lloyd: Grêt. Symud ymlaen i
Jayne nawr.
|
Dai Lloyd: Great. Moving on to Jayne
now.
|
|
[534] Jayne
Bryant: Thank you, Chair. I think the points that you’ve
both raised on training carers who’ve come into it, I think,
are very valid, and I think you’ve made a very powerful point
there. Just moving on to the support for carers, we’ve had
evidence criticising the limiting scope of the high-level
performance measure, regarding carers assessment and support plans.
Age Cymru, I think, have said that,
|
|
[535] ‘with no
mechanism to monitor the impact and delivery of the [carer’s
support] plan, an increase in the number of plans is
meaningless.’
|
|
[536] What would your
views be on that?
|
|
[537] Ms
Boothroyd: It might be the wrong measure—that would be my
first thought. Often what we find is that some of the measures that
we have don’t actually measure the right things. The evidence
that we get back from carers is that sometimes they don’t
recognise themselves as carers and don’t want to be put in
that box that has the label ‘carers’ on it, therefore
we can’t count it. A lot of people, I think, picking up on
Neil’s point, are accessing support through support groups,
through different mechanism, whether that’s a dementia cafe
or whether that’s support in the community. We may be
facilitating that and we may be involved, but we’re not
counting it as a stat. I think it’s a valid point that Age
Cymru are making, but, actually, to count everything so that we
could justify whether we’ve made an impact is probably the
wrong bit of the measure. I think some of the work that we’ve
been looking at, particularly around the information, advice and
advocacy service, which is part of the Act, is that actually people
access support in many, many places, and actually it’s quite
difficult to quantify and count.
|
|
[538] So, it’s
the right challenge, but it’s because it’s the wrong
measure, and, in effect, we need to have better measures or we need
to be able to put other evidence on the table that says—. So,
for example, we hold a database of carers, and there are about 800
people who are on that, who receive a newsletter, who come to
events. They don’t want to be caught as a stat in a measure
that says, ‘I’ve had a carer support plan’.
That’s not helpful, so what we do is we say,
‘We’ve got 800 carers who’ve had this sort of
support’, but that doesn’t fit in the box. So, I think
it’s a very complex area. If you want assurance from a
number, there’s a lot of context underneath it that I think
we’ve got to understand more.
|
|
[539] Jayne
Bryant: Just on the suggestion that carers are experiencing
tighter eligibility criteria for accessing support
services—you know, things like much needed respite
services—do you have any views on that?
|
|
[540] Mr
Ayling: The evidence that I’m aware of in Flintshire and
throughout my colleagues is that actually the Social Services and
Well-being (Wales) Act 2014 should have actually, in many ways,
increased the access to services in terms of eligibility criteria.
Certainly, we haven’t seen any evidence that we’ve
reduced that. The social services and well-being Act, if anything,
was around actually offering support on people’s own terms.
So, actually, the, ‘What’s important to you?’
conversation is something that we take forward in north Wales, and
other colleagues do. Clearly, I’d be interested to know about
the evidence behind that question, but I wouldn’t say that
that has been the case in relation to the social services and
well-being Act. I think one thing I would say is that Naomi
mentioned Dewis, around that as a very user-led and community-led
approach to actually giving people more information and more advice
so that they can actually make those connections within the
communities, and that’s probably something—. I know
there’s a lot of specific information on that system around
dementia, and that is a resource that we should seek to actually
use. So, yes, that would be my response.
|
|
[541] Around carers,
and in terms of the actual—. You know, in trying to get a
performance indicator that makes us perform better, I would support
what Julie said. It’s often tempting to try and pigeonhole a
particular area of activity and, actually, what’s important
for me, my colleagues and my voluntary sector colleagues in
Flintshire is how we support carers as a whole, in terms of the
whole area of service—both people who support people with
dementia and in other areas where people are caring.
|
|
[542] Jayne
Bryant: So, what are your views on the national approach to
respite care? Do you think that that is something that you would
support?
|
|
[543] Ms
Boothroyd: I was just going to pick up on the—. I think
I’m probably understanding where this might be coming from,
which is that, actually, often, when carers do come forward there
is, and can be, a lack of the right respite available. It
isn’t that we’re not willing to sponsor or support;
it’s that actually the provision isn’t in the right
place or it hasn’t been developed enough. Certainly,
we’ve been having conversations with carers about what that
looks like. It doesn’t necessarily just mean two weeks in a
residential home, because actually that may not help. It might be
that we need to sponsor some support in somebody’s own home.
So, I can understand why people might think—. But it might be
to do with the gaps that we have in some of the provision that
people require.
|
|
[544] Dai
Lloyd: Okay. Lynne.
|
|
[545] Lynne
Neagle: The document is quite light on actual concrete
performance measures anyway across the board. Do you think, then,
it would be better to have more figures in there to tie the
Government into progress, taking this forward across the board?
|
|
[546] Mr
Ayling: I think, as Julie said, we need to get the right
measures of performance, and I think those need to be broadly
based. I think the Government, or Welsh Government, needs to work
with other partners to actually develop those in partnership. I
think it’s not necessarily the best approach to actually say,
‘In this context, this is what’s going to happen,
you’ve got to comply with it’. I think we need a
broad-based approach to actually improving the lives of people who
have dementia and their carers and supporters, and actually having
quite tight PIs I’m not sure will take us there, to be
honest. So, that’s my honest response.
|
|
[547] Lynne
Neagle: Predictable from local government, I’ve got to
say. [Laughter.]
|
|
[548] Mr
Ayling: Okay, there we are.
|
|
[549] Dai
Lloyd: Moving on to palliative care.
|
|
[550] Ms
Alleyne: I was just going to say that you can have some
measures that include numbers and figures, and I think what’s
missing from some of these measures is that it’s not clear
where the baseline is—so, where we’re moving from,
where we want to go to and in what time frame. Some of the measures
are certainly not SMART in terms of being able to be clear about
that progress, but I think some of the measures—well, not
necessarily measures, but there is importance around the
qualitative input as well, because this is about improving
people’s experiences, and the figures or stats won’t
always give that. So, I think there is something about needing to
tighten up some of these measures, and very few of these
performance measures actually link to the key actions in the
document. So, there is something about how we’re going to
measure a lot of the key actions, a lot of the aspirations within
it, but I think there is something where we need to actually talk
to people and find out what their experiences have been as
well.
|
|
[551] Lynne
Neagle: Thank you, that’s very helpful.
|
|
[552] Dai
Lloyd: Okay. Carry on.
|
|
[553] Lynne
Neagle: Our previous witnesses raised concerns about the
provision on palliative care in the document. They said that they
thought there should be a distinction between palliative care and
end-of-life care. Have you got a view on how effective the strategy
is likely to be in improving things in that area?
|
|
[554] Mr
Ayling: I clearly didn’t hear the discussion, so I
don’t know what their reasoning was for separating those two
out.
|
|
[555] Lynne
Neagle: I think they were saying that dementia is a terminal
illness and that the palliative phase can go on for a long, long
time, and that is different from the end-of-life phase, which could
be just a few days or a couple of weeks.
|
|
[556] Mr
Ayling: Well, in that case, as I understand it better, I would
support that. Quite clearly, the end-of-life care in relation to
how people are sensitively supported in those last weeks and months
of life is a fundamentally important part of the strategy and for
us in our services. We have a partnership approach in Flintshire,
which, I think, is the six steps towards care. That is another
partnership with health and with the independent sector, around
that. But, quite clearly, when people could be supported through
living with dementia for years and, indeed, sometimes five, 10
years, quite clearly, that is very different from the end-of-life
support.
|
|
[557]
Dai Lloyd: Ocê, mae gennym ni bum cwestiwn mewn pum
munud yn sylfaenol, so, os caf i ofyn i’m cyd-Aelodau fod yn
fyr efo’r cwestiynau a gofyn yn garedig i chi fod yn fyr
efo’r atebion hefyd. Jayne, ti sydd â’r cwestiwn
nesaf.
|
Dai Lloyd: We have five questions in
five minutes essentially, so I ask my fellow Members to be brief
with the questions and ask you to be brief with the answers as
well. Jayne, you have the next question.
|
|
[558] Jayne
Bryant: Thank you. We touched on this a little bit, about the
dementia-friendly Wales. I’m very pleased that, in Newport,
we’re working really hard to try and get a dementia-friendly
Newport, and I’ve got a dementia-friendly office as well, so
I really think it’s very important. But, do you think that
that will go enough of a way to change the attitudes that we need
to change to help with dementia?
|
|
[559] Mr
Ayling: I’ll start. I don’t think it will in
itself, no. I think it’s a really helpful measure, which
actually starts bringing about some basic realisation about the
issues, and then we need to build on that and actually achieve
further awareness. Another practical example in my area is that we
have a cinema in a particular town in Flintshire—I
won’t name it—but there were issues with the mat.
People with dementia were actually terrified going into the
cinema—they had a big black mat and, in a sense, people
thought they were falling down a hole. We’ve had the same
issues in shops, in businesses, in local towns and, actually,
businesses have changed simple things around that, which has made
considerable change and improvement in people’s lives. Those
are the small practical examples that we need to move on, you know,
month on month, year on year. Dementia Friends is a really
fantastic advance and we need to improve that. But, I suppose, as a
director of social services, my awareness has improved, and
colleagues who are senior officers and members, their awareness
around dementia has improved. I’ve seen a lot of positive
change, which I think is really quite encouraging.
|
|
[560] Ms
Boothroyd: I would just—
|
|
[561] Dai
Lloyd: Sorry, this is covered by a similar question from
Caroline.
|
|
[562] Caroline
Jones: Yes. What are your views on the provisions in the draft
strategy for improving the training of people working in dementia
services and how they manage challenging behaviour? It’s
partly been answered by Julie.
|
|
[563] Ms
Boothroyd: I think one of the things that I would say is that
the terminology is a bit of an issue, so ‘challenging
behaviour’ isn’t something that we necessarily
recognise. It’s actually people living with altered,
different realities. I think there has to be some language refresh
around this because, actually, it’s not helpful if people are
seen, with dementia, as being challenging, when actually
they’re not. They’re having some episode that’s
actually quite difficult at that moment in time. How do we support
our staff to recognise that and actually deal with that in a
meaningful way that doesn’t label somebody as
‘wandering’, ‘challenging’? Those are
things that we’re trying really hard to move away from,
because they’re not about a person, they’re about a
label.
|
|
[564] Ms
Alleyne: I think there’s quite a bit in the strategy
around training, which is welcomed in terms of awareness raising
and, obviously, referring to the needs for specialist posts and
specialist training. I think what I particularly welcomed as well
is that much broader approach of looking at our colleagues and our
partners across public service and all parts of society in terms of
what we can do. I think that comes back to partly answering your
question about the awareness raising, but also about what each of
us as individuals could do to assist people should we come across
them. I think it would be helpful to review what training is out
there now—does that fit with the strategy and the ambition
moving forward, and have different levels for different people in
the roles they undertake? But I think there’s a lot in there
that we can build upon.
|
|
[565]
Dai Lloyd: Y cwestiwn olaf—Rhun.
|
Dai Lloyd: A final question from
Rhun.
|
|
[566] Rhun ap
Iorwerth: A quick response from the three of you, just to wrap
up on resource implications of this strategy. We have a saying in
Welsh that is ‘diwedd y gân yw’r
geiniog’—literally ‘the end of the song is
the penny’, but it can be translated as ‘it all comes
down to money’. I know, in your submission, you say that the
strategy’s very quiet on financial resource implications.
What are your thoughts on what the strategy means in terms of the
financial resources that you’ll be expected to put in, and
also on your capacity—your capacity as social service
departments and also the social care sector?
|
|
14:45
|
|
[567] Ms
Alleyne: I’ll start. Very quickly, I think, obviously,
resourcing is always a big issue. The strategy starts by setting
out how much has been invested and in what areas, and a lot of that
is in hospital settings. I couldn’t find anything
that’s gone in specifically around social care within that.
But I think there are also actions within the strategy that we can
take. Because it’s about cultural change, it won’t
necessarily require additional resourcing. There are things that we
could be doing—or how we look at them through a dementia
lens, what we’re already doing—but there are some
aspects of the strategy that may need some additional resources and
pump-priming.
|
|
[568]
Rhun ap Iorwerth:
Does that frighten you, seeing as those
resources aren’t there?
|
|
[569] Ms Alleyne: It depends on that oversight
and how it’ll be taken forward, because, going back to
before, some of those key actions and the performance measures,
it’s not really clear how some of all of that will be
delivered, moving forward. So I think I’d like to see that
there are continuing conversations about what those resources are,
and when there is a need for additional resources, we can have some
discussion around where they come from. But we could also look at
how we use our collective resources better in some instances in the
strategy, as well.
|
|
[570] Ms Boothroyd: I do think, as well, that actually a lot
of work is in train, in progress and well developed, so it’s
quite hard to say, ‘What would the pound sign look
like?’ because everybody’s in a slightly different
place and may use resources in a different way to address this. My
view is that it comes down to leadership, passion and commitment to
wanting to deliver around this. Some of this you can do for free
and you can do without resource; I think we’d need to size
what would be—. I think the bit that I know is resource
intensive is training. That isn’t money that we have, and
when we invest it, it’s quite a bit of money, but it’s
a good investment.
|
|
[571]
Mr Ayling: My answer is: there is capacity in authorities;
we’ve had to make sure that there’s capacity in
authorities because it’s such a crucial agenda, and
we’ve used resources from other elements. In terms of the
overall resource element, whatever you spend in institutions, spend
twice as much in the communities, as you’ll get better value
out of it and we’ll get better value out of it, and the third
sector is where to invest, in my view.
|
|
[572] Rhun ap Iorwerth: Thank you. Diolch.
|
|
[573]
Dai Lloyd: Diolch yn fawr ichi. Dyna ddiwedd y sesiwn
dystiolaeth. A gaf i ddiolch yn fawr ichi unwaith eto am eich
cyfraniad ar bapur yn y lle cyntaf, cyn y cyfarfod yma, a hefyd am
ateb y cwestiynau mewn modd mor raenus ac aeddfed? Diolch yn fawr
iawn i chi’ch tri am eich presenoldeb y prynhawn yma. Diolch
yn fawr iawn ichi.
|
Dai Lloyd: Thank you very much.
That’s the end of the evidence session. May I thank you once
more for your contribution on paper in the first instance, before
this meeting, and also for answering the questions in such a mature
way? Thank you very much for attending this afternoon. Thank
you.
|
