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2. Questions to the Cabinet Secretary for Health, Well-being and Sport

May 17, 2017

68 speeches by…

  • Elin Jones
  • Caroline Jones
  • Darren Millar
  • Vaughan Gething
  • David Rees
  • David Melding
  • Eluned Morgan
  • Suzy Davies
  • Rebecca Evans
  • Rhun ap Iowerth
  • Simon Thomas
  • Jenny Rathbone
  • Hannah Blythyn
  • Mark Isherwood
  • Llyr Huws Gruffydd
  • Bethan Jenkins
  • Gareth Bennett
  • Russell George
…and 8 more speakers

Elin Jones

The next item is questions to the Cabinet Secretary for Health, Well-being and Sport, and the first question is from Caroline Jones.

Caroline Jones

1. Will the Cabinet Secretary provide an update on progress the Welsh Government is making in reducing waiting times for diagnostic tests? OAQ(5)0170(HWS)

Vaughan Gething

Thank you for the question. I understand, Presiding Officer, that you’ve agreed for questions 1 and 5 to be grouped. The number of people waiting over eight weeks for diagnostics at the end of February 2017 was 41 per cent lower than February 2016. This is the lowest figure since June 2011. The latest median waiting time for diagnostic tests across Wales is 2.6 weeks.

Caroline Jones

Thank you, Cabinet Secretary. Regretfully, far too many people are still waiting far too long for diagnostic tests. We still have nearly 2,000 people waiting more than 24 weeks for diagnostic and therapy services. Diagnostics are the central pillar of our health service, and we must do more to improve access to testing and eliminate waits over 24 weeks. What is your Government doing to ensure that no-one in future has to wait half a year for diagnostic tests?

Vaughan Gething

We’ve made real and significant progress, as I outlined in my earlier answer. I’m clear that the progress is significant and sustainable. In particular, a number of health boards—Hywel Dda, for instance—have no-one waiting over the relevant target time. The challenge will be for the numbers that are left, primarily in south-east Wales, and how they are resolved. I’ve been very clear with both executive officers, but also in particular chairs of health boards, that I expect people to meet to make further progress this year, because whilst I celebrate the progress that is made, I’m never complacent when in fact there is more progress still to be made and some people do wait too long, and I’m determined that NHS Wales will continue to deliver and improve.

Darren Millar

Cabinet Secretary, access to diagnostic tests and treatment is particularly important in emergency situations, so I was wondering whether you could comment on the fact that, in a recent coroner’s report following a tragic case of a lady who waited seven hours in an ambulance outside Glan Clwyd Hospital, who passed away shortly afterwards in hospital, he actually said, and I quote his report here: ‘It is of grave concern to me that my statutory duty requires me to report these concerns by way of regulation 28 reports on a very regular basis.’ So, this isn’t a one-off. This is something that has happened on a regular basis—‘a very regular basis’, according to the coroner—outside that particular hospital. This poor woman, this 56-year-old lady, was unable to get access to the tests and treatment quickly enough that she needed to get access to, and that may or may not have resulted in and contributed to her death. Given that this is a health board that is in special measures and that you’re ultimately responsible for that health board as Cabinet Secretary, what are you doing to heed the concerns of the coroner and to make sure that these events don’t happen on ‘a very regular basis’ in the future?

Vaughan Gething

Well, I’ve described the improvements that have been made, but I should just start by recognising that a wait of seven hours outside any hospital department is not acceptable. We need to be clear about not just the level of improvement we’ve made, but equally what we don’t find acceptable within our healthcare system, so we’re clear about the improvement that is necessary. I’m confident that with the improvements that have been made—in fact, in Betsi Cadwaladr, for diagnostic tests, they’ve made significant and sustained improvements for diagnostic waits. The challenge about how our whole system joins up is one that is not complete. I know that in some of the sites across north Wales, the waits outside hospitals are much prompter than others. So, I expect this to be a continued focus of attention—not just the individual case that you highlight, but understanding the broader picture—so we do have a position that is generally acceptable and providing the high-quality healthcare that each citizen in Wales is entitled to expect.

David Rees

Cabinet Secretary, I welcome the reduction in waiting time waits for the diagnostic tests that you’ve identified. It’s very important that we get people through as quickly as possible. I also welcome the investment in the hub at the Royal Glamorgan Hospital that’s been put into place to ensure that diagnostics work with clinicians on site to improve the service for people. Will you be doing more of these hubs across Wales, and if so, can I put a bid in for Neath Port Talbot Hospital, which is ideally situated for such a hub?

Vaughan Gething

Well, I recognise that he is the local Member for Aberavon. Look, there’s been real progress made in every single health board. Again, Abertawe Bro Morgannwg health board have made real and significant progress in this area. The diagnostic hub to be based at Royal Glamorgan is part of the south Wales programme: the development of a more joined-up service, understanding where those tests could and should take place, as we recognise that whether it’s in unscheduled care or scheduled care, having diagnostic certainty is hugely important to then make proper treatment decisions. I’ll decline from indicating where I’m about to locate, or advance the case for a diagnostic hub to be based in anyone else’s particularly local hospital, but I expect the whole service—the planned for, the demand that we know exists now, that we know will exist in the future—to have a system that is properly geared up to meet those demands that are utterly predictable. We do though know that will require some reform in the way we organise our service. There’ll need to be a properly mature conversation about that in the future. Obviously, I hope that—[Inaudible.]—will help to advance their cause.

David Melding

Cabinet Secretary, you know that the vast range of new diagnostic equipment is very expensive and very, very effective, leading to more investigations sometimes, and using the new equipment as efficiently as possible is a key to reducing waiting lists—I mean in the evenings, for instance, and over weekends, which often provides more convenient appointment times for people who are in work for instance.

Vaughan Gething

I recognise some of the points that he’s made, as does the service. We invest significant amounts of capital in providing the latest diagnostic equipment. It is important we make best use of it and understand what it’s potentially useful for. For example, I visited equipment that was required for one purpose, but it was actually able to deal with different diagnostic tests. So, it’s well understood in the service, and that’s part of the broader point about what reform does mean. It doesn’t just mean reorganising the physical location of services in primary and secondary care. It also means making the best and most efficient use of the assets that we already have—those are the staff and the equipment that we have. So, your point is well made and well understood by the service.

Eluned Morgan

2. Will the Cabinet Secretary make a statement on how the Welsh Government aims to provide the health services that the people of Wales need in light of current economic challenges? OAQ(5)0172(HWS)

Vaughan Gething

Thank you for the question. As a direct result of the UK Government’s commitment to austerity, the Welsh Government budget will be 9 per cent lower in real terms by the end of the decade. Despite the cuts imposed upon us, the Welsh Government continues to invest in NHS Wales. That means that in the first two years of this Government, we will have invested over £0.5 billion of additional funding into NHS Wales.

Eluned Morgan

That’s very good to hear, but it’s also worth, I think, underlining the point that it’s not just economic challenges that the NHS is facing; there are particular problems in terms of recruitment. And, as well as in parts of England, there are particular problems in rural Wales in terms of recruitment, where, for example, the Hywel Dda health board have committed to revert to 12-hour consultant coverage at the paediatric ambulatory care unit in Withybush, once they’ve managed to strengthen their clinical team. The problem is that the Royal College of Paediatricians have suggested that 41 per cent of neonatal clinics across the whole of the UK had to be temporarily closed in the past year because of recruitment difficulties, and Withybush is fishing in the same pool for those experts. I just wondered how we’re going to address that issue, and can you confirm that, in an emergency, Withybush accident and emergency can deal with paediatric cases?

Vaughan Gething

Thank you for the question. On the final point, it continues to be my understanding there is paediatric capability within the A&E to properly meet the needs of patients who do require treatment in an emergency. Look, there’s a broader challenge here that you’re quite right to highlight about our ability to recruit and the particular shortages in some areas, where they are UK-wide problems and more than that—right across western Europe there are challenges in some areas of recruitment. So, that’s part of the honest challenge we have to take on board on actually improving but reforming the way our health service works in the future. That’s why having attractive models of care organised across the community, and, where necessary, in a hospital, really do matter. If we’re going to recruit the best people, if we’re going to recruit people into these shortage professions, we need to have an attractive place to work. And, for all the significant success that we’ve had in the first phase of ‘Train. Work. Live.’ for recruiting doctors—a significant move forward for Wales—we recognise there is more for us to do and that campaign in itself won’t get us over some of these speciality areas. So, thinking very clearly and carefully about the future of the service, how it’s organised, who we want to attract, and the terms on which we ask people to work, who they actually work with, are really important for the future in a whole range of different areas.

Suzy Davies

In March, Cabinet Secretary, the community and children’s Secretary said that good, secure housing not only reduces the burden on other services, such as the NHS or social care, but it will also improve the quality of life for people, and I think none of us would disagree with that. However, I would go a little further and say that housing that’s designed to be easily adaptable, perhaps designed with the guidance of rehabilitation experts, is also important, as it allows older people to stay in their properties for longer without having to move out of an area that they’re familiar with, for example. So, can you tell me what kind of cross-portfolio conversations have you been having about preparing guidance for the construction industry, not least those who are building council properties, that will anticipate changes in people’s lives because of health and old age and that will actually make it cheaper for them to adapt and to receive rehabilitation in their homes in the future?

Vaughan Gething

Thank you for the question. I’m pleased to confirm that the investment that the Welsh Government has made in improving the quality of people’s homes, in particular making them more energy efficient, has had a real benefit in both financial terms, but also in health outcomes as well. There’s developing evidence there are better health outcomes for those people as a direct result of that Welsh Government intervention. And, in terms of the point about not just adaptation, but about the sort of housing that we commission in our use of capital, I’ve had direct conversations with the Cabinet Secretary for communities about the way in which capital is used. And it needs to be a part of a developing theme of this Government to make sure we don’t just meet our targets on house building, but that the sort of housing that we build, the way in which local authorities and health boards commission care, and what provision they’re looking for, is properly taken account of by house builders, and, in particular, the registered social landlords sector, but more widely as well. And I’m confident you will see more progress and a more joined-up approach from this Government. I’m sure I’ll have more to say on this in the coming months.

Elin Jones

Questions now from the party spokespeople to the Cabinet Secretary. The Conservative spokesperson, Suzy Davies.

Suzy Davies

Thank you again, Llywydd. Minister, thank you very much for your statement on social care funding that came out this morning. In the face of the £2 billion extra that came from the Conservative UK Government for this, I think it was important for you to make an early statement that you are prepared to commit money that we’ve acquired through the Barnett consequential for the same purpose, and so I do welcome that. You’ve already announced additional moneys, aimed, I think—it seems to me, anyway—almost entirely to meet the additional cost of providing the national living wage; obviously, I support that. But this new £9 million from the Barnett consequential that you’ve announced today seems to be aimed at exactly the same purpose. Is that because your original allocation was insufficient, or do you have new figures that have revealed that the costs of this were higher than you anticipated?

Rebecca Evans

I thank you very much for the question and for the warm welcome that you have given to our additional funding and additional investment in social care in Wales. And, just for the benefit of Members, the additional funding that I announced today did include that extra £9 million to help meet the pressures of the national living wage within the sector, but also a further £8 million to support work to prevent children from entering care and improve outcomes for those who are in care, and also £3 million to local authorities to support respite for carers, given the crucial role that we know that carers play as well. The domiciliary and residential care workforce has a crucial role in society and we have been concerned at the level of turnover within that sector, which is around 30 per cent in some areas at the moment. So, the aim of the funding is to allow local authorities to invest, and providers to invest, in their workforce—to raise the pay, obviously, that their workforce receives at the moment, but also to look at what more we can do to keep people in the sector as well. So, it’s investing in skills and investing in the individuals more widely as well, ensuring that people don’t have to pay for the clothes that they wear to undertake their role, and so on. So, the additional funding was made because we’re able to do it because of the extra money that we had through the consequential funding, and it’s welcomed by local authorities. I’d add as well that we have written to local authorities because this is grant funding in this first year. So, we’ve set out quite clearly to local authorities what we will be expecting them to achieve for the sector through the additional funding that we’ve made available today.

Suzy Davies

I’m very grateful to you, particularly for the last part of your answer there. As I say, I’m more than happy to welcome everything that’s in the statement, but, obviously, I’m going to be scrutinising you on how well you are watching how that is spent. The £3 million given to local authorities for respite, obviously, and particularly in view of what we were talking about here yesterday, is very important. It’s an area where provision is particularly weak, and I’m very keen to know what you’re going to do to make sure that that is spent on front-line respite provision and that it doesn’t get eaten up in procurement or commissioning processes, which do have a tendency to eat up money, particularly when it comes to respite for social care, where we need every single penny.

Rebecca Evans

I prioritised respite for carers because this is one of the areas that carers repeatedly tell us that they need more support in, and we need to look after our carers to ensure that they’re able to continue to look after the people who they care for in return. So, I will be working up the specific details in terms of what we will be requiring from local authorities with regard to the funding for respite care particularly, and, again, that will go out through grant funding, with specific requirements on local authorities as to what we would expect them to see for that money, and for support for carers locally as well, because we absolutely are clear that this has to make a difference for carers on the front line, who will be in receipt of respite, to, as I say, enable them to continue the important role that they do.

Suzy Davies

Well, for that very reason, I’m very pleased it hasn’t gone into the revenue support grant, so I do thank you for that. Could I ask you: do you welcome the Prime Minister’s announcement of a statutory right for leave for those with caring responsibilities?

Rebecca Evans

When you initially see that there’s a right for carers to have statutory leave, fantastic, and then you see it’s an unpaid year off work, and then you realise that that is going to be completely out of the reach of most people who are carers, unfortunately. I don’t know many carers who can afford to take a year off work, and it just seems again that it’s a Conservative policy from the UK Government that is an empty promise, but which also benefits those who have, and so benefits the few, not the many, in the sense that only the highest-earning people and those who are in families that are already wealthy are going to realistically be able to take a full year off work completely unpaid. So, in that sense, I don’t think it will be taken up by huge amounts of people in Wales. So, what we do need to do is ensure that the respite care, and the things that are in our gift in the Assembly to deliver, really do meet the needs of carers right across Wales. And, actually, we know as well that carers find it very difficult to find employment anyway, so many carers are out of work because of the nature of the caring responsibilities they have. So, there’s a role for us as well to look at what we can do to make employers in Wales more carer-friendly, more flexible, to allow carers to return to work. And we’re also looking at interesting projects to see how we can perhaps look at whether or not carers are able to access some kind of accreditation for the caring work that they do. So, it might be that, at a point in the future, they’re able to use the experience and expertise that they’ve gained as carers to take that step, then, into paid employment in the caring field.

Caroline Jones

Diolch, Llywydd. Cabinet Secretary, I welcome the nurse recruitment campaign and the news that the Welsh Government is to retain the student nursing bursaries for another year. We need to do all we can to encourage people from all walks of life in Wales to consider a career in nursing. What plans does your Government have to extend the nursing bursaries in the future to ensure that Welsh residents considering a career change can afford to train as nurses?

Vaughan Gething

I welcome the support provided for the NHS bursary, provided not just for nurses, but a range of other allied health professionals, to help them through their training. We recognise, given that the average age of a nurse in training is in their late 20s, that they’re likely to have ties to a local area and they’re likely to have responsibilities. Taking away the financial support, as has been done by the United Kingdom Government across our border for those people training in England, has a serious and significant effect. We’ve seen a significant drop—24 per cent—in the people applying for nurse training across the border as a direct result. We made a choice, based on the evidence, to support people undertaking healthcare courses, including nurses, and it was very well received when I attended the Royal College of Nursing congress in Liverpool on Sunday and Monday. This Government will provide not just the direction of travel that we’ve been very clear about recently, but a fuller and more comprehensive long-term approach to supporting people undertaking healthcare education, when we announce our full and final response to the Diamond review in due course.

Caroline Jones

Thank you for that answer, Cabinet Secretary. While the nursing recruitment campaign can help address short-term staffing issues, we need to think about the longer term and how we can encourage more Welsh people, particularly Welsh speakers, into nursing. UKIP would like to see the reintroduction of the equivalent of the state enrolled nurse, which would allow healthcare assistants and others to train as nurses without requiring a degree. What consideration has your Government given to the reintroduction of some form of enrolled nurse into the Welsh NHS?

Vaughan Gething

Well, I welcome the recognition that the ‘Train. Work. Live.’ campaign is a positive step forward for nursing in Wales. It’s had an incredibly positive response at the outset from the current nursing workforce, who are very proud to see themselves being highlighted and featured—the four individual named and photographed people are nurses with different career routes, and that’s been very much welcomed by the current nursing workforce. They recognise the focus of attention and, if you like, some hope for the future and a deliberately different approach here in Wales. This Government does not support a return to a state enrolled nurse role, partly because we have spent significant time and effort working with the nursing family to develop a career path and a development path for healthcare support workers. In fact, the Member for Merthyr Tydfil and Rhymney behind you was part of the conversation in her previous role about developing that career path and development. We also see a number of healthcare support workers undertaking training from their current role into nursing, so they’re still undertaking work as well. That’s part of the flexibility we’ve provided, to make sure that that can take place so that those people who are in work with responsibilities can still carry on working whilst undertaking their nursing qualification. There is no support from representatives of the nursing workforce for us to remove the status and the requirement for nursing to be a graduate career, and I’m happy to listen to those people about how we develop the very best nursing care from the whole nursing family, and we do properly value and support the role of healthcare support workers.

Caroline Jones

Thank you, Cabinet Secretary. Finally, we not only have to recruit more nurses, but we also must ensure that we retain our existing nurses. According to the RCN, nurses in Wales often do not feel valued by the NHS or the Government. There has been a 14 per cent real-terms fall in nursing pay since 2010, and 69 per cent of nurses work overtime at least once a week. What plans does your Government have to improve nurses’ pay, terms and conditions and ensure that they have access to continuous professional development in order to reflect how we, as a nation, value the profession?

Vaughan Gething

I recognise the points that are made about the feelings of a number of people within the nursing workforce. Part of what we’re doing to retain people, of course—those people that are training—is not just support with the bursary, but also the fact that that comes with the expectation that people will take up the offer of two years of employment here in Wales, so people will continue to work within Wales as well. We actually have pretty good retention rates, as well, for people who actually complete their courses. On the broader point about the 14 per cent fall in the real terms of nurses’ pay since the Conservatives came in to lead the UK Government, the reality is that the direct imposition of a public sector pay cap is a real barrier not just for nurses, but a whole range of public sector workers. I would dearly love to be in a position where we had a different approach taken. You will recognise, of course, that there are different manifesto pledges being made outside of this place ahead of the general election, and my party on a UK level has to pledge to break the public sector pay cap if we return to the UK Government. That is good news for nurses. We would be able to properly value them and recognise in their pay the real support the public have for them. But, in terms of your point about nurses not being valued by the Government, I can confirm there is a radically different approach and understanding for nurses here in Wales compared to across our border, and that point was made plain to me on a number of occasions forcefully, clearly and politely by nurses, both in Wales and in England, who I met at the recent Royal College of Nursing congress in Liverpool. So, a good story for us in Wales. There’s more that we could do if only we had a UK Government on the side of Wales.

Rhun ap Iowerth

Diolch, Llywydd. Now, last week was Mental Health Awareness Week, and, though that’s been and gone, we’ve got to keep the issue’s prominence, of course, on our agenda. Last week, I raised the issue of mental health services in the north of Wales with the First Minister, in particular the number of mental health patients who had been sent out of north Wales, hundreds of miles away from their families, including children. The First Minister’s response was that he didn’t accept the figures. Do you accept the figures?

Vaughan Gething

We know that there are a number of people who are being sent out of area. We’ve seen a significant improvement in the number of people going out of area for treatment. Some of those people will go out of area because they require specialist support that is not available in Wales—we don’t have the number or the ability to commission and provide that care directly in Wales. Some people are still, though, going inappropriately out of area, but we’ve made significant progress on this issue over this year. So, for example, there are now single-digit numbers of children going out of area for placements. I accept that, for each person where there’s long travel to go to an appropriate placement, that would be a real issue for them, their family and their loved ones. The point is, though, there is real progress that has been made over this last year, and we expect further progress to be made in the years to come.

Rhun ap Iowerth

So you keep telling us. Some of the figures that the First Minister didn’t accept this week were that waiting times for CAMHS haven’t improved. He claimed things had moved on significantly. We all know that if you want to demonstrate improvement, you simply take the month where figures were at their worst as your starting point and compare with more recent ones and, unless the performance is worse, the maths will show an improvement. That’s what the First Minister did yesterday. In reality, an honest look at CAMHS waiting times shows that, prior to July 2013, the percentage of children waiting over 26 weeks never went above 10 per cent. Then, waiting times skyrocketed to 36 per cent waiting over 26 weeks in September 2015, before, yes, recovering to the current level of 20.5 per cent in February this year, which is when we have the most recent figures. An improvement in a period of time, but not overall. Do you accept that this is a more accurate reflection of the performance of CAMHS, and when will you accept that the First Minister or yourself simply standing there saying that targets are being met is a long way from the reality faced by desperate staff and desperate patients who share with us as Assembly Members their experiences?

Vaughan Gething

Well, I would hope that we could have a searching but reflective conversation about this, and I’m disappointed by the tone that is struck. I don’t try to avoid scrutiny at all, but the reality is that, when looking at the period over the last few years, we’ve seen a significant rise in the number of referrals and the ability of our system to cope. There was a time when people were waiting significantly longer than they should have done, and some people do still wait too long—we have a backlog to clear—but we have made undeniable, real and significant progress. The investment decisions made over the last couple of years have made a real difference for families entering into the CAMHS system. There’s additional focus on the support that should be available outside of the CAMHS network, as well—the progress of Together for Children and Young People. There is real progress being made, and I don’t deny your right to scrutinise me, I don’t deny your right to ask difficult and awkward questions, but I do wish they could be a more reflective and a more accurate picture of the progress that really is being made. And when we see—. We’ll have figures out tomorrow across a whole range of NHS services, but NHS health boards have committed to meeting the waiting time standard for people who should be seen within 28 days of referral. They say they are confident that they will meet that standard, and I look forward to seeing the figures published, to see if they have done that. I will certainly hold them to account. There will be no lessening in scrutiny or expectation from Ministers in this Government, to make sure that people are seen appropriately and by the right service.

Rhun ap Iowerth

But people aren’t stupid; they know when people are being selective with figures. There’s clearly a shortage of staff in mental health, and I hope that you would agree with that. Another area of health workforce where we have shortages is among GPs. It’s a Wales-wide problem. It’s one of the reasons to support Plaid Cymru’s pledge to train and recruit 1,000 extra doctors. Now, patients in Burry Port are the latest to hear that they have to leave the area to see a GP, due to the closure of a surgery. The Member for Llanelli has been typically lively on the backbenches today. I do understand that local Labour politicians are protesting against this. Will you be joining them, I wonder, in their protest, as I seem to recall the former education Minister doing, against the closure of a school in his constituency? Or will you own up to the fact that it’s Labour’s, Welsh Government’s failings in workforce planning that has led to this shortage of GPs?

Vaughan Gething

The honest and mature approach that I thought we would have to discussing healthcare in the future, which was taken by the parliamentary review, of course, doesn’t exist when it comes to ministerial questions. The reality is we are recruiting more GPs. We are training more GPs in Wales. We’ll have a more successful approach in the future. The Train, Work, Live campaign has been significantly successful in us actually having more GPs coming into Wales. I expect to see, as we make commissioning decisions in the future, that we will properly take account of the workforce planning that we need to do, in a much more joined-up way. There has been real improvement in this area. Now, when you then talk about 1,000 extra doctors as the answer, well, that’s what we’d politely call an aspirational target—not a real or an achievable one. In this position, in the Government, you have to commit to things that will make a difference. That’s what I’m doing in this, and I’m proud of the fact that we are making a real difference for people right across the medical workforce here in Wales. And I say that every Member is entitled to stand up for their local community and ask awkward questions of health boards and me. That includes the Member for Llanelli, who is standing up for his community and asking what arrangements will be in place for the future of primary care. I don’t complain about that from any Member in this place, and nor should I. That’s people doing their job. I just wish we could have a much more honest and grown-up conversation between ourselves in this Chamber, as well as outside of it.

Simon Thomas

3. What discussions have taken place between the Cabinet Secretary and the UK Government regarding the effects of air pollution on public health? OAQ(5)0165(HWS)[W]

Rebecca Evans

The Cabinet Secretary for Environment and Rural Affairs leads for the Welsh Government on air quality, and her officials continue to have significant engagement with their UK counterparts on matters such as UK-wide air quality modelling, EU legislation on trans-boundary air pollution, EU reporting, air quality research, and air pollution episodes.

Simon Thomas

Thank you for that response, Minister. I understand that the Cabinet Secretary leads on this, but this was a specific question on the impact on public health, because it’s been accepted that air pollution is the second greatest factor in terms of early deaths in Wales and has been described as a public health crisis in evidence to the Climate Change, Environment and Rural Affairs Committee by the head of Public Health Wales. So, specifically, what are you going to do to mitigate the impacts of air pollution on health and, specifically, are you going to commit today in the Chamber that the Government, in its clean air plans that were mentioned yesterday by the First Minister, will have a target to reduce air pollution in Wales and specific targets within the plans to demonstrate that we’re on the right track to reduce air pollution in Wales?

Rebecca Evans

Well, I thank you very much for that question and would reiterate that the Welsh Government does recognise the seriousness of air pollution and the impact that it does have on public health, because we have recognised this through our public health outcomes framework indicators, in which we actually specifically include the average concentration of nitrogen dioxide at dwellings as one of those indicators. We’ll be issuing guidance very shortly to support health and public health professionals in NHS Wales by providing key messages about the role that they can play in supporting local authorities on air quality and communicating the public health risks of poor air quality to the public and to other agencies as well. We will also be undertaking an awareness-raising campaign on air quality for health professionals and the general public. Public Health Wales also is currently undertaking a research project to enhance the local air quality management regime in Wales to maximise the public health outcomes as well. So, we absolutely see air pollution within that important public health context. With regard to the specific question on the clean air zone framework, of course this comes about as a result of the joint UK consultation on nitrogen dioxide. You are aware, of course, of our commitment to consult within the next 12 months on the details of the proposals for the clean air zone framework for Wales. This is something that the Cabinet Secretary will be developing. I wouldn’t want to pre-empt anything that the Cabinet Secretary decides to do in this regard.

Jenny Rathbone

I appreciate that it’s the primary responsibility of the Cabinet Secretary for climate change and the environment, but I hope we can see a whole-system approach by the whole Government. I’m sure that the Cabinet Secretary for Education would also have some responsibility for ensuring that our children in school are not being subjected to unnecessary levels of nitrogen dioxide. Therefore, what would the advice be to schools from public health experts as to whether it’s safe on particular days for children to be playing outside?

Rebecca Evans

I completely agree that schools do have a crucially important role to play in terms of managing pollution when children are being dropped off at school, because we know that the start and the end of the day are particular points at which children are exposed to high levels of air pollution. That’s partly because of the school run, and that brings into focus all the important work that we are doing on active travel as well. But schools also have an important role in terms of educating children and their families about the dangers of air pollution. Now, there are simple things that people can do in their individual lives to reduce air pollution as well. The Welsh Government has committed to issuing new air quality policy guidance to local authorities next month, and I can confirm that that guidance will recognise schools and active travel routes, amongst others, as sensitive receptor locations. Local authorities really do have to take a risk-based approach in terms of siting their monitors, and that should be based on the evidence that they have in terms of areas that are likely to be exposed, or areas where people are likely to be exposed to the highest levels of air pollution.

Hannah Blythyn

4. Will the Cabinet Secretary provide an update on the provision of mental health services and support in north Wales? OAQ(5)0169(HWS)

Vaughan Gething

We recognise that the health board are working hard to make the necessary improvements to mental health services across north Wales. A new mental health strategy for north Wales was agreed by the board on 20 April and has been endorsed by their six local authority partners.

Hannah Blythyn

Thank you. Thanks for your response, Cabinet Secretary. I’d like to acknowledge the work that the Welsh Government is doing and the commitment to raising awareness and tackling the stigma around mental health. The challenges facing us in north Wales have been and are well documented. I welcome the health board’s new multi-agency approach to developing the new mental health strategy, which you’ve just mentioned, and the commitment to work with service users as well as staff to improve our services. However, it’s clear, and I know that the health board also acknowledges, that there is so much more we can do to improve mental health services in our area. Hopefully, the new strategy and the health board’s engagement with service users are a step in the right direction, but, clearly, there is much more that needs to be done, and it’s something that I will be paying close attention to, holding them to account on behalf of my constituents in Delyn. Cabinet Secretary, can I ask that you continue to strongly monitor and make sure that improving mental health services and support is a priority in, and for the people of, north Wales?

Vaughan Gething

Yes, I am happy to give that assurance. It’s been a real step forward, though, to actually get to the point where there is a proper mental health strategy to consult upon—not just to consult upon, but it’s been drawn up following work that the health board has done with local government, as I mentioned, but also with the third sector and with staff in the service, and with users of the service as well. To be fair, that wasn’t the case and wasn’t the position prior to special measures. It wasn’t an acceptable position, and this was a significant factor in the health board going into special measures. The reality is not just the provision of the service, but actually the forward strategy not being where it could and should be. So, there’s a real step forward, and the new leadership brought by Andy Roach, and also the significant progress made by both the interim chief executive and the current chief executive, should give us more confidence for the future. But it’s certainly not an area to let go of or to be complacent and say everything is fixed because there is a new strategy. There are real challenges to overcome and this is a significant part of interest to the regulators when they meet to advise the Welsh Government on the progress that Betsi Cadwaladr has made and that progress that is still required to come. So, Healthcare Inspectorate Wales continue to take an active interest in the provision of mental health services, I continue to be concerned about the progress being made and I’ll maintain that concern and that interest until we are in a position not just where we can see the health board leaving special measures when the regulators advise us it is appropriate to do so, but even after that there needs to be a continued focus on the provision and improvement of mental health services right across north Wales.

Mark Isherwood

Continuing gaps in north Wales in dual diagnostic treatment for people with mental health problems and substance misuse mean that the revolving door is tragically still alive and well. It’s a decade since a Welsh Government-commissioned report into tier 4 inpatient detoxification and rehabilitation services was leaked to me, having being buried, identifying people deliberately reoffending because of these gaps and the hospital admissions because of the absence of this treatment. The Welsh Government did come forward with a proposed model working with three third sector providers in north, central and south Wales. A decade later, where are we up to with that, so that those people desperately needing that dual diagnostic treatment can receive it in the region they live?

Vaughan Gething

You ask about provision across a range of different areas and substance misuse, obviously, is a matter that the Minister leads on. I’m happy for us to write to you to give you an update on where we are with tier 4 services in north Wales and, more generally, for Members across the country as well.

Llyr Huws Gruffydd

You’re entirely right, of course, to say that we shouldn’t mislead ourselves in thinking that the situation has been resolved, because I had quite a shocking meeting with professionals in the sector in north Wales a week or two ago, and they mentioned that it was a lack of capacity, a shortage of beds and a shortage of staff that was one of the central problems, which creates a vicious circle where people are released from units too soon because the capacity isn’t there to take new patients into a community regime that doesn’t have the capacity to deal with the numbers, which, at the other end, is going to push more people into those units in order to deal with the burden. What they told me was that the situation is now worse than it has ever been before. Now, I accept what you say in terms of a long-term strategy and looking to the future, but the reality is, of course, that there have been two years now since the Betsi Cadwaladr health board was put into special measures, and, as you said, one of the reasons for that was the deficiencies in mental health services. So, I’m sure you will acknowledge that the situation as it currently exists is not acceptable. But what people want to know is: what is the plan to deal with these difficulties now, today, whilst, of course, moving forward to longer term plans in the future?

Vaughan Gething

I thank you for the question and I recognise that the challenges that are faced by the service in north Wales are about a proper understanding of capacity and demand and need, but also how the service is organised—that really does make a difference—and making sure that the resources available to it are properly used and organised. There is something about having a proper, clear strategy to understand what we’re trying to achieve and why, as well, and there’s a really significant step forward that has been made. But objectively, the provision of mental health services in the round is in a better place in north Wales than it was a couple of years ago. But as in every other service, if you’re at the front line and you’re in a busy and a difficult and demanding job, you may not be able to take a step back and think ‘This is better than where we were a year ago, 24 months and 36 months ago.’ That’s part of the reason why we have an objective process with the regulators. They don’t take my word for it about the progress made. The regulators come up with a rounded assessment independent of Government and they then give us advice about the progress through special measures. Whatever happens with special measures, there will be a need to continue to look at, as I said in answer to Hannah Blythyn, the provision of mental health services, the quality and the outcomes delivered with and for people in north Wales. I am under no illusion whatsoever that the progress we describe must be honest, but it must also recognise there is more still to be done, both in the here and now, in the immediate period, as well as for the medium and longer term future. So, I certainly don’t try to deny the challenges and I’m sure I’ll get many more questions in this Chamber about where we really are.

Darren Millar

6. Will the Cabinet Secretary make a statement on access to mental health services in Wales? OAQ(5)0160(HWS)

Vaughan Gething

The Welsh Government is committed to the continuous improvement of access to mental health services in Wales and to support this we have increased funding for mental health services to £629 million in this financial year.

Darren Millar

There’s been a lot of concern already expressed about mental health services in north Wales and I can tell you that my postbag is just as bad now as it was before the Tawel Fan scandal emerged into the public domain. One of the concerns that has been raised with me is about capacity, and Llyr’s already picked up on this, but that capacity problem that we have in terms of inpatient beds is requiring some vulnerable people to sleep on sofas in open lounge areas; some vulnerable individuals are being put into inappropriate male wards—young women, for example—and others, of course, are having to be transferred hundreds of miles to other inpatient care settings, all of which, I am sure you will agree, is totally unacceptable. Given that this is a health board that has been in special measures for almost two years now, and that these things are happening on your watch, Cabinet Secretary, what are you personally doing to make sure that these sorts of bad and unacceptable practices are stamped out immediately in the health service in north Wales?

Vaughan Gething

I thank the Member for his follow-up question. I understand you’ve directly engaged with the health board on a number of these issues. As I’ve said in response to previous questions, it’s important that we do see real improvement. The change in leadership has been a step forward. We recognise, though, that the way in which some of the services are currently organised is not as we wish it to be, and that does mean some people don’t receive the service that we would wish them to. On the point about where vulnerable people are placed for a period of time, on the particular point about sofas, my understanding is that a conversation has taken place with that service user, that person, about what their preference is, because they’ve been offered on some occasions a transfer, and they’ve declined, and they’d like to stay in that particular place. It is a temporary measure until they move to an appropriate setting. But it is not an appropriate long-term position to be in, where that is happening to any of our patients. It should be an extreme measure rather than a regular one. So, I’ve made clear, and our officials are making clear with the health board, that the current practice isn’t appropriate, and they do need to move on and improve it, and have the appropriate capacity in the appropriate place to deliver on the needs that exist. So, as I say in answer to other questions, I won’t try and dodge the reality that some parts of the service are not delivering as they should do, and I expect there to be improvement, and for that improvement to be sustained as well.

Bethan Jenkins

I’m very pleased to hear about the £500,000 that’s going into transition for eating disorders between CAMHS and adult services, via the Plaid Cymru and Labour Party negotiations on the budget deal. I’ve heard from people who came to the last cross-party group saying that that’s where they wanted the money to go, because they recognised the change in structure of treatment from a more family-type provision of service to the adult provision. So, I just wanted to clarify whether that funding would be recurrent, ongoing, and whether you are in discussion with specialists in the field of eating disorders about training up current levels of staff for that new provision. Also, with regard to the recruitment of new staff that would be able to come into the field of eating disorders in relation to this new funding, I think it will go a long way to making sure that these services are much more effective in future.

Vaughan Gething

I’m pleased that there’s a general welcome for how that money’s being utilised within this year to improve the service. I think in terms of the recurrent position we really need to talk about not just the money for this year, but about the broader services around them. I think it would be helpful, rather than me trying to think on my feet about how much money has been spent in each area, again, if I write to you and copy that to Members about the current position and future developments. So, that may also be helpful for you and the cross-party group to see as well.

Gareth Bennett

7. What assessment has the Cabinet Secretary made of the impact that the Champions League final will have on the national strategy for community sport? OAQ(5)0167(HWS)

Rebecca Evans

Major sporting events can provide a step on our journey toward a healthy and active nation. The UEFA Champions League final is one of the biggest and most prestigious sporting events worldwide. The FAW Trust is working with partners to use the event to inspire more people to play football and sport, thereby supporting active communities.

Gareth Bennett

Thanks for your answer, Minister; that is encouraging. We did touch on this with the First Minister’s questions yesterday—there’s a broader issue of the connection between professional sports clubs, such as our professional football clubs, and their activities to promote grass-roots sport, to improve health targets and things like that. So, I wondered what reflections you’d had on the progress the Welsh Government is making in that area.

Rebecca Evans

I thank you for that question. I do think there will be some really tangible benefits from hosting the UEFA Champions League final. For example, there’ll be a maxi-pitch, which is a gift from UEFA to the city of Cardiff for hosting the event, and that will be in Grangetown. It will be free to use for communities; I think that’s really important. We’ll also have the floating pitch out in Cardiff Bay and that’s going to be used to host a legends match. It will also be used by local community groups and teams including refugee teams, deaf squads, women and girls teams, teams for people with a learning disability, walking football and youth teams, amongst others as well. So, there’s the opportunity there to really support and promote grass-roots football as a result of this particular sporting event. In addition, as well, it’s inspired the creation of a whole new set of specially designed cross-curriculum materials by the Football Association of Wales, which is being disseminated to 1,300 schools across Wales in the run-up to the event. That certainly will enhance the curriculum and engage over 136,000 children as well, using the power of sport to really engage with children and to help learning as well. I’m also really looking forward to the women’s final as well. We have a festival for women on the same day, so 2,500 women and girls will be participating in that football festival on the day of the final as well. So, lots of opportunity there to engage people who perhaps haven’t tried football before, with that particular sport. I’m also really encouraged by the work that’s going on through the UEFA champions as well as part of their volunteer programme, so using the power of sport and the enthusiasm of the final as well to help people develop skills that are transferrable beyond football as well in terms of volunteering in their local communities after the event has been and gone.

Russell George

8. Will the Cabinet Secretary make a statement on the Welsh Government's priorities to improve health outcomes in Montgomeryshire? OAQ(5)0168(HWS)

Vaughan Gething

We continue to work with the health board and other partners in Wales to take a range of actions to improve access to healthcare services that are safe and sustainable and as close to people’s homes as possible and of the highest quality.

Russell George

I’m very pleased to hear that answer, Cabinet Secretary. You’ll be aware of the work that’s going on in Shropshire in regard to where emergency services should be located, either in Shrewsbury or Telford. The overwhelming view of my own constituents is that those services should be located in Shrewsbury. That’s where emergency services should be located—I’ve not met any constituent that says otherwise. The Welsh Government had previously been silent on its preference, but I was very pleased when the First Minister confirmed a few weeks back to me in the Chamber that his preference would be that emergency services should be located in Shrewsbury. Can I ask, have you made representations to the trust yourself and have you been directly involved in the consultation? I’m very keen that you respond yourself, as the Cabinet Secretary, rather than just through the Powys health board.

Vaughan Gething

Thank you for the question and the invitation to get involved directly in the process. I don’t think it is appropriate for me to get directly involved in writing to or trying to take part in the process that is ongoing. There’s a very difficult process ongoing with the Future Fit programme. There are essentially diametrically opposed views between two different actors and clinical commissioning groups that are equally balanced in the decision-making process. That’s bad news for residents in Shropshire and Telford and Wrekin, but also for Welsh residents who rely on the services that are provided there. I think there’s a real challenge here for the UK Government, acting as a Government for England, to resolve in how this process is actually resolved and the evidence base that is provided. But Powys health board have been engaged and they are directly making representations on behalf of Welsh residents who use those services. What the English services need to consider in this is not just from an altruistic point of view—the impact upon Welsh residents using those services—but to understand their services are being commissioned and paid for by Welsh residents. If those services move then that financial flow may disappear as residents are directed elsewhere. To be fair, Powys have been upfront about the fact that they may have to make different decisions if a different choice is made about the location of services between Shrewsbury and Telford. It is a difficult issue but it is primarily a difficult issue for NHS England to resolve, with the Secretary of State for Health in the UK Government. From our point of view, we will continue to make sure that Powys health board safeguards and represents the interests of Welsh residents, which you represent in this place.