Cynulliad Cenedlaethol Cymru

Yn ôl i Chwilio

Y Cyfarfod Llawn

Plenary

12/02/2020

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

1. Questions to the Minister for Education

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

School Counselling Services

1. Will the Minister provide an update on the provision of school counselling services? OAQ55082

Our most recent statistical release, for the period of 2017-18, shows almost 11,500 children received counselling, comparable to numbers in previous years. In the current year, we also made an additional £626,000—no; yes, £626,000—available to local authorities to support improvements to the service as part of our work on developing a whole-school approach to mental health and well-being.   

I thank you for that answer, and it really is a good investment in the well-being of young people. But there was a report by the Children, Young People and Education Committee in 2018, and it reviewed school-based counselling and found that the service was indeed making a significant contribution to building an emotionally resilient population of young people. But there was one area of concern that was raised by the children, and that was the sense of being stigmatised about accessing the service by having to leave school lessons in order to do so. So, my question, really, is: that having been said, Minister, what actions have been taken since that report to reduce that stigma around school-based counselling so that children and young people continue to access what, for them, is a much needed service?

Thank you, Joyce. Well, since the publication of that report, a great deal of work has been undertaken and continues to be driven forward. For example, by making all aware of the availability of both counselling provided in schools, in community-based settings, and, indeed, online, in a virtual world, our revised counselling toolkit, which will be published next month, will, I believe, help reduce stigma and normalise the use of counselling services. Our draft whole-school framework guidance, which will be formally consulted on in the next few weeks, also highlights the need for schools to ensure that spaces provided for school-based counselling and other well-being work should avoid having any such space labelled, so that we can avoid such stigma. 

Of course, as we move towards the delivery of our new curriculum, our health and well-being area of learning and experience will encourage children to take better care of both their physical and their mental health, and encourage help-seeking behaviours as an acceptable response when children feel upset or distressed. 

Some of the schools in my region quite rightly use part of their pupil development grant to help support on-site school counselling services for pupils. What feedback have you had from schools who don't get high levels of PDG, and have seen cuts to their core funding, about the difficulties they might have in offering counselling on site?

Well, Suzy, as I have just answered to Joyce Watson, we are making over £600,000 extra available in this financial year to support counselling services, and, in the new financial year, additional resources will also be made available to look to extend support services for children—traditional counselling, but perhaps group-based approaches for younger children, to extend the help available to all schools. 

Minister, in my constituency—I suppose I declare an interest, first of all, as a trustee of Eye to Eye, who provide some of the youth counselling service in my constituency—the work that is done is really in response to the fact that there are so many issues that are arising amongst young people. And the counselling service and the work that is done, I think, only re-emphasises to all of us how important that work is. What I do wonder is: across Wales, what work is being done to actually collate the overall statistics for the whole of Wales to get a picture of what is happening across Wales in respect of this incredibly important service?

You're right, Mick: we need to ensure that any Government investment and policy response to promoting children's good mental health and well-being needs to be on the basis of evidence. And there are a variety of ways in which we do that. We have the formal statistics that are collated as a part of the formal counselling service. Most recently, in reporting back to the 'Mind over matter' stakeholder group, representatives of the Association of Directors of Education in Wales had canvassed each local authority and had asked for details of services across Wales that both local authorities and schools were employing. And, of course, we also hear from young people themselves, via our support for the healthy schools questionnaire that goes out to young people, where they themselves have an opportunity to express how they're feeling about their own mental health and well-being. So, we use a variety of sources and data collection points to establish a firm evidence base for investment in this important area.

13:35
Post-16 Education

2. Will the Minister provide an update on the delivery of post-16 education for learners in Merthyr Tydfil and Rhymney? OAQ55084

Post-16 delivery in Wales supports access to a range of programmes that support lifelong learning. Whether it's up-skilling to access employment, a first step into post-16, or a return to learning, delivery serves to improve economic prosperity and to ensure that people in all areas are equipped for their futures.

Thank you, Minister. And I'm sure you'll want to join me in congratulating Merthyr College on being nominated for the TES further education college of the year award 2020. The nomination recognises outstanding achievements, continually improving learner outcomes, and their overall contribution to training for learners. And, as our First Minister said on his visit to the college last autumn, it is one of the great success stories of devolution. However, in spite of such success, the future of their funding arrangements remains a concern, especially around our departure from the European Union. Now I believe such funding has had a massive impact on the quality of the learning experience, as the college has been able to provide improved learner retention, completion rates, and contributed to a year-on-year increase in overall success rates. So, are you yet able to give any assurance that EU moneys currently being used to support learners at risk of dropping out of college—for example, on the Inspire to Achieve scheme—will be factored into the regional investment in Wales, and is such valuable learning secure as we leave the EU?

Well, Presiding Officer, I'm immensely proud of the success and the achievements of the FE sector in Wales. The fact that nominations have been made for six colleges, in total, from Wales in the TES 2020 awards is a testament to the good work that is going on across the sector. And I'd like to wish Merthyr College, and indeed other colleges that are nominated, all the very best when those awards take place on 20 March. The Member is right to draw attention to the issue of the successful use of EU funds by the FE sector. I wish I could give the Member some reassurance as to the continuation of those funding streams. Of course, that will be dependent on our calls as a Government for replacement funding from the UK Government to be met. In the meantime, we're continuing to work closely and productively with our stakeholders across Wales to put in place successor arrangements for Wales. And an important part of that is our regional investment for Wales's steering group, chaired by Huw Irranca-Davies, of which FE colleges are a part. And that forms an important part of that work, as we look to the future, now, to protect those particular funding streams and those successful programmes.

Again, with Dawn Bowden, I want to say the same thing—Merthyr Tydfil College is one of the top-performing further education colleges in Wales. And will you join me, Minister, in welcoming the news that Merthyr college is shortlisted for the TES further education college of the year award for 2020, which seeks to recognise and reward the achievement of the very best further education providers in the United Kingdom? Equally, the teachers and students must be congratulated, who have worked very hard to make sure that this sort of teaching and training rolls out in our other schools in the region. Thank you.

Presiding Officer, if the Member had missed it the first time around, I am incredibly pleased that Merthyr college finds itself subject to such nominations. And, as I said in my previous answer, I wish them—as well as Gower College, Bridgend College, Cardiff and Vale College, and Dolgellau construction and engineering team from the Llandrillo Menai Group—all the very best in those awards.

Does the Minister believe that the advantages of consolidation of post-16 education at Merthyr Tydfil College outweigh any reduction in choice or increase in travel times for those students who, in the past, have attended school sixth forms?  

13:40

The organisation of post-16 education is a matter for local areas. I believe in a mixed economy. I believe that both our sixth forms and our FE colleges provide really important opportunities for our young people. Of course, greater co-ordination across the post-16 sector and the ability for that sector to meet all the education and training needs of our local population form the bedrock of our post-compulsory education and training proposals and my determination to establish a commission for tertiary education and research. 

Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. Plaid Cymru spokesperson, Siân Gwenllian. 

Thank you, Llywydd. We are aware that recruitment and retention of teachers is a challenge in Wales, and in other nations too, and there are a number of reasons behind this, and we need to tackle the problem in a number of different ways. Welsh Government statistics show that 40 per cent less than the target set for trainees in the secondary sector are in place, for example, and recent reports by the Education Workforce Council demonstrate that there are more assistants than teachers in our schools now. Now, I know that you're highly aware of this problem, which has been discussed over a period of years in this Chamber, so, how confident are you that we will see this situation improving over the next few years?

Well, Siân, you're absolutely right. This is an issue that is common to education systems, actually, across the globe and was the subject of much debate when we hosted the Atlantic Rim Collaboratory conference here in Cardiff back in the autumn. There is no one single thing that we can do to address these issues, but to outline some of the actions this Government is currently taking, we have agreed a new approach to promoting teaching as a career with the Education Workforce Council and hopefully—not long now—Members will be able to see adverts on a variety of platforms highlighting the important and the rewarding career that teaching is.

We are looking at new ways in which we can support qualification for teachers. So, the Member will be aware of the recent accreditation of the Open University scheme to train teachers. We're looking particularly there to attract career changers—those people for whom perhaps a traditional way of qualification is not appropriate, but have a desire and a passion to teach. The Member will also be aware of our recent scheme, for instance, to allow Welsh-medium teachers in the primary sector, who perhaps have not been able to find work in that particular sector, to convert to be able to use their skills and their passion in the secondary sector.

So, there are a variety of actions this Government is taking to address the issue of teacher recruitment. But, of course, once they are recruited into the profession, we also have to work harder to maintain them in the profession and we're taking steps in that regard also. 

Thank you very much, and I do look forward to seeing the upshot of that work, because the teachers are our most important, valuable asset in our schools, of course.

Given the million Welsh speakers strategy and the importance of Welsh-medium education to the success of that particular aim, the recruitment of teachers who can teach through the medium of Welsh is a specific concern, isn't it? Statistics from the statistical bulletin show that only 17.5 per cent of students in their first year of initial teacher training in 2017-18 were training to teach through the medium of Welsh, with the numbers relatively equal between the primary and secondary sectors, as it happens.

So, I do warmly welcome what I read in the press last week, namely that it is your intention, and the Welsh Government's intention, to ensure that partners do work towards ensuring that 30 per cent of those recruited to all initial teacher training programmes should be teachers who would be able to teach through the medium of Welsh. So, this afternoon, I would just like a little more information on this policy. Will you expand upon your rationale for setting that target, and why do you think that setting this target is an effective way of increasing Welsh language skills within the education workforce?

13:45

Well, Siân, you're absolutely right: recruiting more Welsh-medium teachers is a vital component of our aim to reach 1 million Welsh speakers by 2050. The requirement for teacher training providers to work towards training 30 per cent of teachers to teach through the medium of Welsh is an important instruction to them, and the Education Workforce Council, of our intention to be able to ensure that we have the right staff to respond to that target, but also to respond to the parents of Wales, who increasingly are looking to choose a Welsh-medium education for their children, and to respond positively to that. It's not the only initiative, as I referred to, but I'm grateful for the Member's support for that, and indeed the various supportive comments from Cymdeithas yr Iaith, for instance, as an important indication of this Government's intention in this regard.

Certainly, we are pleased to see these targets being put in place. It's something that we've been calling for for some time, and we do see it as a positive step forward. I would like an assurance from you that you will be monitoring delivery against that target. Perhaps you can confirm today that you will have a system to monitor progress so that the target is truly meaningful. You have now set this target for one specific area, namely prospective teachers, and it's clear that the Welsh Language Commissioner and others believe that what you have done with prospective teachers is a good precedent for other areas. So, can you tell us this afternoon about expanding this practice of setting targets in order to enhance bilingual skills? Are you in favour, for example, of rolling out this practice of setting targets for the future workforce in areas such as health and care, and other areas within your portfolio in terms of HE and FE?

Well, Presiding Officer, I'm not in charge of health and care, but I think what's important for me is that if we are to respond, as I said, proactively to the demand that there is out there for Welsh-medium education, if we're to meet that target, then the first important element is our teaching workforce. The Member joined me and other Members recently at the event organised by our coleg cenedlaethol. We are working collectively with them and our FE partners to increase the availability of Welsh-medium FE tuition, building on the very real success the coleg has had in terms of expanding Welsh-medium tuition in the HE sector.

It is absolutely an important principle to me that we give children and young people in Wales a Welsh language continuum, from our childcare offer through to access to our nursery schools via the mudiad, into Welsh-medium schooling, and then for them to be able to continue to develop and use their language skills in both an FE and an HE setting wherever possible.

We will continue to look to ensure, in other aspects of education workforce, that we address the linguistic needs of staff, whether that be, for instance, our teaching assistants, our nursery assistants in the mudiad, or other professionals who work with our children and young people. It's really important from an equity point of view that we continue to work as hard as we can to address those linguistic skills of professionals who work alongside our children and young people.

Thank you, Presiding Officer. Last month, headteachers in Wales called on the Welsh Government to revise its draft budget proposals for education. The National Association of Headteachers Cymru said that the proposed expenditure on education set out so far does not come close to repairing the damage done by years of Welsh Government underfunding. Schools are in deficit positions, struggling to retain good teachers and support staff, and they could face difficulties in delivering the new curriculum. Minister, why have you refused to commit to spending more money directly on schools, and will you agree to ring fence the consequentials arising from the UK Government's announcement of additional spending on primary schools in England for education in Wales?

13:50

In all my dealings with headteachers' unions and with teachers' unions, Oscar, I have to say their first concern is the inability of your Government in Westminster to give this Government an appropriate level of public expenditure. One very real example, Presiding Officer: we received no consequential this year to pay for the teachers' pay rise. We were short-changed again this year to pay for teachers' pensions, which is not a devolved matter. It was the finance Minister, working across this Government, that had to fund the shortfall, and that's money that could have been spent on other aspect of education, but we've had to find that money for the non-devolved area of teachers' pensions to address the shortfall.

Let me be absolutely clear to the Member, we have worked hard to give Welsh local government, who are the main funders of our education system, the best possible settlement, as well as significantly increasing the amounts of resources that are in the education main expenditure group. I could do so much more if his Government would give Wales a fairer deal.

Thank you for that answer. [Laughter.] NAHT actually blamed you, not us.

Minister, you recently released a progress report on the £36 million grant made available to reduce infant class sizes in Wales. Under the scheme, funding is provided for new school staff or extra school rooms for pupils aged from four to seven years old. However, most schools that appointed teachers to cut infant class sizes say that they will not be able to keep them when this grant ends. Given that reducing class sizes is, in your words,

'a key strand of our national mission to raise standards and extend opportunities',

how do you intend to further reduce class sizes in Wales now?

First of all, Presiding Officer, I don't want the Member's thanks for answering his question, what would be more useful to me is if he did something about it and had a conversation with his Westminster colleagues.

With regard to the class sizes reduction fund that we have made available to schools, I'm glad that the Member recognises that, first of all, small class sizes can be really beneficial to teachers and children. He is absolutely right: in the report, teachers have expressed their concern about what will happen once that grant comes to an end. That grant is safe until the end of this particular session of this Senedd. It'll be for the new Senedd to look at the evidence and to listen to teachers and parents about the importance of that grant, and I would hope to see it continue.

Schools are required to protect pupils from radicalisation and extremism as part of their safeguarding duties. An Estyn report said recently that most schools had an understanding of their role and responsibilities in this regard; however, in a minority of schools, leaders do not perceive radicalisation and extremism as relevant to their schools or surrounding areas. They went on to say that staff in these schools may miss an opportunity to identify and address early concerns about a pupil. Minister, what action will you take, in the light of Estyn's finding, to ensure all schools in Wales meet their obligations to protect pupils from radicalisation and extremism in Wales? 

I very much welcome Estyn's thematic report and draw the Member's attention to the good practice in schools already delivering very positive actions, whilst also accepting the recommendations in areas requiring further improvement. For instance, we are funding the Welsh Extremism and Counter Terrorism Unit, working in partnership with the all-Wales school liaison core programme, to produce videos and resources on preventing radicalisation and extremism to be delivered in schools by our school beat officers. We are currently revising our 'Keeping learners safe' guidance to ensure that any developments in the Prevent agenda are fully reflected. The message that Prevent falls squarely under the safeguarding umbrella is clearly articulated in the updated guidance that we will publish later on this year.

13:55
Talking about Suicide and Self-harm

3. What steps is the Minister taking to ensure that all local authorities and schools are using the new guidance on talking about suicide and self-harm in schools? OAQ55100

Lynne, since you and I launched that guidance in September, hard copies have been distributed to schools, and it's also available online on the Hwb platform and on the Welsh Government website. We are working with partners to raise awareness of this issue as part of our whole-school approach to emotional well-being.

Thank you, Minister. And of course, I very much welcome the excellent guidance that has been published. I'm also really pleased that you've made a commitment to including the guidance in the new framework that is being published on a whole-school approach to mental health. But in the meantime, what more can we do to ensure that all schools and all local authorities are aware of the guidance and are actively promoting it?

Lynne, back in September, the existence of the guidance was publicised in our weekly newsletter, Dysg, to all schools. We have used a variety of Welsh Government platforms to draw attention, not just to schools, but to the wider community, of the availability of the guidance. I'm very pleased to say that we've had significant traffic, with regard to clicks, on that particular guidance on our Hwb website, and we've had numerous requests for further copies of the guidance from individual schools. At the end of March, we'll be holding a conference with all secondary school headteachers and I have asked that the event is used to both further promote the availability of the guidance and to consider its usefulness and take-up by those schools.

First of all, Minister, I'd like to thank you and Lynne Neagle for all the work that you are doing in this area, because it is vitally important. Lynne touched on a question that I wanted to bring up, about how we are making sure that it gets out to secondary schools and primary schools, because of course one of the big issues I have concerns over is the use of social media and the way that social media really does drive vulnerable children—particularly at an age when they've got so much happening in their lives. I'd like to see that happen in primary schools, that kind of education on social media.

So, really, I have two questions. The first is to re-emphasise the point that Lynne made about how do you get it through to all of our local authorities. Today, we've had a very disappointing report on Pembrokeshire County Council schools. So, if they're struggling to do educational standards, how are they struggling to do the well-being standards? Secondly, specifically on social media, because I think it does cause so much angst, is there anything more that the Welsh Government can do?

Presiding Officer, I absolutely agree with Angela Burns about the importance of educating our children on the potential harms and the safe use of the internet and social media channels. Just yesterday was Safer Internet Day, as I'm sure the Member was aware, and I was delighted to join finalists in the Welsh Government's Safer Internet Day competition, where both primary and secondary schools had been producing films to highlight the dangers of inappropriate internet and social media use amongst their peers. I'm sure the Presiding Officer would be delighted that it was Ysgol Bro Pedr who won the primary school competition, and I was delighted to meet them and to watch their film yesterday. So, schools are very alive and alert. They're taking very proactive steps to work with their children and students in this regard. And of course, our digital competence framework, which is the first part of our curriculum for reform, focuses very heavily on ensuring that children know how to use social media and digital skills and the internet in a safe way, and what to do if they are unhappy or unsettled by anything that they see, or see other people doing, using those platforms. But you're absolutely right: there is a close correlation between mental ill-health and distress and some of the stuff that our children and young people are accessing online.

Funding for Education Providers

4. Will the Minister make a statement on funding for education providers in north-east Wales? OAQ55078

The draft budget for 2020-21 outlines my priorities for education funding as set out in 'Our national mission', which includes funding for education providers in north-east Wales. This budget continues to be committed to the success and well-being of every learner, regardless of their background or personal circumstances, or whichever part of Wales they are studying and learning in.

14:00

Thank you for that answer, Minister. With the labour market constantly changing, adults often need to retrain and upskill. This is particularly the case with the need for many to acquire new digital and technical skills. The need for a dedicated regional adult skills budget is clear. Now, this will enable us to properly react to the skills required by employers in north-east Wales and will also help to attract new employers to the area, boosting the local economy. What consideration have you given to funding such a budget for adults over the age of 19 to train full time? 

Well, Jack, I've recently announced my continued support for the skills development fund. That is £10 million, allocated on a regional basis, to specifically respond to priorities that are identified by the regional skills partnership to ensure that there is an alignment between curriculum and the skills needed in the labour market in a particular area. The SDF is aimed at those learners needing to upskill to improve their employment prospects and, therefore, if digital skills are identified as a key regional priority, this funding can be utilised accordingly by training providers in that area.

You will also be aware, I'm sure, that we are piloting individual learning accounts at present. The ILAs are designed for people who are currently in work but on a relatively low income. That funding is available for them to use again to upskill themselves, and those provisions are also aligned to the regional skills needs as identified by the RSP. So, for instance, whilst not in your particular area, in the Gwent area, digital skills have been acknowledged as something we need to focus on, and the individual learning accounts are there to enable people to access those new digital qualifications to allow them to enhance their career opportunities and prospects.

Well, it's now 17 years since secondary headteachers in Flintshire raised concern that they receive one of the lowest school budget settlements in Wales, and they told me about the constant pressures they face managing this while striving for educational excellence. They've continued to receive from Welsh Government every year since one of the lowest settlements—this current year, 2019-20, they got the nineteenth out of 22 overall school budget expenditure per pupil, and eighteenth for delegated budgets per secondary school pupil out of 22 local authorities. What action have you therefore taken, if any, since publication of a report last September showing that seven of the county's 11 secondary schools were in the red, with an overall deficit of nearly £1.5 million, made public shortly after an inspection by education watchdog Estyn found that Flintshire council had allowed a small number of schools to carry a shortfall for too long?

Well, Mark, as you rightly identified, the funding of secondary schools in Flintshire is predominantly a matter for Flintshire County Council. Flintshire are in receipt of a percentage increase in their budget of over 3.5 per cent, and it is for them, now, to decide how best to use those resources.

Safeguarding Children who attend Private Schools

Thank you, Llywydd. It's worth waiting for, if I may say so—[Laughter.]

5. Will the Minister make a statement on the safeguarding of children who attend private schools in Wales? OAQ55064

Diolch yn fawr, Llyr. Safeguarding children in all education settings is of paramount importance. Independent schools must exercise their functions in a way that safeguards and promotes the welfare of their pupils, and they must comply with the 'Keeping learners safe' guidance to meet regulatory standards.

Thank you for your response. I know that you're very aware of the situation that arose at Ruthin School in my region. And before saying any more, I think we should thank Kelly Williams, the Daily Post journalist who did so much to expose the situation there and to bring it to the attention of the wider public, and also to help bring matters to a head. And now that some of those heads that needed to roll have rolled, we need to look forward, of course, and work with the school, but we also need to learn wider lessons from this terrible episode that we encountered at Ruthin.

And it became clear, of course, that independent schools aren't subject to the same rules as local authority schools, and that's of a huge concern, particularly when things, of course, go wrong. Now, some of the things that have been suggested to me that need addressing include making sure that those who teach in independent schools should be registered with the Education Workforce Council. We need to look at ways of ensuring more rigid requirements on councils of management, or governing bodies as most of us would describe them. We really do need representatives who are appointed by local authorities. We need to make sure that there are representatives of teachers and parents and pupils on those bodies. We need to extend the powers of Estyn so that they can remove governors and senior leadership when there are issues around professional concerns.

Now, not all of this is devolved and I appreciate that you wouldn't, maybe, be able to address all of those issues, but I just want to understand what the Welsh Government is now doing to address some of the deficiencies that are clearly in the system so that we can make sure that the experience at Ruthin School isn't one that can happen anywhere else in future. 

14:05

Can I thank Llyr for raising these issues today and thank him also—? We have been keeping in close touch in recent months, and I know that you have been taking this very seriously in your own region, and I'm grateful for your interest and your diligence in continuing to pursue these issues, Llyr. 

You are right, the situation at Ruthin raises some fundamental points about the regulation of the independent school sector. I hope that you will be pleased, Llyr, when I tell you that there are a number of issues that we are looking at at present and hope to make progress on. 

Firstly, we are already out to consultation on changing the regulations that will require an independent school to notify its local authority of the pupils who are on the register at that school so that we know exactly who is attending that school. We are also actively looking at the requirement for staff in independent schools to register with the Education Workforce Council, going forward, as well as enhancing the EWC's powers to suspend registrants who they have concerns about. Those pieces of work are live and are actively being taken forward at the moment and I think they will take us one step forward in providing the safeguards that, I'm sure, across the Chamber, we would all want to see in all of our schools, but in this case, independent schools. 

Like Llyr Huws Gruffydd, I was also very concerned about the situation at Ruthin School, Minister, and I was very grateful for your very firm message in relation to the desirability of the leadership to change at that school in order for it to be able to continue to operate. I think it did make a difference and I think that that was the straw that finally broke the camel's back in terms of moving the principal of that school on. But, of course, as has already been mentioned, unfortunately, because of the regulations, that principal could easily pop up in another independent school somewhere else in Wales, unless there is a change to the requirement to register with the Education Workforce Council. Of course, it's not just teachers; it could be a senior manager, or anybody, indeed, on those sites. 

One of the other issues that was exposed by this episode, of course, was the limitations of domestic abuse legislation also, because there were suggestions that there could have been an element of coercive control to some of the messages that had been exchanged with at least one pupil in that school, between the principal and the pupil. Can I ask whether you will be considering this more widely as a Welsh Government? And, if it's not already on your radar, in terms of being, perhaps, able to look at the law in respect of domestic abuse in particular, I do think that this needs to change. An independent school with boarders is effectively in loco parentis when those children are in its care, and yet the domestic abuse legislation doesn't seem to apply to a school as a corporate parent, which I think is inappropriate. So it clearly needs to be looked at. Is this something that you will look at with your Cabinet colleagues to see whether it can also be addressed, in addition to the good work that's already under way with regard to registration with the EWC? 

I am more than happy to look at that specific point, as to the relevance of domestic abuse legislation with regard to schools, but let me be absolutely clear and repeat once again: we already have very comprehensive 'Keeping learners safe' guidance. That is to be complied with by all schools, whether they are maintained or independent. The inability of an independent school to satisfy me of that, then, ultimately, we have the sanction of withdrawing the registration of that school, but I'm more than happy to look at the point that the Member raises. 

14:10
Relationship Teaching

7. Will the Minister provide an update on relationship teaching in schools? OAQ55087

I am committed to ensuring that all young people receive high-quality relationship and sexuality education. That's why relationship and sexuality education will be a mandatory part of our new curriculum.

The Minister is a massive supporter of the European Convention on Human Rights, and article 2 of protocol 1 says that if the state exercises any functions in relation to education and teaching, it

'shall respect the right of parents to ensure such education and teaching in conformity with their own religious and philosophical convictions.'

What she's just said, of course, rides coach and horses through that protocol. This is part of a trend now with the Welsh Government of ignoring the rights of parents and ordinary people. We saw it in relation to the smacking ban as well; both polling and consultation results were overwhelmingly against restricting the role of parents in bringing up their own children. So, is the Minister telling me that one of the great advantages of devolution is that people's opinions can be ignored at a more local level in Cardiff, rather than in London? 

Presiding Officer, the Member is right: this is a rights issue. It is a children's rights issue, and all children have the right to receive education that will keep them safe from harm, that will protect them and will give them the skills and the knowledge that they need to become healthy, confident individuals. And that approach to children's rights lies at the heart of my decision. 

We've just heard from another Member of the importance of coercive control and ensuring that our children and young people know what that looks like, and what to do if it happens to them. It is exactly examples like that that means we have to ensure that all children have the right to receive these lessons going forward. 

Minister, aside from the statutory age ranges that are set out with regard to the five to 16 and the different ages that children will receive sex education, relationship education, I think you're on record previously as saying that there will be a certain amount of credence given to the developmental point of children within that cycle. So, perhaps there is a way, a compromise solution too here, where, on the one hand, yes, you are providing children with the education that you say is their right to receive, but at the same time parents' views and the developmental point at which an individual child is at are also taken into account to make sure that children aren't receiving education that is inappropriate for them particularly at a point in time. 

I want to reassure the Member that it is more than just credence that we're giving to the age appropriateness of lessons in this part of the curriculum. It is absolutely fundamental that these lessons are delivered in an age and developmentally-appropriate way for children. I recognise that there may be some nervousness, concerns and sensitivities in this regard. That's why, as we move towards the implementation of the new curriculum, I have set up an involvement group that has parental representatives on it. That group met for the first time just last week and will provide a really valuable vehicle for us to be able to continue to work with interested parties as we develop guidance in this area, and content in this area, to reassure parents that what we propose that their children learn about is, indeed, age appropriate and is done a way that is sensitive and is respectful of the fact that children reach levels of maturity at different points.  

Dyslexia

8. Will the Minister make a statement on the availability of a test to diagnose dyslexia for Welsh-speaking children? OAQ55072

Thank you, Andrew. I am committed to supporting learners with special educational needs, such as dyslexia, within Welsh-medium education. Our additional learning needs reforms aim to create a bilingual system of support for learners. The availability of Welsh-medium resources is being considered as part of our ALN transformation programme.  

Thank you for that answer, Minister. It is a fact that, in most classes, three children will have dyslexia of some shape or form. It is quite alarming, I have to say, to find that whilst there's a screening test, there's not a diagnostic test for children who use the medium of Welsh. I hear that your department is taking some action to understand what the needs are, but can you offer us any comfort that there might well be some assistance in this particular area before this Assembly goes into dissolution next year? Because at the moment, a huge cohort of children the length and breadth of Wales, especially as Welsh-medium education increases, are being disadvantaged and that disadvantage will carry on throughout their lives unless they get the support they need through the education system.

14:15

Well, Andrew, as the mother of two dyslexic children who have received their education in the Welsh medium, this is an issue that is really personally important to me. You are correct to say that a dyslexia screening test for learners between six years and six months and 11 years and five months is available in Welsh from Dyslexia Wales, and that particular screening test provides a profile of a learner's strength and weaknesses that can be used to inform development and support for learners going forward.

A dyslexia screening test for learners between four years and six months and six years and five months has been translated into Welsh, but, again, there are certain constraints and disadvantages to that approach. I can give you my commitment that my officials are working with the sector to be able to identify different ways and better ways and better approaches to ensure both equity and excellence in this regard. 

School Attendance

9. Will the Minister make a statement on school attendance rates in Swansea? OAQ55080

Diolch, Dai. The latest statistics on school absenteeism by pupils of compulsory school age in all maintained primary and special schools in Wales, which were published in December, show that Swansea's overall attendance rate is 94.4 per cent, which is just above average compared to the rest of Wales, which is 94.3 per cent.

Thank you for that answer, Minister. Clearly, school attendance is vital if pupils are to achieve their potential, but in looking at the local data in Swansea in more detail, what is absolutely apparent is that despite efforts by both Welsh Government and the local authority, there remains a stark contrast in school attendance rates between relatively affluent areas such as Bishopston and Pennard, at over 96 per cent attendance, and less affluent areas such as Townhill and Mayhill, where attendance rates are around 91 per cent. 

Estyn has consistently made recommendations to the effect that local authorities need to create strong links between schools and supporting services, including community groups, social services and the education welfare service, which can obviously assist in engaging and supporting vulnerable families. However, attendance is not where we would want it to be in some schools still. Do you accept that this is an area that needs additional attention and additional resource, and what steps are you taking to ensure that children in the poorest parts of Swansea do not continue to suffer in this regard?

You're absolutely right, Dai, to point to a trend not just in Swansea but across Wales, that there is a great propensity to absenteeism in schools that work with our most disadvantaged and deprived communities. Understanding the needs of individual learners and providing the right support at the right time to ensure that they access school can make all the difference. As you quite rightly outline, it is that regular attendance at school that will have a dramatic effect on the ability of that child to gain the most out of education and fulfil their potential.

Just one way in which we are looking to support this, the newest element of our pupil development grant, the access element, has been introduced to directly support parents and carers with some of the costs of the school day, which could be a reason why sometimes children don't feel able to go to school, whether that's because they haven't got the correct uniform or they haven't got the correct kit, the correct school equipment, that could be a real barrier to them going in.

We've also worked with Children in Wales to produce guides for schools around being cognisant of how decisions a school can make can influence a child coming to school. So, for instance, whilst there are lots of opportunities to be had from celebrating World Book Day, the pressure on a parent to provide a costume for that child may mean that's a day that the child does not go into school. So, being aware of some of these decisions, and how the school organises itself, can make a significant difference. That's not to say that schools can't be creative. I recently visited a school in the Ogmore constituency that plays a full part in World Book Day—they just have a wardrobe full of costumes that children can come into school and choose from so they don't feel the need to be excluded from those activities. So, we do need schools, local authorities, as well as Welsh Government, to be cognisant of those barriers and work collectively to break those barriers down.

14:20
2. Questions to the Minister for Health and Social Services

The next questions are to the Minister for Health and Social Services, and the first question is from Jayne Bryant.

The Use of Arts to Improve Health and Well-Being

1. Will the Minister outline how the Welsh Government is supporting the use of arts to improve health and well-being in social care settings? OAQ55095

Arts-based initiatives can play an important role in improving the health and well-being outcomes of people in care settings. That is why we are supporting arts-based projects, including through the integrated care fund and Age Cymru's healthy ageing programme.

Thank you, Deputy Minister. The cross-party group on arts and health, which I chair, has been looking at areas of good practice around Wales. In our meetings, we've seen some innovative examples of how arts-based activities are being delivered in social care settings across Wales to improve people's physical and mental well-being. One such example has been Age Cymru's six-year programme cARTrefu. It aims to improve access to quality arts experiences for older people in residential care. Artists deliver weekly creative sessions with residents, staff and family members over eight to 12 weeks, inspiring and reigniting a passion for creativity. Since 2015, nearly 2,000 two-hour sessions have been delivered in over 25 per cent of the care homes across Wales, making it the largest project of its kind across Europe.

As demand on social care services across Wales continue to rise, and with a growing understanding of the importance of the arts on health and well-being, support and expansion of projects like cARTrefu are important. Would the Deputy Minister endeavour to look at the good practice that is taking place and how to properly embed this work in our care settings? I'd also like to extend an invitation to the Deputy Minister to attend one of our cross-party groups to hear about some of the excellent collaborative work that's going on.

I'd like to thank Jayne Bryant for her question and for her work on the cross-party group on the arts and health. I was a member of that group and I know what important work it does and how important the arts are for health, and I'd be very pleased to come to one of the meetings.

Obviously, one of the challenges to enable arts to happen in social care settings is cost, and I'm very pleased that the Welsh Government is continuing to support Age Cymru's healthy ageing programme. Yesterday I published the loneliness and isolation strategy, which commits the Welsh Government to working with the Arts Council of Wales to continue to raise awareness of the health and well-being benefits of participating in the arts, and this is obviously so important in social care settings. And in addition, the Arts Council of Wales will explore the role that arts on prescription can play, particularly in preventing loneliness and isolation.

And I'd like to finish, really, by saying I'm aware of the role that Jayne Bryant plays in supporting the arts in the community from my visit to Derwen Pobl housing complex, meeting the Reality Theatre yesterday.

Deputy Minister, engaging in arts activities empowers people living with dementia and enriches life for them and those who are around them. The charity, Arts 4 Dementia, helps develop activities at art venues to re-energise and inspire people in the early stages of dementia and their carers so that those who need it will be able to find artistic stimulation in their chosen art form close to where they live. Deputy Minister, what support and encouragement is the Welsh Government providing to organisations such as Arts 4 Dementia to enable people living with dementia in Wales to live more fulfilled and active lives for longer at home and in the community they live?

I thank Mohammad Asghar for that question, and I think he makes a very important point—how important it is for people with dementia to live as near to their homes as possible and to have the opportunity of benefiting from the arts. He'll be aware of the dementia action plan for Wales from 2018 to 2022, which sets out our vision for Wales to be a dementia-friendly nation and that absolutely recognises the rights of people with dementia to live as independently as possible. Through the implementation of the plan, we're trying to develop community approaches that will provide more opportunities for people who are affected by dementia to be involved in activities, including participation in culture and the arts. I always remember, when I think about the area of dementia and the arts, the fantastic work of the Forget-me-Not choirs, which the Member may have attended, where somebody with dementia and their carer both take part in singing, and the words all come back of the old songs to the person suffering with dementia who may not be able to communicate in any other way. So, I think there is huge power in the arts to help people with dementia.

14:25
Minor Injuries Services

2. Will the Minister make a statement on the provision of minor injuries services in north-east Wales? OAQ55077

Yes. Betsi Cadwaladr University Health Board has established a pan-health board group to assess the scope of minor injury services across north Wales to ensure standardisation and to reduce demand on busy emergency departments within north Wales.

Thank you, Minister. The Welsh Government's Choose Well campaign rightly urges people to only use accident and emergency departments as and when they need to. It also helps them to choose and advises them to choose other healthcare services where appropriate, such as those provided by community pharmacies, general practitioner surgeries or through minor injuries services. Llywydd, a minor injuries unit in Deeside hospital in my constituency would help my residents choose well, as would fully staffed GP surgeries open at accessible hours right across my constituency. So, Minister, will you do all in your power to make sure that the health board properly considers this request for a minor injuries unit in Deeside and also looks at improving GP provision, right across Alyn and Deeside?

Yes, I'm aware. In fact, the Member has taken the opportunity to raise this issue with me in the past and does so again, as he should do. There is current work that is already ongoing within north Wales to review minor injuries provision, as I indicated. Within the last two years, there have been about 20,000 minor injuries attendances at the Wrexham Maelor emergency department—a significant number of people going there. They've actually put in additional support, both with general practice and also advanced nurse practitioner support within Wrexham from the start of November last year. I think part of this journey is not only to understand what that means in terms of releasing pressure, but also to keep an open mind about the issues the Member is raising, whether it's Deeside or another area that is relevant, and that is being considered as part of the review. So, I'm very clear that not only is the review the right thing to do, but there also is a need to engage with local representatives, like the Member, to have an open conversation about the data and the information they've got and any potential choices they make to make this a much more accessible service for people right across the north-east of Wales.

According to Betsi Cadwaladr's website, there are, I think, five minor injury units identified, other than A&E units, across the north Wales regional constituency. Luckily for me, one of them is in Mold, but most people aren't so lucky. Of course, in accordance with Welsh Government policy, in 2013 Betsi Cadwaladr closed five others—Colwyn Bay, Ruthin, Llangollen, Flint and Chirk—despite local campaigns to retain them and despite repeated warnings that this would place extra pressure on our A&E departments and GP practices. Of course, this is exactly what's happened. So, given your comments a few moments ago, what consideration are you giving to perhaps restoring minor injury units to the communities that lost them or that are accessible to them in other communities nearby?

Well, I think I've essentially dealt with that in response to Jack Sargeant's question. In the review that is being undertaken to consider alternative locations, the challenge isn't just how many locations people may want to have, it's actually about where the need is, relatively, but also the ability to properly staff those, because if you're going to have adequate minor injuries provision on its own, you need the right number of nurses, in particular, and emergency nurse practitioners and our ability to invest in the advanced nurse practitioner workforce as well. So, it's not just about putting a pin in a map and saying, 'That's where it will be.' It is about having a proper plan to get there, with a workforce strategy to get there, and to meet the demand and need that we do recognise exist within north-east Wales. As I say, over the last two years, there have been 20,000 minor injuries attendances at Wrexham in each one of the last two calendar years.

Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. The Conservative spokesperson, Angela Burns.

Diolch, Llywydd. Minister, phenylketonuria, which we'll call PKU because it's much easier, is a very rare genetic metabolic disorder that affects around one in 10,000 people in the UK. Patients living with PKU are not able to metabolise phenylalanine, which is an amino acid that's found in the proteins within your brain. And you're born with it, and, as soon as you are born, if you do not start to control those protein levels, it can lead to severe brain damage, thereby affecting the rest of your life. One of the ways that this disorder can be treated is by leading a very restricted diet. Now, the National Society for Phenylketonuria has come up with a number of recommendations to help improve PKU sufferers' lives, one of which is that all people with PKU should be followed up in an integrated, specialist, metabolic service led by an experienced physician and dietician. So, Minister, I wondered if you would give some consideration to adopting this recommendation, because, although the numbers are small, it does affect a significant group of people within Wales, and has long-term and absolutely devastating effects on their lives if they do not get the balance of this diet right.

14:30

Thank you for the Member's question, and I think it's positive that we're talking about some of the rarer conditions that exist. There are a number of Members across the Chamber who have taken an interest in this. I know that my colleague to the left, the Trefnydd, during her time as a backbencher, took a particular interest in rare diseases and conditions, and, in fact, on this particular issue, I've seen both David Rees, the Member for Aberavon, and the Counsel General in his role as the constituency Member for Neath, who have had constituents who are concerned about the ability to adequately provide something to help them to make choices. 

And the point about diet is well made. So, there's a challenge about what we can, could and should provide and have the workforce to do so, and actually investing in having the right number of dieticians, because this is a pretty controlled regime that people need to follow to allow them to make other choices in their lives. So, I'm more than happy for my officials and the Government, and indeed the health service, to engage with the PKU society to talk about what is possible, and, equally, where that's possible to provide, and it may well mean that we need to make different choices about investing in the training of our future workforce.FootnoteLink 

Well, thank you for that, because that's actually quite a positive answer. I'm the current chair of the cross-party group on rare and orphan diseases here, and I was actually shocked when I met a whole group of people with PKU, because it's not just—. I think you termed it a 'pretty controlled regime'. Imagine spending your entire life living on soups and shakes, with the added disadvantage that, apparently, they taste disgusting. I was offered a sample; I did actually decline, because I could smell it before I even got anywhere near it. And it wasn't just that. These people were showing me, people with the condition, that, if they're going to eat a piece of cheese—literally, once a week, they can have a piece of cheese, which is about a centimetre by a centimetre by a centimetre. And, of course, this also has an enormous impact on their health and mental well-being as they grow older, particularly teenagers, young adults going out, having a social life, wanting to be part of normal society and just not being able to join in with the pint in the pub, the pizza down the local takeaway, or whatever it might be. 

And the other really shocking thing that I found out was that, actually, from birth, the babies have to have specialised milk, and that milk is very often not on the NHS, it's eye-wateringly expensive, and, worst of all, it's incredibly hard to get. Now, Minister, if this is something that the lack of which would be detrimental to somebody's life and long-term well-being—. Will you please also ask your officials to look at this supply situation? Because to deny a baby the right food from the moment it's born all the way through its growing life, where parents are struggling to either afford the right milk, this synthetic milk that's made, or can't even get it—because you can't order it on Amazon or whatever—is truly shocking, because that young child will actually just develop these high levels of amino acids, and, of course, in the longer term, will need more and more help from the state. So, we need to keep them as healthy as possible. And there's also just something so unfair about having a perfectly lovely little baby and not being able to get the food it needs to have as good a life as it possibly can have. 

I'm more than happy for the conversation I've offered with officials in the health service to include this specific issue around early milk supply as well. And I think there's something about—. It's a choice for the Member whether she wants to write to me in her capacity as the spokesperson for her party, or in her role as chair of the cross-party group. I'm happy to engage in either way, but I'd want to be able to share information, because I know there are other Members in this place, across parties, who take an interest in this issue as well. 

Okay. So, I'd like you to work one more miracle, and that's about a drug called Kuvan. Now, Kuvan is to people with PKU what Orkambi is to other people with conditions. Now, we've been waiting for 12 years for the National Institute for Health and Care Excellence to really get to grips with Kuvan. Earlier this month, Jeremy Hunt, the former health Secretary, called on Matt Hancock, the current holder of the post, to use the same magic to secure access to Kuvan that he used to give the go-ahead for Orkambi for cystic fibrosis. And there is a legal challenge going on by a PKU sufferer in England, currently, against NICE. It is costly, but it would make a dramatic difference to the lives of those small handfuls of people who have this really horrible condition. Minister, you're always saying that you want the NHS in Wales to follow a different path, you strive to try to be a lot more inclusive, in your view, more equitable. Will you have a real go at this, and would you consider trying to move it so that this drug, which is available in all the nations of the European Union other than Poland—I will exclude Poland—and the UK can be prescribed to patients here in Wales? Small numbers—but we can't just ignore the rare and orphan diseases and conditions simply because there aren't masses of people who need those. And you proved it with Orkambi; let's do it with Kuvan, please.

14:35

Well, I'm broadly aware of Kuvan—it's an issue that I've seen in some of the correspondence that I've had—but I'm not so aware that I could give a pledge to determine an outcome. If, however, the manufacturers want to submit for appraisal through our own appraisal process—the All Wales Medicines Strategy Group—they are free to do so. I think the challenge about Jeremy Hunt calling on Matt Hancock to do something shows you something about the danger of having former Ministers on backbenches. But it wasn't magic that got Orkambi over the line, it was a hard, commercial conversation, because the manufacturers of that drug weren't prepared to move until a very long, damaging and unpleasant campaign—which I think damaged a number of families in the process—to actually change the offer they were prepared to make to the national health service.

And this isn't just an issue for one particular form of medication. It's pretty common, not just for new treatments for, if you like, more common conditions, but certainly on rarer conditions as well. And, in fact, in the new treatment fund, which we're celebrating three years of making a real difference, many of the treatments that are brought online are for rare conditions—rare conditions that are now supported because there's a NICE appraisal. And, often, it's that initial cost to health boards, where there's a challenge that the new treatment fund helps with to get it available more broadly within the service. And we'll face this challenge in the future with advanced therapies too. So, I'm more than happy if the Member wants to write to me, and I'll be honest about where we are in the appraisal process and the things that we can do and are prepared to do here in Wales. And I'm more than happy to maintain that level of honesty with her, both within and outside the Chamber.

Is it still the Welsh Government's policy that Wales should have fewer accident and emergency departments, so that staff can be concentrated on fewer sites—yes or no?

It is the policy of the Welsh Government that care should be provided as close to home as possible. And there is a recognition that, for some services, that will mean fewer specialist centres. But, in terms of any particular point about how many emergency departments there could or should be, the Welsh Government doesn't have a magic figure in its mind about the number of departments there could or should be. These are difficult questions, which are reliant both on the need of the population, but also on our ability to recruit the right numbers of staff to provide the right service that people rightly expect.

Do you agree with what the First Minister said yesterday, that it should be the decision made by doctors about the future of the A&E department at the Royal Glamorgan Hospital?

Well, the decision made about the future of the Royal Glamorgan Hospital, which we'll be debating later on today, is one where the health board have a responsibility to make a choice. They do need to listen to and engage with their medical workforce to understand what doctors are saying about the safety of that service. That's a short-term challenge and a longer term one. But they also of course have a responsibility to listen to the public. And that's not just about the numbers of people who are engaged and genuinely anxious about the future of services. They've got to be able to listen to those concerns, those fears—because, actually, the health board themselves may not know everything about the direct impact upon the communities they serve, the challenges about access, about equity—and to be able to listen to what the public are saying and to respond to that in providing any answer for the future. And of course I expect not just members of the public, but their elected representatives too, to ask those questions. And I expect those questions to be answered, in a way that is genuinely open and transparent, about any choice the health board make in providing the sort of high-quality and safe service that people in every part of Wales are entitled to expect.

I agree with you that the public should be listened to. It's a real shame that the 60,000 responses to the consultation that went into the south Wales programme, back in 2014, weren't listened to. 

Minister, I can reveal, this afternoon, that, in the last couple of hours, the overwhelming majority of consultants at the Royal Glamorgan have agreed, in a meeting, that a full 24-hour A&E should remain at the Royal Glamorgan Hospital. Now, both yourself and the First Minister have said that this decision needs to be led by doctors. In the light of the views of those doctors, will you now commit to restoring A&E at the Royal Glamorgan and guaranteeing its long-term future?   

14:40

Well, actually, the health board themselves have made it clear in the statement they made yesterday that they don't have a final answer to what should happen. They do, though, have an unavoidable challenge about the future safety of that service, and that is because the last permanent consultant at the Royal Glamorgan is leaving at the end of March. Now, you can't ignore the reality of what that means for the future safety of the service. And for all those people who, understandably—within this Chamber and outside it—want to have a 24-hour service remain in the emergency department at the Royal Glamorgan and consultant-led, that has to rub up against the reality of whether or not they can recruit staff to deliver that service safely and effectively—

You need to change the south Wales programme if you're to have a chance of recruiting.

And the problem—the problem that all of us face is that, if we can't recruit the right number of permanent consultants to deliver that service, then we won't be able to do that. And it's not simply a matter of saying the south Wales programme is to blame. That doesn't resolve the problem. It would just avoid the problem we face, and, actually, we all know that if you ignore safety concerns that are provided by staff, by people delivering that care—if you fail to deal with that challenge—then, actually, you will end up providing an unsafe service, harm being caused, and then people concerned will quite rightly say, 'Why didn't you do something about it? Why didn't the health board do something about it?'

And this isn't a question of the amount of effort that goes into recruitment. Emergency medicine is a shortage area of practice. Right across the United Kingdom there are challenges. This is not a situation that is unique to one part of Wales. And I understand why people have strong feelings, and I don't ask people to park their feelings or to avoid the challenges that exist. But I do want us to have a debate that is honest about the real challenges that we face and not to try to pretend to ourselves or anybody else that there is an easy answer—that, if only people tried harder, all of the challenges wouldn't exist. 

Diolch, Llywydd. Minister, just a few days ago, we marked Time to Talk Day here in Wales, aimed at getting us, as a nation, talking about our mental health, but more importantly helping to change attitudes and remove the stigma that still surrounds mental health, and, while we have made some progress, it's sadly not enough.

The annual population survey ranks Wales behind all other UK nations for measures of mental well-being. One in four of us will experience mental ill health, yet a staggering 90 per cent of people have been treated negatively because they have mental health issues. Minister, what more can the Welsh Government do to encourage more positive attitudes towards mental health issues to get more of us talking about our own mental health issues in order to break down barriers? 

Well, as you know, we continue to part-fund the Time to Change Wales campaign. That has actually made a difference in persuading people to talk more openly and to be more understanding about mental health challenges, because almost all of us, if we haven't had a mental health challenge ourselves, know someone who has. This isn't an uncommon challenge and issue. So, it's not just about funding the campaign; it is about the way that we make choices and the way that we behave.

And, in fact, in the last Assembly term, Members from all of the parties in the Chamber, at that time, spoke about their own challenges. And I think that was a really important moment for this place, to have elected representatives openly talk about the challenge they face, but the fact that, despite that, they still go on and achieve. And there's a challenge here about recognising that having a mental health condition does not mean that the rest of your life needs to stop. We don't say that when people have physical health challenges either, and it's about a much more open and understanding conversation. But this is cultural change. The Government is part of leading that, but all of the answers certainly don't rest in our hands. 

Thank you for that answer, Minister. When it comes to changing attitudes to mental health issues, we have to lead by example, and we have certainly set an example here in the Assembly, with Members talking freely and openly about their own health issues. Unfortunately, the positive example we have set does not pervade the public sector as a whole. I recently had to represent an elderly constituent who was facing eviction by his housing association due to the cleanliness issue of his home. My staff had to point out that this gentleman had severe mental health issues, along with other physical health issues, and was receiving zero support. Thankfully, in this case, the tenant was not evicted and is now receiving the help that he needed. However, had we not been involved, I have no doubt that this elderly gentleman would have ended up on the street, homeless. We know that mental health issues are prevalent in our homeless population. Minister, what guidance can the Welsh Government issue to local government and registered social landlords to increase awareness of mental health issues and ensure people with mental health issues receive the support they need, and staff the training that they also need? Thank you.

14:45

This isn't just a single-shot measure, because actually we do know that, across both local authorities and housing association partners, there is a growing level of awareness about stress and mental health challenge that people face for a variety of reasons. It's not just about the challenges that many people face, for example, about changes in the benefit system; real anxiety. Money worries often lead to mental health challenges. It's not just about the homeless population; people who actually live in homes and have jobs also face some of the same challenges.

So, there's no perfect way of looking at it, but I think you'll find that housing associations in particular have a pretty well-structured national campaign where they're looking to raise awareness both within their own memberships and the wider landlord sector about the challenges people do face. It's a national conversation, it takes place here in the Assembly, in public services, but also in workplaces too. Because I think we need to accept that, for all that we want to achieve, we actually do need to get alongside the public to make the sort of difference that the Member refers to.

Psychological Therapies

3. Will the Minister make a statement on psychological therapies in north Wales? OAQ55073

The health board recently commissioned an independent review of its psychological therapies provision as part of its own improvement programme. The review findings highlighted examples of positive practice but also made a number of recommendations for urgent improvement, which I expect to be implemented as a matter of priority.  

Thank you for that response, Minister. As you will know, I've been greatly concerned to read the conclusions in that report, and I've read it from cover to cover. It talks about serious unwarranted variation in the provision, access, practice and culture amongst the delivery of psychological therapies in north Wales. Unacceptably long waits in some areas; pathways that are under-resourced and not fit for purpose; an enormous data deficit; and, amongst staff, a sense of despondency and helplessness as to how the organisation might lift itself into a better place.

That, to me, makes pretty terrible reading for an organisation's psychological therapies, when we consider that the Betsi Cadwaladr University Health Board has been in special measures for almost five years. We were told when it was placed in special measures that there would be a sense of urgency in terms of improving mental health services for patients in north Wales, and I know that that's an ambition that you and I both share. The self-evaluation reports that are produced by the health board, and then reported through its governance processes, including to the Welsh Government, are completely at odds with the findings of the psychological therapies review.

I want to know what action you will now take as Minister to make sure that the governance systems in the health board are fit for purpose; that when reports like this are commissioned they are absolutely shared in a timely manner with the Welsh Government, with Healthcare Inspectorate Wales, and the Wales Audit Office given the advice that they provide to you about special measures; and I want to know what assurances you can give to the people of north Wales that these issues will be remedied very quickly, and that we won't be here in another five years looking at a similar report again.

I'm happy to confirm something of a timeline that may provide some assurance and information for people who are concerned. So, the health board started to undertake the review from January last year. The report was received in September/October. It was due to go to the mental health partnership board in September/October, but that was then pulled as a result of there being apologies when people weren't able to attend the meeting. It did then go that partnership board meeting in November last year. And after a verbal update provided to the board's quality and safety meeting, it's then gone to a formal discussion at the meeting at the end of January, where independent members commented upon the report and they put in place the range of measures to implement recommendations.

The oversight and the terms of reference for the task and finish group that will look through that will be openly discussed and endorsed and reported back, for oversight, to the quality and safety committee. So, it is going through the board process. Indeed, the report and the response to recommendations will go through the final board reporting mechanisms in March of this year, I understand. So, it is being openly dealt with. There is no challenge to people seeing the report and it being shared, and of course the response of the health board as well.

And in terms of the governance questions the Member raises, we know that both Healthcare Inspectorate Wales and indeed the Wales Audit Office regularly report on their views on governance structures within the health board and whether they are working effectively. I don't think this particular challenge—and it's a challenge that the health board themselves have uncovered, in terms of asking for the review and dealing with it—is a fair way to try to describe the whole picture on mental health services in north Wales. That rounded picture is provided by a range of evidence, and I will get the advice that I do usually receive from Healthcare Inspectorate Wales, the Wales Audit Office, and indeed my officials, in the normal way, and I look forward to reporting back on that in the Chamber on a number of occasions in the future.

14:50
Staffing Levels

4. Will the Minister make a statement on staffing levels in community health settings? OAQ55071

The number and skills of community-based, multi-professional health and care teams should be determined by local population need. We expect health boards, local authorities and other service providers to plan multi-professional teams organised around local communities and delivering co-ordinated care and support.

Thank you, Minister, for that answer. Phil Banfield from the British Medical Association recently said it's clear that the latest developments are getting worse, not better. He ended his comments by saying, unless the issue is taken seriously, there's a

'real chance of lives being needlessly lost.'

In between those two statements, he said what's important is that extra beds are put into hospitals, more staff are put on the front line in community setting to relieve the pressures, and additionally, out of the budget process, additional money made available to the health service.

Now, we know additional money has been made available to the health service through the budget process. What commitment can you give in light of these comments from the BMA about additional staff and, importantly, additional beds within our hospitals, so that lives are not 'needlessly lost', as he has said?

Well, I think there's a challenge about where there's space and capacity created within our system. That doesn't necessarily mean those beds have to be within a hospital setting. If you look, for example, at winter capacity, it's been increased; there are bed equivalents in social care. We know a large part of the pressures at the front door of an emergency department in any of our district general hospitals actually comes from the inability to get people out of the hospital and into their own home, or into a different step-up/step-down bed.

We've lost capacity in domiciliary care, which supports people to return to their own homes. We're also facing a real challenge with the the independent sector, which provides most of our residential care as well. So, actually, having more stability within that part of our care system will make a real difference for the health service.

But we are already taking a range of measures on community facilities: the extra investment we're making into district nursing, there have been significant and sustained increases over the last six years in percentage terms; the extra money we're putting into general practice training; the extra money we're putting into pharmacy training as well.

I appreciate you weren't able to attend, but Dr Lloyd, who is now out of the room, hosted a meeting today for the launch of a multidisciplinary working in general practice settings event, hosted by the Royal Pharmaceutical Society and the Royal College of General Practitioners, and a report endorsed by both the Chartered Society of Physiotherapy and the Royal College of Occupational Therapists, and the Royal College of Nursing.

So, the approaches we're taking you can already see in different parts of the country. You'll continue to see that investment being made in the future of staff resource, so more people can receive care closer to home, and equally so we get more people out of the hospital when it's no longer the appropriate setting for the care to take place, and for them to be properly supported in their own home in a bed, whether that's in residential care or in their own home in a town or village in the rest of the country.

Cervical Screening Rates

5. What action is the Minister taking to improve cervical screening rates in Wales, please? OAQ55070

Public Health Wales is working to improve cervical screening uptake, particularly in women from the age of 25 to 30, who are the lowest-attending demographic. I'm pleased to say that uptake has increased with over 30,000 more women screened by the programme in Wales in 2018-19 compared to the previous year.

Thank you for that answer, Minister. Figures provided by Jo's Cervical Cancer Trust show that cervical screening attendance in Wales is just over 73 per cent. This is well below the 80 per cent target set by your Government. However, their research reveals that 63 per cent of women who have physical disabilities have been unable to attend cervical screening. What action are you taking, Minister, to tackle this inequality in cervical screening to ensure that women with disabilities have access to this potentially life-saving test in Wales?

14:55

Public Health Wales are already reviewing access to a range of their screening programmes to try to understand the lowest attending groups and to understand what they can do on the way the programme is provided, but are also taking a real interest in the self-screening trials that are being run in north and east London. That will be especially interesting to see if that does make a difference for those people who are invited to take part or who are at least six months overdue. So, there is a range of measures being taken, not just in Wales but across the UK. But in Wales, we have a good story to tell about the effectiveness of our screening programme, and in particular we are still the only UK country to have introduced high-risk HPV testing as a primary screening method. It's a more accurate and more sensitive test that will prevent more cancers. So, we look, and we continue to look, for areas of improvement as opposed to simply doing what we've done in the past. 

Last year, 260,247 individuals aged 25 to 64 were invited for screening, whilst 173,547 individuals were actively screened in 2018-19. Minister, a majority of Welsh women were invited from the screening programme to make a screening appointment, and these figures show that the Welsh national health service is progressing in a vital area for women's health. What further actions, though, can be undertaken to further increase this vital screening coverage and to further increase the uptake of screening invitations by Welsh women, which as we know saves lives?

Yes, you're right, that final point is an important one: this screening programme saves lives. We've listened to the evidence about who to target within the programme, and also the reality that cervical cancer is the most common type of cancer in women under the age of 35. So, it's about the Government, about Public Health Wales and the campaign they're running, it's also about campaigns that other groups run. The #LoveYourCervix social marketing campaign that was launched in March aims to encourage uptake and to reduce the embarrassment that can be a barrier to some people undertaking screening, and to remind that a simple test can be the difference between having an early awareness of a challenge or actually the reality that not undertaking screening can cost lives as well. 

Recruiting and Training of Dentists

6. Will the Minister make a statement on the recruiting and training of dentists in north Wales? OAQ55079

There are now more dentists providing NHS care in north Wales and we have increased training for dental hygienists and therapists by 41 per cent. Building on this progress, Health Education and Improvement Wales is reviewing training provision and considering different service models that could improve dentists' workloads and make practices more sustainable.

Thank you for that response. The truth of the matter is that a shortage of dentists is the major problem we are facing, rather than a lack of money, in this context, in terms of the provision of dentistry services in north Wales. We haven't been training enough dentists in Wales, and too few of the dentists who are trained come from Wales and intend to remain here.

These may sound like very familiar arguments, because these are the very arguments that we were making over far too long a period in terms of the need to have medical training in north Wales. It took too long. Now that that medical training is in place, people are seeing the possibilities and are already talking about establishing a full medical school, and also looking forward to having a dental training unit in Bangor to run alongside the medical school.

This is something that I would warmly welcome. I'm asking for a commitment from you as a Government to ensure that there will be no barriers in terms of ensuring that this unit can be established, and established soon, in order to ensure that this problem of the dentistry workforce can be given every chance of being addressed.

Well, looking at the broader dentistry workforce, on my last visit to north Wales, I managed to visit the Valley Dental Practice on my way to celebrating the opening of the all-Wales faculty for dental professional training in Bangor University. So, we're investing in north Wales and that is, like I said, the all-Wales faculty, providing training and leadership for that wider group of dental care professionals. Actually, the example of the Valley practice is a good example of where contract reform is making a real difference, from recruiting a dentist who then works with a wider range of professionals, that now means that there are 3,000 more NHS patients on lists in that particular area compared with two years ago. And that is because of the deliberate use of skill mix and the professional development needs they've got. When I met people in the faculty in Bangor, they were talking about the help they've been able to provide to a range of practices about how they run their practice and what that means in terms of the best use of the time of the dentists themselves, and also making it a more attractive proposition for people to come into the area.

I am, of course, open-minded about the future for dental training. I don't have a hard-and-fast idea about not increasing numbers or, indeed, where those people train. It's about having a properly evidenced case and understanding what that means in terms of investment and the opportunities to do so. As we have done with general practice training, we've shown a level of ambition that we've been able to meet and to consistently increase over the last couple of years. I'm entirely open-minded about the evidence that we get from the investments we're already making about what that could mean, not just for north Wales, but for the rest of the country too.

15:00
Health Services in West Wales

7. Will the Minister make a statement on the Welsh Government's priorities for health services in west Wales for the next 12 months? OAQ55067

Our priority is to provide the people of Wales, including those in west Wales, with health services that deliver the best possible outcomes for patients. We will be guided by the best and most up-to-date clinical evidence and advice to deliver the high-quality care that the people of west Wales deserve.

Minister, I'm sure that one of your priorities for the west Wales health service will be in response to the latest eye care measures data, which shows that only 60.6 per cent of patients are being seen within the target date at Hywel Dda University Health Board. This figure has dropped by nearly 7 per cent since April last year, when 67.5 per cent of patients were seen within the target time, so it's clear that intervention is now needed to ensure that these figures do not continue to decline. Can you, therefore, tell us what immediate steps the Welsh Government will be taking to address this issue, and can you also tell us how the Welsh Government will futureproof ophthalmic services so that enough ophthalmic staff are available to prevent long waiting lists and irreversible harm in the future? 

It's actually about investing across the whole system, as I'm sure the Member will be aware. This isn't simply about the consultant end of the service, it's actually about getting the right people to the different parts of the service. That's why our reform programme in the primary care end is really important. I did recently discuss these matters with the chief optometric adviser, and these are matters that I intend to take up with chairs and vice-chairs of health boards in my next round of meetings, because having decided to introduce the new eye care measures because they are more accurate and useful measures, I then want to see achievement against them. 

Actually, without properly reforming the way that the system works, we won't see the sort of improvements that you and every other Member in this place would want to see. So, that is, then, about making sure that we have the availability within high-street optometry for different services so that those people don't, then, need to be on a consultant list. You can expect to see the consistent implementation of those pathways within this year, in place in every part of Wales—that's the expectation that I've set. That should, then, make better use of the capacity that exists in secondary care, and, actually, it would make our services more attractive, because consultant ophthalmologists themselves are people who can still choose where they wish to work. We need to address the whole workforce to deliver the sort of outcomes that you and I both want to see.

Accident and Emergency Services

8. What is the Welsh Government doing to avoid unnecessary attendance of accident and emergency services in Wales? OAQ55088

We know that pressures across the whole health and social care system contribute to challenges at our emergency departments. We continue to work with NHS Wales and partners to manage demand across the system in different ways. This includes providing a broader range of care much closer to home.

Thank you for that response, and I heard your earlier responses to Jack Sargeant on that question. The Choose Well campaign, of course, is very obvious at the moment, but, realistically, sometimes people have to choose between NHS Direct and A&E—it is an experience I've actually had myself. I note the minor injury unit review that you mentioned, but what increase have you seen in the number of GP surgeries that are open on the weekends that offer MIU services and the number of pharmacies that are open out of hours?

I can't give you the exact figures on those two particular areas, but I do know that, with our deliberate investment in community pharmacy, we're seeing more services delivered consistently across community pharmacy. Good examples are, of course, the minor ailments service and the sore throat testing service available. Actually, showing the success of that measure, one of the new intake of Conservative Members of Parliament in north Wales was celebrating the success of the sore throat testing service that this Government has introduced, so it shows that we are dealing with real demand in a way that makes a difference.

It's also, then, about our ability to properly staff some of the out-of-hours services, so the 111 roll-out programme is really important as part of it. And it's investing across our whole system. That's why the additional staff that have gone into the clinical desk service in the Welsh ambulance service really matter, because there are more people who could be treated over the phone and discharged, as well as having people who can be seen and discharged without needing to go to a hospital as well. So, there's a range of progress already taking place right across the system, and I look forward to being able to report more on that success over the months ahead.  

15:05
3. Welsh Conservatives Debate: NHS Emergency Departments

The following amendments have been selected: amendment 1 in the name of Rebecca Evans, amendment 2 in the name of Siân Gwenllian, amendment 3 in the name of Neil McEvoy, and amendment 4 in the names of Mick Antoniw, Dawn Bowden, Huw Irranca-Davies and Vikki Howells. 

The next item is the Welsh Conservatives' debate on emergency departments in the NHS, and I call on Angela Burns to move the motion—Angela Burns. 

Motion NDM7266 Darren Millar

To propose that the National Assembly for Wales:

1. Notes the concerns expressed by patients and clinicians across Wales regarding the performance and future of NHS emergency departments.

2. Rejects proposals by Cwm Taf Morgannwg University Health Board which could lead to an end to 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department.

3. Calls upon the Welsh Government to intervene to prevent any downgrading or closures of emergency departments in Wales during this Assembly.

Motion moved.

Llywydd, thank you. I formally move the motion before us, tabled today in the name of the Welsh Conservatives by Darren Millar.

You will see that we ask that the Welsh Assembly

'Notes the concerns expressed by patients and clinicians across Wales regarding the performance and future of NHS emergency departments.

'Rejects proposals by Cwm Taf Morgannwg University Health Board which could lead to an end to 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department.'

and we're calling upon the Welsh Government

'to intervene to prevent any downgrading or closures of emergency departments in Wales during this Assembly.'

Now, before I start, I do want to make it clear that the numerical information within my contribution has been taken directly from StatsWales, the Nuffield Trust, the Welsh Government itself or the Royal College of Emergency Medicine. And this is an important point to make, because we must not allow the Welsh Government to be in denial over the situation we are seeing and that staff and patients are experiencing across Wales's emergency departments. Nor can we allow Labour and the Welsh Government to continue to blame austerity or finances, the Conservatives down the M4 corridor, or untold, unknown and unexplained pressures or, indeed, the statistics they don't like, because the concerns expressed by patients and clinicians are at an all-time high. 

Yesterday, I heard the First Minister repeat the mantra that the NHS satisfaction survey reported a 93 per cent satisfaction rate, but you know, Minister, and I know that this is a use of quantitative statistics at its worst, because it pays no heed to the deeper analysis required. People are grateful for the service they've got, but when you ask them how the service performed they will tell you about the waits, they will tell you about the lost records and the moving around the hospitals. And let me quote directly from some of the responses to the big NHS survey that the Welsh Conservatives are currently running across social media platforms. Here's one:

'In the main, quite  happy with my treatment with the exception of A&E where, due to understaffing, due to too much money spent of management who don't appear to understand what a hospital's supposed to do, they work their socks off despite being under-resourced'.

Or another:

'I called an ambulance for my 87-year-old unconscious relative. It took over an hour and a half to arrive. They took her to Wrexham hospital. After eight hours, they'd done nothing. Fantastic staff are working reliably. A&E waiting times are not good enough. My relative wouldn't be here today if it wasn't for the doctors and nurses, but the system was appalling.'

So, of course, they are 93 per cent satisfied that their relative is still there, but the experience was horrendous. And clinicians tell us that winter 2019-20 has been difficult, with the lowest percentage of patients being admitted, transferred or discharged within four hours since records began—and let me repeat that—since records began. In December 2019, only 66.4 per cent of patients were seen within four hours—sounds good? Well, let's flip that around. That's 33.6 per cent of patients who are not seen within four hours. Let me repeat that: that's one third of patients who waited longer than four hours to be seen at an A&E in Wales. 

But Members, the number of attendees in December 2019 is not a shocker. This is an average of 55,560 patients turning up to our emergency departments each month so far this winter, compared with 67,490 last winter, and 65,629 the winter before that. So, let me repeat that: fewer patients are turning up at our A&Es this winter than last year and the year before, but the performance has gone down. And given that a third of patients were not seen within four hours, then it is only logical that the number of patients waiting more than eight and 12 hours is increasing every winter—StatsWales, your information. 

15:10

I will in a moment, Jenny. In fact, winter 2019-20 represents the highest number of patients and the result is that patient safety is being compromised, staff morale is at an all-time low. While money for winter pressures, Minister, is welcome, ad hoc cash injections are simply a temporary solution. What the NHS needs is a substantial increase in resources, which should be deployed to ensure that there's measurable increase in available staff and acute beds.

Thankfully, the UK Conservative Government has committed to boost Welsh NHS funding by £1.9 billion over the next three years. This is a significant sum that could and should be used for the betterment of our NHS. Before the Labour backbenchers leap to their feet, I would make the point that no Conservative Prime Minister has ever cut an NHS budget. So, shame on Mark Drakeford and your Welsh Labour Cabinet for cutting yours. Between 2010-11 and 2015-16—[Interruption.] I most certainly will for you, First Minister.

Thank you. Considering that you decided that you would name me—

—name me the year in which I was in Government in which the NHS budget in this Assembly was cut. Given that you named me specifically, give me the year.

You've cut it year on year and we can give you the statistics, First Minister. 

And, First Minister, you are responsible for the Welsh Labour Government.

You can't answer the question because what you've said is not true.

Between—. I'm giving you the years. Between 2010-11 and 2015-16—

First Minister, you were the special adviser to the—. You are now in Government, you were the health Minister, you were the finance Minister and now you're the First Minister. 

Maybe I should call you First Minister Pontius Pilate. 

The Welsh Conservatives do recognise that winter pressures are no longer exclusive to winter months. Poor performance is now a year-round reality and whilst there are particular issues experienced in winter, overall performance continues to decline, which in and of itself, Llywydd, must bring a ferocious level of stress and exhaustion to the front-line staff tasked with delivering services. And to them I give my heartfelt thanks. This debate is not about trying to hammer them into the floor, but to give them the support and resources they need to lift them up so that they can do the job they love; they can have the training and career they wanted; and the work-life balance that we all need for our health and our mental well-being. 

I challenge totally the notion that untold, unknown and unexplained pressures are to blame for the situation across our emergency departments. It is a fact that attendance at emergency departments has only grown by 7.4 per cent, yet in the same time period, eight-hour waits have gone up by 254 per cent. And, Welsh Government's data has come up trumps because we know that since 2013, when data collection for 12-hour performance began, the number of people waiting for 12 hours or more has gone up by a staggering 318 per cent. We know that longer waits in emergency departments are almost always associated with poor patient flow through hospitals, congestion in hospital wards and inadequate social care provision in the community. This is certainly true when we consider the number of hospital beds available. 

I think it was Andrew who might have mentioned hospital beds earlier—somebody did—and occupancy rates. Data from the Royal College of Emergency Medicine demonstrates that the correlation between bed occupancy and the ability to meet the four-hour target is strong. In short, fellow Assembly Members, it's simple: additional bed capacity would mean a significant improvement in patient waiting time. The Royal College of Emergency Medicine strongly believes that we need 226 beds. Those extra beds would achieve a safe bed occupancy of 85 per cent. So, this pressure we see on our A&Es could be alleviated by having just under 250 extra beds.

The whole-system problem that we are seeing here will be exacerbated by the desire of Welsh Government to cut and to centralise their provision of emergency care services. Please don't roll out the recent mantra that it's up to the clinicians to decide. I think, Leanne Wood, you put your case very clearly earlier on: clinicians are saying, 'Keep our emergency services', and it's health boards, Governments, the south Wales programme, the Marcus Longley report that's all about centralisation, centralisation, centralisation.

I'm going to quickly turn to the amendments because I can see my time is running out. I do despair to see the Welsh Government has done yet another 'delete all' to stifle debate. I acknowledge that the Labour and Plaid backbenchers have signed a statement concerning the Royal Glamorgan Hospital, but point 2 of the Government's amendment is the usual hand-wringing promises that health boards will ask you for your views and then do what they've always planned to do anyway. This comes after years of uncertainty for the hospital's A&E services since the publishment of the south Wales programme consultation document in 2013.

Staffing at the hospitals is hitting dangerously low levels. Not only are all major A&E units in Cwm Taf staffed well below UK-wide standards, but on Christmas Day and Boxing Day 2019, ambulances had to be diverted from the hospital to Prince Charles because of a lack of doctors. The proposals by the health board have met with significant opposition from surrounding communities. Concerns revolve around the safety of patients who will now have to travel further to receive emergency care as well as vastly increasing the pressure on other A&E departments at a time when the other hospitals serving Cwm Taf did not even reach the Welsh average four-hour waiting times in December 2019.

I will support Plaid Cymru's amendment, which highlights the importance of workforce planning throughout the country, not just in the areas traditionally easiest to staff, such as south-east Wales, because it is only right that staff shortages should never be used to justify closures and service changes.

I also agree with Neil McEvoy's very clear amendment and the amendment from the Labour backbenches, because this Welsh Labour Government must reject proposals by Cwm Taf Morgannwg health board to end 24-hour consultant-led accident and emergency services at the Royal Glamorgan. And I would go further and say that the Welsh Government must review the Marcus Longley case for change report of 2012 and the south Wales programme, both of which are no longer current, both of which set a direction of travel that may no longer suit Wales, and, to be frank, both of which seem to promote services that are ever further away from the public that the health boards, the Minister and the NHS are there to serve.

I trust that the Labour backbenchers will support our motion and that by presenting a united front across all political parties, we can send a loud and clear message to the health boards across Wales. Listen to the people: do not close, cut or downgrade our emergency departments. I commend this motion to the Chamber.

15:15

I have selected the four amendments to the motion, and I call on the Minister for health to move formally amendment 1, tabled in the name of Rebecca Evans. 

Amendment 1—Rebecca Evans

Delete all and replace with:

1. Recognises the cross party statement on the Future of Safe Emergency Care in Cwm Taf Morgannwg.

2. Recognises the need for openness and transparency from the health board in their engagement with the public, clinicians, the community health council, elected representatives, staff and their unions to inform their decision on the future provision of all types of unscheduled care, including emergency services.

3. Recognises that any unscheduled care provision must be robust, safe and sustainable.

Amendment 1 moved.

I now call on Leanne Wood to move amendment 2, tabled in the name of Siân Gwenllian. Leanne Wood. 

Amendment 2—Siân Gwenllian

Add as new point at end of motion:

Calls on the Welsh Government to adopt a comprehensive plan for increasing the clinical workforce, with specific focus on specialities and geographical areas that are hard to recruit to, such as within emergency departments, so that staff shortages can never be used to justify closures and service changes.

Amendment 2 moved.

Diolch, Llywydd. There have been many references from many Members in this Chamber to the inverse care law, that, essentially, the section of the population most in need of care services often face the most barriers to accessing them. We've also noted on several occasions that people in the poorest areas also face the greatest burden of disease. This is due to a combination of the industrial legacy and the neglect of those people in those communities when they were de-industrialised.

We've also noted that the dismissive attitude of senior management in the NHS when it came to dealing with complaints that led to the maternity services scandal in Cwm Taf, and noted that it probably wouldn't have happened to people in a more wealthy area. But, again, lessons are not learned, as this Labour Government presides over a policy of closing A&E in one of the most deprived areas in Wales. This is despite the University of Sheffield study in 2007 finding that a 10 km increase in distance is associated with around a one per cent absolute increase in mortality, and that relationship is greater for patients with respiratory conditions. And this has been confirmed by at least two other studies for asthma patients.

Now, the board cites staff shortages for this, and it is, of course, trivially true to say that a unit without doctors is going to be dangerous. But we have to ask why. How have we got to this place?

The figures I quoted yesterday to the First Minister demonstrate that in those areas with A&E units that are not under threat, consultant numbers have increased significantly. Those areas where reconfigured proposals were agreed did not. It's a self-fulfilling prophecy. Nobody chooses to work in a place that is under threat, when management rely on agency staff instead of advertising for long-term vacancies. My office has heard from a number of doctors who want full-time posts in the Royal Glamorgan and would take them if they were offered a little bit of flexibility in the hours.

So, what are the immediate short-term actions that need to be taken now? First of all, make a public commitment to the long-term future of the A&E department in the Royal Glamorgan Hospital. This alone will help recruitment and retention. Offer the existing agency staff full-time employment, making adjustments to the hours if needed. We know that there are many people who would accept this offer. Actually advertise some posts, using some financial incentives, like Cardiff has recently done, if that's necessary for the difficult-to-recruit positions. And, importantly, make the expectations to management clear—they have been operating with the opposite expectations and a belief that the unit should close ever since the south Wales programme was agreed.

In the longer term, Plaid Cymru has well-considered and costed policies for the training and recruitment of an extra 1,000 doctors, and that includes investment in the targeting of local recruits and the expansion of training places for doctors. These policies can and should be put in place for the benefit of all NHS services in Wales now.

I want to turn briefly to tackling some myths. First of all, the Tories need to reflect upon the fact that this process has happened in England. Jeremy Hunt made it clear that he wanted centralisation and he gave the go-ahead for this to happen back when he was health Secretary. Coincidentally, this was the date the performance in the English NHS started to decline, and that decline continues to this day. So, the Tories don't have a good track record in delivering a different model of service configuration.

Secondly, to those who want to abolish the Assembly, they need to consider what would happen if the NHS senior management had no political oversight at all. Some senior managers have been heard privately saying that they want centralisation to go far further. If they had their way, we could end up with A&E units in just Cardiff, Swansea and maybe one or two others. It's only because Labour know that they can't get away with agreeing to that that prevents this process from getting worse. But that also highlights another unavoidable truth: that the health Minister could stop these proposals right now, but he chooses not to.

I want to finish with this: we in Plaid Cymru will do everything we can to stop them closing or reducing those hours in our A&E department at the Royal Glamorgan, and we intend to win this battle. If we do, a future Plaid Cymru Government pledges to keep our A&E for the long term. But if we don't win, then we will pledge to restore it. Diolch.

15:20

Amendment 3—Neil McEvoy

Add as new point at end of motion:

Supports a permanent and fully resourced accident and emergency department at the Royal Glamorgan Hospital.

Amendment 3 moved.

Thank you, Llywydd. As leader of the Welsh National Party, I say that we have to save the A&E department at the Royal Glamorgan Hospital.

I'm stood here as leader of the Welsh National Party, saying that we need to save the accident and emergency department at the Royal Glamorgan Hospital. The public message to us is very, very clear. I attended a public meeting, I listened intently outside. They want us to work together.

I support the motion. I cannot support amendment 1, because amendment 1 essentially wrecks the motion. I support amendment 2. I support amendment 4. My amendment is very, very simple—the message is simple. It says that this Assembly—us here, every Assembly Member—supports a permanent—and that is the key word here; it's not in any other amendment or any other motion—a permanent and fully resourced accident and emergency department at the Royal Glamorgan Hospital. We can all support that, and we can all support each other's amendments so we can listen to the public today and actually hear what they told us outside, and support the motion and support each other's amendments, with the exception of amendment 1.

The health of the NHS in Wales is in crisis. Staff deserve better. The public deserves better. We heard outside, Minister—and I hope you listen—that the doctors at the Royal Glamorgan, as my colleague across the way said, want the department to remain open, consultant-led, 24 hours a day. My daughter was born at the Royal Glamorgan Hospital, and they did a tremendous job back in those days. My dad is being looked after at this moment by brilliant NHS staff at the Heath, but I was in A&E on Friday, and I was appalled at what I saw. Staff told me that it was a quiet night, and on other nights, the night before, people were sat on the floor. We have declared, or the Government has declared, a climate emergency. I feel we need to declare a health emergency. Let's vote for these different amendments, let's listen to the public, let's listen to the doctors and let's give the message out that this Assembly wants to save the accident and emergency department at the Royal Glamorgan Hospital on a permanent—the key word—permanent basis. Diolch yn fawr. 

15:25

Amendment 4—Mick Antoniw, Dawn Bowden, Huw Irranca-Davies, Vikki Howells

Add as new point at end of motion:

Rejects proposals by Cwm Taf Morgannwg Health Board to end 24-hour consultant-led accident and emergency services at the Royal Glamorgan hospital and calls on the Health Board to:

a) rule out the closure of the accident and emergency service at the Royal Glamorgan Hospital or the replacing of the existing accident and emergency service with a 24 hour minor injuries unit;

b) reinstate the option of maintaining a full consultant-led accident and emergency service at the Royal Glamorgan, Prince Charles and Princess of Wales hospitals;

c) bring forward other proposals for community health services, including improvements in the out-of-hours GP service and extending the opening hours of the minor injuries unit at Ysbyty Cwm Rhondda and Ysbyty Cwm Cynon, which may alleviate the pressure on all three accident and emergency departments.

Amendment 4 moved.

Thank you, Llywydd. I move this amendment with the support of my colleagues Dawn Bowden, AM for Merthyr Tydfil and Rhymney, Vikki Howells, AM for Cynon Valley, and Huw Irranca-Davies, the Assembly Member for Ogmore. I'm pleased to have the support of the Royal Glamorgan Hospital trade unions, who are behind this amendment. 

Llywydd, Aneurin Bevan said that

'Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.'

That is what this amendment is about. The establishment of the NHS is one of Labour's greatest achievements. Indeed, it is one of the Valleys's greatest achievements, since its founding principles were based on the values of our Valleys communities. In Wales we are defending the NHS, its principles, its people and its funding, from the forces of privatisation and austerity. But that is not enough. The great strength of the NHS is that it is owned by the people of Wales, and we are merely the custodians of the NHS and Nye Bevan’s legacy. To that extent we are accountable to the people who have elected us to this Welsh Parliament.

The Royal Glamorgan Hospital accident and emergency service is a vital and essential service for the people of the Pontypridd constituency who I represent, and to those in the Rhondda, Cynon Valley, Merthyr and Ogmore valleys. It is a life or death service and it is a service that none of us want to use but one we take comfort from in the knowledge that it is there for us when we need it.

It's clear to us that for six years the sword of Damocles has hung over the A&E department and has increasingly undermined the ability of Cwm Taf Morgannwg University Health Board to recruit the necessary consultants. Last week I and my Westminster colleague Alex Davies-Jones addressed a packed public meeting in Llantrisant. Thousands more watched online, and it was clear from the health board’s contribution that recruitment is the root cause of this crisis. Indeed, many were left wondering if there would be a need for a review if the health board’s recruitment strategy had been more effective. So, whilst it is right that the health board is facing up to this emerging crisis, its starting point must be how a full, consultant-led A&E service can by guaranteed now and into the future, not what is the least painful way of closing it down.

There are five key facts emerging. The south Wales programme is massively out of date and increasingly irrelevant to the needs of the people of Rhondda Cynon Taf. Prince Charles Merthyr and Princess of Wales Bridgend do not have the capacity to safely absorb the A&E provision currently provided in Llantrisant. There is massive housing and population growth in the Taff Ely area that was never taken into account, and which will in the future only exacerbate this dilemma. Closing the department and replacing it with a minor injuries unit is just not viable. And the health board's recruitment crisis is the fundamental issue, not the hospital’s location, nor its staff, nor its funding.

The only viable options are, I believe, to rule out the option of closure of Royal Glamorgan A&E; for Cwm Taf Morgannwg LHB to reinstate the option of retaining a permanent, fully-staffed 24-hour A&E unit in the Royal Glamorgan; to bring forward additional proposals for the expansion of out-of-hours GP services and extending the opening hours of minor injuries units at Ysbyty Cwm Rhondda and Ysbyty Cwm Cynon to alleviate the pressures on all three emergency departments; and to pursue a rigorous, comprehensive recruitment campaign across all three hospitals.

Nye Bevan also said—famously said—that:

'The NHS will last as long as there are folk left with the faith to fight for it.' 

And, I think, in moving this amendment, I can assure Members that the people of the south Wales Valleys who so contributed to the establishment of the NHS have the faith to fight for the NHS and the retention of A&E services in the Royal Glamorgan Hospital. Thank you, Llywydd. 

15:30

Back in September, I was told, on a visit, that many of the posts in the Princess of Wales were interim and subject to service-level agreements that expire later this year. Cwm Taf Morgannwg does not yet have full control over some aspects of health delivery at Princess of Wales, and, furthermore, the maternity scandal and the loss of the chief executive has delayed certain decisions. This is a heath board, a new health board, which is simply not fully separate nor fully stable— absolutely not ready to be making this kind of huge strategic change at the Royal Glamorgan. 

Members—and Mick has just done it very well now—have spoken about the demand at the Royal Glam. If it loses its consultant leads, more serious emergencies will be diverted to Bridgend, Merthyr, and even beyond. So, let's have a look at the welcome patients will get in Bridgend. The first thing to say is that they will meet warm and caring staff who work their socks off, as Angela Burns just said, who provide first-class medical and nursing care. There is no question about that. But they may have to wait 16 hours before they can be discharged by the ambulance crew into the hands of the A&E team. And they may also have to wait 72 hours for a bed to become available for them on a ward. Every inch of space in the department is utilised. Once all the bays are full, and the trolleys or chairs placed in front of the reception desk and in front of the cupboards and in the space for the Christmas tree are all full, and the corridors are full of patients in the care of ambulance crew, patients who are fit enough are asked to go and sit in the cafe. Sometimes, people who should have been transferred to wards end up having all their treatment in A&E, they’re there so long.

And all this is after the initial triage, when some patients will already have been sent to the minor injury unit section, co-located with A&E, or back out of the hospital to their GP or to the MIU in Baglan. There can be 70 people in that A&E space, which is really tiny, at any one time. And the reason for this is not lack of consultants or first-class staff. It is the inability to move patients through the hospital due to delayed transfers of care. And, as a result, there is not an inch of space for new demand displaced from the Royal Glamorgan.

Now, this is your responsibility, Minister. Whoever started this conversation, this health board is trying to squeeze a quart into a pint pot, and the reason this is a pint pot is because you have not shown leadership on bedblocking. You are the Minister for Health and Social Services. Between you, both you and the now First Minister have been responsible for six years, yet my constituents with emergency needs have to sit in a chair where the Christmas tree usually goes because there is no space for them elsewhere in the hospital.

I want to move on to two points specifically on the south Wales programme, and the first is this: I went to the Princess of Wales to try and find out why their ambulance handover times were so long, whereas, in the Prince Charles Hospital, it could be as little as 15 minutes. And the answer was: a difference of opinion—a difference of medical opinion about what is safer for patients.

Minister, you and your predecessor said time after time in 2014—and you've said it again today—that you rely on medical opinion as to what constitutes a safe service. There will always be more than one medical opinion—and we've heard today from Leanne Wood that medical opinion has already changed. Your job at the time was to challenge and scrutinise, use all your lawyerly wiles to find the weaknesses in arguments put to you, as well as their strengths. What has not changed is the view of my constituents.

I don't think you did that scrutiny, Minister, hence the views of the consultants we heard earlier, and hence my second point. If you accepted in 2014, after such probing, that a safe A&E service could only be provided at two sites in what is now the CTM footprint, why is the Royal Glamorgan A&E still open? That it has become, as the argument now goes, unsafe is down to you. It is you who has allowed the department to exist—under that sword of Damocles, Mick. It cannot have been unsafe in 2014, or you'd have insisted on shutting it. But, instead of rejecting the south Wales programme, as you should have done in 2014, and allowing Cwm Taf to challenge for those consultants, to compete for them on a level playing field, you have allowed that field to tilt more and more by not challenging the board, until we are where we are now.

I am fed up, Minister, of hearing you say what you expect health boards to do. You're not the Minister for expectations—you are the Minister for Health and Social Services. So, let's see you lead like a Minister for Health and Social Services and halt these proposals now.

15:35

I thank the Welsh Conservatives for tabling this important debate. Our NHS emergency departments are unable to cope and have just experienced the worst waiting times performance on record. In my region, 40 per cent of patients waited more than four hours in the Swansea Bay LHB, and almost 5,000 patients in Cwm Taf Morgannwg, which is why plans to completely or partially close the emergency department at the Royal Glamorgan Hospital are so perverse.

While the Royal Glamorgan is not in my region, these plans will have a significant and lasting impact upon my constituents. Residents in the Bridgend county borough came under Cwm Taf Morgannwg health board last April, as did the Princess of Wales Hospital in Bridgend. I believe that the Cwm Taf Morgannwg University Health Board's plans to either close the A&E department at the Royal Glamorgan altogether, or to operate it only during daylight hours, will have serious repercussions for the Princess of Wales Hospital. The Royal Glamorgan emergency department saw nearly 5,500 patients during December. Should the department closure go ahead, these patients would have to go to neighbouring hospitals, with the Princess of Wales in Bridgend being the closest.

The Princess of Wales is also struggling with demand. It too saw nearly 5,000 patients in December, and only around 60 per cent of those were seen within the four-hour target. The increased demand from the closure of the Royal Glamorgan emergency department could totally overwhelm the department at the Princess of Wales. And Cwm Taf say they are pressing ahead with these plans on safety grounds. However, these proposals make the service less safe, not more. My constituents are paying the price for the abject failure by the Welsh Government and the local health boards to properly plan for future demand.

While these proposals will have the greatest impact on Cwm Taf patients, their effect will be felt across Wales. And, if local health boards are allowed to concentrate services around a handful of hospitals, then we are going to need a much bigger fleet of ambulances. Are the Welsh Government recruiting more paramedics, training more ambulance staff? No, they are not—in much the same way that they did not have any integrated workforce plans, which has led us to a shortage of A&E doctors and nurses.

And it has also been suggested that politicians should not meddle in decisions about the Royal Glamorgan. But, as it puts people's lives at risk, I am proud to be standing shoulder to shoulder with our constituents for something that, if implemented, has disastrous consequences for staff and patients alike. It is pleasing that there have been Members from all parties speaking out against the closure plans, and I wholeheartedly support Mick Antoniw's amendment, and I urge others to do so. And supporting this motion and amendments 2, 3 and 4 sends out a clear message that all parties have Members who oppose the downgrading of A&E services. 

And I repeat, as Mick Antoniw said, Nye Bevan said the NHS will last as long as there are people willing to fight for it, and fight we will. 

15:40

I'm pleased to contribute to today's important debate. I think an important point to be made at the start of this debate is that nobody—certainly nobody in this Chamber—denies that the NHS needs to change and to change in a transformative way that makes it fit for the twenty-first century, not just the twentieth-century, for which it was originally designed. It is, of course, the type of change that is in question. Is that change progressive? And, most importantly, does it carry the public with it? Too often, we see that it doesn't. 

Point 1 of our motion draws attention to the concerns of patients and clinicians regarding the performance and future of NHS emergency departments. The arguments against the downgrading of services in rural Wales are well-versed. Withybush hospital in Pembrokeshire is often discussed in this Chamber; today, we have the discussion surrounding the Royal Glamorgan. The loss of vital services, including paediatrics and accident and emergency, leaves patients having to travel much greater distances for their treatment.

Now, I know, from this debate and questions earlier, and indeed previous debates that the health Minister has taken part in, that he will argue that it is the quality of the healthcare on offer that matters, and its long-term sustainability, its safety, not the distance travelled for it. But the point is that the public are clearly not convinced about this and are not being carried along with the argument in the way that they should be. So, something is clearly going wrong with the proposals before us and the Government's way of consulting. 

Now, to be fair to the Welsh Government, it's not a universally gloomy picture across Wales. The reconfiguration of services in my area, in south-east Wales, as result, primarily, of the Gwent Clinical Futures programme, which I know Lynne Neagle, Member for Torfaen, has been involved in along with me over the years as well, has, by and large, met with support from local people. There have, however, been recent concerns about the extent of the loss of services, particularly A&E from Nevill Hall, to the new Grange university hospital in Cwmbran. There is a moral here—that people support change, but can only take so much in one go, and it has to be sold to them, they have to be part of that change, engaged in it, consulted on it and action it. 

A&E is a very sensitive issue, perhaps one of the most sensitive issues in the health service. Out-patients want to be reassured that those services are going to be available where and when they need them. The term 'minor injuries unit'— and I think it was Mick Antoniw in his excellent speech who mentioned minor injuries units—whilst it may work well on paper, when people are planning the layout and the division of new services, the sad thing is that, when you're out there, on the ground, talking to people, the term 'minor injuries unit' simply does not wash. It does not cut it with the patients and it does not cut it with the clinicians. It is no substitute for an accident and emergency unit, certainly not along the lines of what we've been used to previously. 

As I say, the reconfiguration in Gwent has largely been supported and accepted, but that is certainly not the case in other parts of Wales—certainly Hywel Dda. The proposals to end 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department have, of course, caused major concerns and those have been raised in this debate. There are choices here. Yes, the NHS requires massive resourcing. Modern treatments cost money. Money has been tight. Resources are tight. But, as previous Members have said, the Welsh Government can give a steer. It can intervene, if appropriate, and it can stand up for local people and local services if it wants to, if it believes that those priorities are the priorities of the Government and of the people, and, let's face it, this is what most people want. 

I think we need to recognise that there are no easy solutions here. There are structural problems that have built up over many, many years in the NHS—prior to devolution, in fact—and problems that are not easy to resolve. Simply saying 'We will downgrade services in one area and beef up services in another'—if you're lucky—just doesn't wash in the current climate. Transformative change needs to be accompanied by a vision, a vision that carries the public and clinicians with it, that truly does what the Welsh Government often in debates in this Chamber says that it wants to do: puts the patient at the centre of the process. How often do we talk about co-production, putting the patient at the centre, putting the recipient at the centre? Yes, a great idea on paper, but it hasn't happened hitherto in debates such as this, and that is what needs to happen.

In the absence of that vision, I believe, along with other Members, that downgrades of services should at least be put on hold, that they should at least be reconsidered, and that there should be a reassessment of restructuring across Wales where it is blatantly obvious that that restructuring is not supported. And the patient really should be put at the centre of the process.

15:45

Today's debate is the chance to send a strong message of support in favour of retaining A&E at Royal Glamorgan Hospital; to show just how many people will be affected by these health board proposals; to show just how important it is that the health board thinks again and instead brings to the table strong, safe and sustainable solutions.

I have co-submitted amendment 4 to put on the record my opposition to the closure of the A&E unit at the Royal Glamorgan. For my constituents living in Cilfynydd, Glyncoch and Ynysybwl, patient flows are towards the Royal Glamorgan. Closure of its A&E would have a clear and incontrovertible impact on their ability to access emergency healthcare.

From the number of people sending e-mails, joining social media groups, signing up to the statement of support for the Royal Glamorgan Hospital A&E issued jointly by Labour and Plaid Cymru politicians and a range of trade unions, people attending public meetings across the health board footprint, rallying outside the Senedd earlier today, we can clearly see the passionate attachment that members of the local community have to retaining the service, to making sure the people who need to use that service can access a consultant-led A&E service within their own local community.

Closure also simply doesn't make sense. For example, during 2019, the A&E service at the Royal Glamorgan was attended by nearly 64,000 people. That's over 2,000 more than Prince Charles Hospital, and 4,500 more than the Princess of Wales. While it would be iniquitous to pit one hospital against another, it is only fair to recognise that the Royal Glamorgan has the busiest A&E department in Cwm Taf Morgannwg, and it also performs extremely well. Using four, eight and 12-hour indicators, the Royal Glamorgan Hospital's A&E consistently records the highest percentage of patients being seen within less than the target waiting times. Its figures are also above the all-Wales averages for treating patients. Moreover, closure of A&E services there would increase pressure on other A&E departments, not just in Cwm Taf Morgannwg, but potentially further afield. I mentioned the A&E department in the Royal Glamorgan seeing 64,000 people in 2019. Well, let's break that down. That's over 5,000 people a month, or 166 people a day.

The health board is proposing that these people are to be seen in its other district general hospitals, but do they have the capacity to see this spike in patient numbers, especially when we consider additional house building in the area in the future will add around 20,000 additional properties just in the immediate vicinity of the Royal Glamorgan Hospital itself? No figures have been brought forward by the health board to suggest that either the Princess of Wales Hospital or the Prince Charles Hospital can absorb those extra flows. 

Such plans also ignore the geography that makes the south Wales Valleys such wonderful places to live. Distances and journey times to access the proposed alternatives are further and longer. That means more risk of missing the all-important golden hour for treatment. And when we factor in the age profile of the areas concerned, and the high levels of underlying health conditions, this is all the more serious. Indeed, the most powerful testimony in support of retaining A&E at the Royal Glamorgan is from family members attesting how accessing the service saved the lives of their loved ones.

I hope that today's debate and the united show of support from residents and representatives will encourage the health board to think again. It is already possible to see extra effort finally being put into the recruitment of much-needed consultants. So, I want to place on the record my thanks to the health board for that. But it is also a chance for us to reconsider how we make current provision even better to relieve some of the pressure from front-line A&E services. Let's re-examine the role of minor injuries units in community hospitals; they can relieve pressure from A&E units and do so much more than their name suggests—treating broken bones, for example. I believe it is frankly ludicrous that the minor injuries unit in Ysbyty Cwm Cynon isn't a walk-in clinic but rather an appointment-only service. These things need to be looked at again, and I hope that can be part of the health board's proposals.

The strength of feeling that this has aroused is clear, so I would urge colleagues to send a strong message today and to back amendment 4.

15:50

I rise to speak to the motion today because of the solidarity I want to show with those people who are campaigning for their hospital services in south Wales at the moment, particularly in terms of the emergency department at the Royal Glamorgan Hospital. I've been there, I've done that, I've got the T-shirt, and I've got the scars to show it: for the campaign, which was a cross-party campaign, that we had to have in order to save our maternity services in north Wales. 

The tall and short of the lesson that I learned in that campaign was that you only ever get the right result when Ministers actually intervene, because that was the situation for us. We were told that services were unsafe and unstable; they had been made unsafe and unstable because of the uncertainty surrounding the future of those services, which is exactly the same case as the situation at the Royal Glamorgan's emergency department right now. The situation was so unstable, we were told that the service would have to close, and there were plans, of course, then to change those services and remove the consultant-led maternity services from Glan Clwyd Hospital, as was the case at the time. 

It took thousands of people marching on the streets—tens of thousands; it took tens of thousands of people signing letters and signing petitions in order to make their voice heard; and it took politicians putting their party politics aside, embracing one another and standing shoulder to shoulder in order to campaign for those services to be retained. Because of that action, that concerted action on a cross-party basis, the then First Minister did actually decide to intervene. And we look to you today as health Minister here in Wales, Vaughan Gething, and we plead with you to be brave enough to challenge the information that's been put before you and to listen to the chorus of voices that was chanting outside of the Senedd earlier on this afternoon, calling for the sitaution to be resolved through your intervention, because I don't believe that it will be resolved without it. 

I want to talk just for a few moments about the fragility of emergency departments, not just in south Wales at the Royal Glamorgan, but of course elsewhere in the country. We know that we have a 95 per cent target for people to be in and out of emergency departments within four hours. Regrettably, that target has never been met. In fact, the situation in terms of the worst performance against that target is, unfortunately, in north Wales. The poorest performing hospital in north Wales at the moment is Wrexham Maelor, which has been breaking records across the whole of the NHS, UK wide. You've got just a one in two chance of getting out of that emergency department within that four-hour target at the moment in Wrexham Maelor Hospital, and a slightly better chance at Glan Clwyd, but still one in two. Two out of 10 people at Glan Clwyd Hospital will wait more than 12 hours—two out of 10. One in five people who walks through the door in an emergency situation will not be discharged for at least 12 hours. 

Now, we know that it's a combination of things that gives rise to these appalling performance statistics. One of them, as has already been referred to, is the number of beds in a hospital. We've seen, over the past decade, certainly in north Wales, one in four beds have been axed from our hospitals. That's bound to have pressure at the front door, which is the emergency department, because if you can't discharge a person from the emergency department into a hospital bed when they need one, then unfortunately they're going to clog the front end of the hospital.

Of course, that leads on to problems then with our ambulance services, because ambulances arrive, they want to discharge patients into the emergency department so that they can get off to respond to the next call, and they're unable to do so. As a result of that, unfortunately, we've seen patients dying while waiting for ambulances, and sometimes facing the indignity of dying in car parks in the back of ambulances outside of our hospital front doors, when the assistance they need is just yards away. It is absolutely frightening.

So, we need extra resources in our national health service, more beds in our hospitals, and we need you, Minister, to intervene in this situation in the Royal Glamorgan Hospital and stand shoulder to shoulder with your colleagues on the backbenches—and I take my hat off to each and every one of them today for challenging your Government over this. We will continue to campaign with those people who were marching outside the Senedd today until we know that the future of these services is secure.

15:55

The Royal Glamorgan Hospital needs its emergency department.

The Royal Glamorgan Hospital needs its A&E, and it needs it to be consultant led to be able to deal 24/7 with acute medical emergencies and significant trauma. Of course, major traumas—burns and so on—are better treated in specialist centres, but lives will be lost and pressure will become unbearable on other accident and emergency units within the health board and beyond if the downgrade or closure were to take place. I'm sure Ministers are aware that, as well as the consultants at the Royal Glamorgan saying today that they want to keep their A&E, doctors at the University Hospital of Wales in Cardiff are screaming, 'Please don't close the A&E at the Royal Glam, because we'll be overwhelmed.' Centralisation and the potential pitfalls of that has been a decade-long theme in Welsh politics. It's happening now with the disastrous removal of vascular services from Ysbyty Gwynedd. We're seeing it again at the Royal Glamorgan with A&E.

We have plenty of studies that suggest this isn't the right thing to do. There was a University of Sheffield study in 2007 analysing over 10,000 emergency calls that found a relationship between distance to hospital and mortality. It found that a 10 km increase in distance is associated with around 1 per cent absolute increase in mortality. There are other studies too: a study finding that an increase in journey time of 10 minutes has a 7 per cent increase in the relative risk of death. In this case—with this hospital, that geography, the weather as it can be, and traffic as it can be—10 minutes isn't close to what people would have to travel in addition if this A&E were to close. So, on balance, apart from those major trauma issues and so on that I mentioned, we are convinced here that we need to keep this A&E for the sake of patient safety.

On recruitment, consultants at the Royal Glamorgan are confident that the right medics can be recruited, not least by raising the threat of the closure of the department itself or the downgrading of it. I remember the plan to remove consultant-led maternity services from Ysbyty Gwynedd. We, the community, protested and the decision was overturned. And do you know what? Suddenly, recruitment was no problem and staffing levels were brought up to what was needed in terms of patient safety. So, let's build a future for A&E at the Royal Glamorgan as we seek to build a sustainable and locally focused Welsh NHS as a whole, and let's do it for the sake of the communities and the people that it serves.

I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Llywydd. Before I deal with the wider issues raised by Members in today's debate, I want to start by thanking our staff, because the quality and the compassion of our staff is always the focus for praise when people contact me. It helps to explain why, despite the continuing pressures our NHS faces, we continue to see such extraordinarily high levels of public satisfaction across NHS Wales. As the First Minister reminded Members yesterday, when the public are asked, 93 per cent of people are happy with their own experience of local or hospital-based care. The importance of our NHS and the public attachment to it has been reflected on the Senedd steps and in today's debate, as it has been on so many occasions before. So many of us, including me, have good reason to be grateful for our national health service. The safety of our NHS now and in the future is of paramount importance.

Many of the questions that I have faced in this Chamber as the health Minister over the last year have focused upon where the safety and transparency of the service were not the first and overriding priority. I will not, and I'm sure that Members across the Chamber do not seriously expect me to intervene by directing or attempting to direct any health board or trust to try to run an unsafe service as long as it is local. The professional judgment call on the future immediate safety of the A&E service at the Royal Glamorgan has been made, as it should be, by the medical director, the senior doctor in the health board.

16:00

But that, however, is plainly not the end of the matter. The health board, in considering any possible change of this nature, has to be open and transparent about the following matters as a minimum—

I'm going to deal with this, because I've got lots to deal with.

The immediate and longer term reasons behind any potential service change; the options that it is considering; and the impact of any of those options, including the impacts of doing nothing. And the impacts of options for change should, of course, include the impact on quality, safety and access in terms of time and geography. And the information on demand and need for current and future services should be openly shared with the public. The health board should set out how it will listen to and engage with the public and its staff. 

All of these matters should be shared with elected representatives and, of course, the local community health council. And that staff and trade union engagement is essential to current and any future provision. I really do understand that people have very real concerns and fears about the future service at the Royal Glamorgan Hospital and what it will mean for their families and community. I fully expect elected representatives to represent the concerns of their constituents and to press for alternatives, and that includes the impact of any proposals on community services on Ysbyty Cwm Cynon and the future of Ysbyty Cwm Rhondda, as well as Prince Charles Hospital, the Princess of Wales Hospital and Cardiff. 

It may be helpful to respond to the concerns that some Members have expressed today, both within and outside the Chamber, about other services. The health board set out yesterday that they will not be closing other services—no theatres and no intensive therapy units closing, and there will not be job losses if service change proceeds.

The Government amendment notes the joint cross-party statement about the future of emergency services in Cwm Taf Morgannwg. Within that statement, a range of information is requested from the health board about the evidence underpinning proposals for change and their impact. I expect that information to be made publicly available or an explanation of why not.

And I hear what Members have said today and before about the south Wales programme. Now, this wasn't determined centrally by the Welsh Government; it came from engaging over 500 front-line clinicians who live, work in and serve communities across south Wales. The final agreed position of the south Wales programme six years ago was for a 24-hour minor injury unit at the Royal Glamorgan. It's already developed and been at the leading edge across Wales at the Royal Glamorgan of acute medical care that would have previously gone to A&E. It's already developing, of course, the £6 million diagnostic hub we've heard so much about in reference to its impact upon cancer services.

However, I recognise that the health board are already reconsidering the 24-hour MIU plan, and they have set out possible options for consultant-led care to continue on the site. In considering a way forward, I understand that the health board are indeed reflecting upon the outcome of the south Wales programme, the changes made since then to the delivery of healthcare and the healthcare needs of current and the future population in the area and, of course, the unavoidable reality of staff recruitment. As Members across the Chamber know, simply calling for the south Wales programme to end doesn't answer the problem; it avoids the problem.

I've discussed at length and on a number of occasions the challenges of attracting and retaining emergency medicine consultants in what is a shortage profession across the UK, and indeed a highly competitive international field of recruitment. The immediacy of the current position in Cwm Taf Morgannwg has arisen because of immediate staff shortages that will arise at the end of March. It would not be honest or realistic for any Government to sign up to the wording of the Plaid Cymru amendment. It isn't a credible plan to simply instruct staff from Merthyr or Bridgend to work nights at a different hospital, and we all know from our own experience that staff shortages have led to service change because otherwise the service would be unsafe.

But we are not standing by and doing nothing. We are already developing a joint health and social care workforce strategy. Four doctors in training are expected to complete their certificate of completion training in emergency medicine this summer and to take up posts as consultants across Wales. Between 2021 and 2025, a further 62 doctors are expected to complete their certificate of completion of training for emergency medicine as well. The national unscheduled care board has been established and has reviewed workforce requirements for emergency medicine and further expansion of the consultant workforce, which is supported by Health Education and Improvement Wales. However, that in itself isn't an answer to all the concerns of Members and the public. The truth is that there are no quick or easy fixes.

The Government will vote against the motion to ensure that we reach the Government amendment that balances our expectations on how the health board makes a decision with the legal responsibility of Ministers. As Members across the Chamber know, Ministers, myself in particular, could ultimately have to determine a final service decision. The Government will, therefore, abstain on amendments 3 and 4.

I know that people care deeply about the future of our NHS. I do too. I expect all of our decision makers in our national health service to listen to what the public and their elected representatives have to say, and to be open, honest and transparent with the public and their staff. I expect our NHS to make choices that deliver a robust and safe service. It's what I expect for my family and I expect nothing less for the country.

16:05

I call on Andrew R.T. Davies to reply to the debate. Andrew R.T. Davies.

Thank you, Presiding Officer. In the time afforded to me, I'll do my best to sum up, which is about two minutes and 40 seconds.

I have to say that on that performance, Minister, I can fully understand how Jo Coburn on Daily Politics began her interview with you some months ago by saying, 'What is it like to be the worst health Minister in the United Kingdom?' You did not respond at all to a single point that various Members in this institution made to you, from the Government benches, from the opposition benches, and you failed to take a single intervention. That shows the weakness of the ground that you're on, Minister.

Also, the latter part of the statement that you made, where you said that you ultimately might have to make a decision on some of these service changes, that shows that you are responsible, and the Welsh Government are responsible, for the strategic direction of the health service. We need a decision from you to the health board to make sure that this A&E provision is kept in place. If you're not prepared to do that, at least make sure that the electorate have a chance to do that as this motion has to be put before the next Assembly election.

I would implore colleagues across this Chamber to support this motion unamended because, ultimately, it satisfies all the concerns that have been raised, from Vikki Howells's point that the Royal Glamorgan A&E department deals with 64,000 patients on an annual basis. Your own Government bench did not even respond to that, about how that service provision would be taken care of at the other two hospitals. If they're not prepared to engage with you, engage with this motion and vote for this unamended motion today because, ultimately, it'll show the Assembly speaking with one voice and calling on the Government, the only organisation that can make sure that this proposal is taken off the table.

From the Plaid Cymru benches, it was well made, the point, that if you're labouring under the south Wales programme, is it any wonder that no doctors or very few doctors have looked at this as a career opportunity, when they know that at any time soon the department is going to close down? 

Mick Antoniw, the Member for Pontypridd, touched on the point about development, and other Members touched on the point about development across the area. Twenty thousand new houses are going into this area. This is a district general hospital that is serving a growing population and, actually, to deal with proposals that were first put on the table some six years ago is completely out of synch with what it the requirement for this particular area, an area I know exceptionally well, because I've lived and breathed in that area for many, many years, and I know the people who rely on that service.

And I can see you shaking your head. Come and challenge me, then, Minister. If you want to intervene on me, intervene on me, because I'll take your intervention. You have the ability to intervene here and change the direction of these proposals, and I thank each and every one of the protesters who came before the Senedd today to show their frustration and their anger. Many of those faces, I recognise, had taken days off work because they're so concerned about these proposals that they came to the home of Welsh democracy. This motion has been put down today to respond to those concerns, and the Senedd can speak with one voice—one clear voice, as Darren Millar pointed out in his contribution. When, actually, the senior figures of Government intervene, things start to happen, as in maternity services in north Wales. So, I call on the Senedd to support this motion that's before the Chamber. Instead of just the words, start the action: press that green button and support this motion unamended today.

16:10

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting under this item until voting time.

Voting deferred until voting time.

4. Topical Questions

The next item is the topical questions, and no topical questions were chosen today.

5. 90-second Statements

Diolch, Llywydd. February is LGBT+ history month. It's an opportunity to commemorate the past of the LGBT+ community, to celebrate its diversity and achievements and to offer hope for the future, whilst also serving as a reminder of the struggle for equal rights for all. It was first celebrated in the UK in 2005. Founded by Sue Sanders and the late Paul Patrick, its focus was on educating young people about the issues that members of the LGBT+ community face and making sure that schools feel inclusive for everyone. Since then, the occasion has gone from strength to strength.

This year, the sixteenth LGBT+ history month takes as its theme poetry, prose and plays. During the month, we can remember the rich tradition of LGBT+ poets, authors and playwrights. We can also remember the steps that have been taken towards equality in this Senedd and beyond. I would like to offer a word of congratulations on the National Assembly for Wales once again being the No. 1 workplace in Wales for LGBTQ+ employees. But there are still challenges, not least when a same-sex dance on prime-time tv can lead to hundreds of complaints to Ofcom.

I would like to offer a word of thanks to local groups, like Project Unity in my constituency, who do such important work in tackling discrimination and offering support and advice, and to say, as a proud LGBT+ ally, I stand with you during LGBT+ history month and throughout the year.

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

6. Member Debate under Standing Order 11.21(iv): Online and Offline Public Services

Item 6 on our agenda this afternoon is the Member debate under Standing Order 11.21(iv): online and offline public services, and I call on Rhun ap Iorwerth to move the motion. Rhun.

Motion NDM7263 Rhun ap Iorwerth, Angela Burns, Janet Finch-Saunders, Llyr Gruffydd, Sian Gwenllian, Neil Hamilton, Mike Hedges, Vikki Howells, Mark Isherwood, Delyth Jewell, Helen Mary Jones, Dai Lloyd

Supported by Suzy Davies, Huw Irranca-Davies

To propose that the National Assembly for Wales:

1. Notes that more and more services are only available online.

2. Recognises that not everyone has access to the internet.

3. Recognises that not everyone is comfortable with using the internet.

4. Calls on Welsh Government to:

a) ensure there are offline alternatives to online public services, such as with the bus pass renewal system; and

b) discuss with banks, businesses and other organisations to make sure that customers are not isolated if only online services are offered.

Motion moved.

Thank you very much, Deputy Presiding Officer, and I thank the Business Committee for allowing me to bring forward this debate today. I also thank the 13 Assembly Members who were my co-submitters of this motion, or supporters of the motion. I think that number does demonstrate that this is an issue that has struck a chord with the membership of this Senedd more generally.

We are noting in this debate the increasing number of services that are available online only, whilst many people still don't have access to the internet or don't have convenient access, certainly, or simply aren't comfortable in using the internet for whatever reason. We are asking the Welsh Government to step in to assist. This isn't some old-fashioned opinion; we're not rejecting new technology. I'm more than comfortable, myself, using online services, and like so many people, technology of this kind has certainly made my life easier in very many ways. But as more and more services do go online—banking services, postal services, bus pass renewal systems, even the courts—more and more people are at risk of being excluded. And I do see from casework in my own office that this can cause real anxiety for some people, particularly older people.

Lack of access to the internet is a problem for some, as I said, not only because of broadband problems that you will have heard me discussing numerous times in the past, along with many other Members, but also because many people, particularly older people, don't have computers or smartphones. The older people's commissioner's office tell me that almost 30 per cent of people between 50 and 64 and 65 to 75 don't have access to the internet, and that goes up to around 50 per cent, or over 50 per cent, in fact, among people over 75 years of age.

But it's not just access to the internet that is a barrier for people, but the fact that many older people simply don't feel comfortable using the internet, even those who do feel comfortable with e-mail or Facebook. Perhaps they are still nervous when it comes to making an application for something official such as a bus pass or dealing with financial services online.

Yes, some work has been done to increase digital inclusion, increase people's skills in communities and so on, but there are many older people, particularly, who choose not to go online, and they shouldn't miss out on crucial services or advice as a result of that. And people who aren't online often miss out on better deals when it comes to shopping or services such as selecting a gas or electricity provider.

So, what can the Government do? I'm calling on the Government to do two things to assist people from feeling isolated and from losing out. The first thing is to look at the public services that they themselves provide. The latest example, the more prominent example, is the decision of the Welsh Government to make the bus pass renewal system an online-only system. Particularly given who the demographic was, this was a very unwise choice, in my eyes, and you very clearly see, by speaking to constituents, that people are deeply concerned about having to do this online, and many people don't know where to start.

My office therefore offered that we would help people in making these online applications, and we advertised that through a poster in the window, a poster in the post office, and we spread the word. And since September, my office has dealt with over 300 bus pass renewal applications through the Transport for Wales website. Three hundred people who either didn't feel comfortable in making the application themselves or didn't have access to the internet in order to do that had they not come to my office.

And there were stories about people losing sleep as they were so concerned about how they were going to renew their bus pass because they were so reliant on buses. We are still now having people coming to us telling us that they've tried to make an application on paper and that there were huge delays with that, and some feeling that the paper-based application had gone to the back of the queue. And that was when the online system was crashing continuously at the outset.

Constituents also tell us that they have difficulty in finding face-to-face support in order to make these applications. Many were referred to us by libraries on Anglesey and by the council and so on and so forth. We were more than happy to help our constituents, of course, but we must ask questions as to whether that provision by Transport for Wales was appropriate, and whether the support that they claimed was available to assist people was sufficient.

It is clear that the Welsh Government values the bus pass for older people or they wouldn't offer that free service to them, and we support that, of course. It's very important indeed. So, it didn't make sense, then, to me, to put this barrier in place of the crucial process of renewing these bus passes.

I'll give you another example in my own constituency related to transport: a constituent had gone to a railway station in December to ask for a paper copy of the train timetable, the new timetable, but the only thing that was available for passengers was a sheet advising people that the timetable was changing and that they should go online to see the changes. That's not acceptable.

So, I would like a commitment from the Government that they will look to ensure that traditional options—off-line options, if you like—are available where public services are provided online, and particularly, I hardly need to say, when those services are targeted at groups such as older people or people who have learning difficulties who face similar problems.

The second thing I'm calling for is that Government should put pressure on third parties, the private sector, for example, in order to ensure that customers aren't excluded and that customers aren't disadvantaged if only online services are provided. The most prominent examples are banking services. I'm sure there's no constituency—correct me if I'm wrong—but I'm sure there's no single constituency that hasn't been impacted by bank branch closures. Sixty-three per cent of branches on Anglesey have closed since December 2015, and there are only six left across the whole of the island. You will hear the bank saying, 'Well, don't worry, people can use the branch in the next town', but then they'll close that one too. And in addition to that, you have the situation that we saw with Barclays saying, 'Well, our customers can't withdraw funds from the post office either.' I was very pleased that we had managed to put pressure on them to scrap that particular idea.

But it does demonstrate, doesn't it, the lack of commitment among the major banks to think about their customers, particularly older customers, and specifically, I would say, in rural areas? Yes, I do bank online myself and, yes, I do realise that that strengthens the case for the banks for closure. I am not blind to the change of culture that's happening, the change of habits among the population and the impacts of that. But there are people who simply don't want to bank online. They don't trust online banking because it is too much of a culture shift from what they have been used to. They simply won't change, and they are losing out.

I remember when I visited the Yorkshire Building Society in Llangefni when it was announced that that was to close, and the staff were literally in tears describing the customers who would come in to withdraw money, and it wasn't a single payment in one envelope, but it was, 'Here's your rent money, Mrs Jones, and here’s your money to buy food’, and so on. And that is a personal service that will never be duplicated online.

Another example in my constituency was with the gas service. A 92-year-old constituent receiving a letter from British Gas asking her to organise a boiler maintenance check, and she was advised to make an appointment online through the app. Now, she was hugely concerned at this point. She was concerned that there was a problem with her boiler and a problem with a boiler can be fatal, but she was worried about that, and she couldn't make an appointment. So, she came to my office and we got in touch with British Gas to make that appointment for her. And their response was:

'Our letters currently no longer provide telephone numbers and do direct customers to our online booking system. However, the telephone numbers for customers to contact us on are always provided on our terms and conditions, which are reviewed approximately every 18 months and sent out to all customers.'

But it feels very inadequate for me to expect people to keep hold of those terms and conditions when it's a small matter to continue to provide those contact numbers on all letters. Because that telephone service does exist.

So, I call on the Government to discuss with banks, businesses and services and other institutions to ensure that people don't feel that they are being excluded if online services are the only services provided. As I said, I'm very grateful that so many Members have supported this motion. It is proof, I think, that this is an important issue. I look forward to hearing your contributions and the Government's response too.

16:20

I am very pleased to support this debate, and I thank Rhun ap Iorwerth for bringing it forward. It is an issue that is very important to many of my constituents, including people who I socialise with. Lots of people are not on their—. Like my wife accusing me of being on my smartphone at all times—in fact, many people haven't got a smartphone.

Looking at it from the view point of an organisation, what is there to not like about providing online services? It saves processing time, it saves staff, it saves on money, it checks all parts of the form are completed, because if you don't complete a part of the form it gives you a little red dot and it won't let you go on to the next part. I'm sure other people have had that problem, which seems to beset me with most online forms I fill in. It checks all parts of the form are completed, but also makes sure that everything is valid. So, you put your date in in the right format and you can cross-match key fields. It provides a faster response to the individual. What is there not to like?

But I think this exemplifies the distance between people and governments and big organisations. And can I just say something that might raise shock horror to a large number of people running large organisations and senior people in a lot of the public sector? Many people do not own a smartphone, an iPad or a computer. Many others, for lots of reasons—some relating to health—are not happy using ICT equipment, even when it has been adapted for a disability. And I know you can get a concept keyboard to put over the top, and I'll tell you what—good luck if you're looking for one. But they're not happy and they like—. There's another group of people who just like talking to people. They like getting on a phone and actually talking to people. That's the second-best means of contacting somebody. The best means of contacting somebody is actually talking to them face-to-face, which used to be a way that you could deal with organisations, which seems to be coming less and less available currently.

And Rhun ap Iorwerth mentioned banks. People used to go into the bank to do all sorts of discussions, and it was part of their social lives as well, which is something—. Again, we talked about isolation yesterday—part of the problem of isolation is that people don't have these community meetings in post offices, banks and other places.

Let's look at the bus pass renewal application. Both my office staff and staff at local libraries have spent a huge amount of time helping people to apply online. I've also spoken to lots of people who've had to ask children, grandchildren or other relatives to help them or do it for them.

Can I give the Welsh Government some credit? Transport for Wales has got a paper-based form as well, and that was available to apply for the new bus pass. It wasn't online only. And can I just say, there's an awful lot of things that I deal with that are online only, or not only online only—'Please use the app.' That's sort of saying that everybody's got it on their phone. The benefits system is almost wholly online. It is wholly online—the information is provided online or applications have to be online. At a very minimum, a paper-based version of every Welsh and Westminster Government form should be available for people if they want it, and a lot of people feel much happier filling in paper-based forms.

Rhun ap Iorwerth started talking about it—can I just also turn to the private sector? There's a financial benefit for us if we deal with utility companies online. They actually give us some money off for having online bills and paying by direct debit and all those things. Of course, we get the benefit, but the reverse is true—there's a financial penalty for not dealing online. That's another one of the many ways where it becomes expensive to be poor, because the people who don't deal online are more likely to be poor than people who have double-fuel, direct debit, online bills, which I'm sure affect most of us in here, but an awful lot of my constituents don't have those things and they're paying a price for that.

Finally, I just think every online process should have a paper-based alternative. Some people will want to do it online—I actually prefer doing things online—but many people would like to use a pen and paper. In fact, anybody who's seen my handwriting would realise exactly why I prefer to do it online, but I think it is important that people have the choice and let's see that everybody can have a paper-based alternative and not pay a financial penalty for doing so.

16:25

Well, I agree with you completely there, Mike, and with apps in particular—if I haven't got a pair of these with me, then I may as well not have an app at all.

I have to say, it’s almost six years, actually, since I did a short debate on a very similar issue, and at the end of this, I really would like to hear from the Deputy Minister what she thinks has changed, particularly on that first ask from Rhun ap Iorwerth about what our Government can do within its powers to mitigate decisions by some large organisations to stop communicating with customers by post, or, as Mike alluded to, actually charging customers for the privilege of receiving mail.

Receiving your bills, statements and necessary information, basically, via the mail, allowing paper applications for various services rather than using the web—. Of course, this may be a matter of simple preference for some people, but for a surprisingly large number of people it's no choice at all, and for that they should not be penalised. It's the position of the 'Keep Me Posted' campaign—it's a UK-wide campaign—which has been working to highlight this discrimination since August 2013. And, actually, I'd just like to place on record my thanks to them for keeping me updated on this issue.

Since 2013, the number of adults in the UK with no access to the internet has actually fallen from 9 million people to just over 5 million people and, in Wales, apparently, almost 90 per cent of adults now say they have used the internet over the course of the year. Of course, that doesn't mean they have their own computer, but it looks like a surge, doesn't it? Suddenly it looks like we're a virtually, computer savvy nation. I do wonder how much of that survey was done on the internet, because the number of adults in the UK who admit to not having enough knowledge of the internet to use it confidently—a different question—remains at a very stubborn 16 million. So, even though more people are going on the internet, it doesn't mean that they're feeling very safe using it. The fact that that figure has not changed in six years speaks volumes, I think.

The Office for National Statistics says that more older people are using the internet. Perhaps that's because a number of us have moved from one statistical age category to another, taking our youthful skills with us. Yet the number of over-75s who use the internet has hardly changed at all, and, if my own family experience is anything to go by, dementia can quickly rob you of any IT skills you did have, even in its early stages.

Only this week, I spoke to representatives of Lloyds Bank, which is closing its branch in Mumbles in May—yes, one of the many, Rhun. Sixty per cent of their customers are over 55. That's quite a high amount. A lot of them will be eligible for a free bus pass to get to the branch in the city centre, and of course they've got to go online to get those bus passes. So, some of them, yes, have caved in and they've gone for internet banking, but 22 per cent—that's almost a quarter—of all that branch's customers are over 75. So, these are the people who are targeted by scammers. And, of course, banks don't tend to use e-mail for their customers, but you try telling that to a much older person who's either new to online banking or losing their computer savvy. Two per cent of fraud in this country takes place via the post; 70 per cent of it takes place online. So, we're not just talking about a service for those who have no option but to use paper, but we are talking about those who are safe and confident to use online services. I genuinely think that, for some people, trusting the postman is still far preferable to trusting your password.

Even when people have internet access, they may prefer paper—I'm one of them, actually. Between 39 per cent and 42 per cent of people admit that they often forget to check their statements online, find it easier to keep track of their finances if they have stuff in print, and fear missing payments if they rely solely on online information. So, people have higher levels of debt if they conduct their financial affairs solely online.

Due diligence rules mean that people are experiencing difficulties proving their identity. Some financial institutions and even Government departments insist on original statements. Well, sometimes you don't have an original statement. We'll also have problems with a lack of a paper trail if you're exercising a power of attorney or identifying the assets in the estate of a deceased—and I've got personal experience of this. No password? No access. You may not even know these accounts exist.

One final consideration, and this is for small businesses: even if they have good broadband—and you mentioned this, actually, Mike—if they're conducting their financial affairs online, they may still be employing people with support needs, and sometimes that kit still doesn't mean that people feel confident using the internet.

In Canada, just to finish, telecom firms must exempt the over-65s, disabled people and those without a home broadband connection from being denied postal communication. The French can insist upon free paper bills. In Spain, they can receive all their bills through the post at no cost, unless they're specifically requested by e-mail, and no charge is imposed for those who already receive or switch to paper billing.

I appreciate that not all the levers sit here, but the Assembly—I just want to finish with this, Dirprwy Lywydd—is proud of its rights-based laws and the Government has introduced its economic contract with social purpose at its core. So, how about making the preference for paper part of that contract? Thank you.

16:30

Perhaps I should start by acknowledging the huge amount of work the Welsh Government has done to ensure almost all of us in Wales can access internet facilities and to assure the Minister this is not in any way a condemnation of your efforts in this area.

For all of us, the changing world of communications has altered our lifestyles forever. For most of us, it has been a real and positive change. We can communicate quickly, whether by voice, text or social media, and it's become the norm to walk into a room and to see each and every person staring at a digital screen.

The world of commerce has been quick to exploit these innovations, often to the detriment of all of us. Such manifestations as the closing of the once-familiar high-street banks, and the huge growth of online shopping, leading to the loss of high-street shops and stores, all contribute to the changing tenor and panorama of our high streets. But, for some, often the most vulnerable in our society, this exponential growth in online services has a much greater effect on their lives. Far from giving greater access, it often means limited access or even no access at all.

The impact of this access negativity is most felt in the need to contact relevant authorities or businesses. This necessity for access could be for such essential things as benefits, tax queries, energy facilities—even access to doctors' surgeries and job applications. Local authority and schools notifications are increasingly using digital communications. Schools are also using the internet to facilitate homework, et cetera. This affects those children from poorer families, where digital devices may have to be shared or, worse still, are not available at all.

So, digital isolation is when people find themselves in a position where they can't access the internet or digital media and devices as easily as other people, or even not at all. There are many factors that can affect this inability to connect. It could be that they cannot afford the necessary devices, such as computers, laptops, even smartphones, and, crucially, it can also be a lack of understanding as to how to operate such devices.

Over a third of the people in Wales aged 50 or over do not use online services at all. As mentioned by Mike Hedges, people who do not use digital technology, especially the elderly, are increasingly missing out on benefits and financial savings as a result of their continued use of traditional methods of banking and commerce. Research suggests that older people are paying a high price for not participating in digital services. It has been calculated that offline households miss out on savings of up to £560 a year by not shopping and paying bills online.

We now find that a number of companies are phasing out letters, telephone numbers and even occupation of physical buildings, moving exclusively to digital-only services and customer interaction. These sorts of developments are increasing the isolation of those we think of as vulnerable, especially the elderly, who are used to, and prefer, face-to-face communication, where empathy and understanding are more likely to be evident.

This digital isolation is an issue that homelessness charities are seeing become more widespread, as more and more lifeline services move online. It is true that attempts are being made by authorities to address some of the exclusion. Some temporary accommodation hostels have ICT suites in them, but, with many using these hostels having a lack of understanding in the use of the equipment, it still leaves them in a state of digital isolation. Clearly, there is a training issue that needs to be addressed, perhaps not just in hostels but in the vulnerable population as a whole. The closure of many of our libraries, once the pillars of our education and learning, does not help in this lack of digital training.

Can I finish by saying that this debate today is an extremely important one, in that it addresses a growing problem and one that affects a significant portion of the Welsh population? Can I thank Plaid Cymru for bringing this debate to the Chamber today? It is one that I and my colleagues are happy to support.  

16:35

As the older people’s commissioner noted in her 'State of the Nation' report:

'The increasing use of digital technology means that the way we access services and information, and the way we communicate, has changed significantly in recent years.'

However, not everyone has access to the internet. Superfast availability is 77 per cent in rural areas. Around 87 per cent of businesses in Wales have access to superfast broadband, and yet only 93 per cent of all premises in Wales can access superfast broadband, compared to a UK average of 95 per cent. Ofcom estimates that the number of premises currently without access to superfast broadband in Wales is around 156,000. Bearing that figure in mind and the fact that BT Openreach are only planning to provide 26,000 premises with access to fast, reliable broadband by March 2021, it is clear that many, including my constituents in the Crafnant valley, will continue to be bogged down by lack of access to reliable internet. Equally problematic is the fact that internet usage remains very low amongst our older generations. A third of older people do not make personal use of the internet. The figure is even higher for those aged over 75—that's 60 per cent. 

I acknowledge that the Welsh Government has taken steps to try and address the problem of digital inclusion. For example, the digital inclusion strategic framework and delivery plan of March 2016 set out a goal for reducing digital exclusion for adults aged 16 and over, so that more people could benefit from being online and using digital technologies. However, according to the digital inclusion progress report and forward look 2018, only 77 per cent of social housing residents have internet access, just 51 per cent of single pensioner households are likely to have internet access, and 25 per cent of disabled people are digitally excluded.

I am pleased that the report highlights the need to work with all sectors to tackle digital exclusion. It does recognise that telecommunications companies such as EE, Three, O2, BT and Virgin, and utility companies such as British Gas, Welsh Water, and E.ON, financial services such as Natwest, Lloyds, Principality, Santander and Barclays, and insurance companies such as Aviva, Admiral and Endsleigh—there's a bit of a namecheck going on there—are increasingly looking to customers to manage their accounts online. A promise, however, was made to encourage the private sector to try and lead by example and to consider their digitally-excluded customers. So, I would appreciate an update on what progress has been made through ministerial and deputy ministerial interventions on this issue to date.

I believe that the aim should be amended so to include the need to discuss with banks, businesses and other organisations the need to ensure that alternatives to online services are offered. In fact, this could be supported by adding it as a seventh pledge to the digital inclusion charter. None of us can ignore the fact that alternatives to online services are needed. The older people's commissioner found that offline households miss out on savings of up to £560 a year from shopping and paying bills online. That being the case, being offline is costing our constituents a fortune. According to the national survey for Wales, only 79 per cent of people buy goods or services online. We must act to ensure that services remain as affordable and accessible offline too.

Our colleague Rhun ap Iorwerth has highlighted the example of the bus pass renewal system. I would like to add to the list by including blue badge application forms. I have had many constituents unable to even access these without going online or using a computer, and they come into my office for us to help, but they should have that facility to be able to have that blue badge without having to go to those extremes. 

Undoubtedly, we need to help more people get online and do more to boost superfast availability. But we want a fair Wales too, so I strongly support this motion today and thank Rhun for starting this off in the first place. And I implore the Welsh Government to take steps such as have been suggested here today to ensure that, whilst keeping up with the digital age of technology, we will always ensure that traditional ways of accessing information, advice, support and services remain in place. Thanks. 

16:40

Thank you. Can I now call the Deputy Minister for Health and Social Services, Julie Morgan? 

Thank you very much, Deputy Presiding Officer, and I welcome the opportunity provided by today's very important debate to highlight how the Welsh Government is working across departments to try to ensure everyone can access the support they need, regardless of whether they use the internet. We recognise that more services, as Rhun said in introducing the debate, including vital public services, are moving online and that digitally excluded people are at risk of being left behind in society. As Mike Hedges said, not everyone has a smartphone and, of course, as has also been said, some people do like talking to people. People who do not use digital technology can miss out on vital services, job opportunities and improvements to their health. To be a fair Wales, as Janet Finch-Saunders said in her speech, we must ensure equality of access to public services for all. 

Older people do account for the largest demographic of people who are not online. However, there are other groups in society as well who've also been mentioned here today: disabled people were mentioned; David Rowlands mentioned homeless people. But, certainly, older people are the largest group. Twenty-two per cent of those aged over 50 and—a figure that's already been used—51 per cent of those aged over 75 are digitally excluded.

Following Cabinet's agreement last week, we will be launching a public consultation on our strategy for an ageing society in early spring. I think that many of the issues and many of the proposals that have come up in this debate today could be taken forward by that strategy for an ageing society. This strategy is Welsh Government's response to the wider implications of demographic change for future generations in Wales, but also for today's oldest people. The success of this strategy will rely on cross-Governmental action on a range of pressing issues, which will of course include digital inclusion.

Our vision is an age-friendly Wales that supports people of all ages to live and age well; a Wales where individuals can take responsibility for their own health and well-being, while feeling confident that support will be available and easily accessible if needed. We're already taking steps to achieve this vision. For example, the Welsh Government has made £8 million of grant funding available to the single advice fund this year. Funded services will reach deep into communities to engage with households that tend not to use traditional advice services. The services will also be delivered from venues at the heart of local communities, such as GP practices, so people will be able, through that money for advice services, to have face-to-face advice.

I'm very pleased that today's motion mentions the work of Transport for Wales to offer alternatives to online services for people renewing their bus passes. Although applicants are encouraged to use the online portal, as it is easier and faster, as many people have said here today, paper applications, as I think Mike Hedges said, are also available, and face-to-face support is also available. It's been reported that over 25,000 paper applications have been received. However, I am aware that many people did believe that they had to do it only online, and I certainly had a lot of people coming to my advice surgeries where we, as well as many others in this room, did help them to fill in the online applications. [Interruption.]

16:45

Thank you for taking the intervention. Thank you very much. Isn't the fact that you're reminding us again that doing it on paper is slower and more problematic again symptomatic of the message that's going out to people? Rather than telling people, 'Listen, we believe online works very well, but please feel free to use paper if you feel more comfortable in doing so.'

Yes, I think that is the message that should go, and is going out, really: that paper applications are available.

The other thing, of course, with all this—I think we've discussed the bus pass quite a bit—is that it has illustrated how popular the bus pass is and how important it is to older people. I know this issue of the bus pass applications has caused anxiety, and we certainly don't want that to be the case. Last year, we allocated £20,000 of additional funding to the older people's commissioner to support her work to increase pension credit take-up. This was actually done via paper. The commissioner produced a flyer that was sent out to older people in letters reminding them to renew their bus pass. I think it's very important that we take opportunities like that.

I'd like to share another example of how we've reached people who don't use the internet. Welsh Government recently launched a national awareness campaign to improve take-up of vital information and support about council tax entitlements. We work collaboratively with local authorities, the third sector, and MoneySavingExpert.com, the UK's biggest consumer website, to develop simple and consistent advice. We also placed posters in relevant settings, disseminated hard-copy leaflets to local authorities, and included printed slips with debt advice in council tax reminders, final notices and summonses. These models have been successful in reaching people who do not use the internet, and going forward we will learn from these successes.

However, it's very important to note—and I think the points have been made well here today—that there are many barriers to accessing online services, particularly for those on low incomes, older and disabled people. Barriers can include a lack of skills, confidence, access and mobility. I've also spoken with older people who are worried that they will be targeted by online scammers, and I know Suzy mentioned in her contribution about fraud online, and people do trust the postman more than the password, and I think that is a very important point. She also raised the issue of what they're doing in Canada and France, and I think it would be very beneficial for us to have a good look at what is actually happening in other countries on this issue. So, I think that again is something that the strategy for an ageing society could take on board. 

But although we recognise that not everyone is comfortable with the internet, we want to support people to make informed choices about how they participate safely in a world that is increasingly digital. So, we do want to encourage people to use the internet, because we know that the advantages are there, but we must provide for those people who don't want to use the internet or are not able to use the internet. So, we are taking efforts to encourage the use of the internet: Digital Communities Wales's digital heroes initiative has trained over 5,000 young volunteers to help older people in hospitals and care homes get online, and another innovative project is the Vale tablet loan scheme, which is allowing residents across the Vale of Glamorgan to borrow internet-enabled but secure iPads from local libraries almost as easily as they would a book.

For some, being digitally excluded is not a choice but a result of poor broadband coverage, which has also been mentioned here today. We want to make sure that everyone who wants to access the internet can do so. To date, Superfast Cymru has provided more than 733,000 premises across Wales with access to fast fibre broadband. We've also invested more than £200 million to step in when the market has failed to connect 95 per cent of properties in Wales, including many situated in rural areas.

I think the key principle of all this is that we should design public services around the needs of the end user, and typically this will mean a service that works digitally but also meets the needs of end users who are digitally excluded, and that is what the Welsh Government wants to do.

I'd like to end by addressing the proposal that Welsh Government talks to banks, businesses and other organisations to make sure that customers are not isolated if only online services are offered. I want to raise attention to our support for credit unions, which does enable some citizens in Wales to have access to affordable loans and savings, despite the withdrawal of large banks from Welsh high streets. Credit unions do ensure that people are able to discuss their requirements face to face and access products best suited to their needs.

It's also pleasing just to note—I can see that my time is going—that last year, the number of rural post offices in Wales increased from 619 to 636. Of course, local post offices can't replace banks, but they can offer their customers basic face-to-face banking services. Thank you, Deputy Presiding Officer. 

16:50

Thank you very much, Deputy Presiding Officer. I thank everyone who has taken part in this debate this afternoon, and there is agreement, isn't there, that there is an issue here that is genuinely something that needs to be taken seriously?

I like the point that Mike Hedges made: some people just like talking to someone. And it'