National Assembly for Wales

Bore da. Welcome to Health and Social Care Committee this morning. As always, we operate in Welsh and English, and we'll just do an interpretation check in a moment as well. There are some Members that are on the estate here this morning, and two Members are joining virtually this morning as well, so please be aware of that. But as I move to item 1—we have no apologies this morning—I would like to welcome John Griffiths to committee, who's joined us. Thank you, John.

Diolch, Cadeirydd.

Looking forward to you joining and your contribution. Also to put on record our thanks to Sarah Murphy who's gone on to other parts of her work. Wishing her well and thanking her for her contribution on committee this morning as well. [Interruption.] Sorry, yes, and I should say, we do have apologies from Mabon ap Gwynfor, and Heledd Fychan is substituting this morning as well. So, welcome, Heledd. If there are any declarations of interest, please do say now. No, there are not.

Just before I move to this next stage, I will just ask that we just check translation, if that's all right. Anyone who needs translation, if you can just please check that there's no issue at all. If I can just ask you to put your thumb up if you can hear the translation. Okay. Did you hear okay, Albert? We'll just come and check yours now. We'll just pause a moment just to make sure your interpretation is working. You've got it now. That's great, lovely, thank you. 

Right, thank you, all. I'd like to welcome the Minister, Dawn Bowden, who's with us this morning. Thank you, Minister, for being with us.

My pleasure.

If I can perhaps ask officials to introduce themselves for the public record. I'll start from my left.

Alistair Davey. I'm deputy director of enabling people in the social services and integration directorate in Welsh Government.

Bore da. Good morning. I'm Albert Heaney, chief social care officer for Wales.

I'm Dawn Bowden, Minister for Social Care.

Bore da. Good morning. I'm Taryn Stephens, and I'm deputy director of improvement in social services and integration in Welsh Government.

Bore da. Anthony Jordan, and I am head of programme and legislative implementation within the social services and integration directorate.

Lovely. Thank you for being with us this morning. And, of course, you're here this morning in regard to the Health and Social Care (Wales) Bill, which has been referred to our committee for Stage 1 scrutiny. Perhaps, Minister, I can start by asking you: why is this Bill a priority for the Government?

I think the Bill really is pivotal for our broader transformation vision on children's services. You'll recall that I made a statement in the Senedd earlier this week on the progress on our vision for transforming children's services, our programme for the transformation of children's services, and how that's going to fundamentally change how we provide services for children and their families through local-based services that really have the welfare of the young person at heart. As part of that transformation, we're wanting to see fewer children taken into care, we want services to be providing the right support for families at the right time, helping them to stay together wherever possible. When children are taken into care, we want them looked after as close to home as is possible. And when they're ready to leave care, which I think is equally important, that they're supported with a plan for their future. So, all of that leads to the Bill.

We shouldn't see the Bill in isolation, it needs to be seen as part of this wider transformation programme. And we've decided to pursue the Bill in the way that we have because we are concerned that the market is not functioning effectively and is not meeting the needs of children. We don't believe that profits should continue to be made from caring for children whose circumstances require them to be in the care of the local authority, and instead what we're going to be doing is transitioning to a not-for-profit model for care for looked-after children to ensure that public money invested in accommodation and fostering care for care-experienced children is not extracted out as profit, but is reinvested back into the system to support better outcomes, sustainable services and the professional development of staff. Our commitment to this, I suppose, in part is in response to children and young people themselves who've told us that they strongly oppose to being treated as commodities in the market by privately owned organisations—whether their interests are the highest priority for some of those organisations.

And the second Part of the Bill is around the introduction of direct payments for continuing healthcare. That's in line with our programme for government commitment to improve the interface between continuing healthcare and direct payments, and, really, what is driving that is that we want disabled people, and those with long-term health needs, to live as independently as possible, and direct payments absolutely give them much more control and voice over how and by whom their care is delivered. So, that, in a very broad-brush introduction, Chair, is what the Bill is intended to achieve. 

Thank you, Minister. I suppose, though, that there are other pressing priorities in your portfolio as well, so I suppose the question is: as priorities are given to this, is there concern that there are other parts of your portfolio that are perhaps not given the same attention, if your focus is on this Bill?

I understand what you're saying. As you say, the portfolio is very wide and there are lots of things in the portfolio that require attention. A lot of what is in my portfolio, and I'm sure we'll come on to that at some point this afternoon, around the whole of the social care workforce, and how all of that impacts on the delivery of much that's in my portfolio—. We very much said from the outset of this Government that this was a priority for us, the introduction of this Bill. The elimination of profit, in particular, from the care of looked-after children was very much a Government priority. It's taken quite a while for us to get to this point, where we've been developing the Bill, but we have never wavered from this as being a Government priority.

One of the things that we have to do as a Cabinet as we've gone along—and this is my first term as a Minister in Government, so I've been learning this as I go along—is that you set out with a set of priorities and sometimes circumstances dictate that you need to change some of those priorities, financial considerations in particular, and we saw that through last year's budget process. But we've never wavered from seeing this as an important step towards the care of our looked-after children. 

Minister, I noticed the UK-wide independent inquiry into child sexual abuse recommended that the Welsh Government introduce mandatory reporting for specific individuals to report child sexual abuse. Why is this not in the Bill?

Our response to that recommendation, really, has being guided and supported by the views of our safeguarding stakeholders and partners. We have consulted with them directly around our existing duties to report children and adults at risk, and we believe that the approach that we have is the right one—it mandates organisations to report. We believe that that is the right approach for us in Wales.

What the inquiry did find was that mandating the report of abuse alone isn't enough to protect children, and that has to be coupled with other measures, including greater public awareness, access to effective training, organisational arrangements to create safe environments, and all of these things designed and operated in ways that prioritise the protection of children. We did introduce legal duties on key agencies under the Social Services and Well-being (Wales) Act 2014. I don't know, Albert, if you want to say a little bit more about that.

Of course—

Do you mind if I just come in? I just want to—

Yes, sure.

Either for the Minister or Albert Heaney to respond to, but I suppose from my perspective, what I want to try and understand is—. This UK-wide inquiry was a substantial inquiry. It was a long, lengthy inquiry. It made a recommendation to you as a Government, which, reading it, you didn't take up, because it's not included in this Bill. Have I got that right or wrong?

What we have already is a duty of mandation on organisations. When we looked at the recommendation from that inquiry, we didn't feel that the recommendation around individual mandation was appropriate from the feedback that we had from our partners and stakeholders here in Wales.

So, I suppose the question is: a recommendation was made to you from the inquiry. Do you believe that you've taken up that recommendation or not?

We believe that we have adequate protection in place with our current arrangements. We already have mandation on organisations where there are no parallel duties anywhere else in the UK.

But just to check, are you suggesting that the reason that you're not taking forward the recommendation from the inquiry is because you're already doing these measures? Is that what you're saying?

Yes, and I'll be very clear: we reached that conclusion after direct discussions and consultations with partners and stakeholders. This wasn't something that we just took away from the inquiry and looked at the recommendation and said, ‘No, we're not going to do that.’

So, just to check, the inquiry made recommendations and you think that you're already undertaking the measures that the inquiry is recommending?

We believe we have proportionate and effective safeguarding arrangements in place as is now. But I think it would be helpful if Albert said a little bit more about that, and about the timing as well, because I think that was also important, the timing of the inquiry.

Yes, that's fine. I do really want to understand—some of my questions, I want to follow those through, so perhaps you could address those points.

Yes, thank you very much, thank you, Minister, and thanks, committee. I think the first part of the question is around the Bill and the actual child sexual abuse public inquiry independent report. We tried to time it so that our consultation around the Bill would synchronise seamlessly, but, of course, that just didn't work out. On the actual public inquiry report, significantly, the recommendations come after our consultation, so there was a timing issue there as well.

I think that the second point is we're never complacent in relation to safeguarding. We have worked very closely with the independent inquiry into child sexual abuse during the inquiry itself, always looking at lessons to be learned, taking this very seriously, recognising the impact upon victims and families' lives. And as part of that, we will always continue to look to strengthen our safeguarding arrangements.

In Wales we do have a unique approach in place that was established under the Social Services and Well-being (Wales) Act, and that places duties upon organisations. So, we will all be looking, as the Minister has said, to ensure that we have effective safeguarding arrangements in place in Wales, and we're always striving. But we do have a unique approach in Wales that is further ahead in legislation terms than our counterparts across the UK.

I think what I understand, though—and please correct me if I'm wrong, Albert—but I think what you're outlining is there's currently a mandate on organisations, but the inquiry was looking to put a duty on individuals, which is not the case here in Wales. So, therefore, does that follow through, that you're not following the recommendations of the inquiry?

We're not following the responsibility to place it on individuals. And importantly for this committee—

'Why not?', I suppose.

Because there are lots of concerns from some of the leading child protection charities in the UK as well, our stakeholders working with the local authorities' social services departments, and getting that balance right on individuals. The feeling in Wales is very much that placing that duty on the organisations is the right proportionate and more effective response. One of the critical points is the worry that some of those leading child protection charities and statutory child protection organisations have that actually it could have a counterbalance of suppressing children coming forward to give evidence, and that, for the committee, is something that we are very mindful of. 

And, of course, those stakeholders that you refer to would have given evidence to the inquiry themselves, but the inquiry still made those recommendations. I can't profess to be an expert. 

No, no, no, and, with any of these things, Chair, recommendations are there for us to consider; they're not mandations in themselves. They are recommendations that we have to take in the context of what is appropriate and proportionate for us, and that's what we've done. I'm conscious that that was introduced into the UK Criminal Justice Bill that fell just before the dissolution of Parliament, of course, and I did say in the Senedd when I was introducing this Bill that we wouldn't be looking at introducing that at this time. But that is not to say—you know, you never say never, do you, because you always have to be reviewing your practice.

Thank you. 

And just to conclude, following the Minister's really helpful comments, we've always been clear that we've never ruled out the opportunity of consulting further on this issue as well.

Okay, thank you. We're really short of time, so I just want to get permission from you, Minister—if Members politely interrupt, are you okay with that? 

No. Yes, of course. [Laughter.] 

I was hoping you would say that. Thank you. Mark Isherwood. Oh, sorry. Mark Drakeford. Mark Isherwood used to be on the committee a long time ago. Mark Drakeford. 

Just four quick questions from me, Minister, about the motivating policies that lie behind the Bill, and particularly the part of the Bill that deals with profit taking in services for children. You will know that the average profit take by a private company is £910 per week per child for a child placed by a local authority in private provision. The Competition and Markets Authority say that profit taking in the sector runs around 22 per cent. A normal business would take profits at around 5 per cent. The State of Qatar and the Emirate of Abu Dhabi, both of which run private provision for looked-after children in the United Kingdom, declared profits in 2022 of 26.5 per cent. The Local Government Association in England refers to this as profiteering. Do you think that the current system is sustainable if we didn't reform it and just allowed it to carry on?  

Thank you, Mark, for that question, and I absolutely agree with the premise of the question. Doing nothing in this area is really not an option for us. We know that the children themselves have told us they don't want to be treated as a commodity, but let's just put that to one side. I think that's a hugely important thing for us to consider, because these are children that have had the lived experience of going through the system, and talking to them is actually very informative and very powerful as well, but the specifics that you raise about the level of profit that is being derived from the care of looked-after children I don't think is something that we can see as being sustainable. So, what we have—. In 2016-17, I think the cost to local authorities of looked-after children was around £65 million. We've seen that increase in less than 10 years to nearly £200 million; that's a 300 per cent increase. Somewhere in the region of 20 per cent to 25 per cent of that is being extracted as private profit. 

Now, if we continue on this trajectory, we are going to see within another 10 years potential costs for looked-after children approaching £1 billion. The option of just sitting here and saying that that's okay and we'll continue to do that is not an option that I think is a reasonable or viable one. What we're proposing, of course, is not a like-for-like replacement of the current system; we are proposing transitions to not-for-profit organisations. We are in close discussion with the for-profit sector, to talk to them about how some of these organisations can transition, and I'm very hopeful that a number of them will want to transition. But what we don't want to see in the field is the continuation of the kinds of organisations that you're talking about. I've seen a number of recent press reports about the cost of placing one child in care is more than the cost of sending a child to Eton. It is quite outrageous. So, any profit that is derived from the care of looked-after children, it is absolutely right that that is reinvested back into the service to support those children.

Thank you, Minister. I agree that the financial case for reform is inescapable. Just a question about the ethical case, then. I don't know whether committee members are familiar with the term 'blocks of provision'. It's a term used in the private provision of cared-for children. Well, blocks of provision are children. They are groups of children traded from one company to another. Here is a quote for you from the prospectus set out by Clearwater International, an investment company that operates in the field of private profit-taking care of children, saying to potential investors that there are significant opportunities for investors because of what it calls 'a growing UK population exposed to risk factors'. Well, let me just translate that for colleagues. What they are saying is that there are going to be more children in the United Kingdom in the future who are poor, more children in the United Kingdom in future who have mental health difficulties, and that these misfortunes and miseries provide new opportunities for hedge funds, for venture capitalists and for others to come in and make profits at their expense. Minister, do you think that that is the basis on which services for looked-after children in Wales ought to be operated?

I absolutely don't believe that that is the basis on which services for children should be operated. I do think you're absolutely right that there is a significant ethical case to be made, as well as a financial one, and you've set that out very, very clearly indeed. As I said in response to a previous question, I have met with a number of these care-experienced children, and I've heard the impact that it has on them of being traded around the system as commodities in the market. I've also had detailed conversations with the former children's commissioner, who was a great advocate for this change as well. She will tell you very powerful stories about how these organisations advertise, almost advertise for sale, the placements for children, and about conversations with children who were threatening to run away being told, 'Well, then, go and run away, because we can get somebody with much more complex needs than you that will bring us greater income', and that kind of thing. So, we have to absolutely take all of that out of the system so that the child and that child's needs and what is in their interests, and not the interests of the profits and shareholders of companies, are absolutely central. And of course, key to all of that is the first answer I gave to the Chair, right at the beginning of this session, which is that the whole programme of the transformation of children's services is about reducing the demand for the number of children that we need to have in care. Because, whilst that demand is so high, the private profiteers continue to profit. So, by reducing that demand, we will be in a much better position to control the market in the way that we want to see it controlled.

Thank you, Minister. So, if the financial case and the ethical case are secure, I just wanted to ask you about the practical case. Because is it not the case that the current market-based system leads to gross distortions in the practical provision of services for children? Twenty-five per cent of all new private provision in England last year was in the north-west of England. One in 46 children in Blackpool is a child in care. Wales is a net importer of looked-after children, because English authorities place children in Welsh private providers because it is cheaper for them to do so. And isn't that what the market does? It gravitates to places where housing is cheap, where labour is cheap, and, where provision is cheap, profits are greater. So, is there not also a strong practical case for making sure that we have a planned system of provision designed to meet children's needs as close to home as possible rather than where the market would dictate provision would otherwise be provided?

And again, I would have to agree with your premise there, Mark. In terms of the market-driven aspect, in some ways, this is the most insidious, because of the very points that you've made—the number of children we're seeing transported around the country, away from their communities, away from all the connections and the roots that they have, because the providers are placed in these areas where property prices are at their lowest, and why we see so many private providers in Wales, in areas where property prices are at their lowest. And part of what we are trying to do with this legislation is to ensure that we have accommodation, where that is needed and where that is necessary, that helps to keep a child closer to their family connections, their friends, their education systems, their social groupings, their community links, all of that. We cannot continue with a situation that rips the most vulnerable children out of those communities just to place them in residential care that is cheaper to run elsewhere in the country.

So, I think the marketisation of this is something, absolutely, that we have to see taken out of the care for looked-after children. I want to see the development of smaller residential bases in regions closer to where children live. It is why one of the provisions in the Bill is saying very clearly that that is an objective, that we need to keep looked-after children as close to where they come from as we possibly can, and that's a very clear objective that we need to deliver.

Thank you, Chair. One very final question, which is about timing, because the committee will have heard evidence from those who participate in the current system arguing that a longer period of time is needed to move from the system we have today to the system we look for in future. I've seen some arguing that you need a 10 to 15-year transition period. Well, here's a policy first advocated by the previous children's commissioner in 2016, in the Labour manifesto for the 2021 Senedd elections. The chair of the Association of Directors of Social Services resources committee in England says that it is urgent that action is taken to end profiteering from children's care. Do you think a 15-year horizon matches the urgency of the situation?

No, it absolutely doesn't, and the Bill certainly makes provision for no further new registrations of for-profit providers in Wales from April 2027. That is not to say that private organisations will be completely out of the market by April 2027. We have written into that a transition period, because we do recognise that there are contractual arrangements with a number of these providers, and we also have to take into account what is in the interests of a child that may be settled with a provider for the next couple of years or so.

We've also written into the Bill provision for Ministers to make exceptional cases for the placing of a child in a for-profit provision where no other provision can be found. But that would be in exceptional circumstances, and only with the approval of Ministers. I absolutely agree with your premise that 15 years is far too long a transition, but we have to have a reasonable transition period to allow this to work properly, to work effectively, to ensure that we've got sufficiency in the system. We've been working with local authorities already; this is not something that is just coming out of the blue for them. We've had an eliminate programme in place now for the best part of three years, which has been supported by about £68 million-worth of funding, where local authorities have been able to prepare and to build capacity within their own areas for moving towards a not-for-profit provision. So, I see—. As I say, we will not be taking any further for-profit organisations into Wales in April 2027 [Correction: '2026'], and then I see that transition moving from there relatively quickly. What is key to this, of course, is the discussion that we will continue to have with the sector about getting as many of them as possible to transfer to one of the not-for-profit models that we propose in this Bill. So, we're not looking, necessarily, to chase every for-profit organisation out of Wales. We know that there are many good providers there who we think we could really work well with by transitioning them to not-for-profit deliverers of children's care.

Minister, can I just ask—? Sorry, Mark, did you have a final question?

No, Chair.

No. Minister, why not just support the public sector to deliver effectively? Presumably, they're not delivering effectively now, because that's why the private sector is stepping in. And if they were operating effectively, and they were being supported, the public sector was supporting that to happen, then there would be no need to legislate to remove profit from care.

I think that's a reasonable point. We are at this point because we have seen the demand for children in care rising exponentially, and local authorities have not had sufficient direct provision in their areas, which has meant that the private sector has come in and filled that gap.

But if you support that and support that to happen, then there's no need to bring forward legislation to remove the profit element.

No, because it isn't happening, so we are determined to make it happen, and we're going to make it happen via legislation.

But can't you make it happen without bringing forward the legislation to remove profit?

We have started to prepare for this already and, as I said, we have a three-year programme that we've been funding to prepare local authorities to build their capacity. Some are much further down the road with this than others. But this is really about sending a very clear signal that this is something that we take very seriously and is not going to be a voluntary process—this is something where local authorities, we are expecting, will build that capacity, and it will be building that capacity on a not-for-profit basis. So, it will be local authorities, third sector, not-for-profit organisations working together to fill the gaps that are currently provided for by for-profit organisations.

When I've raised with Cabinet Secretary for health over the past year and said, 'Why didn't you put a cap on agency nursing? We're spending too much on agency nursing. Put a cap on it. We want to see that reduced', the Cabinet Secretary responds, reasonably I think, and says, 'Well, but we need that flexibility, so we can't just put a cap on it, otherwise we'll be in a difficult position.' And I just fear that the Cabinet Secretary for health's argument could be the case here if the legislation proceeds in the direction you're following.

I don't see it in that way because it's very different. That's not a direct comparison, is it, because this is part of a wider transformation programme. This is about saying we have to reduce the demand and, in reducing that demand, it becomes a much more doable exercise, if you like, for local authorities. But it's the right thing to do. Fundamentally, what I come back to is that this is the right thing to do—that any profit that is derived from supporting looked-after children is reinvested to improve the support for those children and is not taken out for the benefit of shareholders and hedge funds. So, I make no apologies for that whatsoever. I think this is the right way to go. It is the right model for delivering children's care, and if we have to legislate to ensure that it happens, then that's what we intend to do.

Okay. Thank you. John Griffiths.

Bore da.

In terms of delivering on that restriction of profit, the edge-of-care funding is in place, isn't it, to try and reduce numbers of children going into care, but, nonetheless, we see numbers continuing to increase at the moment, I believe, unless that's no longer the case. I just wonder, in terms of responsibility for forecasting future need for placements Wales wide, right across Wales, where will that responsibility lie?

So, the forecasting, going forward, lies with the local authority. They are the statutory authority for that, and that's where it sits.

But Wales wide, right across Wales?

So, the local authorities have an existing duty, don't they, to take steps, as far as practicable, to provide accommodation within their area, and that's the statutory responsibility that they have for forecasting the needs. And that responsibility rests with them, and I expect them to be using the next three years to rapidly accelerate their care-reduction policies. That's partly what the Chair was just talking about. And I know that all local authorities in Wales have been revising their placement commissioning strategies—that's a three-year strategy, so, at the moment, that's just about to be replaced by the 2024-27 strategy—and looking at how they strengthen their commissioning forecasting based on both the current and future need. But, as I say, removing profit needs to be seen in the wider context of the transformation programme. I don't know, Albert, if there's anything more you want to say about the work that we'll be doing with local authorities about making sure that they can work towards this kind of sufficiency.

Yes, very much, Minister. I know time is pressing this morning, but there's been a lot of work already taking place, for the Member to be aware of today, around commissioning strategies, planning more effectively, working together to understand how, as local authorities—. One of the challenges that local authorities face, of course, is the issue that we come back to, which is that some of the set-up of some of the private provision is in locations that are inaccessible, distant, so taking children away. So, that makes it harder to plan more on a population need to meet that need locally, and that's very much our focus. 

Upon sufficiency, then, we've been using our funding, as the Minister said. We've used the £68 million on eliminate, but we also have, quite smartly and appropriately, used the regional integration fund, working with regional partnership boards to begin to develop placements locally—residential. And, of course, that takes time, combining capital and revenue, but we are beginning to see now the fruit of that seed of funding coming through, with additional placements being designed. And I know some of you will be very aware of some of the local placements that have been set up around Newport, for example, as really good illustrations of where we build that locally, we can deliver to meet better outcomes and the needs of children. 

Obviously, it would be very good and beneficial in all ways if the numbers of children going into care could be significantly reduced. Do we see any progress at the moment?

Currently, the last big figures were 7,208 children in the system coming into being care-experienced children across Wales. One of the things that we're very mindful of, of course, is that we have seen improvements in local authorities. We have seen that trend being held, being stabilised. One of the factors that we're also mindful of is the number of unaccompanied asylum-seeking children who are now placed in Wales. So, although the figure looks high—and it is high—it's also, in part, holding that higher level because of a change in circumstances in meeting the needs of those children as well. 

How significant is that number, then, of unaccompanied asylum-seeker children? If you took those children out of the equation, would we be seeing a reduction at the moment, or not?

We would definitely be seeing a slight reduction from where we have been. We would, yes, because the last figure for those children across Wales was 260 children. So, in terms of meeting their need—and, as we know, a very important group of children to support, as well—and taking a lot of consideration time and focus from local government to provide a good service—. But we definitely will be seeing that trend moving from the peak to a reduction. 

I think, as well, just to add to that, we've got about 1,000 children placed with parents, and part of the £68 million that we put into the system is to discharge some of those care orders to work with local authorities and to work with those families. Obviously, those children are already there, but it takes up a lot of resource and they are classed as looked-after children. So, we are expecting some steep reductions as we go forward, because I think most local authorities now are really focused on that area too.

Okay. I hope we do see progress; it's badly needed, isn't it.

It is. 

Okay. Could I just ask about, perhaps, some of the more difficult provision—intensive crisis, therapeutic intervention and secure accommodation? Is it going to be more difficult to take profit out of the system in terms of provision of those particular services?

Well, again, what I've said—and I think I mentioned this in response to Mark Drakeford—is where there is a particular provision that is suitable for a child, and the only provision for that that is suitable might be some private provision, then Ministers will be asked to give approval for that. I see that to be very, very rare. But what we are looking to do, with the development of regional placements—so, rather than sending children to other parts of the country—one of the reasons behind that is that we're looking to reduce the number of children that should be in secure accommodation or tier 4 accommodation, because what we have found is that, actually, that's what it leads to. That's what it potentially leads to by placing children further away. So, we would very much see them as part of the programme. We don't want private provision in that area as well, but we are looking particularly at accommodation that is smaller and that is regionally based to support children in their own locations.

Could I ask, as well—? One of the issues for legislation, always, I think, is the possibility of unintended consequences, and there is going to be a transition, as you say, Minister, with regard to taking profit out of provision. At the moment, there are a lot of concerns about illegal unregistered placements in use in Wales, and also deprivation of liberty orders, or, indeed, children being kept in police custody overnight, arguably sometimes at least because of a lack of suitable placements. So, in the short to medium term, could these issues be worsened as you take profit out of the equation?

Work on that has already been taking place, and we are seeing the numbers of services operating without registration falling, in terms of the placements. So, at the beginning of this year—well, in February of this year—we actually only had 25 placements in unregistered services [Correction: '25 unregistered services']. Now, that's still far too high. That's 25 too many. But it's coming down, and I want to see that come down considerably further. Following on from your previous question, about working towards the minimal use of secure accommodation, we're looking towards the minimal use of unregistered placements as well. It's about increasing and building the resilience into the arrangements of suitable places. That's what this whole programme is focused on, and it goes back to—. I have to keep coming back to it, because we cannot see this Bill sitting in isolation of everything else that we're doing. This Bill is putting a legislative slant on a wider programme for a particular element of that.

But I think it's probably worth me just coming back to your previous question, because you were asking about secure units and units for children with very complex needs, and all of those, of course, do require significant capital investment. We've allocated over £25 million through the integrated care fund and the housing-with-care fund to deliver around about 40 residential schemes for children across Wales that fit that very description. Half of those are for children with complex needs, and they're going to be delivering 96 beds. We've already got five operating with 15 beds. So, that work is already ongoing; it's not something that's waiting for the legislation. It's an ongoing piece of work through the transformation programme.

Yes. Could I ask you, in general, Minister, in terms of that need to increase capacity in the public sector, which, obviously, you and your officials have already referred to on some of the funding that's available, if you can tell committee the number of new not-for-profit placements that have been created to date as a result of the £68 million allocated, and what percentage that is in terms of the forecast need for placements?

Have we got details of the new—?

Because we're short of time, could you put that in writing?

Can we write to you about that?

That would be helpful.

Yes, we can do that.

We're a bit short of time, so if there are any other technical questions—

All right. Okay, Chair. Perhaps I could just ask one further question, maybe, then, in terms of the duty on local authorities to prepare and publish the annual sufficiency plan for accommodation for looked-after children. Could you give us an indication, Minister, of the sort of reasons why the Welsh Government might reject a sufficiency plan and why the Bill is silent on what happens if a second draft of a sufficiency plan is rejected?

Okay. So, the plan has to include prescribed information about the not-for-profit and private providers who are likely to be named in applications for approval of supplementary placements, and then there has to be an estimate of such applications, and so on. If we are not satisfied that there is sufficiency in the plan, we would give robust direction to the local authority about putting in place a plan that has sufficient capacity to deliver the objectives, utilising the right type of provision and provider. And then they will be reviewed by us, and they'll be carefully scrutinised to check that all the requirements are made. And if not, as you quite rightly say, Welsh Ministers can decline to approve the plan.

If we don't approve the plan, we then notify the local authority of that decision and the reasons for it, and they've got a specific period of time then in which to submit a further plan. Again, I will ask Albert about this, because there is technicality about this on the new section, section 75, Albert, of the Act, isn't it, about what happens if there is no further—

Sorry, Minister. Would it be okay if we had that in writing as well?

You can have that in writing as well. You may indeed. Some of this is quite technical. I understand that.

I understand. 

I'm not sure I'd describe some of these issues as 'technicalities', but there we go.

No, they're not technicalities, but they are technical. They're definitely not technicalities, but they are technical in terms of what is required within the terms of the Act. 

Thank you. We've got more to get through than the time allocated, so I'm just encouraging shorter questions and shorter answers, if that's okay.

Sure.

Thank you. Sam Rowlands.

Hi, Sam.

Thank you, Chair. Good morning and thank you, Minister, for your time this morning. Clearly, at the heart of all of this is the welfare and well-being of children who are looked after. I'm just wondering what your thoughts are on any unintended consequences, especially if there was a mass exodus of providers in a short period of time, where that leaves those young people who are currently looked after by them. What contingencies might you have in place to deal with that, which may be within a short timescale and include lots of children?

Sure. Well, as I've said previously, this is not something that we're just dropping on local authorities, this is something they've been preparing for over a period of time. And some of that work includes regular market intelligence that they've been seeking, both from the children's commissioning consortium and Care Inspectorate Wales. So, the Bill addresses potential unintended consequences in a number of ways that I think I've already covered this morning. So, transitional arrangements, which will enable existing not-for-profit providers to continue to operate; the ability of local authorities to continue to place children in for-profit provision, where that is consistent with their well-being; and, subject to Welsh Ministers' approval, new duties on local authorities in respect of sufficiency and sufficiency plans. And all of those measures, taken together, will be serving to ease that transition process as far as possible.

To date, we've seen very little change in the children's social care market as a result of our commitment. So, we're not seeing for-profit providers rushing to leave Wales, and we are seeing a number of those providers having positive conversations with us about transitioning to that not-for-profit model. But what we are doing, because you are quite right, it is a bit of an unknown situation that we will find ourselves in, so we have to do quite a substantial amount of scenario planning, and the Bill is predicated on—. If you look at the explanatory memorandum, you will see that the Bill is predicated on various scenarios. So, that would be 100 per cent [Correction: '50 per cent'] of for-profit providers changing to a not-for-profit model right down to zero, and everything in between. And we will have to follow that as we go through. But, at the moment, our focus is on working with—. Well, our focus is twofold: one is on reducing the demand—that's the key to all of this; and the second is working with for-profit organisations to help them to transition into the not-for-profit model.

And just on that risk, about identifying it, as you say, scenario planning may be there, are there any particular areas of Wales—geographical areas of Wales—that are more high risk for this potential fast exit than other areas?

Yes, Cardiff is the biggest risk we have. I think something like 80 per cent—. Is it something in the region of 80 per cent?

We've got over 1,000 children in care in Cardiff and about 80 per cent in private provision. So, that's one of the local authorities we really will need to work closely with. You'll find others with very little provision from the private sector. So, part of this is we know that we have variation across Wales in terms of rates of children in care, but also their reliance on private because, generally, they're the bigger geographical areas.

Yes, and there are plans in place to support those areas that have the highest risk.

Yes.

Okay, and then a further question: you mentioned earlier, Minister, about the allowance, within the Bill, for Welsh Ministers to approve for-profit supplementary placements, for example, in an emergency situation that may take place. Just briefly, I want to understand the reality of delivering on that when that emergency placement needs to take place very quickly, and how that will practically work through the system for you, or whoever, to sign off, so that there are no delays for those children—again, keeping children at the centre of this and their welfare and well-being. 

And then also to understand whether those supplementary placements that may be needed on an emergency basis will have to be outside of Wales, because I believe that the Bill provision does not allow for-profit providers to legally register here in Wales. So, if they're going to be placed in that emergency situation, will those children be ending up outside of Wales?

So, when we talk about Welsh Ministers, then obviously that does mean that Welsh Government officials act on behalf of Welsh Ministers, and there are situations now where Welsh Ministers have to sign off placements and so on. That doesn't prevent the local authority from placing whilst that is happening in an emergency situation. So, that would continue in that way. Sorry, the second part of your question—.

The second part was that the Bill does not allow for-profit companies to be in Wales, so, if you will be placing in for-profit organisations, where will they end up?

Yes, yes, we can certainly do that, but I'll ask Albert to explain that, yes.

Yes, very much. We've had meetings with our UK Government colleagues to explore cross-border issues. They're equally concerned about children from England being placed a long way from home in Wales. So, we'll be having very clear relationships with those that are currently in provision, looking at the same relationships in terms of provisions and making sure that we continue to work with the UK Government, because they want to see that change as well in terms of children being closer to home.

I'm sorry, I'm not sure we're getting to the point of this then. So, what we're saying is that, in an emergency situation, where the Minister says they should be placed in a for-profit centre, there will be no places in Wales for that to happen, so a child in St David's in Pembrokeshire will have to be placed all the way over, say, in Bristol, rather than somewhere else in Wales that would be closer to home.

[Inaudible.]—if I may, Minister. Thank you. So, essentially, in that scenario, under the transitional arrangements that we are proposing, there will still be, until they exit the market, some for-profit providers within Wales and the conditions will be placed on their registration from a certain date, which will allow them to take placements under the permission of the Welsh Ministers. So, local authorities will still be able to use that provision for as long as it continues to exist. Obviously, we would hope that by the time we've worked through all of the implications of transition, then there will be much less of a need to make emergency provisions because there will be sufficiency of not-for-profit provision. Until that happens, existing legacy for-profit providers, as we're calling them, will still be able to take placements, but under conditions.

And those will be outlined in the sufficiency plans because the local authority would need to name the private providers they were using as legacy providers.

Yes, but I guess once that transition has finished, that part of the legislation then would only allow for children to be placed outside of Wales in an emergency situation. Am I right?

But this is about building provision within Wales, so it's not exclusive.

Yes.

Okay. So, what we're saying is that in an emergency situation in the future, after that transition, you've got the capacity you want to see in Wales, therefore that emergency placement into private provision shouldn’t be needed after transition. That’s what you’re saying, in an ideal world. Okay.

Yes.

All right. Okay, I think we’ll move on to just talking about the direct payments to continuing healthcare, Chair. Am I okay to move on to this part of the question here?

There have been concerns raised about the impact on the workforce and the lack of services in the extended direct payments for continuing healthcare. One of those is the pool of personal assistants that would be available. I’m just wondering what work you’re doing to expand that pool of PAs that people would be able to get hold of.

Well, the pool of PAs, what we would expect is that the vast majority of PAs will actually be drawn from an existing pool. To explain that: what we anticipate happening is that a number of people who are currently in receipt of social care direct payments will transfer to the continuing healthcare direct payments, and will probably take their PA with them to provide the CHC direct payment, rather than the social care direct payment. So, that’s what we see as being the key around the employment of PAs. Because what this is really trying to do is to make sure that people who should be receiving healthcare—as opposed to social care—can transfer, because a lot of people who are currently in receipt of social care direct payments are not transferring because they cannot have a PA to provide their care. So, we would anticipate that a lot of these people will be the same people.

And have you anticipated the proportion of those who would be family members or unpaid carers?

Absolutely, and for some people in receipt of home-based healthcare, we know that family and close friends often provide much of that care without any recognition at all; they don’t get any payment or adequate respite opportunities. So, this actually provides the opportunity for those people who are currently providing unpaid care to receive that payment as well.

And the final point on this, Chair, in relation to this, is that concerns have been raised that what we may see is just labour market displacement, so just movement within a very similar group of people, so social care workers perhaps moving to be PAs. Do you have concerns about that, rather than seeing a new group of people being made available, just seeing movement within, and therefore creating pressures elsewhere, perhaps within social care or other parts?

As I said previously, we don’t see that that will be a huge problem, for the reasons I just explained, but we do recognise that that is a concern, and my officials are discussing that issue with other teams across Welsh Government and stakeholder groups, and with Care Inspectorate Wales and Social Care Wales. So, it is something we are alert to, and we’re having the conversations with the governing bodies and the inspectorate bodies about how we might deal with that.

Okay. Thanks, Chair.

Minister, can I ask: do you have availability to stay with us till 11:10, rather than 11 o'clock, and your officials?

Possibly, but I know I'm going on a visit. I haven't got my diary with me, so—.

I can message your office, Minister—

There we are, thank you.

In that case, happy to do so, yes.

I appreciate that and what I’m going to suggest to Members is that we curtail our general scrutiny session, because I think this session is particularly important.

It is, yes.

So, we’ll continue with this and then we’ll reduce our general scrutiny session from 30 minutes to 15 minutes, and if I can just ask Members to think of anything very pressing that they want to raise in that general scrutiny session.

And what I would say, Chair, is I’m quite happy to come back and do a separate session with you on my portfolio if that makes life easier for the committee.

That’s very generous of you. Thank you, Minister. Our issue is time ourselves—

Of course, I understand.

—because this scrutiny is taking up our time, but that’s very much appreciated. Thank you. Joyce Watson.

Good morning, Minister. 

Morning.

I’m going to carry on talking about continuing healthcare and some of the potential risks that have been passed on to us. And one of those, of course, is that it leads to improvement in quality of care rather than the opposite.

Sorry, I didn't quite—

They want to see improvement in the quality of continuing healthcare when we're talking about extending direct payments, rather than the opposite.

Yes, absolutely. Certainly, the experience of England, which has had direct continuing healthcare payments for about 10 years now, has been that the health outcomes and the delivery of healthcare to those people requiring continuing healthcare at home have been considerable. They've seen a considerable improvement in both the care and the outcomes. So, we're talking about payments for people that receive care at home, as opposed to in care homes, and as opposed to in hospital. So, if people require hospital services, this wouldn't cover them. This is about the care they get at home.

Absolutely. Of course, Carers Wales and the older people's commissioner were concerned about safeguarding issues, because it is about people at home, as you quite rightly say, and those people being able—and some of them would be very vulnerable—to trust those people who would be delivering that care in their home and any safeguarding issues surrounding that. How are you going to ensure that that is adequate and meets their needs? Because at the moment they would perhaps have domiciliary care. 

The direct payment is made to the individual, so the individual is then responsible for the payment. So, none of these payments go directly to the person that is providing the care, unless there are capacity issues, which is something different. The individuals themselves need to request the direct payment, so this is a completely voluntary process. If they are looking to employ people that are unknown to them, outside of the family, the kind of people I was just referring to in my answer to Sam Rowlands's question, then there is also the provision for Disclosure and Barring Service checks on people that are providing these services, as I say, if they're unknown. But we would expect a lot of these payments will be made to people who are known to the individual. So, in terms of safeguarding, we—. Go on.

Thank you, Minister. Just maybe two comments in terms of safeguarding. We've got long relationships around direct payments, for example, in social care. So, those arrangements currently take place. As the Minister said, in terms of the current issue, what are we trying to solve? One of the issues we're trying to solve is that a lot of people who have direct payments already with social care don't want to lose that, their carers. They want consistency of care as they move into continuing healthcare, so some of them are actually declining or anxious about having continuing healthcare assessments for fear of losing their current carer. This will, potentially, overcome one of the worries that we have, which is around them then coming to harm because they haven't had a continuing healthcare assessment, and their healthcare needs are not being attended to in the way that we would want them to do so. In relation to safeguarding, we have very strong arrangements that are currently in place, and we will continue to work with the health boards as well. One of the things that we have done, Minister, that you'll be aware of is we've tried to group together supporting health boards around this new arrangement, so there's a lot of confidence in terms of how we respond, as well.

And are you going to help people with that transition? Because a change when you're vulnerable, regardless of age, is a significant challenge to the individual, both mentally and the fear that you've just described. So, how are you going to help with the transition? What examples have you seen where that's worked quite well?

Do you want to say a bit more about the hub arrangements for the administration of direct payments? Because that's where there will be support offered to people that are in receipt of direct payments for the first time. A number of people, as I say, will already be familiar with direct payments if they're transferring from social care direct payments to health direct payments. They will be familiar with it. But we're very conscious that there will be a new cohort of people that will be accessing this for the first time. We've looked at the arrangements for administering that, and supporting people within that would be delivered on a hub basis.

Yes, very much so. Just a couple of things to expand upon. We have been in contact, of course, with our English counterparts in terms of how it has worked in an English context. They are very positive about continuing healthcare direct payments and the arrangements that they've put in place over a number of years. So, learning from that has enabled us to, as the Minister said, focus on our support with health boards. But what we don't want to do—and very much meeting, I think, the Member's question—is have six or seven different approaches in Wales. Therefore, there's the concept of a supportive hub, which has the expertise and the skills, so that those individuals coming through can be supported by the health boards.

The second point then is that we work with—. Because we're in an integrated health and care world, continuing healthcare really means that health and social care need to work together to meet the needs of people and support people. We'll be continuing to work with our local government colleagues around our continuing healthcare work. Because they already have, for many people, existing arrangements in place, and, of course, the support. There may be opportunity, I think, as we go forward, as well, for the Members of this committee to be aware, in terms of exploring some of the things that have been successful in the social care direct payment world about how we've supported those individuals. We have a number of collective arrangements in place that have been very successful as well. Thank you. 

The other area, of course, is people being charged, according to the older people's commissioner, top-up fees to access essential services that will be paid by the CHC direct payments. I'm sure you've taken that on board. And she gives examples here, perhaps in care homes at the moment. How are you going to nullify that happening to individuals in their homes?

Firstly, the charging of top-up fees is not allowed under CHC, but we are aware that it is an issue that has arisen in relation to some CHC payments in care homes. It's been for things that are beyond continuing healthcare; it's things like going on outings outside of the home, and so on. But, of course, that wouldn't apply here, because these direct payments would not be made in that way to somebody in a care home. This is only for somebody in receipt of continuing healthcare in their own home. So, we wouldn't see the same issue arising there. And as I say, the option of direct payments really would be about reducing the risk of being subject to top-up fees for individuals by offering them the choice to access those direct payments at home, and therefore avoiding them having to go into care homes. But there's a difference: it's not paid to people in care homes, it's paid to people in their own homes.

My final question is about people's capacity to choose whether they want to go to this system or carry on in the system that they're already in. We are also fully aware that there's an awful lot of control around where money resides, and coercive control is very much at the forefront of people's thinking now. So, what sort of safeguards or red flags would you recognise if you felt that somebody was being coerced into moving from a situation they were perfectly happy with into a situation where that could be abused?

I think that's a very valid point. We would have to look at exactly the same processes that we apply with direct payments for social care. We have to take very careful steps to ensure that people are protected in that and it would be exactly the same process that would be applied here. The fundamental point about direct payments is that they are voluntary, nobody can be forced to accept them. This is something that will be done in the interests of the individual, and unless they are without mental capacity, then the payment can only be made to them, or I believe they can also ask for the payment to be made to a nominated person, providing they have capacity. So, I think it is a question of ensuring that the procedures that we currently follow for direct payments for social care are followed through in these payments; there are safeguards written into that as well.

Thank you.

Thank you, Joyce. John Griffiths.

Diolch, Gadeirydd. Minister, I guess we're all pretty familiar with the tension between local authorities and health boards in terms of whether continuing healthcare is provided, because, obviously, it's a question of which one is paying for the care. There is a concern from directors of social services and the Welsh Local Government Association that alongside legislative change there should be change to implementation and practice around the interpretation of continuing healthcare and gatekeeping. They believe that changes are needed to ensure that it's much more robust in terms of whether it should actually be continuing healthcare or not.

Firstly, can I just say that the wider policy around the implementation of continuing healthcare is, actually, not within the scope of this Bill, and is, actually, outside of my portfolio? What I can tell you is that in preparation for the Bill, officials have worked very closely with local authorities and their representative bodies, and there is widespread support for the direct payments amongst those stakeholders. But, on that wider issue of policy, I'm quite happy to ask the Cabinet Secretary to write to you about that, as I say, because that's not within the scope of the Bill and it's not within my portfolio, I'm afraid.

Take-up of direct payments for social care is quite low, isn't it? Audit Wales found that, in their view, people in Wales are not consistently supported to take up those direct payments. Do you believe that there should be a strengthening of the legal provisions to provide information and advice to promote direct payments and to support people who manage them? Are there any plans in terms of raising public awareness? 

Again, the take-up of direct payments in social care is outside the scope of this Bill. I'm quite happy to take some time of the committee this morning talking about it a little bit, or rather I could write to you, because it's actually not about the Bill. But I could write to you and set out some information for you, if you just want that wider information.

We'd be grateful for that, thank you.

That may apply also to this question, Minister: it's just in terms of ensuring there isn't a disincentive for health boards to promote the use of direct payments for continuing healthcare, because of this tension about who's paying for the care, again, between health boards and local authorities. Is that something that you recognise with colleagues?

In terms of disincentives, the stakeholders have been very vocal about the need for this, and I think the awareness raising amongst those stakeholders would make it very difficult for any health board, I would suggest, to not be applying that. But, again, incentivising and disincentivising are probably outside the scope of the Bill. I can wrap all of that up, again, in a letter to you, Chair, if that would be helpful, so that we cover all of that in one piece of correspondence.

That's fine, yes. It appears that all of John Griffiths's questions today are in writing, I think. [Laughter.]

What I would say, Chair, is that most of the issues around the continuing healthcare direct payments [Correction: 'around continuing healthcare'] are probably not associated with the Bill. The Bill is only about enabling the provision for direct payments to be made. So, policy areas around continuing healthcare are not covered in the Bill.

Okay, I part-understand that. I think Albert wanted to come in.

It was just a small point, but, perhaps, significant, following on from the Member's question: one of the incentives I would suggest is here is that, actually, in terms of the feedback that we've had from our English counterparts, people feel satisfied in terms of going into CHC with direct payments. Also, for the health boards, actually, it's a lower cost, so it has a financial efficiency as well.

Thank you. Our last section is from Heledd Fychan. Heledd, you've got up to 10 minutes; if it's shorter, great, but if not, 10 minutes is fine.

Thank you, Heledd, for that question. I think what it does do is it takes time to get multidisciplinary teams together to progress the assessments, and sometimes delays due to CHC are reported as part of the delayed pathways of care reporting. However, there are timescales to which CHC assessments should adhere, and compliance with those timescales are being built into the new CHC national data collection performance framework proposals. Again, generally, CHC assessments are not within the scope of the Bill and are not within my portfolio, so I can only tell you what I know about how this is operating in relation to potential delayed transfers of care, where the Cabinet Secretary for health and I have a joint interest and responsibility.

Thank you, Heledd. So, the regulatory impact assessment does contain extensive modelling about the financial implications for LHBs. It's anticipated that probably about 110 people—that's around about 1 per cent of the continuing healthcare cohort who are currently refusing CHC assessment and remain on social care—may choose to make the transition to CHC when direct payments become available. That move would cost somewhere in the region of £4.2 million a year to local health boards between 2025 and 2028. That figure is going to be split between LHBs; it doesn't actually represent the cost for each. But this, added to the new CHC recipients opting for direct payments, will mean that the proposal is estimated to increase costs for local health boards by between £20.5 million and £24.2 million, between the seven health boards, over the 10 years from 2025 to 2035. But, that needs to be seen against the context of the total annual CHC spend for Wales, which is around £448 million. So, it's a relatively small figure. The figures for 2023-24 are going to be considerably higher—we're expecting them to be considerably higher. But, again, I'll turn to Albert to see if he has anything he wants to add to that. But, there is cost associated with it. It's cost that, of course, won't then be on the local health board, but it is a cost, albeit a small cost, in the wider scheme of the cost of continuing healthcare.

Very much so, Minister. The costs are calculated in the RIA. You will be able to see that as committee members. In terms of figures, those are being factored in, and, of course, in terms of financial settlements to future arrangements for health, those will continue to be considered. I think, importantly, the contextual frame that I was referencing in response to the previous Member's questions is that our experience in discussions with England has shown us as well that packages of continuing healthcare delivered via direct payments cost roughly between 11 per cent and 16 per cent less than the traditionally delivered packages. So, whilst we clearly are projecting the cost, we're also anticipating that, as we journey forward, there should be efficiencies and financial efficiencies that can be delivered as well, whilst producing better outcomes.

All I can say is none of the modelling has been based on expected savings due to lower wages for PAs and social care workforce. The financial modelling has been based on an average figure of £50,000 per annum for a CHC package, and that was obtained from the national care commissioning unit.

So, as Albert has already said, we do expect to see reductions in costs. We've got 10 years' experience of this in England, where they have seen significant savings by the introduction of these direct payments. But, of course, the way in which we fund the NHS, going forward, will be a matter for the Cabinet Secretary for health, of course, not for me, so I think that is a question that needs to be put to her. But, of course, we would have to look at that in the round in terms of budget setting for the NHS.

Thank you, Heledd, I appreciate that. We'll come on now to our general—[Interruption.] Sorry, yes, Sam, absolutely.

I just wondered, Minister, what your biggest concern is with the Bill?

Not getting it quickly enough, or not seeing the outcomes delivered quickly enough. I have no concerns around the provisions and what we're trying to achieve—I think they are absolutely right. I think some of the practical applications may be a bit slower than we would want. I think that would be my concern. But I very much hope, given the preparation we've done for this, that that won't be the case.

Thanks. Thanks, Chair.

There we are. Thank you. 

I'm just going to ask Members, for the general scrutiny session, to focus on any areas that they particularly want to raise, rather than going through the layout suggested earlier in our meeting today—so, any particular questions that Members want to raise. John Griffiths.

In terms of delayed transfers of care, Minister, which, again, is a long-running issue, the last figures I have here in the committee briefing is that, in April, there were over 1,700 people occupying a hospital bed who were ready for discharge. A couple of years ago, this committee did some work on hospital discharge and found that the lack of social care capacity due to staffing shortages was the biggest contributor to delayed discharges and restricting that patient flow through hospitals, and we recently heard from the ambulance service that this is still very much the case. They highlighted that the problems in social care and delayed discharges are a major cause for ambulance response delays. So, I'm just interested in your view on this, and should it be a higher priority for the Welsh Government to deal with these long-standing matters?

Firstly, I would say that it absolutely is a very high priority for both me and for the Cabinet Secretary for health. This is an area that I mentioned earlier we have joint responsibility for, and we are jointly concerned about it. We do meet regularly to discuss how we can improve in this area. We know that we are nowhere near where we need to be, but the progress we are making around this, I think, is in relation to actually now having data, which enables us to target more effectively, which we hadn't previously had. So, we've now got the pathway of care discharge delays reporting framework—it's always a mouthful, isn't it, the reporting framework—and that data gives us an absolute breakdown of the reason, of every single category of reason, for the delay in the transfer of care. Fifty per cent of the reasons for delayed transfers of care are related to both health and social care assessments.

So, whilst there is a concern around the social care workforce—and I can speak to you a bit more about the social care workforce, if you like, because we are doing an awful lot of work around trying to recruit more people into social care and to deal with the kind of things that you're talking about—the delays in the transfers of care seem to be evenly split between NHS assessment and social care assessment. So, there is a wider systemic thing going on here. At the moment, the Cabinet Secretary and I are having very detailed discussions with officials about how we can more effectively target some of those areas for delay, because we have put in measures to try to address those, including bringing in trusted assessors into the NHS who can deal with assessments of the less complex cases. We found, when those were first introduced into the NHS to do assessments, we saw some significant improvements in the delayed transfer. That seems to have tailed off again. So, what we're now having to look at is whether that means that the high levels of figures that we've got are related to actually more people coming in the front door? So, we actually are starting to tackle some of these delays, but we're actually seeing more people coming in the front door anyway. So, it's becoming more and more difficult to tackle the back door.

But what I can say is it is absolutely front and centre of the concerns that both the Cabinet Secretary and I have, because we absolutely understand—the Cabinet Secretary in particular absolutely understands—that delayed transfers of care have a significant and direct impact on waiting lists. To have 1,700 people occupying medical beds in hospitals—. Just in my own health board area alone, there are 300-odd, which is the capacity of Prince Charles Hospital, for instance.

I guess, no doubt, we will see variation, and considerable variation, between health boards and local authorities.

There'll be variation, yes.

This data that you mentioned, Minister, will it enable you to drive down into those variations and how good practice can be spread?

Yes, that is absolutely what we're hoping to do. And I think also it is about regions working collaboratively to improve community-based care capacity, because one of the things that we have identified as being absolutely critical to this is actually preventing people going into hospital in the first place. I don't need to tell you as a health committee—you must be discussing this all the time—but we see far too many people going into hospital that should never be there, and then they end up occupying beds for weeks and weeks on end because they've deteriorated while they're in hospital, and then we can't get them out, particularly elderly, frail people. So, I think there is a lot around targeting our work into that community prevention aspect as well.

Okay, are there any other questions on transfer of care? I've got a question on the social care workforce, but if other Members want to come in on anything, could they indicate? Sam, yes.

Transfers of care, as you’ve indicated, Minister, are fundamental to dealing with those waiting lists, and also, as you just outlined, those people who are in hospital, sadly, are sometimes getting iller because they are in there. There's a real urgency to deal with the situation. How confident are you that it is being tackled and it's being gripped by you as a Minister and your ministerial team, but also by your officials—a grip on the situation and not just accepting it for what it is?

We absolutely aren't just accepting it for what it is. I can absolutely guarantee you of that. This is a significant priority for me and the Cabinet member. We are looking at different ways of engaging with our partners in the regions. We clearly have to get some consistency across the way in which this is dealt with across health boards and local authorities. We see, too often, different things happening. Twenty-two local authorities—we see different approaches to this in 22 different authorities in 22 different ways. We have to look at this being dealt with on a regional basis so that we have the local authorities and the health boards in particular areas working collaboratively, engaging and doing it the same way in a consistent manner. So, we are absolutely focused on doing this. We are even proposing to take a paper to Cabinet in a couple of weeks' time so that we can project all of this across to our Cabinet colleagues as well, so that they fully understand the issues that we're dealing with and, hopefully, we can get some kind of cross-Government buy-in to the need to address this as a matter of urgency for all the reasons that we've talked about. But, mainly, this is about trying to help tackle some of the waiting lists in some of these areas. 

I'm really sorry, Chair, on that point, it's really, really important—

It is. 

You talk about regional working, and I agree with you, but you've got the regional partnership boards that have been set up for, I don't know, six, seven years now probably. They're clearly not doing the job they're supposed to be doing because, actually, that would be the forum, you would have thought, for social care and health to come together to deal with this, probably being one of the most pressing issues, and it hasn't tackled it. So, are you confident that things like regional partnership boards or the public services boards, whichever governance structure is set up to encourage the closer working of health and social care—are you confident they're actually working, doing the job they're supposed to do?

Let me just say in starting that regional partnership boards are responsible for £145 million of regional integration funding, which is going towards supporting this programme of eliminating the delayed transfers of care. And there are some really good examples right the way across Wales of where projects have been very effective and are meeting that demand. Clearly, that is not rolling out as quickly as it should and as effectively as it should right the way across the country. So, one of the things that we are in the process of doing is actually consulting on how things need to change within the regional partnership boards. The consultation on that has gone out now. When is that closing, the consultation on regional partnership board working?

I don't have the date in my mind, but I will check immediately after committee. 

I'll write to the committee about that because we do have a consultation out on regional partnership boards and strengthening their governance and so on. 

Lovely, thank you. I've got Heledd waiting. I've got a question, then I'll go to Heledd. If there are other Members after that, please indicate. So, my question is around the social care workforce. The real big issue here is about the retention of staff. So, how can you improve the retention of staff beyond pay?

There's been a lot of work going on already. We published a health and social care workforce strategy about three years ago. That was a 10-year plan—I'll ask Taryn to come in and say a bit about that in a moment—and I'm shortly going to be publishing a social workforce delivery plan for 2024-27, which is building on the progress that we've made so far. And it's going to be about how we go forward and build on what we've done. We've got recruitment exercises, we're trying to build in resilience, we're trying to build in retention, training, delivery, career pathways—an awful lot is going on.

But are they working? 

And we are starting to see some improvements but we still have a long way to go. I think we have about 5,000 vacancies still across social care. Sorry, go on. 

We can write to committee to confirm the number, but I believe it's in the region of 3,000 vacancies currently across social care, which equates to roughly 10.9 per cent of the workforce. 

Because this is the real challenge—to resolve the retention of staff. You've got to recruit staff but the staff are leaving. 

It absolutely is, Chair, and one of the—

What's the bullet point to stop staff leaving, do you think? 

One of the things that we know is that pay is not always the overriding determining factor.

No, that's why I said leave pay out, because I appreciate that. 

Yes, so pay is one issue and it's absolutely vitally important. Put that to one side at the moment. There are lots of other things that people want when they are at work. They want to be happy at work. They want to feel safe at work. They want their well-being looked after. They want health and safety. They want career opportunities. They want progression. They want training. They want development. They want all of that. That's what we're building into the social care workforce strategy. That's built into the social care workforce strategy. That's only been in place for a couple of years, and we're seeing that being rolled out and delivered by Social Care Wales. It will take some time to deliver those improvements and see the gains that we want to see, where we're starting to fill some of these 3,000-odd vacancies. But I don't know, Taryn, if you want to say a little bit about some of the work that we've been doing around the strategy.

Just briefly, in bullet points, if you can. 

I think it's probably important just to speak about the structure a little bit with regard to how we intend to support this and about the collaboration with wider partners. So, as the Minister has shared with us, there's the 10-year plan for health and social care workforce, but underneath that there will be a plan published this year for 2024-27 for the social care workforce. 

Now, sitting underneath that plan, we are developing a strategic implementation group that will work across the sector, including trade unions, to look at how we bring that plan alive and how we react to real-time change for our workforce. We do know that there's a number of Government incentives, such as the bursary for social workers, the grow-your-own scheme, which are seeing increases in staffing, but we know that there's significant work to do. There will be significant work around how we ensure that people are aware that social care is a career for life, and how we use the WeCare campaign underneath Social Care Wales to further that work as well.

Okay, thank you. I've got Heledd waiting, nobody else after that, so if any other Members—. We've got time for one more person after Heledd, so, please, just indicate if you want to come in after Heledd. Heledd Fychan.

Yes, absolutely, Heledd. I'm happy to reassure both the committee and the public that improving support for unpaid carers is a priority, and continues to be a priority for Welsh Government. Just this week, I attended the ministerial advisory group for unpaid carers, in person—the first time they've met in person since before the pandemic. And I was pleased to hear that there are several areas of work that are progressing around supporting unpaid carers. Delivering sustainable outcomes for these people, for carers, and listening to what they have to say, is absolutely key, for all the reasons you've just set out in your question.

Now, the ministerial advisory group for unpaid carers, of course, provides a cross-sector response to all those challenges, and they input and inform our policy direction. So, we're listening to what the needs of unpaid carers are, and looking to monitor and improve the four national priorities that are currently on the strategy for unpaid carers. We're continuing to fund the short breaks fund. We're putting a further £3.5 million in this year to regional partnership boards and the Carers Trust, for tailored opportunities for unpaid carers. That scheme will have delivered around about 30,000 short breaks over three years. And, of course, we're continuing to fund Carers Wales and the Carers Trust to deliver carer aware work, and that includes training for social care and healthcare staff on carers' rights. So, there's still a lot of work going on in that area.

We're also working very closely with young carers, through the young carers advisory board, which is hosted by Children in Wales, to ensure that our policies benefit from the input from young carers. And there is a young carer representative on the ministerial advisory group as well, which I was really pleased to see. That's certainly about ensuring that young carers and their challenges are recognised in schools, further education colleges and so on, and that we get the improved take-up of the young carer ID card. So, I suppose, really, what I'm saying in short is, absolutely, that remains a priority for us, that we continue to support this very important group of people, which, as you quite rightly say, if it weren't for them, would be costing the public purse an awful lot more money.

Yes, absolutely, Heledd. I'm more than happy to send you a detailed paper for the committee, for you to have a look at. And I'd be quite happy to come back and have a further conversation with you, specifically about unpaid carers, if you wish to do that. I think we're going into unpaid carers week now, aren't we, this week or next week. So, yes, absolutely, I'm happy to do that.

Joyce, if it's a very quick question.

It is. If you can just send me an update on the work that is coming together to protect young carers. You know, it's multifaceted, so it'd take too many questions and too much time, but if we could have that, please.

I will include that in the response. And if I could just come back to—very briefly, Chair—the point I was making earlier about the regional partnership board consultation, on the governance of the regional partnership board—that consultation went live on 16 April and closes on 9 July.

And I was just going to say the same thing. Thank you. [Laughter.]

So, you tarried and I got in first.

With that, Minister, can I thank you for your willingness to stay on this morning, and your offer and willingness to come back for further general scrutiny?

I'm more than happy to do that, yes.

It's very much appreciated, so diolch yn fawr iawn. Thank you, Minister, and your officials.

Diolch yn fawr.

I move to item 4 and I propose, under Standing Order 17.42, that the committee resolves to exclude the public for items 5 and 8, if Members are content. Yes, Members are content, therefore we'll move into private session.

Welcome back to the Health and Social Care Committee. I move to item 6, and this is an opportunity for the committee to scrutinise the new Minister for Mental Health and Early Years on her priorities in Government. So, I'd like to welcome the Minister, Jayne Bryant, the Minister for Mental Health and Early Years, and also Alex Slade, the director of primary care, mental health and early years. So, welcome, both, to committee this morning. Minister, when are the final mental health and suicide prevention strategies, along with costed delivery plans, expected to be published?

Thank you very much, and bore da. It's a pleasure to join you this morning to have this opportunity in front of the committee. The consultation on both strategies concludes on 11 June, so not long away, and the final publication date will, obviously, need to be informed by the amount of consultation responses that we've received, and we'll need to ensure that these findings are fully considered. Just to let the committee know that, as of 4 June, we have received 73 responses for the draft mental health and well-being strategy, and 29 responses for the suicide and self-harm prevention strategy. Obviously, as we get closer to 11 June, we'll expect a flurry of more responses, so I'd like to take this opportunity to thank people who have already contributed to that consultation, or those consultations, but also I put out this plea for anybody who would like to do that and contribute to do that, because 11 June will be fast approaching.

We're currently working on the basis that the summary of consultation will be published in October. It's at that point we'll confirm timings for publication. At present, we envisage that the final strategies, accompanied by those initial delivery plans, will be published at the end of the calendar year.

Okay, that's a clear answer; thank you, Minister. In terms of working up—. I appreciate what you've said, but, in terms of working up the strategies, I wonder how the Government and you have worked with the mental health sector to develop the strategies.

Thank you. Since I've come into post, in the short space of time, one of the first things I did was read both of those strategies, and I was very impressed, personally, with how they were set out and written. I'd like to pay tribute to the former Minister in this area, Lynne Neagle, for her work on these draft strategies. They've been developed over the last 18 months or so, and I do think we've got a really good story to tell in terms of co-production and engagement with people, particularly with lived experience. We have engaged and we continue to engage with those with lived experience through our mental health service user and carer forums, and all health boards have local partnership arrangements that include service users. We've also worked with the national youth stakeholder group and the Welsh Youth Parliament as well. Last summer, we carried out a pre-engagement exercise to hear the views of a wide range of stakeholders and the public before putting together those draft strategies. I think that they've been written in a very sensitive, realistic way, and will resonate with people with lived experience, and I really hope—and I have heard from people with lived experience—that they can hear their voices through those strategies, which I think is really, really important. 

The pre-engagement exercise resulted in over 260 responses, and that's helped to shape the documents that have been consulted on. Again, I'd like to take the opportunity to thank those people with lived experience for sharing what are very personal to them experiences. I'd like to thank them for doing that, and thank people who, hopefully, will continue to contribute, but their voices are so important in this. 

I really appreciate that answer, because I strongly agree with that point. I think you can, of course, talk to the sector, but talking to people with lived experiences I think is key in developing the strategies. So, thank you for that, Minister. Sam Rowlands. 

Thanks, Chair, and, Minister, thank you for your time this morning—and your official as well. The draft mental health strategy takes an all-age approach, but there are, clearly, some inequalities within certain age groups that we're aware of, and one of the particular age groups is older people, where there perhaps is, at times, less openness around some mental health issues. I just wondered how you'll be delivering, whilst taking an all-age approach, for some of those specific age groups, and some of those particular needs in the age groups, within the strategy. 

Thank you, Sam. And it is important, and I know that, with these strategies, we have taken an all-age approach, to ensure that we have a better system that will support everyone, to promote a better integration between services. That is the aim. It does draw out where we do need specific focus on—you mentioned older people, but, as well, younger people. But what is crucial is that our services need to be person led and person centred, rather than being age led. 

As we've developed the strategies, we've considered the impact on different age groups, as we've just mentioned, the Welsh language, people with protected characteristics, people living in poverty, black and minority ethnic people. So, it is something that we are very much aware of, and we are working to ensure that this does work for them. 

As part of the consultation, we've published draft impact assessments, and we also asked in our consultation whether people are clear about how it does deliver for all age groups and all of the groups that I've mentioned. So, we're able to use those consultations to gather further impact in those areas. 

We've got a joint ministerial assurance board, which has been established to ensure robust governance arrangements are in place to provide that strategic oversight of both strategies. I'm going to be chairing that board, alongside my colleague, the Minister for Social Care. I believe the next meeting—. I haven't been to one of those meetings yet, but the next meeting will be, I believe, in the middle to the end of July. So, I will be chairing that one. So, I look forward to progress in that area as well. 

Thanks, Minister. And just on particular age groups, in my inbox, often, access to CAMHS services for children and adolescents seems to be particularly poor. Do you have any concerns at the moment around some of the child and adolescent mental health services that are available in Wales?

I think there's been some real progress in terms of CAMHS, and I do appreciate that we still have people who are coming to CAMHS services, and we have to remember that, people who have mental health issues, not everybody has a certain level of need and for a certain level of mental support—so, CAMHS is a particularly acute service. And we have to do all we can to have that early intervention and prevention where we can. And I think the objectives that we have at the moment—. That 'no wrong door' approach is so important, that we hear and we try and do as much as we can early on. 

Yes, and—

But I do take that very seriously, about CAMHS, and that's something I am looking at as well.

I appreciate that, and you're absolutely right in terms of that prevention in the first place. Now, you'll be aware that the committee here produced a report in 2022, I believe it was, around mental health inequalities, and one of the recommendations in there was to understand the levers available to Welsh Government, against levers available to UK Government, in tackling some of the social determinants of mental health. I just wonder what your assessment is of your ability to influence—whether it's tackling poverty or some other social determinants that impact people's mental health, how much you're able to influence that as Welsh Government versus the things that are in the control of the UK Government, and how, perhaps, in your early days into this role, you've been able to engage with the UK Government to tackle some of those issues.

Yes. Thank you, Sam. I appreciate that question. It's really important. I think, while tackling poverty and many other of the social determinants, as you mentioned, for mental health, are not in my portfolio, I really do see my portfolio through that lens as well, where we can actually have the most impact. One of those areas, particularly, is around early years and what we can do in that area. I'm keen to look at that, how we can tackle poverty in terms of we've got things like—. You know, how we do that through childcare and Flying Start. But I think the implementation of the mental health strategy will require joined-up action, and the Cabinet have agreed to support the delivery of those strategies, and my officials have been working closely with other departments during the development of the document. I'd say that officials do work really closely together, and I'm really keen as a Minister to work across Government as well. So, I am really keen that I have that level of contact with Ministers and Cabinet Secretaries, because, whilst the officials work well together, it's really important that I work with other colleagues, and I know that the other Cabinet Secretaries and Ministers are keen to do so as well. You mentioned the child poverty strategy, for example, so I'm looking to work closely with the Cabinet Secretary in that sphere, and just across all portfolios.

Yes. Is that able to be expanded beyond Welsh Government ministerial roles and things, so looking at UK Government? Obviously, it's in a certain place at the moment, waiting for a general election on 4 July, but would you be looking to see how you could work with colleagues at UK Government level to influence those issues that are impacting people's mental health in Wales?

Yes, absolutely. I'm very keen to do that, and I had looked to work with colleagues already before the general election was called, and I will certainly be doing that after that, with whichever Government is formed, because it is so important that we work together.

Yes. Thank you. Just finally, from me, Chair, if I may, just around some of the data available to you—this is, I guess, a theme of most committees when it comes to all sorts of issues—and understanding how satisfied you are with the level of data that is available to you. There has been talk of the patchy governance, unclear accountability and a delay to the launch of the mental health core data set. I'm just wondering what your assessment is of that at the moment, and when you expect to get a better set of data to help you in your role to see the mental health of people in Wales improve.

Thank you, Sam. Yes, in my short time in this role, it has really become clear to me, the importance of improving digital and the data set in mental health, and it has really become clear that has to be a top priority, because that really underpins the services that will see improvements. So, I can assure the committee that this, for me, is a priority and one that I do expect to see real progress on. To be clear, we have developed that core data set for mental health, and Digital Health and Care Wales have recently impact tested this with health boards. This means assessing what elements of the core data set each health board can record and report on. As you mentioned, Sam, the issue we have is the variation in the systems used by the health boards and their ability to collect and report on that data set. Reducing the variation is key, and officials, the national director for mental health and DHCW are working closely to improve this position. I will be keeping a very close eye on this as well, and I'm sure that this will come up within meetings with vice-chairs as well, that I have, across health boards.

Thank you. Mark Drakeford.

Thank you, Chair. Minister, I was very encouraged, reading your report, by the level of detail that you've provided about your ambitions in learning disability services, because here is a group in society who can't always mobilise voices to speak up for them and where a Minister taking an active interest in the provision of services really does make a difference. I could spend a long time talking with you about learning disability services. I'm going to ask you four quick questions, and then you can pick out of that what you are able to respond to.

First of all, you will know that there are concerns in the learning disability community about learning disability services being co-located ministerially with mental health services. What more can you do to reassure people that, in Wales, we take a social model of learning disability, not an overmedicalised model?

Secondly, I was encouraged to read in your report where you say that

'We want to...reduce the number of people being cared for in a hospital setting...reduce length of stay...reduce overmedication and restrictive practice.'

In the 1980s, under Conservative Secretaries of State, to be ecumenical here, Wales led the way in the United Kingdom in closing long-stay hospitals for people with learning disabilities and finding ways to resettle people in the community. What's the scale of the challenge we face today, and what do you think we can do about it?

My third question is about transition, because here is something that really does frustrate people who come to my surgery and I'm sure yours too, because here is something that is utterly predictable. This is a group of people in the population where we know, from early on, the nature of the difficulties they face, and we know when they will be 18, and yet the system far too often appears to be taken by surprise by the fact that people are going to need a different form of help from adult services when children's services are no longer available to them. So, what can we do to make the system just react in a more effective way to this utterly predictable point in people's lives? 

And then finally, reflecting on an earlier part of the committee's considerations today, I remember being absolutely shocked by the number of children in care in Wales where the record records the reason for them being taken into care as 'parents have a learning disability'. The idea that it's just enough to say that because you've got a learning disability you can't be a parent seems to me to be absolutely unacceptable, and I wonder whether you are able to work with Dawn Bowden in the Welsh Government's efforts to reduce the number of children in public care in Wales by doing more to allow parents with learning disabilities to continue to look after their own children with the help and support that would be necessary.

Diolch, Mark. Thank you very much for those questions and for your kind words at the start. I really do appreciate it in terms of people with learning disabilities. I think it's a real privilege and a pleasure to actually be a Minister responsible for learning disabilities. I'm really glad that it is in my portfolio. I've had an opportunity to meet a number of people relating to learning disabilities who are doing some incredible work, whether that is the learning disability ministerial advisory group, who I met with earlier this month, the learning disability third sector consortium, which includes All Wales People First, the All Wales Forum of Parents and Carers of People with Learning Disabilities, the Down's Syndrome Association, Learning Disability Wales, Mencap Cymru, Cymorth Cymru. I have met with the Stolen Lives campaign as well, and I'd like to put on record again that we share the ambition of the Stolen Lives campaign that home is not a hospital bed. So, I feel real privilege having learning disability in my portfolio. 

As you mentioned, people have raised with me the title and people have been concerned that it sits now within my portfolio. They've been very clear that it's not me personally, which has been very nice, but I've just been really keen to put on record that I really do see this as a priority, and that I do not see that, just because it's Minister for Mental Health and Early Years, learning disability is a mental health issue. It isn't about mental health; it's the fact that a number of things sit under my portfolio that aren't in the title. So, I have been clear that it is a distinct portfolio responsibility and is not going to conflict with mental health. I've asked, and we will be reviewing the ministerial titles with the First Minister to look at the need for any change to provide any further reassurance, but I can assure the committee and others that I have really tried to go out of my way to make that clear—that I do not see it as a mental health issue.

I'm really keen that we work together. I am working closely with the Minister for Social Care, and officials already do. I think it's just important that there are no gaps. I've been trying to think where can I bring the Minister for Social Care in as well or where can I fit in to make sure that learning disability is something that comes across both of our portfolios and is thought about in both areas that we have responsibility for. So, I can assure the committee that we'll do that, as well as officials having great relationships in terms of those portfolios already.

You mentioned, Mark, Wales leading the way in the 1980s and the things that we've done. As I said, home is not a hospital bed—we have to do all that we can to reduce restrictive practices, and we launched the reducing restrictive practices strategy in 2022. This is currently being implemented across all sectors. There is specific activity associated with this area included within the learning disability specialised adult in-patients work stream, which is being taken forward under the direction of the learning disability national implementation and assurance group. I have had to get used to all these acronyms since coming into post. There are lots of different groups all doing lots of good things. But that consists of the Welsh Government, health boards, local authorities and private sector health and care providers. I'm waiting on a report from them on how they're progressing on delivering the national actions arising from the implementation of the 2020 'Improving Care, Improving Lives' review of adult learning disability in-patient provision, and this report will be published when available.

I think in terms of transition, absolutely, as you say, it's utterly predictable. We know when people turn 18, it still baffles me somehow that it is a surprise to everybody, and that's in this area and in many others. We need to have a real focus on this and look at what we can do and make sure that, actually, it's all about the person—it's going back to that person-centred approach. Because it doesn't matter what service it is, it's about them at the end of the day and we need to really focus on that.

I have also written something down, which I have to look at my writing for, which is care-experienced young people and care-experienced parents. In another time, before this position that I have now, I was in the privileged position of chairing the Children, Young People and Education Committee. We embarked on a report on care-experienced young people, and hearing from those young people and what they said will stay with me for the rest of my life. It's incredibly powerful hearing young people. And as you mentioned, there are instances where people who have a learning disability have their children taken into care. We have to do everything that we can to support parents and to support new parents, to support people who have learning disabilities on parenting and to support them to keep their children at home with them, if at all possible. I'm keen that we do everything that we can in that area. I can assure you that I will work very closely with the Minister for Social Care on this, because it is, I know, a priority for this Government, as it has been for the previous Government.

And I'd just like, again, to put on record my thanks for all the work that you have done, Mark, in this area, and to the previous Minister, Julie Morgan, for her work on children in care.

Thank you, Minister. John Griffiths.

Diolch, Gadeirydd. Bore da, Weinidog. I wanted to ask you about the real-time suicide surveillance system introduced in 2022—how important, how significant, how useful that is in providing this real-time intelligence on patterns around suicide, and what those patterns are in terms of Wales and the national and regional picture. What key concerns does that system flag up for the Welsh Government, Minister? Could you point committee to how that information is used to shape policy and policy delivery?

Thank you, John. It is really important and I think it's really good progress that we’ve got this real-time suicide surveillance data. It published its first annual report on 11 January. I don’t know if the committee has seen that report, but we can make sure that’s shared with you. So, if that’s helpful, we can do that. The real-time suicide surveillance was developed because there was a delay between unexpected deaths being recorded as suicide following an inquest. It provides us with information on suspected suicide without delay, enabling services to respond sooner. It's a robust and unique mechanism, I think, and it’s been a real positive. It means that we can target support for those most at risk.

The information already has informed groups where we’ll target support, and that’s in our draft strategy. This will help inform local partners to inform local response. We’ve now got that robust infrastructure in Wales to implement our new suicide and self-harm prevention strategy to reduce those suicide rates in Wales. That includes our surveillance, our national and regional suicide and self-harm co-ordinators and the suicide and self-harm prevention programme in the NHS Wales Executive. Again, we’ve got our draft strategy out for consultation at the moment, and again, I’d take the opportunity to encourage people to submit their response to that consultation by 11 June.

Diolch yn fawr, Weinidog. In terms of key concerns and patterns, what has it actually shown, that surveillance system?

We can share with you the annual report. We use that alongside the publication of the Office for National Statistics data. Overall, rates are broadly in line with pre-COVID rates in 2018. For example, over the last 10 years, there was an average of 330 registered deaths by suicide in Wales. I think it’s really showing us things like, for example, as the annual report will show, there were 356 deaths by suspected suicide between April 2022 and 31 March 2023, and it shows about men aged 35 to 44 where there is the highest rate, but there are links with other factors too, for example individuals in the criminal justice system and those who were unemployed.

Do you think we can be confident in the figures as to whether deaths by suicide are recorded as deaths by suicide? Because there are always issues around that, aren’t there, for various reasons. How confident can we be?

I think this surveillance data is a real game changer, again, with the data from the ONS. I don’t know if, Alex, you want to come in on that.

I think the point that it aligns with the official statistics from the ONS gives us an assurance in terms of the wider data picture. The real value here is the real-time responsiveness, so that partners can respond to those issues when they arise and look to address those. Of course, data is key to this in terms of identifying the wider links, so there are both micro and macro benefits around the surveillance system, looking at those aspects around—as the Minister said—age, gender, as well as employment, people who are known to the police, some of those risk profiles, such that we can respond to those, both with the strategy and the delivery plans that will sit beneath that.

Okay.

Sam, you want to come in.

Yes, thank you, Chair. Just on the back of John Griffiths's points there, and you mentioned it, Minister, as part of your response, suicide is the biggest killer of men under the age of 50 in the UK, and it's the biggest killer of people of both genders under the age of 35. I'm just wondering: are there any specific things you think we should be doing more of, or areas of focus that we should be considering, to not see that number at the level that it is? In particular, with it being the biggest killer of men under the age of 50, is there something we should be doing, or you as a Government would want to be doing, to see that number not be that high?

Yes, absolutely. I just want to say 'thank you', Sam, and every death by suicide is a tragedy and we must be doing everything we can to prevent that. I think that's why the strategy's really, really important. Again, in a previous role, I was chair of the cross-party group on suicide prevention here in the Senedd, and I think there's a lot of positive work that has been done over the last few years, but we must really focus on doing everything we can to prevent death by suicide. Part of that is around, again, the 'no wrong door' approach and how we can try to make sure of early intervention with people, and that people know that support is available. I think that is crucial. We've got some helplines that have really been key in trying to make sure that people are aware that help is available and support is available, and it's just about ensuring that we can get people who need help to seek help when they need it. The earlier we can get people to do that, obviously, the better.

Can I just, in terms of this point, have one moment further, Chair? It's really important as well, and it's a really sensitive issue, but are we seeing any indication of a role of social media with suicide, particularly with younger people? And if so, is there anything we could or should be doing as parliamentarians, or yourself as Government, to understand that further and perhaps consider what action may be appropriate to intervene where necessary? So, I don't know whether the dataset you discussed is able to pull out some of the role social media may or may not play. If there is not an answer to that question—. I really appreciate I'm springing that on you today, but it's just something that's going through my mind.

Thank you, Sam. I think, you know, it's—. It is an issue. I don't know if Alex, perhaps, has some specifics on the data around social media. I think the way we discuss suicide and talk about suicide is really important, and that's how it's reported, whether that's in the press, whether it's talked about after somebody's taken their own life. I think there are sensitivities around that, and we've done a lot to reduce some ideas of stigma there. But, in terms of social media, that becomes a lot harder, how people talk about things. So, I don't know if Alex would like to say anything specifically on social media.

Yes, thank you, Minister. So, it definitely has an impact, both positive and negative, actually, given the accessibility and availability of social media, not just in very high-risk areas, but, equally, in mental health and well-being, self-care et cetera. Equally, we should look at that in terms of how we use that as an opportunity, as a platform for raising awareness, promotion of opportunities, the helplines, as the Minister described, '111 press 2' as an avenue for urgent crisis care and support. So, there is a role that social media can help us with with this agenda, and wider partners; it's not just a role for a single entity. But, given that access, we need to evolve and adapt to the landscape in which social media now plays a role.

Yes.

Very, very quickly, if I could, Chair, is it the case—? I've heard it said that, in general, there's a societal view sometimes that talking about suicide is a risk factor, that it might make suicide more likely in general terms. I suppose it's about putting ideas in people's heads and so on, but, in actual fact, the reverse is true, that being more public and open, and talking about the issues, is actually helpful in preventing suicide. Is that the Welsh Government's general view?

Yes, absolutely. I think it's really important how we discuss suicide, and I think that is all ages, really, and if we're able to do that in a sensitive way—. And I think, again, it's how things are reported and if we don't talk about it in that way, with the support available—. I think, in the past, that's certainly something we haven't done, and that has been to a real detriment, I think.

Okay. We'd better move on to the next section. Heledd Fychan.

Diolch, Heledd. Prevention and early intervention is a priority for me to ensure that specialist services better meet the needs of people with severe and enduring mental health illnesses. Our draft strategy sets out our commitment to ensure access to quality, evidence-based mental health services that are outcome and recovery focused. Our early engagement on that strategy told us that we need clear actions that would support those with severe and enduring mental illnesses, as they currently experience much worse health outcomes. One such action will be developing our mental health quality statements. They'll be based on the health and care quality standards and will be setting out the vision for specific clinical services and pathways. They'll be underpinned by more detailed service specifications, describing the outcomes and benefits of the support offered. We'll also be focusing on supporting the physical health of people with severe and enduring mental health conditions, which is really important. So, we have a number of things that we're putting in place, but it is crucial, that prevention and early intervention, and the priority has to be ensuring that specialist services better meet the needs of people with those severe and enduring mental illnesses.

So, you accept that, currently, in terms of that, that there are some failings. There have been a number of instances, I think, that have led to very tragic instances of people with severe mental health issues perhaps injuring themselves, injuring others, perhaps resulting in the killing of some individuals, which have been reported widely in the press, and many families talking about their desperation in trying to get support for their family member who was then responsible for that action and failing to do so, or medication not being available and no follow-up appointments. So, how are we going to ensure that there's consistency in terms of support for people?

Absolutely. The points and cases that you refer to, Heledd, are incredibly tragic, and I feel that that's something that we have to acknowledge, and it's in terms of how we learn from those cases. Some of those points are around ensuring that learning is done at every level, really. I will be meeting with vice-chairs of health boards, and we've got the NHS Wales Executive, as well, which will be driving some changes as well. But I will be ensuring that, meeting with those local health boards and the vice-chairs, I can monitor where progress is, because it's important to learn. I don't know if Alex wants to come in.

Yes. Thank you, Minister. On the reference to the NHS executive, we've recently established a mental health patient safety programme as part of the strategic programme for mental health, with a focus around, exactly as you describe, managing that risk of discharge, ensuring quality and consistency. And whilst that programme is in the early days of establishment, the engagement is taking place with health boards in that supportive role to ensure that we minimise the risk of those issues happening and the focus on patient safety is consistent across Wales.

Thank you.

Diolch, Heledd. The committee aims to simplify and streamline those previous arrangements by creating one central point of NHS commissioning expertise in Wales. This will also strengthen arrangements for mental health. Officials have had a strong working relationship with both the Welsh Health Specialised Services Committee and the national collaborative commissioning unit previously. The draft mental health and well-being strategy will be developed alongside them, and WHSSC has undertaken to develop specialist mental health services in the strategy. NCCU have also historically been involved with commissioning a number of mental health services and undertaking national reviews. I'm keen that, in all our mental health work, we consider the full mental health pathway and early intervention through the in-patient support. So, it'll be important for the JCC and the strategic programme to work closely together. I do know that's already happening. The JCC are represented on the strategic programme board. I know that officials will continue to work together to ensure these strands of work are brought together effectively. I don't know, Alex, if there was anything on that in terms of an official—.

Yes. Thank you. So, this is the bringing together of a number of functions, as the Minister described. It's not a reduction in terms of the capacity there. If anything, the focus around commissioning in the mental health space has strengthened during that time. Obviously, a number of the components of the now joint commissioning committee have undertaken specific pieces of work in the mental health space across Wales to support health boards and in the national environment in those roles. So, if anything, this gives us a stronger centralised function around how we approach our commissioning, as the Minister describes.

And just to say, the JCC will report on progress of their work through the joint ministerial assurance board, which I'll chair. I haven't had that opportunity yet, but I look forward to doing that.

Diolch, Heledd. Absolutely, our mental health workforce is crucial. They do an incredible job under a huge amount of pressure. I met with Health Education and Improvement Wales and Social Care Wales on 22 May for an update on the implementation of the strategic mental health workforce plan. A report on the first year of the implementation has been published on HEIW's website. There has been a lot of progress and activity to implement the plan. It's an area that I have already raised routinely in my meetings, but I will do that when I meet all the vice-chairs again to ensure that the strategic workforce continues to align with the needs of the health boards. I think that's a really important point.

I think the other important point is around the implementation, which is really key, of that workforce plan. The workforce plan is supported by that implementation plan. It has been developed for 33 actions, and HEIW and Social Care Wales have convened the implementation group that meets on a monthly basis to oversee and drive delivery in this area. So, there is a lot of work going on. I am really aware of keeping a very close eye on this, and I will continue to do so on that, because the workforce is really, really important, obviously.

Thank you, Minister. Joyce Watson.

I'm going to move on now—good afternoon, I think it is now, Minister—to substance misuse, addiction and gambling. There are widespread reports about the rate of drug-poisoning deaths, which are continuing to increase, particularly when it comes to cocaine use, according to the ONS data on drug poisoning for England and Wales. But, at the same time, the substance misuse delivery plan in Wales is for 2019-2022, and we're in years beyond that now. So, what work is being done to tackle that substance misuse and to try and bring down some of those statistics, which are actually people dying?

Absolutely, yes. Thank you, Joyce. With tackling substance misuse in that area, our approach is rooted in harm reduction, which I think is really important. Addiction is a health and care issue, as opposed to one that is in the criminal justice system, and I want to ensure that people in Wales are aware of the dangers and the impact of substance misuse. Just to say that current areas of focus are on the ongoing distribution of naloxone, and since 1 July 2009, over 41,000 kits have been distributed in Wales. We've seen a real increase, and the world has seen this increase, in synthetic opioids, such as nitazenes, and all areas are being encouraged to provide more naloxone to individuals, including providing more than one kit. And I know that additional kits are being purchased by area planning boards to ensure an adequate supply.

Just to say that the Welsh Government has also supported the national implementation of injectable buvidal. This significantly reduces the need for service users to attend community pharmacies and clinics. Over 1,700 service users across Wales are now benefiting from this treatment, and there's significant anecdotal evidence that many are experiencing significantly improved outcomes.

The current substance misuse delivery plan was revised in 2021 to take account of COVID. Area planning boards and other stakeholders are currently working to this plan, and consideration will be given to substance misuse priorities, which we'll take with stakeholders at the appropriate time. 

I'd also just like to perhaps highlight the work of the Welsh Emerging Drugs and Identification of Novel Substances. The WEDINOS programme is a part of harm-reduction agenda in Wales, and I think it's been groundbreaking. It provides real-time data and harm-reduction information about new and emerging substances circulating around Wales, reducing the harm to individuals. WEDINOS works closely with all the drug and alcohol agencies in Wales, alerting them and providing information around current drug trends. As I mentioned, one of those at the moment is those synthetic opioids, and particularly nitazenes. Agencies then cascade this information to service users in numerous ways, including face to face, bulletins and the use of social media. So, I just want to highlight the work that we have been doing in this area, and particularly WEDINOS.

I thank you for that, but, of course, one of the areas, according to the chief medical officer and Public Health Wales, is a need to reduce the harm from gambling. So, what scope do you think there is for Wales to develop a system-wide approach?

Thank you, Joyce. I fully agree that we need a comprehensive system-wide approach to tackling gambling. We asked Public Health Wales to undertake a health needs assessment in order for us to understand the needs of people in Wales experiencing harms from gambling, and to inform our ongoing preventative and early intervention and public health approach. Whilst there's no specialist NHS services for gambling in Wales, several third sector organisations work throughout Wales to provide help, support and advocacy for services for those affected and with families affected. However, this is an area I'd like to strengthen, and my officials have been working with Public Health Wales on those services' development work. I don't know if there's anything else, but we can keep you updated on that.

Gambling regulation is a reserved area. Prior to the Prime Minister's calling of the election and the dissolution of Parliament, we were working closely with the UK and Scottish Governments on plans to reform gambling legislation, including the development of a statutory levy on the gambling industry, which I think would be a step forward. I'm disappointed that this work has been paused, but I'm sure I will ensure that this issue is raised with the next UK Government at an early opportunity as well. I'm fully supportive of comprehensive reform to the industry. As I said, I consider the levy a real step forward.

I think, Chair, we haven't got time to explore this in depth today. It's something that we might think of coming back to. There are many factors that influence gambling as seemingly harmless, and one of them at the moment—and I'm a huge football fan, as you know, as you are yourself, Jayne—is every time you watch a football game, you're more or less being told you can gamble harmlessly on whatever it is that's coming next, whichever goal, whoever scores it, whatever it is. And the reason I bring that up is that it has the potential to influence very young people who are viewing football games, and I will focus on football particularly, because I think that's where I see it the most. So, I don't expect an answer now, and I know that we have no jurisdiction over it, but what I would like is an assurance that, whoever forms the next Government, you speak to whoever it is in charge to try and get some concerted, co-ordinated action in this space. Because football is on in the afternoon, for example. So, I'm just saying.

Thank you, Joyce. I’ll just say on that, yes, absolutely—you've highlighted football as an example, and it seems that you can bet on so many things within that now, and you can do that from your phone. I can assure you that I will work with whichever Government comes in at UK level, and also across the rest of the UK in terms of Scotland. I'll be advocating for more action in terms of gambling advertising, which I think we just do see so much of, but especially that online advertising to improve consumer protection and minimise that gambling-related harm. I've heard in my own casework in the past of people who have been severely harmed through gambling, and they've lost everything that they had, and the shame that they felt through that, and it affected their family. So, I've seen that through my own casework, as we have with many other people, sadly.

The chief medical officer has highlighted this as a particularly important area, particularly for children and young people, and vulnerable people. So, we've seen this area being normalised for quite a long time now, and it has really changed, and I think it's something we really do have to tackle. The previous UK Government did say they were working on this, so I'd hope there was cross-party support on work in this area. I think we're working closely with our own stakeholders here, and we have a stakeholder advisory group to support those policy changes in Wales.

Okay, thank you, Minister. John Griffiths.

Diolch, Cadeirydd. The mental health inequalities report of this committee, Minister, emphasised the importance of attachment and good parent-child relationships. So, I wonder if you could tell committee what is your vision of policies for further development of support for those parent-infant relationships?

Thank you, John. Absolutely—again, this is an area that I would really like to focus on in this portfolio. As I mentioned earlier, early years really is the key to so much, isn't it? And I think the attachment, parent-child attachment, is something that we really need to look at as well, and to do more work in this area. I've previously—. It feels like—. I was trying to add up how many years ago it was now, but it's probably about five or six now. I did the Gwent attachment training here. I learnt an awful lot. It's a really, really good system. I'm keen to do a refresh in that, and perhaps that's something the committee would like to look at as well. It is really good training, and I'll do some refresh in that. 

The first 1,000 days, the First Minister has said how important that is, and I just think we really need to focus. We had a question earlier around young people who are going into care, and developing that attachment and supporting people is good for both the parent and the baby. Keeping families together and supporting them is crucial, really, isn't it, as much as we can do that.

Yes, absolutely. I think the early years are very, very important, and there seems to be more and more evidence day by day, really, of the importance of those early years. I think it's probably fair to say, Minister, isn't it, that Flying Start has been evaluated in terms of clearly demonstrating its value, and it is a good programme. I know that evidence to the Equality and Social Justice Committee raised concerns that the planned expansion of the childcare element of Flying Start might risk overshadowing other elements such as the health visitors and the speech and language therapists, which I think have been absolutely key to the success of the programme. So, I just wonder are you able to offer any assurances that those issues have been considered by Welsh Government, and that you're confident that we won't see an overshadowing of and overlooking of those vital health visitor and speech and language therapists' services?

Thank you, John. First of all, just following on from the point around early years, I just want to say again, this is something that I'd really like to see what opportunities are around in this area. So, it's still early for me in this post, but this is where I really want to see what will make the greatest difference. So, I'm keen to learn that, really, and have the greatest impact in those early years.

In terms of Flying Start, absolutely, that's a flagship Welsh Government priority. My first visit was visiting a Flying Start provision in the Vale of Glamorgan, in Barry. It was really, really good to be able to meet with parents, carers, staff and young people themselves to see what difference that has made to them. I got led very quickly by one child to talk to her mum about how much she was enjoying being there, and I think it really, really was heartening. 

But talking to some of the parents, what was interesting was around those early years and the fact that one parent told me that it was speaking with the midwife before she actually had her baby, and then learning about what support was available and one of those, then, was Flying Start. There were a number of services that were also provided in that area, not just the Flying Start and the childcare parts, but you had health visitors, community midwives being there.

I think there's an important point around the expansion. We know that high-quality, accessible childcare is transformational for children. It brings out opportunities for parents, particularly mothers, and it really is one of the key levers that we have in our efforts to tackle child poverty and inequalities. The phased approach to the roll-out means that local authorities are clear which elements need to be provided in each of the phases. Following phase 1, local authorities now aim to deliver Flying Start to 38,500 two-year-olds, and all practitioners in Flying Start are required to meet the core-level speech and language communication training on the pathway. 

Perhaps it would be helpful to provide a note on Flying Start childcare settings about how the programmes operate, because I think sometimes there's a little bit of confusion there. So, maybe if we provided a note to the committee—

We'd be grateful for that. 

—that could help.

Thank you, Minister. Thank you. Minister, thank you for your—

Could I—?

Oh, sorry; yes, of course.

[Inaudible.] Thanks again, Minister, for your time. It was a question from Mark Drakeford, actually, which triggered a memory from yesterday. I chaired the cross-party group yesterday on outdoor activities. That's from across the outdoor activities sector, obviously with Members of the Senedd as well. They were keen in the meeting yesterday to talk about the opportunities that the outdoors generally has to play, both in terms of prevention around mental health issues, but also where there's social prescribing, as Mark Drakeford commented on earlier—so, where there are opportunities at clinical intervention of making the use of the outdoors and outdoor activity space. Perhaps just a short response, Minister, just to confirm that that's an area that you're fully aware of and that you're keen to engage with, as and when those opportunities arise.

Yes. Thank you, Sam. I know how passionate you are, working in this area and the work that you've done on that. This is an area where social prescribing really does help and does work, and I'm very happy, perhaps, to join a cross-party group to hear as well—so, keen to engage with the cross-party group on that.

Thanks, Chair.

Thank you, Sam, and thank you, Minister, and Alex Slade as well, for coming in to committee this morning. Diolch yn fawr iawn. We really appreciate your time this morning.

Diolch yn fawr. And thank you for your work.

I move to item 7. There are several papers to note. There's a letter from the former Chair of the Legislation, Justice and Constitution Committee to the Chair of the Welsh Affairs Committee regarding Parc prison. There's a response from the Cabinet Secretary for Health and Social Care to the former Chair of LJC committee regarding the legislative consent memorandum on the Tobacco and Vapes Bill. There's a letter to the First Minister from the Welsh Royal Colleges Child Health Collaborative regarding improving child health. And there's also a letter from the Business Committee regarding committee remits, which I know we discussed earlier today. And finally, there's some supplementary information from the ambulance service, following our evidence session last month. Are Members happy to note the papers? John Griffiths.

Could I just mention something, Chair, in terms of the Parc prison issue? Because I think we're all aware that there are extensive, long-standing and very alarming concerns around the prison system in general. But, obviously, we do have health responsibility—the Welsh Government has health responsibility, and this committee also—which includes prisons and the prison estate in Wales. So, I wonder if we might give some thought as a committee to how we might play our part in addressing what's a very concerning situation at Parc prison, particularly, and how the health provision there might help address the problems that have come to the fore in such an alarming way.

Thank you, John. It's something that—. I consider it myself also—. Of course, a large part is not devolved, but the aspect of health is devolved, so I think there is potential scope for us as a committee to do some work in this area. So, I think I'm more than happy to agree, if other Members are happy, that we have a paper brought forward to us to see how we can address that and look at this as a committee.

Right, in that case, that brings the public part of our meeting to an end today, and we'll now move into private session.