National Assembly for Wales

Welcome, all, to this Plenary session. Before we begin, I want to set out a few points. A Plenary meeting held by video-conference, in accordance with the Standing Orders of the Welsh Parliament, constitutes Senedd proceedings for the purposes of the Government of Wales Act 2006. Some of the provisions of Standing Order 34 will apply for today's Plenary meeting, and those are set out on your agenda. And I would remind Members that Standing Orders relating to order in Plenary meetings apply to this meeting.

I also wish to inform the Senedd that, in accordance with Standing Order 26.75, the Local Government and Elections (Wales) Act 2021 was given Royal Assent today.

The first item on our agenda this afternoon is questions to the Minister for Health and Social Services, and the first question is from Jayne Bryant.

Thank you. On 11 January, I published our national vaccination plan, with key milestones and priorities for delivery. The plan reflects months of detailed NHS planning, together with support from colleagues in the military and local government. Within Gwent, 72 out of 74 GP practices are supporting the delivery of the vaccination programme, and five mass vaccination centres are also operational.

Thank you for that answer, Minister. It's really encouraging to hear that the roll-out rate is increasing at pace in the Aneurin Bevan University Health Board area. I know from anecdotal evidence and constituents getting in touch with me that this is indeed the case in Newport. What has been concerning my constituents is the communications and the suggestion that the Welsh Government's not going as quickly as possible. Many of those who are elderly and vulnerable in these first priority groups have been shielding for 10 months, and some have been outside only a handful of times. They and their families are desperate to know that they have not been forgotten and want to hear that the Government will leave no stone unturned to get this vaccine to them. Minister, please can you assure me and my constituents about the speed of the roll-out of the vaccine in Wales, and specifically in Newport, that the focus and priority is on delivering this vaccine as quickly and as safely as possible, and that those over 80 who haven't heard just yet will do so very, very soon?

I can assure you we are going as fast as possible. In particular, over this week, we've released 60,000 Pfizer vaccines into the system to help in mass vaccination centres. We also have a significant increase in our supply from the UK procurement programme of the AstraZeneca vaccine, so we'll be able to go much faster—again, both the care home residents and the over-80s. That's why those 72 general practices across the Gwent area are so important to us in reaching those first two category groups. So, I expect that, every week, we'll be publishing now—as I've committed to—more information, showing where we are with those priority groups and the successful roll-out. And I've also indicated that I think that health boards across Wales will be starting to issue invites to the over-70s over the next week, because I am confident that we will have vaccinated a high number of over-80s by the end of this week as well. So, Powys are already doing so, and I don't think Aneurin Bevan will be far behind. Again, I just want to say 'thank you' to all those staff who really are working above and beyond to help protect people right across the country. Aneurin Bevan, I think, are doing a fine job within that, as indeed are other health boards.

Minister, I'd like to second that—I think Aneurin Bevan are doing a fantastic job, from what I can see, and everyone is working so hard to get this vaccine out as soon as possible. But there seems to be a lot of nonsensical stuff going on. I'm getting many, many e-mails in my inbox about couples not being vaccinated at the same time. Obviously, we're on the elderly at the moment, and we're going down to the 70-year-olds. Can you guarantee that you—? Or, what are you doing to look into the fact that one member of a couple is being told a vaccination date, and then the other person is getting a date far removed from that? It just doesn't make sense. Obviously, they're elderly and getting to those points is an issue as well. So, please can you look into that, if you haven't already? Or, what have you done to ensure that that won't carry on, because I'm getting a lot of e-mails about this? Thank you.

Well, it would help if you could provide me with detail of the instances that you refer to, and it would also help to be clear about whether you've raised these individuals either with a general practice or with the health board. We want to make sure that the vaccination programme is rolled out as fast as possible, but also in a way that provides confidence and understands the challenges of how people do and don't live their lives. I've seen many examples, actually, where couples have been deliberately invited together to make sure they can have the vaccine at the same time. So, I'm not aware of the issue that you refer to, but if you provide me with some more details, then I'll happily look at it to try to resolve the issue. 

Across Islwyn, the Welsh national health service in its entirety is rising to the challenge of this pandemic, but there is still much concern about a misinformation campaign in circulation, namely that the vaccination programme is way off target and off track, and any such deliberate fear-mongering is exacerbating the anxiety and fear already present in our communities. The truth is, every day, we are vaccinating more and more people in Wales. The latest figures show that 161,900 people have had their first dose of the vaccine, an average of 10,000 people every day now receiving that first dose of the vaccine. So, every week, that vaccination programme is speeding up as more clinics are opened and more vaccines are available for the army of healthcare professionals administering vaccines, in 28 vaccination centres across Wales, increasing to 45, and 100 GP practices vaccinating, set to rise to 250 in the next fortnight. So, Minister, how would you assess the success of the vaccine roll-out currently across Islwyn with this backdrop, and how do you see that proceeding in the future?

Well, I think it's fair to say that we've made a modest start in comparison to other UK countries, but in terms of other countries around the world, we've made a really rapid start in the first few weeks. If you think of what's happened in the last three weeks, you'll see a really significant increase in the pace of our vaccination effort, as the infrastructure has been put in place to allow more mass vaccination centres to be delivered, and that's really important for use of the Pfizer vaccine. As we're getting more of the AstraZeneca supply, our primary care professionals in particular—general practice, with pharmacy, dentistry and optometry—are making use of their staff coming on board in the very near future as well. Actually, the figures today have gone on even further. We have now vaccinated with at least one dose of the vaccine nearly 176,000 people in Wales, nearly 14,000 people in the figures we've provided for the last day, and you can expect that, by the end of this week, we'll have made another significant step forward compared to last week. So, the pace really is increasing. The numbers demonstrate that, and I look forward to people in Islwyn having their vaccine in the very near future in very large numbers, and I'm very grateful to every general practice within the Islwyn constituency that is playing their part to vaccinate and to protect their residents as quickly as possible. 

All those working in domiciliary care are making tremendous efforts to provide this vital service safely. There is a huge range of pressures, and we are working closely with local authorities, health boards and other stakeholders to help manage these pressures.

Can I thank the Minister for that response? I wish to stress the important work done by homecare. Sometimes, efficiency and transformation is confused with poorer service and poorer working conditions. Will the Minister support greater direct service provision by local authorities of homecare?

I thank Mike Hedges for that response, and I'd like to echo his words about how vitally important homecare is. We're very aware of the challenges within that sector. Only 6 per cent, at the last reckoning, of domiciliary care services were managed by local authorities, which is obviously a very small amount. As the Member will be aware, we're looking at this balance of local authority and independent care providers in our White Paper on social care futures. And we've also recently set up the social care forum to look at how we can use the levers we've got available to us in Wales to improve working conditions in social care. So, yes, we are looking at the issue the Member raises. 

Minister, that's an encouraging answer, but I think we all acknowledge these are front-line workers and the importance of domiciliary care in allowing frail and older people to live to the maximum degree possible in terms of well-being is really crucial. And I'd like to know, given the fragmented service, much of it in the independent or private sector, what support is given to domiciliary care workers who need to isolate for whatever reason?

Well, as David Melding will know, the vast majority of domiciliary care providers are in the independent sector, and so, obviously, their employers are responsible for ensuring that they have the right working conditions and the right support. But, of course, if they are obliged to isolate, they will receive the same benefits as the people in the public sector, who will have their pay topped up and they will be looked after in the same sort of way. Because the sector is so fragmented, it's really important that we use all the levers we've got to try to reach them, and this is one of the key points in the White Paper that we've recently published. 

Minister, I have grave concerns about the safety of those in assisted living, particularly adults with learning difficulties. Understandably, the pandemic has put health and care systems under tremendous strain, but we can't neglect the most vulnerable or place them at greater risk. I've been contacted by constituents concerned about family members being put at greater risk of contracting COVID from the domiciliary carers entering their homes. So, Minister, will those living in assisted living be receiving the vaccine at the same time as those living in care homes, please? 

Those that are living in assisted living places will be receiving the vaccine during the overall first tranche, which we hope to get completed by the middle of February. But I do accept that they are in a very vulnerable position and, as the Member will know, domiciliary care workers are now being tested, as well, which provides for increasing support. But I do understand that relatives are very concerned about some of their loved ones who are living in these situations, and many of them have contacted me as well. So, certainly you make a valid point, but we are doing what we can to protect those people. 

Questions now from the party spokespeople. The Conservatives spokesperson, Andrew R.T. Davies. 

Thank you, Presiding Officer. Minister, earlier in the week, there were reports that 26,000 doses of the AstraZeneca vaccine had to be put rejected at the testing stage. These doses were designated for Wales. Can you update the Plenary as to your understanding as to the reason for rejection and how that might affect supply in Wales? 

Yes. It's actually about a delay to the doses in terms of the batch testing. So, we think there's going to be a delay to supply in Wales, as opposed to an entire loss, and it's an issue that affects the UK as well. So, I have another meeting with the vaccines Minister, Nadhim Zahawi, this week, from the UK Government. I have another meeting with Cabinet health Minister colleagues from across the UK this week as well. So, we are continuing to talk with each other about vaccine supply issues and delivery, and there isn't, as I understand it, a particular issue that I can give more detail on in the way that the Member asks, other than I hope to give what is a helpful reassurance about the fact the four nations are working together, and the delay to our supply is something we expect to be made up so that, of course, our hard-working, fantastic NHS staff and colleagues can get on with delivering the vaccine programme to help protect people right across the country. 

Thank you for that answer, Minister. I just want to be clear: I was talking about the AstraZeneca vaccine, not the well-documented delays— 

No, I understand. 

—with the reconfiguration of the factory and the Pfizer vaccine.

But if I could also ask you about evidence that appeared in the Scientific Advisory Group for Emergencies papers in relation to our BAME communities and work that SAGE has undertaken about the perception of the vaccine programme in those communities, the work that they undertook indicated a high percentage—72 per cent, in fact—of people questioned were either unlikely or very unlikely to have the vaccine. What work is the Welsh Government undertaking to allay people's fears within our BAME community and address this evidence that SAGE has put forward that there is reticence about taking up the vaccine in those communities? 

Well, we are already working with not just figures who have helped us in the past—so Emmanuel Ogbonna and Ray Singh are also looking to be helpful—but also Race Council Cymru. We're looking to reach out to community leaders, as we have been doing, because I do recognise this is a real concern. So, you have this juxtaposition of, on the one hand, people from black and Asian origin communities being more likely to suffer harm from COVID, and, on the other, rather than being the keenest to get protection from the vaccine, it's actually where there is the largest amount of vaccine scepticism. And, as you will know, there is a lot of fake news being spread around about the vaccine, about its efficacy, about the whole COVID pandemic in any event, and it's one of those occasions when I actually think it's not just about this Government, but about all four Governments and all people at the responsible end of politics, regardless of which party we're in, having a unified message for our constituents, and that is that these vaccines are approved only by an independent regulator. No politician decides whether the vaccines are safe and effective. The regulator decides whether they can be used and how they can be used, and it's then the job of politicians and our health services to make sure they're delivered. So, I would encourage everyone, when it's your turn, to make sure you're ready, take the vaccine, have the protection and then you will be protecting yourselves, your loved ones, and, of course, many other people across the country too.

Thank you for that answer, Minister, and if you could provide us with a regular update as the progress and the vaccine roll-out goes forward here in Wales around these figures, because they're quite alarming—72 per cent in the Scientific Advisory Group for Emergencies papers. So, I think it's important that we try and allay any fears that might be pervading those communities to stop people taking up the vaccine.

But also, evidence is now emerging, as we're getting further into the vaccine programme that, in care homes, for example, one in five staff members are refusing to have the vaccine. Now, that is a choice, because obviously, people are offered the vaccine and there is no compunction, but that does have an effect, if one in five staff members are refusing to have the vaccine, on residents, in particular, obviously, who might have all accepted the vaccine. Do you recognise that figure of one in five not taking up the offer of a vaccine? And if you do recognise it, what work has been undertaken to reassure staff members, who are in a vulnerable location, that the vaccine is a safe bet and ultimately a safe bet to protect the residents that the staff are so dedicated to?

Yes, I'm aware there's an issue with some staff not taking up the protection that the vaccine offers. In fact, I had a conversation with Vikki Howells about this yesterday on the work that we're looking to do, not just with providers and commissioners, but also with trade union representatives to reinforce to their members, again, the point that I made in your second question: the vaccines are only made available if the independent regulator approves them as being safe and effective and there are conditions upon their use as well.

So, it's really important to say that loud and clear from all political perspectives: to encourage staff to take up the offer of the vaccine when it's made available; to recognise that they're in a position where they're caring for some of our most vulnerable citizens—it's about protecting them, the people they work with, the people they care for, as well as people in their families and communities. We will continue to look at uptake rates to make sure we're providing the whole-community coverage and protection that we all want to see from the vaccine and a path out of this crisis. When the pandemic will eventually end, at some point, we'll still be left with a significant job of work to do in recovery, healthcare and economic terms. We can get there much sooner, though, if we can deliver the vaccine programme as quickly as possible and if people take up their vaccines when they're offered the chance to do so.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Llywydd. This morning there's been a suggestion that the Joint Committee on Vaccination and Immunisation could recommend changes to the priority groups for vaccination if evidence, which is starting to emerge, demonstrates that vaccination has an impact on the transfer of the virus too—not only does it prevent people from becoming ill, but it protects those around them too. I know that following the advice of the JCVI is the Welsh Government's policy, but can the Minister tell us how willing the Government is to change strategy, if necessary, in terms of the necessary digital infrastructure and so on? Can the Government implement a new policy at short notice if that is the advice the Government receives?

Well, there's a bit of a hypothetical question there about what we can do if a certain change is or isn't made. What I think is much clearer though, and I think it is a fair question to ask, is if the JCVI—the independent expert group that has given us advice on how to make the best use of vaccines, how to have the greatest public health benefit and how to save the greatest number of lives—if their advice were to change, what would be the position of Ministers? I think that's a fair question and I'm happy to say that if the JCVI do change their advice, I'll obviously consider it with the advice that I get from my chief medical officer and I would expect that the position and the policy direction of the Welsh Government would then change as well. Because throughout this, I've been interested in making choices that follow the advice as clearly as possible and help to save lives. If the JCVI think there is a different way or a better way to do that, as we understand more about the vaccines we have available, as we understand more about COVID and its various strains and types, then, of course I'll be prepared to change my decision and what that means for the Welsh Government and our national health service and vaccination programme.

That doesn't answer my question. I wasn't asking whether you would change policy, I was asking if you had the capacity within your systems to take a new path if necessary and what preparations are being made for that.

If I may move on, clearly, the Oxford-AstraZeneca vaccine that has been favoured, because it is more flexible; it's easier to store and to transport and so on and so forth. But, as evidence reaches us, from Israel particularly, in terms of how the virus is transferred by those people who have been vaccinated, it does appear possible—and this is not a rhetorical issue, because we need to make preparations for all eventualities—that only the Pfizer vaccine would provide this improvement in terms of transmission. Now, this is a very new kind of vaccination. This new mRNA technology is likely to be a prominent part of dealing with future pandemics. We will need infrastructure in place that would allow the roll-out of these new mRNA vaccines very quickly and the need to keep them cold, and so on. In the midst of this pandemic, does the Government have its eye on developing that kind of infrastructure for the future, as well as seeing how quickly it can be rolled out for the problem that we are currently facing?

Well, of course we'll consider the developing evidence base on the effectiveness and characteristics of vaccines and the threats that we're looking to combat. I think going beyond that is rather unhelpful and speculative, because we need to understand the confirmed evidence, rather than what may or may not be developing. There is always the potential for different things to happen at various points in time. I'm confident, though, that the flexibility and the can-do attitude that our NHS has shown throughout this crisis is something that will also help us with future events, as well.

It's also worth pointing out, I think, that I do think we should look forward to a more optimistic end to 2021 than the year we've just gone through, but that doesn't mean that the year will be risk-free. Even as we vaccinate the adult population, I don't think people can look forward to going back to entirely the way things were at this point in January 2020. I think the challenge is that we're going to be living with COVID for some time. Once we have protections from the vaccine, we'll have the changes that you and I would see every year with the flu, for example, where different strains emerge and there's a need to consider how we best protect people and what we need to build in as a regular part of our infrastructure, and that will, of course, also feature in how we deal with new and emerging threats, whether they're from a different strain of COVID or, indeed, other healthcare threats, as well.

Diolch. I must say, I'm disappointed that you seem to be brushing off my questions as being hypothetical ones. I want to see Welsh Government preparing for different eventualities, because if we've learnt something of the last year, it's that this pandemic can throw all sorts of curve balls at us and we need to be preparing for different outcomes.

Now, with case numbers thankfully falling, as well, many people are suffering, after almost a year of severe restrictions on their lives, will understandably want to know now the timescale for when they can get their lives back on track. Now, I'm not going to ask you today to give us that timescale, because, as I say, this pandemic has been a tale of surprise after surprise, so things can change even in a few weeks, but what I do want is an assurance that the Welsh Government does recognise the real hardships and health problems caused by the lockdowns themselves, and that the central focus of Government is to have an exit strategy from the cycle of lockdowns, and that there will be a recovery period that addresses the harms that have occurred, particularly, for example, to children and young people.

Well, of course we recognise that lockdown comes with harms as well as benefits, and we've been very upfront about that in statements made by myself, by the First Minister and by the evidence papers that we've published from our technical advisory group, and, indeed, the statements published by our chief medical officer. So, this isn't a new factor for us to take into account. It's always a balance between the harm that a lockdown can cause in terms of the greater sense of isolation, the dislocation between different people and the impact on children and young people, and that's why we've been so keen to try to maintain face-to-face learning for as long as possible; it's why it's our first significant priority, as we've always said, in terms of being able to come out of level 4 lockdown measures as they currently stand today.

So, we recognise the longer term impact of the lockdown measures we're taking, together with the significant benefits that lockdown is providing in helping to reduce infection rates, and helping to prevent people acquiring COVID and the harm that would cause. We've already seen eye-watering and shocking statistics on the number of people who are in hospital now, the number of people who've lost their lives and the percentage of excess deaths, matching and exceeding the excess deaths that we've not seen since the second world war. These are extraordinary times we live through and lockdown is an extraordinary set of measures.

The recovery will need to be economic, and people's loss of work produces health harms as well. We know there'll be physical harm to recover and to account for, and not just in conditions like stroke and cancer, but also a significant challenge in terms of mental health and well-being as well. So, we recognise that the health recovery will be long and significant, but I am confident that our NHS will stand up to that challenge. It will require our support, it will require our understanding and it will require us to make choices about the budgets we have available to us.

The next year, though, even though it will be difficult—the next term of this Senedd, even though it will be full of COVID-related challenges—is a much more optimistic one to look forward to with that sense of recovery, as opposed to the last 10 or 11 months we've just gone through. So, I think all of us can have confidence our NHS will still be here and fit for purpose, as long as we make choices about how we support it as elected Members here in the Senedd.

Thank you. During the pandemic, the available capacity has reduced to enable appropriate social distancing and improved infection-prevention and control measures to be implemented. As I've stated previously on a number of occasions, these measures, and increased personal protective equipment usage and requirements, have significantly reduced throughput in our NHS. Health boards have concentrated on treating the most urgent patients and, unfortunately, this has resulted in significantly longer waits for some patients.

Thank you, Minister. According to research by the South Wales Argus, over 32,000 patients had waited beyond the 36-week period in Gwent up to October, which was the latest date when they had figures available. One of the key reasons for the delays is that not enough staff are available due to being off sick or self-isolating.

According to the British Medical Association, the Welsh Government recently changed its policy for vaccinating NHS staff, forcing many to wait 12 weeks for their second dose of the Pfizer vaccine. This goes against the World Health Organization advice of giving it within three weeks, and certainly no longer than six weeks. This means that doctors who volunteered to work on the front line don't feel safe to do so until they know that they're fully inoculated.

Huw Edwards reported yesterday that a senior clinician suggested it could be deemed a criminal act if a staff member died due to being infected while on duty between receiving their first and second dose. I cannot understate how strongly doctors feel about this. Will the Minister, therefore, overturn this policy and resume giving front-line health workers their second dose within three weeks, in order to protect our front-line workers and allow them to return to work to keep us safe and sound?

I understand there's real anxiety from everyone who's a front-line health and care worker, but I really don't think it was Huw Edwards's finest hour to promote on social media that incendiary comment that doesn't actually have a basis, I think, in the public health advice we've received and are following.

It might be helpful for me to explain to the Member how we get to this point again. So, I explained earlier that vaccines are only approved when the independent regulator approves their use. The advice we are following, then, on the deployment of those vaccines has to comply with the conditions they've imposed. It also, then, goes through the independent Joint Committee on Vaccination and Immunisation to give advice to all four Governments in the UK about how to make the best use of those vaccines.

Their advice, which has been endorsed by all four chief medical officers in the UK, including our own chief medical officer, Frank Atherton, of course, is that the right thing to do is to provide the protection the vaccine offers to as many people with the first dose as quickly as possible and to think about it in these ways: if you have two doses of the vaccine available and you have two doctors or two nurses, you could choose to give both of those doses, within an interval, to one doctor or one nurse, and then the other one would have to wait until more supplies are available much later on. So, that person would be working without any protection. The good news is that the two vaccines we have available provide a high level of protection with their first dose. So, you have a choice between providing as many people as possible with good protection as quickly and as broadly as possible, or you can provide excellent protection and then leave other people bearing a different risk in having no protection at all. I think it's very easy to understand public health advice—endorsed by Public Health Wales too. That's the advice I have received as Minister.

It's also been very clear that not following that advice would mean not only that I would turn over the direct advice of the chief medical officer and the direct advice of the JCVI, I'd be doing that on a basis where the understanding is, and the advice I've been given, that that would lead to hundreds of avoidable deaths. So, we're doing the right thing in terms of the public health advice we've received, and made that clear on many occasions. And it's the advice that my decision is to follow, just as, indeed, an Ulster Unionist health Minister has done in Northern Ireland, a Scottish Nationalist Party health Minister in Scotland, and a Conservative health Minister in England. This is straightforward public health advice, and it's the way we're going to roll out this programme to protect as many people as possible, including those NHS and social care staff working on the front line, and I'm tremendously grateful for all they've done for us and they will continue to do as this crisis unfolds and eventually ends.

In terms of the ability to deal with the coronavirus in south-east Wales, I wonder if you could update us, Minister, on the Grange University Hospital and the role of that in providing treatment for those suffering from COVID-19.

In direct conversations I've had with the health board—and I'm sure the Member has engaged in the regular briefings that the Aneurin Bevan University Health Board provides—the provision and the early completion of the Grange hospital is a key part of the practical COVID response. It allows for much easier and greater isolation, because of the single rooms that are provided throughout the facility. It allows much greater space than the former infrastructure that existed in the Royal Gwent, and the hospital in Abergavenny that I know that many of the Member's constituents will have gone to, and it's where, of course, my own father passed away as well. So, this isn't to criticise those hospitals or that infrastructure—it's a recognition that it needed to be updated. That's why the Member, and indeed other Members from across the political spectrum, including, of course, Lynne Neagle—I should mention her—were campaigning for the completion of the Clinical Futures vision, with the Grange at its centre. We didn't know at the time that I made that choice to go ahead with that hospital within this term that it would play such a key part in the pandemic response. It's also, of course, provided a much better place for emergency care to be delivered as well. So, I think that the decision to complete the Grange University Hospital, to accelerate its completion, has already stood the test of time, and I'm sure, as you do, if you listen to the voices of staff who work in that hospital, then they will say it has been a real benefit to them and the people they serve and care for to have it as part of our healthcare infrastructure.

Thank you. The Welsh Government accepts and has followed the recommendations of the Joint Committee on Vaccination and Immunisation, and is committed to ensuring that front-line social care workers are vaccinated as a priority. Front-line social care workers are, of course, in the current list of priority groups. Care home residents, and the staff that care for them, are in the highest group of priority for vaccination.

Thank you for that answer, Minister. I'd like to raise the matter of those providing domiciliary care, those going into the homes of the elderly and the vulnerable to provide care, particularly those who have been taken on by direct payments, or those providing care privately. I've spoken to some in the workforce, and they are in some doubt about whether they will form part of the social care workforce that will be prioritised for vaccination. Are you able to provide any clarification for them, please?

Yes. Domiciliary care workers are social care workers. People going in to deliver care in people's homes are certainly front-line workers, and you wouldn't just hear that from me. I can see not just my deputy—I see former Ministers who have occupied that brief—and they will recognise that these front-line workers, I think, have got greater recognition as heroes within our health and social care system, where they weren't recognised not that long ago. So, I expect them to be covered in the first few priority groups, and hope the Member will join with others across the political spectrum in encouraging them to take up the vaccine offer, when they're offered it, for the protection it will provide for them and the people that they care for.

It could well be that that question has arisen because so much emphasis has been on social care workers within care homes. I've got a question about those who administer personal and intimate care to children in school settings. I think we can agree that the communication of prioritising these individuals wasn't fantastic—you admitted as much last week, Minister. But the education Minister further clarified that all staff, whether they're in special schools, mainstream schools or further education colleges, if they're involved in the intimate care of pupils, will be classed as social care staff. So, that will include relevant teachers, I'm assuming. How will the information on who all the relevant staff are—how is that going to be fed into the lists that the local health boards are operating, especially as it sounds as if they're going to be late additions to this priority list under the heading of social care staff?

We're working through that with colleagues not just here in education—and the education Minister and I have a very constructive and good working relationship in sharing information and decision making—but also, of course, with staff within local government and within the school sector to identify relevant staff, to make sure they're identified for the vaccination process. We'll need to continue to work through that to make sure we do understand who those people are, so they can get invited for their vaccination. If the Member has individual examples where she's concerned people may be missed, then I'd be happy to consider those together with my colleague, the education Minister.

Thank you. And, Presiding Officer, I understand you've given your permission for questions 5 and 8 to be grouped. All health boards are geared up for significant expansion of capacity in January, with the coming onstream of the Oxford-AstraZeneca vaccine. Our plans are dependent on Wales receiving vaccine supplies in fair proportion and in good time. Supply is outside of our control, but the UK vaccines Minister has further reconfirmed his indications previously that vaccine supply to Wales will be delivered on time and in that fair proportion.

Thank you, Minister, and that assurance is good to hear, because we have, of course, heard separate stories over the last few days of some supply chain and production challenges, and we should anticipate that there will be glitches as we go along; it's not going to be perfect. Firstly, we heard of the Oxford-AstraZeneca vaccine challenges, because one of the four batches of the vaccine over the weekend produced for Wales was delayed. And then we heard, of course, of six EU health Ministers putting in writing to the European Commission their severe concerns about delivery delays on the Pfizer-BioNTech vaccine. So, can you tell the Senedd whether these sorts of challenges that will happen from time to time with the supply chain and manufacture will impact on the safe and rapid deployment of the vaccines in Wales and across the UK, or whether the planning that you've got in place can mitigate these problems in the vaccine supply and manufacture?

I think it's a fair question, and I thank the Member for the way he's put the question as well, because it's important we don't stoke people's fears, in terms of the roll-out. I think Pfizer-BioNTech themselves have made a public statement that they're reassessing their own manufacturing process and there'll be a brief pause before they then have a more robust manufacturing process for the increased volume of their vaccine they are producing in Belgium. So, we may see a slight reduction for a period of time in the Pfizer vaccines coming into the UK, but the manufacturers have been clear that they think they'll then have an increased and more robust supply coming into us.

And with the AstraZeneca supply, it's easier in terms of supply chain, because some of it has been manufactured in Germany, but we expect the delivery unit in Wrexham to be delivering more and more of the UK's supply. But we do then understand the Medicines and Healthcare products Regulatory Agency quite rightly undertake batch testing to make sure that batches are properly tested and assured before they're released into the system. So, we've seen a pause in that, a delay in one of the batches. We can expect that; we can also expect that to be smoothed out over time, as AstraZeneca have committed to provide significantly increased amounts of that vaccine to all nations in the UK. And it is important. With relatively complex supply and delivery chains, there may be some bumps. If those are material, then I will report those openly, and what it means in terms of vaccine supply. I'll be clear about whether that pauses or moves backwards any of the milestones we have. But what I can say is that, as soon as we get vaccine that our health service can use and deliver, it'll be supplied to go to people as quickly as possible. I'd ask the public to bear with our NHS. No-one will be left behind; people won't be forgotten. Working all together, I'm confident we can do something that Wales can be really proud of with our NHS-led vaccination programme.

Minister, may I associate myself and my party with your remarks about the safety and efficacy of the vaccine? I—and, I think, all of us—would encourage people to take the vaccine as soon as it is offered to them. May I ask you: following the First Minister saying he'd clarified his remarks, could you clarify—has he actually retracted his statement that we should make the Pfizer vaccine last until the next delivery is scheduled, or his statement that the reason for that is to avoid any risk of vaccinators being left standing around with nothing to do?

The First Minister has clarified his position on several occasions, and I answered not just questions in the media, but about 20 minutes' worth of the emergency question yesterday. I recognise there's a lot of public interest in this.

But has he retracted? You haven't answered.

I don't think I can be any clearer about the actual position—that the vaccine isn't being held back, it's being delivered to our NHS as quickly as the NHS can deliver itself, and our infrastructure has increased significantly to allow even more of those supplies to go out, and we'll carry on doing so. And I should say that we're in the same position as other UK nations in having a store of the Pfizer-BioNTech vaccine that is being stored in significant storage facilities to then be delivered as quickly as all nations can have it. So, the Pfizer vaccine delivered today in England, Scotland and Northern Ireland is from a delivery they will already have had, just as it is here in Wales, and it's about the capacity of each of our delivery systems to be able to deliver that into the arms of the public. And I look forward to figures for the end of this week to see the significant increase that I fully expect in the delivery both of the Pfizer-BioNTech vaccine and the AstraZeneca one, and I look forward to people across the Chamber welcoming and celebrating the success of our NHS in doing so.

Well, the gap between the supply of vaccines and the capacity to deploy those vaccinations in Wales is causing particular concern when it comes to police officers. Responding to you last week, I referred to calls by the North Wales Police Federation for policing to be considered for some—not full, but some—priority on the COVID-19 vaccination programme. Many current and former North Wales Police officers have written to me since stating that, 'Every single day, police officers and staff run the risk of coming into contact with a person with COVID, contracting it themselves and then bringing the killer virus back into their own homes', and asking for the Welsh Government to commit to giving policing some priority. And on Monday, the North Wales Police Federation told me they were contacted last weekend by, quote, 'Very reliable sources working within the vaccination centres', who advised that hospital secretaries and even social workers working from home are receiving the vaccine, yet front-line policing is still not considered to be a risk, or even being allowed to use up any spare or unused vaccines. How do you therefore respond to their specific statement that even getting front-line police officers on a stand-by list, like is happening in some parts of England, might be a start?

Well, I think I should go back to some of the points I rehearsed with both Delyth Jewell and others on the prioritisation list. The independent, expert JCVI have given us advice on how to make best use of the vaccines that we have available; chief medical officers have endorsed that advice, because it will help to save as many lives as possible. The current priority list one to nine that the JCVI have recommended—and every Government, including your Conservative colleagues in England, has followed that prioritisation, because it should mean that 99 per cent of the hospitalisations and deaths that take place will be covered within those first nine priority groups. The JCVI will be considering advice to give to chief medical officers and Ministers like myself in all four Governments on the next phase of the vaccination that is to come. And I'm looking forward to receiving that advice and an understanding if they'll give advice on occupational risk groups for that second vaccination stage—whether people are teachers, police officers, taxi drivers or bus drivers, people need to consider the risk to different occupations of the harm that can be caused by COVID. When I get that advice, I'll then make a decision. I'll be open and transparent about what it is, but you can rely on the fact that my choice will be about the public health case, to save the greatest number of lives as quickly as possible.

Thank you. The ongoing response to the COVID-19 pandemic has seen considerable change to acute care services in Wales. Practitioners continue to respond with agility and innovation to meet the requirements of this exceptional situation that balances an increase in demand with the levels of COVID-19 cases and the resulting and unavoidable pressures.

Thank you for that answer, Minister. I'm sure we would all in the Senedd want to pass our congratulations on to healthcare staff who've been able to provide a remarkable amount of non-related-to-COVID care in this terrible public health emergency. However, we now know that, as the second wave has been so much more serious than the first, even, nearly half of in-patients, for example, in Cwm Taf Morgannwg are there with COVID, and I don't think that pattern is atypical to many other areas around the United Kingdom and Wales, and that, unfortunately, some urgent operations are now being cancelled. We need a plan as we move out of the COVID phase with the vaccination, so that those who had urgent operations postponed are treated as soon as possible and that we make a very careful risk assessment of all the people who had elective surgery and urgent surgery delayed.

I think the Member makes a very sensible point. If you get your news from BBC, then you'll have seen this week the series they're running on the very real pressures in our healthcare system. The hospital may be in England, but, actually, the pressures are real in every part of the United Kingdom, and that COVID care does mean we've had to interrupt non-COVID care. I have explained previously that the expansion of critical care up to about 150 per cent of capacity, in terms of its use, means that people have had to be deployed from other areas. Other areas like theatres have had to be turned over for use in a critical care-style environment. That means we can't undertake non-COVID care in the same way, and it's not just elective care. There are urgent services that are being interrupted because of the measures we are having to take to save as many lives as possible.

That, in itself, will produce anxiety and frustration, but also, potentially, greater harm, because the NHS may not be able to recover all of the harm that is caused. It's why we all need to pull together to do the right thing through this extraordinary crisis we're living through, but the Member and others can have confidence that not only is our NHS doing the right thing through the height of the pandemic, but we are, of course, planning for the necessary recovery, including the point the Member makes about trying to risk assess and understand the change in the position of people who have had their treatment delayed. That's why I say that this mammoth task will dominate the whole of the next Welsh Parliament in healthcare terms. Recovery won't be easy or quick, but it's entirely necessary, and our NHS understands and is already trying to plan for that reality.

Finally, question 7, Helen Mary Jones.

Thank you. On 11 January, I published the national vaccination plan, reflecting months of detailed NHS planning. The strategy set out a number of key milestones that the Member will be familiar with. Hywel Dda health board, which serve the population of Carmarthenshire, confirm that all general practices have signed up, and are increasing their mass vaccination centres from two overall to at least one per county.

I'm grateful to the Minister for his answer, and I'm very grateful to the staff for all that they are achieving in getting patients vaccinated. But I've received correspondence from the families of two patients over the age of 90 in Llanelli and one patient over the age of 90 in Llangennech, who, as yet, haven't heard from the NHS as to when they will get vaccinated. Now, obviously, these patients are in the very vulnerable age group, and given that this is more than one, I do have a concern that there may be an issue with the health board's communication with patients in this group. May I ask the Minister just to ask his officials to reassure themselves that Hywel Dda is effectively communicating? Because if these patients need to wait and there's a good reason why they need to wait, it's very important—I'm sure he would agree with me—that they and their families understand the situation and understand when they are likely to receive the vaccine.

I think it's fair to say there will be some people who won't have heard yet, because the NHS will be contacting more and more of those people progressively through not just this week, but the next week as well. And it's the case that, in other parts of the UK, there'll be people who won't have heard and people who won't have been invited to an appointment yet, including the over-80s and in some parts in care homes too. In Wales, I expect this week to make really significant progress on care home residents and the over-80s. You may well still, as indeed may other Members, get contact from people on Monday who say that they still haven't had their appointment, but I am confident that the pace will increase further this week. I am confident that more and more of our over-80s will receive their vaccines this week or will receive their appointment letters this week.

Powys have managed to act probably faster than any other health board in getting through their population, and that's why they're able to already start issuing invite letters to over-70s within that county. I expect every health board to rapidly get to that position over the next week or so. So, your constituents should either have received their jab or have received an invite letter in the coming days. I'll report openly about where we are with the overall pace of the programme once more, and I do just want to say that I think that Hywel Dda, throughout the whole of the COVID crisis, deserves a great deal of credit for the way they've organised themselves, the way they've gathered their staff and partners together, and I think they deserve a tremendous amount of praise. I hope that the public will not just reflect on that, but have some confidence that our NHS won't leave people behind. We know what we have to do to protect people, and the vaccination programme remains our No. 1 priority.

Thank you, Minister. 

The next item is questions to the Minister for Mental Health, Wellbeing and the Welsh Language, and the first question is from Jack Sargeant. 

Diolch, Jack. We continue to monitor the impact of the pandemic on mental health and well-being through a range of surveys and other evidence. Overall, levels of anxiety remain higher than pre-pandemic levels due to a range of concerns, including personal health, the health of loved ones, and of course finances.

Diolch, Minister, for that answer. One of my constituents today talked openly in The Leader newspaper about the impact of being excluded from the UK Government's financial support, and the effect that is having on people's mental health. I was also contacted by a business owner before the current lockdown, who told me of customers who were openly talking about ending their lives. And, as a fellow sufferer, someone with poor mental health, I really recognise these signs and feel strongly about this issue. Llywydd, we often talk incorrectly about one in four people having mental health problems; I think this vastly underplays reality. The old ways of reaching out aren't working. Hard-to-reach groups will clearly pay the price. Not only must we do more, we must do better. So, Minister, on that basis, how can you as a Welsh Government reach out better?

Diolch, Jack, and I'm really sorry to hear about your constituents. They are not on their own. I am really concerned about the pressure people are under. Anxiety levels have certainly increased. People are feeling very isolated, they're lonely, they're very concerned about losing their jobs, and a lot of people are concerned about family members. And, of course, we are concerned that we may see an increase in suicide rates, which is why, right at the outset of the pandemic, we commissioned the NHS delivery unit to work with Public Health Wales, and we asked Professor Ann John to chair a national advisory group to review deaths by suicide.

Now, obviously, what we want to do is to put measures in place to stop that from happening in the first place. I've just come off a call with Time to Change Wales, and you're familiar with that, Jack, because I know you were instrumental in asking me to make sure that we continue our funding to that organisation at a time when England stopped theirs. And I think that was a huge mistake, to stop people from talking about mental health issues in the middle of a pandemic, or to stop funding an organisation that encouraged that to happen.

It's absolutely clear that there are some groups that are more reluctant to reach out for help than others. We're particularly concerned about the black, Asian and minority ethnic community, which is why one of the things we've done is we've given additional support to Diverse Cymru, so that they can reach out and reach out to the communities that they're in touch with. But the other group that I'm particularly concerned about is middle-aged men, and that is a real problem that we have, which is why it's really important that we support groups like Men's Sheds, and it's really interesting to see that a lot of those now have recognised the importance of their work and are continuing their work online, and I'd like to encourage that to continue.

Minister, you will no doubt be aware that my constituency of Aberconwy sits within the Conwy County Borough, and that we have the highest percentage of old people aged 65 plus in Wales. We also have a number of 80 to 90-year-olds who have been shielding since last March, facing life like never before, living indoors, struggling with loneliness, fear and anxiety. I am reliably informed by those in medical practice here that treatment for mental health issues has exacerbated greatly amongst this age group and that this needs to be addressed quickly to avoid long-term life-threatening consequences. This has increased further as a result of the most current and recent lockdown as a result of a more highly infectious virus now in circulation. Our single biggest weapon providing assurance to these individuals is a quick vaccination process, however, that is not happening here. Worse still is the fact that these people have received no information whatsoever and their anxiety is increasing. Yesterday, the health Minister did promise in the Senedd that, within a week or so, seven out of 10 of those aged 80 years and older would be receiving their vaccination. Can you confirm to me today that this will indeed be the case, and that our most elderly and vulnerable with mental health issues will receive their vaccine within these timescales? Diolch, Llywydd.

Thanks very much, Janet, and we're particularly concerned about older people who are living in isolation, who've been on their own for a long time now, who are fearful of going out even to the shops, and we're very concerned about these people, which is why we have put some projects in place to make sure that we can stand by these people. So, one of the projects we've put in place is called Friend in Need, and we've got Age Cymru to help us out with that. So, I would encourage you to ask your constituents to link up with that scheme if they need some mental health support.

But we have given significant additional financial support to Betsi Cadwaladr, and in addition to that, we've just increased the mental health budget by £42 million. So, if you look at how much we spend on mental health now, it's about £783 million, so the key thing now is to make sure that that money gets to the right people. And I think it's that low-level intervention; it's not the kind of—. We need to get to the mass numbers now, which is why we need to increase—and we have increased—the tier 0 support.

Of course people are concerned about the vaccine and you've just heard the health Minister explain what the programme is in relation to the vaccine. My understanding is that Betsi Cadwaladr was ahead of lots of other parts of Wales in relation to the roll-out of the vaccine. I would listen to the assurances that have come from the health Minister in terms of those targets that have been set out.

Minister, while I understand that the collation of suicide figures is often subject to a lapse of time due to the need for investigation and inquests, I would draw your attention to the comments of the north Wales coroner, John Gittins, in December, who presided over seven suicide cases from the summer in the same week. He noted the effects of lockdown as a contributory factor in all of those cases. It seems to me that continued lockdown, a climate of fear, and the effects of winter can only be causes for deep concern. Can you outline what additional support is available for those who are really struggling?

Thanks very much. We're very aware that we need to keep an eye on this, which is why we're not waiting until we get the inquests from the coroners, which can take up to a year. We need to get a better real-time sense of what's going on on the ground, which is why we're working with the police. We've got a range of services working together to make sure that we analyse the real-time data and put measures in place. One of the things that we're very anxious to make sure of is that the support for people who are contemplating suicide is in place. That's why we've got a 'Talk to me 2' programme, and one of the features within that programme is making sure that those people who've been bereaved, who may be feeling very low at the moment, are getting the support that they need, because it's very difficult for them to mourn in a normal way at the moment. We're making sure that that support is in place. I would encourage your constituents to get in touch, first of all, with the CALL mental health helpline, and they will then be able to direct your constituents to the most appropriate level of support.

Perinatal services have been positioned, as you know, as an essential service during the pandemic. Community teams have worked hard to ensure that that support has remained accessible, including through digital and telephone-based support. We're continuing to monitor the evidence to inform our approach, for instance with the 'Babies in Lockdown' report and the Born in Wales study.

We know that the pandemic has meant unprecedented pressure, heightened anxiety, and a greater risk of mental health problems for new parents. We know too that all this is happening at a time that is absolutely critical—those first 1,000 days of a baby's life, which can influence their development throughout their lives. Before Christmas, this Senedd passed a motion, tabled by myself, Bethan Sayed, and Leanne Wood, calling for a focused effort to support new parents during the pandemic, and also calling for ring-fenced funding for perinatal mental health. While I welcome your assurance that you gave in the health committee this morning that you would look at ring-fenced funding, I think that needs to be done as a matter of urgency. Can I also ask what further update you can provide, particularly in terms of ensuring that health visiting support, and other services, are there? Because we can say as often as we like that these are designated essential services; in my experience, that is not the experience on the ground. Can I also ask if you'll agree to meet with the Maternal Mental Health Alliance in Wales, so that you can work in partnership with them to ensure that new parents do get the support they so desperately need?

Thanks very much, Lynne. Certainly, you'll be aware that we've refreshed our 'Together for Mental Health' delivery plan, and within that we have made sure that perinatal services are absolutely central to what we need to focus on. One of the key things we're trying to do is to make sure that we get all the health authorities to meet the standards that are set out by the Royal College of Psychiatrists—the quality standards that are set out there. Now, some authorities are further ahead than others in this space, and so what we need to do, and what I'll be looking at in response to your question today, is to see how far along some of these health boards are in terms of delivering on that. There will be an expectation that they will meet those service standards, and we will provide enough money to make sure that they can meet those standards. So, they'll be making their applications to us, effectively, and we will make sure that that money is there.

I guess, in some health boards, they may be able to reach those standards quicker than others, and they may want to release some of that money to, for example, give more support to eating disorders, or whatever else, if they have reached a certain standard. So, I think we can certainly look at—. I think what we've got to look at is outcomes, rather than money going in. That's my interest, as I informed the committee this morning—it's outcomes that are important, not the amount of money that goes in. If we're meeting those outcomes that are set out, then I don't think we'll need to put that ring fence in. But leave it with me, because I'm very anxious to look at that in more detail. You will be aware also that we've appointed a new clinical lead—Sharon Fernandez—and that's to help support those health boards to make sure that they reach those required standards that have been set out.

In terms of the visiting, I am aware that, in some areas—. You know, this can be a very lonely time. It's a very isolated time as a new parent. I'll never forget just waiting, desperately, for my husband to come home, to hand over the baby at the end of the day, because you're tearing your hair out. You do need that support, and lots of people don't have that support, which is why it's essential that we keep an eye on this space. That support is being given online, but if there is a medical reason why that needs to be face to face, then I think that is able to continue in this space. 

Minister, I concur with everything that's just been said by Lynne, and would support what she's said. I am very happy that the Welsh Government has classed this as essential, because it is critical care, the perinatal care. It's such an important time for the parents and for the children as well, as has already been outlined. Therefore, I welcome the extra money that's going towards mental health, and I'd ask too that a lot of it is pushed in this area particularly.

As you know, I've got a one-year-old myself. I'm lucky that he gets to see other children of his age in nursery twice a week, but a lot of children won't be able to see children of their age. It was a massive worry when we were in the proper lockdown, when nurseries closed too, that he didn't have that access to seeing other children, and obviously he couldn't hug anyone and see the people he would normally see. So, it is a worry about his development in that way. I wonder about the knock-on effects, and I wonder what the Government is doing in that regard.

But, also, for the parents—it really takes a village, not just parents, to raise a child, and as you just said, Eluned, you need that rest, you need to get some sleep, because some children don't sleep. My first didn't at all and it has a massive impact on your mental health to have that break. Has the Government looked into the possibility of maybe extending support bubbles for new parents in that regard, so maybe they see children or maybe they have that extra support themselves for their mental health issues? 

Can I start by saying, Laura, that you look amazing for someone with a one-year-old, I must say? I don't know you manage it. One of the things that we've tried to make sure is available is that childcare provision, because we recognise that that is important for so many people. Just in terms of support bubbles for new parents, obviously at alert level 4, we had to suspend the ability to form extended households, which meant that only single parents or single households were able to form support bubbles. But even for those who are not part of a support bubble, under our rules, parents of babies are allowed access to support from their families or close friends if they need to, and if there's no reasonable alternative. So, there is more space there perhaps than people recognise. But I must emphasise, having said this, that just because you can do it, it doesn't mean you should do it. I can't overstate the seriousness of the situation, and I think it is important that we ask everybody to think very carefully to protect their friends and families. 

My office held a survey throughout the autumn and winter of last year. We got 1,000 responses to one, and 300 to another most recently, asking parents about their experience of perinatal services. We've had many responses, telling us that 80 per cent of them feel anxious about the restrictions that still exist in maternity services, 68 per cent feel that they didn't receive support, despite experiencing mental health problems, and 90 per cent saying that their partner had no opportunity to discuss their mental health—fathers perhaps being forgotten in all of this, very often. 

What can you do to do more in this sphere to ensure that things can operate better? Would you agree to meet with me, along with some of the charities active in this area, to discuss our survey? A number of details have emerged in the survey that could help you as a Government to steer this, and to help mothers and fathers to move forward in a period, as Lynne Neagle and Laura Anne Jones said, that is very difficult even at the best of times, never mind giving birth during a pandemic?

I have been looking at the responses to the survey. I've been following that, and I must say I was surprised to see the figures quite so high in not seeing follow-up services, and that's something that worried me a great deal. That's why we are going to provide additional funding so that health boards can reach those standards that are expected. Within those standards, there is an understanding that it's not just mothers that need this help; fathers can also feel that they're being excluded, so they too need assistance. 

I haven't met with people on the front line in my new post on this issue of perinatal services. So, what I would suggest is that I bring people together. Lynne Neagle also asked me if I would meet with certain groups and individuals. Perhaps we can arrange one big meeting, and then I'd be very happy to hear from the front line about what the situation is. I'm keen not to just look at statistics, but to hear people's front-line experiences. 

Questions now from the party spokespeople. First of all, Plaid Cymru spokesperson, Rhun ap Iorwerth.  

Thank you very much, Llywydd. Minister, a report was published yesterday that stated that one in four young persons had failed to cope with the challenges of the past 12 months. The reasons for that are quite clear, but if we are to avoid a mental health pandemic, then we must put services in place now to assist these young people. So, what investments in services are you planning? 

I recognise that we must intervene at an early stage, because from my understanding, 80 per cent of mental health problems begin to occur when people are children or young people. Therefore, it makes sense for us to focus any additional funding in that area, and that's exactly what we're doing. We are ensuring that £9.4 million of additional funding is provided directly to assist young people. Some of that will be provided through schools, but there is also additional work being done to ensure that we introduce not only CAMHS in schools—. At the moment, they're pilots, but we hope that once we know what the outcomes of those pilots are, we will then be able to see that rolled out across Wales. So, that is a very practical step that we know works. We want to see that developed across Wales. But, also, there is the national early help and enhanced support framework group, and this is something that we have seen that has worked very well in the Gwent area. I'm very eager to see that programme being rolled out throughout Wales. So, those are the two things we're doing directly to assist young people.  

I do look forward to hearing something on a far greater scale with far more urgency. Over a period of years in reports from Senedd committees and from other stakeholders we've seen a great deal of evidence of where we're not getting things right in Wales in terms of assisting our young people with mental health problems. One of the problems is that people who don't fit the narrow medical model of an urgent problem can't access the support that they need. They're turned away from treatment or their treatments is concluded too soon. You've referred to earlier intervention and that is crucial. But another thing that works—and the evidence demonstrates that, I believe—is when a young person, having had early access to services, can keep that connection, can build that relationship with the counsellor over a longer period of time. So, how are your plans for changing the way in which services are provided and funded going to allow and, indeed, promote that kind of longer term relationship between the young person and those providing support? 

One thing that I have learnt over the past few months is that there are many people who perhaps don't need medical intervention, but they do need a great deal of support, and the best people to provide that support are people within their communities, people they see regularly—their teachers or members of the community. So, the idea with the model that's working particularly well in the Gwent area is that you train people within communities rather than expect specialists to always be available. So, that continuity will be available for those young people so that they can tap into services where necessary, and so that it's not just a one-off event that is then withdrawn. But there's a great deal of training that needs to be done in that area.

And I applaud the work being done in Gwent too. I've been keeping an eye on the provision available there, but that provision needs to be available in all parts of Wales. And I agree entirely with you on the need to ensure availability within communities across Wales, and there's an urgency here. You will have heard me mention one-stop shops, which I and Plaid Cymru have been recommending, which could assist people with mental health problems and other problems that young people face too, as a result of unemployment or poor housing, sexual health, and so on. This is something that could be established across Wales as a matter of urgency, and it strikes me, in light of the problems that have arisen during this pandemic, and its impact on young people, that now is that time to do that. Will you therefore create the kinds of services that we are calling for as a clear sign to that one young person in four that they haven't been forgotten in the past 12 months?

Well, I have been looking at those ideas and I've been looking at what's happening in New Zealand. I think there are lessons to be learnt, but also, we must be careful that those centres don't become places where people don't want to be seen and therefore, stigma is something that we need to be aware of in this area. There are hubs available in some areas across Wales already, and our interest, therefore, is in doing more in terms of health hubs, so that it's broader than simply focusing on mental health. So, we are looking at what's possible, but I think even what Plaid Cymru is suggesting—. It's at a low level in relation to the need, in terms of hubs, in my view. I think I would prefer to see how we can make that provision available in broader community hubs that already exist.

The Conservative spokesperson, Suzy Davies.

Thank you very much, Llywydd. Minister, the number of teachers who speak or are able to work through the medium of Welsh has remained quite stable over a period of years now. Estyn describes applications this year for initial teacher training as an increase, although the Education Workforce Council is a little more guarded on the issue and a little more realistic than that. So, why didn't more of the new cohort make applications to teach Welsh or to teach through the medium of Welsh? And have you reached your target in terms of the number of people being trained through the medium of Welsh?

Well, as you'll be aware, Suzy, we have been trying to do a great deal of work in this area. We do have targets in place, and to be honest, we're having difficulty in delivering those targets when it comes to increasing the number of teachers, particularly in secondary schools. That is why we have provided an additional £5,000 to people who are training to teach through the medium of Welsh, so that we can encourage more of them to take an interest in providing that service. We've provided an additional £150,000 to see whether we can get more children to take an interest in taking A-levels through the medium of Welsh. And also it's possible now for people to train as teachers through distance learning and that, hopefully, will be—. It's a new initiative that is now available, so that those living in, for example, Ceredigion don't have to go away to college but can train to become a teacher remotely. So, we're doing all that we can. I am always asking whether there are additional ideas out there in terms of what we should be doing, and so, if there are ideas out there, then I would be more than happy to listen to those because we are having difficulty in this area.

Thank you for that. I know that it is difficult, but I was wondering whether you'd be interested in degree-level apprenticeships, for example, for teachers who come via different vocational backgrounds rather than through the academic system that we're seeing at the moment. That could be something to be considered.

I'd like to move on now to another issue. Almost immediately after the beginning of lockdown, we heard that the demand for online taster sessions from the National Centre for Learning Welsh had increased. That was very good news. Now, I understand that there are delays in providing data across your policy areas, but perhaps you can confirm that you may have caught up with that. So, can you tell us to what extent that early interest in the courses has remained? What actually works in retaining those learners so that they persevere with learning Welsh?

Thank you very much. We have seen a huge increase in the number of people who did take an interest in learning Welsh, and that didn't just happen through the National Centre for Learning Welsh. You will be aware that Duolingo and Say Something in Welsh and many other services have seen these increases, and these are all things that we welcome, of course. The question, as you said, is whether people will continue to learn as the pandemic comes to an end, and that's the challenge. We don't yet know, but certainly that initial surge in interest has been maintained. But I don't have the latest data to see whether people have persevered through the period, and, of course, I can come back to you with details on that if that would be of assistance.

Yes, thank you for that. I hope you will be able to share any new data that shows any progress on the Cymraeg 2050 target, including any new ideas that we may not have considered in the past and which would work.

I'd now like to look particularly at any progress in Welsh language apprenticeships, and how we can mainstream more Welsh language skills in English-medium apprenticeships. We will be focusing on vocational apprenticeships towards excellence in the Welsh Conservatives manifesto, because we see this as a way of delivering the Cymraeg 2050 targets in terms of creating an inclusive and appropriate space for increasing the use of the Welsh language on a daily basis in the workplace.

I'm sure you will have looked at the Senedd official languages scheme, because there are very good ideas contained within it, But could you tell us how many Welsh language or bilingual apprenticeships we have lost as a result of COVID, and what are you doing to broaden the Welsh-medium apprenticeship sectors beyond Mudiad Meithrin, the Urdd, and so on, whilst also retaining those?

Thank you very much. I think there is scope for us to see what more can be done in order to encourage people to dip their toe into learning Welsh, and that's why I appreciate what some schools are doing, which is that they ask teaching assistants to assist. There are projects in some schools where they ask sixth-formers to return for the following year so that they get a taste for teaching. I hope that will encourage more people to take an interest in undertaking teacher training, and to teach through the medium of Welsh.

Now of course, in terms of apprenticeships, at the moment—and we're still at the early stages in this—through the Coleg Cymraeg Cenedlaethol, what we have done is to focus on a few specific areas. One is childcare and the other is elder care. Therefore, our provision is focused in those areas at the moment.

In terms of Welsh language apprenticeships, one of the problems we had, of course, was that many of the apprenticeships were with the Urdd, and, of course, the Urdd has suffered a great deal during this pandemic and so it's been very difficult for them, particularly in terms of sports apprenticeships. It's been a tragedy to see that, and we are having regular discussions with the Urdd to see what we can do to assist them, because in the past they could use funding that came from their residential centres to help pay for the core funding for apprenticeships. So, we're still in discussion with the Urdd as to whether we could do more in that area, because they do excellent work.

Thank you, Helen. We expect all health boards to maintain mental health services and to monitor and respond to changing mental health needs. Health boards set out their plans in the quarter 3 and 4 NHS operational framework, submitted in December. They will produce an annual plan for 2021-22, in line with the priorities set out in the NHS annual planning framework for this year. 

I'm grateful to you for your answer, Minister, but just in the last three weeks I've received a number of constituency contacts from people in the east of Carmarthenshire county, in Llanelli and surrounding communities, that I'm really concerned about. One was around the lack of support for survivors of sexual abuse, and very long waits where there is support; a case of a constituent being told to go to A&E when they were having suicidal thoughts and expected to make their own way there; people waiting over a year for counselling through talking therapies, when we know how important that can be; and no support for talking therapies through the medium of Welsh, which can be particularly important here. If somebody has a mental health problem, being able to express themselves around those issues in their language of choice or their first language is so important. 

We would all acknowledge that the Welsh Government has made some big financial investments in mental health, but I would suggest to you that those issues coming out from Llanelli and surrounding communities suggest that we really need to take a long hard look at how those resources are being used. And I have a particular concern about that lack of specialist support for survivors of sexual abuse, and about the lack of access to talking therapies. In the end, Minister, we can end up spending a lot of money in these communities on drug therapies, but those don't solve people's problems; they just help them manage them. So, if I write to you with these cases—and I don't want to mention individuals' names or circumstances here—will you undertake to contact the health board to take a look at what's going on? These may be problems, of course, that are being exacerbated by the COVID situation, but these are people in severe distress and they really should not be being treated in this way.

Thanks, Helen. I think it's really important for us to underline that the health route is not the only route—that, actually, the third sector can do a lot of amazing work in this space. And one of the things that I'm really keen to do is to develop the confidence of GPs, in particular, to feel that they can refer on to other places as well as the medical route. So, I had meetings with the Royal College of General Practitioners last week, just to talk about what more we need to do to increase their confidence that, if they refer to a third sector organisation, they will know that there will be quality associated with that and a consistency in terms of where that can be delivered. So, I think those are conversations that need to continue.

That specialist support, you see, is not necessarily something that the health board is best placed to do. There are third sector organisations who can do this probably better than the health board, because of the sensitivities surrounding them, because of lived experience, or whatever. So, for me, that additional support for tier 0, for that third sector, is absolutely where it's at, but now we've got to build that confidence between the medical, the primary care settings and the third sector. It works brilliantly in some areas, but it's not a consistent picture across the whole of Wales.  

Thank you very much. We've positioned mental health services as essential services during the pandemic. This means that we expect services to be maintained, although we accept that delivery models may need to be adapted due to the restrictions. 

Thank you for that.

Following on from Helen Mary Jones's question, and the answer, actually, obviously we know as a result of the many pressures—[Inaudible.]—waiting times are incredibly long and services are stretched. Now, in some areas there is little or no support available. However, we also know that there are independent counsellors across Wales who are prepared to help the NHS in dealing with this issue now, but simply need to be paid to do it. I realise there are all these arguments about workforce planning and time lags and stuff, but these are qualified people now working in the independent sector. As well as that, many people can't afford to go private to access that support. Therefore, will the Government commit to proactively contacting all qualified counsellors in Wales and pay them NHS rates in order to increase the availability of counselling and mental health support services?

I think it would be very difficult for me to commit to contacting all the people in this space who are available, but I certainly recognise that there is a pool of experts that we could be making use of, and I think one of the things that I'm keen to do is to work with the health boards on this additional funding that we'll be putting in place for that tier 0 level support. There's no reason why those health boards then can't determine that they will effectively contract out some of that work from the health board, which is effectively what they're doing through third sector organisations. I'd rather, if I was honest, see that done through third sector organisations, but I recognise that at the moment there's a shortage of experts and we need to make use of those who are there. So, we can keep an eye on that, but I think when we're dealing with a system that has to cover the whole of Wales, you need big systems in place, rather than a system that tries to connect everybody individually.

Can I express my support for the Minister and my belief in the importance of mental health support, and can I go along with what Dai Lloyd said about using everybody who can help? I think that excluding any one group of people will only be to the detriment of mental health in Wales. My question is: from my experience, bereavement is a major cause of mental health deterioration—what additional bereavement support is being made available?

Thanks very much, Mike. There is significant additional bereavement support that has been made available, and there's a recognition, in particular after suicide, that people may need some additional bereavement support under those situations. We've got to recognise that there are tens of thousands of people in Wales now who have lost loved ones during this crisis, and we need to make sure that there is support for them. That bereavement support is in place. If we find that there is a need for more, then we'll look at that, but certainly, one of the things that I've been very keen to do in recent weeks is to make sure that people know where they can access the support easily, and I've been pushing in particular for health boards to make it easy for people to navigate to where they can find help, and I hope you, along with all the other Senedd Members, received a letter from me last week, indicating where people can go to for help, and we've ensured that every health board now has that information clearly set out on their web pages, which is something that was very much welcomed by the children's commissioner. She asked for that to be done in a much clearer way, so that it's easier for people to navigate.

Thanks, David, and I understand that there's been permission given to group this with question 8. Is that right? Great.

The Welsh Government published a national rehabilitation framework underpinning population-specific guidance in May 2020 to help services to consider increasing the demand for rehabilitation, reablement and recovery throughout health and social care services. Mental health and well-being needs are embedded across the populations identified in that framework.  

Thank you, Minister. Can I urge that the mental health ministerial delivery oversight board that you have established looks at this? You also reflect on the recent report of the Senedd's Health, Social Care and Sport Committee, which looked at the pandemic and its implications. We will have people with long COVID, we've become increasingly aware of post syndromes—post polio, for instance, those who had polio in the last great epidemic in the 1950s presenting with problems and mental health is often one of them directly associated. And also, there will be people who would've been quite traumatized by their treatment, just because of the invasive nature of it. They are going to present with some very real mental health concerns that will require quite a specific response that relates to the context of those mental health difficulties being created.

Thanks very much, David. We absolutely recognise not just that long COVID is something that people are going to have to live with, and as you've seen, we've developed an app to try and help recovery for people, which we've launched this week. But also, we've got to focus, I think, on particular groups. Some of those are people who've had a prolonged time in hospital and critical care, so that's one group of people we've got to understand. People who, perhaps, are not being directly impacted by COVID, but have been indirectly in the sense that they were waiting for a different kind of operation, and that can lead to mental health issues. There are people, of course, who've avoided accessing services because they were concerned that they may catch COVID, or whatever, while they're in there. And also, there are socially isolated groups where lockdown has really increased the pressure that they have felt, and that lack of social connectivity. So, there is a lot, I think, that we need to recognise, and slightly different aspects. 

It's clear that every person who lives with a mental health issue has to be dealt with as an individual, and that it is a uniquely individual issue that needs to be understood. But I do think that we, as a community now, need to understand that we have gone through trauma, as a society, and that trauma-informed approach needs to inform our response to the pandemic. Certainly, the oversight board will have COVID as something that we keep an eye on and that we need to remain flexible with. 

The other issue that I think is probably worth noting is that there will be a particular issue, I think, with people on the front line. And it was interesting to speak to the Royal College of Physicians last week about what they see as being an issue in terms of the longer term, that, actually, people on the front line have not got time to think at the moment, but when this is over, the kind of post-traumatic stress could really kick in and they're suggesting that that could take about three or four years to actually hit. So, we've got to put all of that provision in place to prepare for what could be quite a significant impact on the people who are on the front line.

Minister, the amount of questions you've received today from Members regarding the impact of COVID on mental well-being, I think, highlights the challenges that are ahead of us in addressing some of those issues. And it's not often that we talk about the individuals in relation to this, but of course, the individuals are part of a family unit, very often, and families are also affected by their trauma—and I think the word you used in answer to David Melding, 'trauma', was correct, and we need to address this.

Mike Hedges highlighted the bereavement issue and there'll be challenges there with people who feel guilty because they weren't at the end of life for the individual because they weren't allowed to be. So, it's a large trauma upon our families, and my colleague in my neighbouring constituency of Neath, Jeremy Miles, has initiated a trauma awareness programme that he runs with Neath Port Talbot Mind. What discussions is the Welsh Government having with the third sector organisations and mental health charities to discuss how they're going to address the trauma awareness agenda, which is definitely going to be coming down the line to families as well as individuals?

Thanks very much, David. I meet very regularly with the third sector and it was there where there were people who emphasised the importance of understanding trauma. They're the people who have really made sure that I've understood that that is fundamental to the way we move forward as a society—that we have been through a traumatic experience as a society. But of course, you're quite right, there are individuals who are affected, but the individuals within the families may then have a ripple effect on other members in the family, and those are things that we need to keep an eye on as well. 

There are different projects that we're funding. Certainly, we've given about £750,000 to Action for Children and Mind Active Monitoring. So, we're recognising that there's a family issue here that needs to be addressed. Also, we have given an additional £900,000 to our hospices and bereavement people to make sure that there is that support there to help those families through what is a very, very difficult time in their lives.

Minister, those fortunate enough to leave hospital following admission for COVID-19 not only face many months of physical recuperation, they also have to come to terms with the mental trauma they have suffered. New research shows that one in five survivors will develop mental illness and many survivors struggle with post-traumatic stress disorder for months after leaving hospital. It has also been discovered that survivors are at a greater risk of developing dementia. Minister, how will the Welsh Government ensure all survivors are closely monitored and receive the necessary support early enough to stave off the most severe complications? Diolch. 

Thanks very much, and you're absolutely right, Caroline, that we must recognise that when people have a physical problem in these very difficult circumstances, there is a real possibility that there will be a spillover into a mental health problem. In particular, those who've had, frankly, a confrontation with death—there are a lot of people who've come very, very close, and that in itself is a traumatic experience. That's why we recognise that PTSD is likely to become something that we need to pay more attention to in future. Also, we need to monitor people who have left hospital. Obviously, at the moment, people are very focused on just getting people well, but there has been follow-up in local authorities just to make sure that people are on the right track.

Dementia is another point that you mentioned. I think one of the things that is clear to me is that a lot of people who are, perhaps, beginning to have an issue with dementia—we've seen that the isolation that many have felt has actually increased the speed at which that dementia has taken hold. So, that is, again, something that we need to keep an eye on, and you'll be aware that we've got a £10 million programme addressing the issue of dementia in Wales. 

Betsi Cadwaladr University Health Board is responsible for ensuring service provision meets the needs of the local community, including for mental health. Health boards set out their plans for quarter 3 and 4 in the operational framework. 

Well, there are grave concerns as to whether mental health services in Betsi Cadwaladr should have been taken out of special measures because of the ongoing weaknesses within the service. In a recent report to the health board, the interim nursing director listed a number of weaknesses within the service. The report concluded that at the moment it couldn't give a full assurance to the board on the quality of the service provided. So, if he can't provide assurances on the service, how can you?

Thank you. I think it's worth saying that just because the board is no longer in special measures and that we, as a Government, aren't directly responsible, it doesn't mean that we have stepped back entirely. The targeted intervention policy that's in place at the moment is still a measure that requires intervention. It ensures that we look in detail at what's happening.

In addition to that, before we came to that point, and it's worth saying that it wasn't us who made the decision—we made the decision having heard what experts had to say—there was an additional £12 million provided directly to assist with mental health issues within Betsi Cadwaladr, because we were aware that there's a great deal of work still to be done in north Wales. I do know that the I CAN hubs have been effective, and we will be looking at how they operate in the future.

I’m pleased to report that the Hywel Dda health board has worked closely with stakeholders over the past few years to develop its mental health transformation programme and they have reflected the changing mental health needs of the community in the updated framework.

Well, I’m grateful to you for that response, Minister. You may be aware that the online well-being and mental health counselling service for young people has been launched by the Hywel Dda University Health Board, and this digital service is a huge step forward. Young people will be able to receive anonymous support in counselling and peer-to-peer services, as well as to access a broad range of self-help materials. Minister, what discussions have you had with the health board on this service? Can you tell us how the Welsh Government is promoting this support among young people across Pembrokeshire? Also, can you tell us one specific mental health service improvement that has taken place since you were appointed Minister with responsibility for this area?

Thank you very much. I meet with the health board regularly and I did have a meeting with them to hear what their intentions were for transforming mental health. I'm very pleased to see that they have taken these steps that are targeted at young people. Kooth has proved to be of assistance in other areas already, so it’s good to see that being developed. I do know that Public Health Wales has certainly been supportive in ensuring that people are aware of the assistance available to young people. One of the first things I did on appointment to this post was to ask Public Health Wales and our team to ensure that we target that information at areas where young people could access it—so, we ensured that it was on Tik Tok and so on, because there's no point putting that information in places where we as adults might see it; we also need to ensure that we take it to young people. So, that's a thing that I have ensured has happened. I think the fact that people now have an awareness of what is available and that it's available on all health board websites, and it's more clearly available, the fact that I am entirely clear that we must make far quicker progress—and that’s why I have established this new group in order to ensure that we do drive forward these policies that are already in place, but we’ve also ensured that an additional £40 million is available for this important area.

Thank you, Minister.

There are no topical questions or 90-second statements today under items 3 and 4.

So, we move to item 5, the debate on the petition to legislate to prevent people from changing Welsh house names. I call on the Chair of the Petitions Committee—Janet Finch-Saunders.

Diolch, Llywydd. On behalf of the Petitions Committee, I am pleased to open this debate on a petition calling for steps to be taken to help prevent Welsh house names being changed and lost. This was submitted by Robin Aled Davies, having collected more than 18,000 signatures, a fact that I believe demonstrates how many people feel strongly about this issue, and about the protection of Welsh language and heritage more widely. Now, though the petition received signatures from across Wales—as well as further afield—I wanted to note the particularly strong support from the west and north-west of Wales, where this is perhaps seen as an especially important issue.

The Petitions Committee considered the petition in November last year, noting some of the previous efforts that have been made to provide protection to Welsh place names in recent years. Those have included a Member's Bill proposal put forward by Dr Dai Lloyd MS in 2017 and an inquiry by the Culture, Welsh Language and Communications Committee into the historic environment, also in 2017. Now, Members who were directly involved in those pieces of work may wish to say more about them, though the Petitions Committee has noted that this inquiry led to a recommendation that the Government should keep the issue under review and introduce further protection if the current approach does not prove effective. I'm also aware that the Culture, Welsh Language and Communications Committee intends to follow this issue up as part of its legacy work.

Now, of course, with the end of this Senedd term—it is now rapidly approaching, and the Petitions Committee recognises that there is simply not sufficient time remaining to directly enact the petition's call to introduce new legislation before that time. However, we did not feel that fact should prevent a debate on the issue and I hope the sources of protection that could be provided to historic names, both now and in the longer term. There are roles for a range of bodies in providing those protections, including the Welsh Government, local authorities and Cadw. The approach needed will also depend upon the type of name being considered.

Now, this petition itself is very specific, directly concerning only individual house names. However, it is part of a wider issue, including the names of settlements and other larger places, natural features, farms and large buildings, down to individual properties. At the largest scale, measures such as the Welsh language standards do already provide a degree of protection for our cities, towns and villages, with duties on local authorities, for example, in relation to signage. Names of historic places have also been maintained in a register since 2017, with statutory guidance in place for public bodies.

Then, at the smallest scale, protecting house names is likely to be more difficult in practice, and the Minister has pointed out some of those difficulties in her written response to our Petitions Committee. Where a property is only known by its name, owners must apply to their local authority to change it. Now, I'm aware that some authorities provide guidance to actually encourage owners to use Welsh names on their properties, though this is not to be considered mandatory. In addition, where a property is known primarily by a number, owners may be able to add or change a name without requiring approval. And, for example, an owner can operate a business from a property, such as a farm, under a different name. So, this is by no means a simple issue, and, as the petition does help to demonstrate, it is one that prompts strong feelings and reactions. This should be expected, given the importance that names can have in reinforcing who we are and the history of the communities that we live in and we wish to identify with. I hope that this debate can help us today to take stock of the situation and to consider what more could be done to protect traditional or historic names. Diolch yn fawr.

Can I thank, first of all, Janet Finch-Saunders as Chair of the Petitions Committee, and also the petitioner and the 18,000-plus people who signed the petition? As alluded, this is an issue close to my heart. That's why I presented a Bill to the Assembly—the Senedd now—in 2017, seeking to protect historic place names in Wales. As part of that Bill, I also wanted to look at protecting historical house names.

House names, the names of farms and places more generally are very important for a nation's memory and history. Often, they have a direct link to the history and geography of the area or a link with famous names, events such as battles for our independence as a nation, and important elements in Welsh history, with links to ancient traditions, historical industry and the myths and legends of our lands.

We know that, across Wales, names of historic farmhouses and homes are being lost. Losing these names means that we are losing part of our local and national heritage. It was disappointing that the Government in 2017 voted against the principle of developing legislation in this area, and I still believe that there is more that the Welsh Government can do to protect these names—mere guidance does not do it. There is currently no legal protection for house names in Wales. It is clear that there are a range of ways in which the Government could do that, and we know that there are organisations and academics who support further Government intervention in this area. A number of countries worldwide have identified that historical place names are important and have developed legislation in order to protect such names. So, there is certainly potential there to learn from others. There may be scope, for example, to create a requirement for an individual to seek legal consent from an authority when seeking to change the name of a house or any other place. This authority might be the local planning authority, as is the case now with listed building consent. Currently, if a householder wants to change the name of their house, they must apply to their local authority department responsible for street naming and numbering. However, the local authority doesn't generally have any powers to reject a name change, apart from instances where there may be duplication of the name locally.

In cases of applications for changes to property names, current Welsh Government guidance sets out that local authorities are expected to check the national list of historic place names, mentioned by Janet, when processing such applications. If a historic name appears on that list, or if an officer is aware of one from another source, the applicant should be encouraged to retain that name. Unfortunately, as I have argued on a number of occasions, encouragement doesn't guarantee the protection of historical house or place names. Legislation does, which is why the Welsh Government should explore this further. Diolch yn fawr.

The Minister for Mental Health, Wellbeing and Welsh Language to contribute to the debate—Eluned Morgan.

Thank you very much, and thank you for the opportunity to discuss this important issue. The fact that the petition has attracted so much support does demonstrate that there are very strong feelings about this issue. And I have to admit that this is an issue that I am concerned about, but there are practical problems that we need to look at.

The fact is that people have a right to name their homes, for better or for worse. Anyone can put a plaque on their home without informing the local authority, if that home has a street number. But I do think that naming a house against the will of the local populace can feel like actually cutting that tie between ourselves and our community. I did respond to this petition through this committee, which highlighted the fact that we had already taken action in terms of cities, towns and villages, that we'd asked the Welsh Language Commissioner to provide advice to individuals and organisations on the standardised forms of place names in Wales. And I think that those standards have done a good job. The fact that we are seeing these names now does mean that we have seen a shift in this area.

I do feel that our statutory guidance does require particular public authorities to consider a list of historic place names in their naming functions. That is a statutory issue and that is already in place, and a local authority has to recognise the importance of historical place names in naming streets and house numbers. And if a local authority has an application for a historical place name to be changed, then that council should encourage the applicant to reconsider. And that's where I see Dai's point: can we go further? Can we say that—rather than asking nicely that individuals change their minds, can we go further and can we legislate and tighten the guidance that is in place? So, I must admit to having a great deal of sympathy with that view, and I would be more than happy to speak to committee members and Dai, to see exactly what we can do to tighten things up, so that we don't see more of this happening. One example that we've seen cited—. I think it's worth saying that there's nothing preventing the owner of a property with a historical name giving an additional name to that property—a business name, for example. So, there's one example that's angered a lot of people: Happy Donkey Hill. That's the new name, but the farm is still called Faerdre Fach, and the name hasn't officially changed, but there is a new plaque on the wall for the business. So, we do just have to be aware that there are practical problems in this area, but I'm quite happy to work to see if it's possible for us to tighten up in this area.

But I think it's worth saying that the evidence we've seen shows that, in some counties, they’re receiving more applications to put Welsh names on houses than vice versa. For example, in Ceredigion, where, fair play, they really have made an effort in this area, they've received only one application to change the name of a house from Welsh to English, although they have had 10 requests to change from English to Welsh. Therefore, something is working in Ceredigion, and perhaps it's worth us looking to see whether there are things that other people could learn from there.

But I also think that local action—community pressure—can help us in this area. If you look at what happened, for example, at Plas Glynllifon: they tried to change the name there to Wynnborn Mansion, but the community rose up and stopped that from happening. Therefore, it is possible for the community to stop these things from happening.

However, thank you very much to Janet. I don't think that this is just something to do with houses. I want to see where we can go further, for example, lakes—that is something that we have to look at next. And also, we have helped, for example, by providing funding to develop an app that shows the names of mountains in north-east Wales. So, there are things we can do, but I'm happy to see whether it's possible for us to do something on a statutory basis as well. But, I have to say, I'm not sure if it's possible, but I'm more than happy to see if we can move further in this area.

The Chair of the committee to reply to the debate—Janet Finch-Saunders.

Thank you, Minister, for your response, and to Dai Lloyd, as a Member, for your contributions today. In concluding this debate, I also wish to thank the petitioner, Robin Aled Davies, for bringing this petition forward, and to all 18,000 people who signed this, and who themselves have engaged with the petitions process within our Senedd. I do hope that the points raised today will contribute to future decision making. The Petitions Committee will return to consider the petition at a future meeting, when we do hope to receive further reflections from the petitioner and anyone else who has followed the petition or today's proceedings. Diolch yn fawr.

The proposal is to note the petition. Does any Member object? I don't see or hear an objection, therefore the motion is agreed in accordance with Standing Order 12.36.

The next item is the debate on the Children, Young People and Education Committee's report on children's rights in Wales. I call on the Chair of the committee to open the debate, Lynne Neagle.

Thank you, Llywydd. Ten years ago, a new law, the Rights of Children and Young Persons (Wales) Measure 2011, put children’s rights on a legal footing in Wales. It’s now more than six years since all parts of this legislation have been fully in force. This means that Welsh Ministers must now have regard to the United Nations Convention on the Rights of the Child when exercising any of their functions. What’s clear is that this legislation has never been more important.

The COVID-19 pandemic means that our children are not going into their schools. Their playgrounds were shut at the start of the pandemic. They can't hang out with their friends, and they've got restrictions on going to their usual clubs and leisure activities. Some children may be more at risk of being harmed at home. This is less likely to be picked up by front-line services because children are not being seen as much in school, and they're less likely to have face-to-face contact with social services. We also know that looked-after children have had restricted contact with friends and family. What we know for sure is that, for many children and young people, their mental health and well-being is being seriously affected. If any adult needed an example of what children’s rights are, and why they matter, then this pandemic illustrates the point in the sharpest of ways.

The Children, Young People and Education Committee has worked hard to ensure that children’s rights have been at the heart of all our work during this fifth Assembly. Children’s rights matter in everything we do. This has been the case whether we are scrutinising Government policy on youth services or mental health, whether we are considering the need for legislation about the physical punishment of children, or whether we were looking at school funding.

In June 2019, almost a decade since the introduction of the rights of the child Measure, we felt it was the right time to examine whether this legislation has been working effectively. In 2011, this law was seen as breaking new ground and led to Wales getting international recognition, but the measure of its success must be whether it has actually made a real difference to the lives of children and young people in Wales.

The first thing we did was look at how this law is having an impact on Welsh Government’s decision making. We also wanted to know whether it has made any difference to the way the Welsh Government allocates its funding. We heard clear frustrations from stakeholders about the pace at which the Measure has influenced policy and spending. They told us that there is a lack of reference to children’s rights in key strategic documents. They also told us there is insufficient evidence that the duties in the Measure are being delivered across the whole of the Welsh Government. It’s not clear whether there is systematic consideration of children’s rights across Government. Whilst there are good examples in some departments, more progress must be made. As well as the obvious examples, such as education and social services, policy areas such as housing, health, planning, the economy, the environment and transport have a massive impact on children’s daily lives. Children’s rights must have an impact on decision making across all ministerial portfolios, and proof that this is happening must be more transparent.

Next, we looked at the duties within this new legislation that are intended to make children’s rights a reality. We wanted to know if the right mechanisms are in place to deliver change. We heard that child rights impact assessments are an important tool to support the implementation of this legislation. These assessments should analyse whether Welsh Government actions will have a negative, neutral or positive impact on children’s rights. The intention is that they are used at an early stage of decision making in order to inform that process. The committee heard concerns that these impact assessments are often produced too late in the policy development process. There were also concerns that they are sometimes written in a way that looks as if they are explaining policy decisions that have already been taken, rather than informing decisions that are yet to be made. This demonstrates to us that children’s rights are not driving the Welsh Government’s decision making as the legislation intended.

More recently, it’s pleasing to hear the Children’s Commissioner for Wales’s view that the quality and detail within some of these impact assessments have improved. One positive example relates to the level of detail and analysis published by the education department about school provision during the pandemic.

The 2011 legislation also placed a duty on the Welsh Government to make sure adults and children know about the UNCRC. This was so that adults and children understand what children’s rights are and why the law is in place. However, many of the children and young people we heard from made it clear to us that there has been no systematic approach to telling them about their rights. Our evidence also showed us there is a real gap in the knowledge and understanding of children’s rights amongst the general public.

In light of this, 10 years since this legislation was enacted, we conclude that a national awareness-raising strategy is long overdue. We have also recommended that the Welsh Government should tell children and young people how to complain if they think that this new law is not working well. This information must be given to them in a way that is easy to understand.

Since our report’s publication, the Welsh Government has published a new children’s rights scheme for consultation. This is a plan it's required to have by law, and which sets out how it intends to deliver the legislation in practice. We are pleased to see that an awareness-raising strategy and a child-friendly complaints process has been included in the new scheme. What we must see next is the detail behind it and a commitment as to when these outputs will be delivered.

One other important aspect of our inquiry was to look at how well the Welsh Government is implementing article 12 of the UNCRC. It says that children have the right to have their say when adults are making decisions that affect them and to have their opinions taken into account. It’s vital that children and young people have an influence on decisions that affect them, not just because they have a legal right to do so, but because, more importantly, it leads to better decisions and better outcomes. We recommended that the Welsh Government set out in its revised children’s rights scheme a clear strategy to ensure the participation of children and young people in discussions on Government decisions that affect them. We welcome the fact that this has been included in the new draft children’s rights scheme. We will monitor how this progresses in the remaining months before the election.

The final recommendation that I would like to focus on today is about strengthening the legal position of children’s rights. Never has the extent of local authorities’ influence on children’s daily lives been more visible. Yet, while public bodies, including health boards, play a pivotal role in delivering services to children and young people, and receive significant amounts of public money, the rights of the child Measure does not impose duties on them. We heard that the Welsh Government is therefore not always able to ensure that children’s rights have a direct influence on the services children and young people receive, or the decisions these public bodies make. We were persuaded by the evidence we received that extending the duties in the Measure to bodies such as local authorities and health boards will help deliver this change.

In drawing my opening remarks to a close, I have already said that the COVID-19 pandemic has meant that the rights of the child Measure has never been more important. But what we must remember is that implementing this legislation properly has always been important. As a committee, we believe there must be a renewed emphasis on getting the implementation of the Measure right. We also note that the United Nations is scrutinising progress on implementing the UNCRC across the UK in 2021.

Before the pandemic, we heard from children and young people about the rights that are important to them and what can happen when they are not made a reality. It was great to hear from nearly 1,000 young people from all five Senedd regions. It was also wonderful to meet the children from the Lleisiau Bach projects in north and south Wales. They gave us a really warm welcome and were keen to tell us what children’s rights meant to their lives. One of the rights that was clearly important to the young people we spoke to was the right to be safe: the right to be safe at home; the right to be safe in their communities; the right be safe online. A stark reminder, if any was needed, of the lives that some children and young people in Wales are living. A reminder of what children’s rights mean in reality.

I would like to thank all those who have helped us with this work. The detailed input from stakeholders and the views of children and young people have been invaluable to our scrutiny. We are particularly grateful to those who have waited patiently for our report, which we postponed to enable all efforts to be focused on the public service response to the pandemic, and to those who provided feedback to us on the Welsh Government’s response, in order to inform today’s debate. With their help, we have made a set of practical recommendations that we believe have the potential to make rights a reality for all children and young people in Wales. Ten years on, it is now over to the Welsh Government to put renewed emphasis on getting this right. Diolch yn fawr. 

Thank you. Am I okay to speak now, Deputy Presiding Officer?  I can't hear you. Sorry, if I'm—. Can everyone hear me? Yes, good. Okay. I take it that's for me to speak. Okay, thank you.

I'd like to start by thanking Lynne Neagle and the committee and all who have inputted into this important work for all the hard work they've put into it. I welcome this report and its aim of measuring progress in Wales towards the principles set out in the United Nations Convention on the Rights of the Child. The report was agreed before lockdown and before the full impact of the coronavirus pandemic on the lives, health and well-being of children and young people were known. We now know that the consequences have been severe. So, this report is timely and is a relevant milestone in enhancing children's rights in Wales.

The committee makes 16 recommendations to the Welsh Government and I wish to address some of those in my remarks today. The first three recommendations relate directly to the Welsh Government. In her report to the committee, the children's commissioner said that there is no training for Ministers on how to exercise due regard to children's rights through their role. The commissioner called for compulsory training for Ministers—a point repeated by Save the Children UK, which said that

'without a strong body of knowledge about children’s rights amongst all officials and Ministers, it will be difficult to ensure that the due regard duty will be effective across Welsh Government cabinet portfolios and policy.'

We also believe that a ministerial role should be created at the earliest opportunity, with clear and defined responsibilities for children and young people.

The committee was also concerned about the gaps in knowledge of children's rights that exist amongst both adults and children. Efforts to promote awareness and understanding of their rights are not reaching all children, including those who may be disadvantaged or less engaged. Significant improvements are needed in letting those children most in need know about their rights. We call upon the Welsh Government to develop and publish a strategy to raise national awareness with measurable outcomes to promote wider knowledge and understanding amongst the public. By widening knowledge of their rights, it also follows that there could be an increase in complaints by children who feel that the Welsh Government has not complied with its requirements under the Rights of Children and Young Persons (Wales) Measure 2011. As such, we need to ensure that the complaints mechanism is fit for purpose.

At present, the complaints system outlined in the children's rights scheme is being underused and needs to be improved. Criticism was also made that it is geared towards an adult audience and that it is neither accessible nor suitable for children. The Welsh Government must address this and include a strengthened and child-friendly complaints mechanism in its revised children's rights scheme to ensure that our children and young people can seek to protect their rights.

In 2016, the UN Committee on the Rights of the Child gave its verdict on progress to deliver and enhance children's rights in Wales. Although they recognise that progress has been made, concerns were expressed about whether the Welsh Government's response to the concluding observations is strategic and systematic. The children's commissioner said that the concluding observations were a really useful guide for the Government as to what they should be doing and that the lack of a detailed response from the Welsh Government was a missed opportunity. We call on the Welsh Government to publish a detailed strategic response in the next six months, detailing progress made and outlining action being taken in addressing the concluding observations, and to update this on an annual basis.

Presiding Officer, I believe the recommendations contained in this report will greatly progress the rights of children and young people in Wales. I would encourage everyone to look at the good practice that I've seen since joining the children and young people committee last year and how they're doing things. I think it's been a very welcome move and I've been very impressed with what's going on there. So, if we could repeat that throughout the Parliament, that would be fantastic. I believe that this is a positive move by the Senedd and I look forward to a response by the Minister.

I'm very pleased to take part in this debate on behalf of my party, Plaid Cymru, but also as co-chair of the cross-party group on children and the cross-party group on looked-after children, roles that I'm very proud and grateful to share with David Melding. I'd like to thank the Chair and the committee for what is an excellent report, with very powerful recommendations and very well evidenced recommendations. I also echo the gratitude that's already been expressed to all those who participated in giving evidence, particularly children and young people themselves.

Those of us who were Members of this Senedd in 2011, as the Chair of this committee was, when the rights of children and young persons Measure was passed, will remember that the process was by no means straightforward and that there was resistance from within some parts of the Welsh Government at that time, because they felt that placing the convention on a legal footing was constraining to the Government. Those more progressive voices prevailed, and I'd like to put on record again my thanks to all those who helped us in civil society, many of whom went on to give evidence, and particularly to the academics at Swansea University.

When we passed the legislation, it felt like a really exciting development on a route that had been part of our Senedd's pathway right from the beginning, when one of the first things that we had to deal with was the terrible Waterhouse report into child abuse. Right from the beginning, we have debated these issues, and passing the legislation felt like an important step forward. In that context, in some ways, this report makes disappointing reading, because while absolutely there has been progress, there is clearly so much more to do.

I want to give my personal support and Plaid Cymru's support to all the recommendations. There's no time, of course, in this debate to refer to them all. I want to begin by highlighting those that relate to child rights impact assessments. We need to transform the culture so that all those involved in producing these assessments see them as what they are intended to be, which is a resource to help Government improve practice and not a further burden. Knowing the pressures on our public services, it is understandable if that's how these impact assessments are sometimes perceived, but that is not the intention. This is a tool to help us all do better by children, and we need a shift so that people understand that. It doesn't work to include child rights impact assessments under broader equality assessments. They're not there to do the same things. So, I very much hope that the Government will accept all that the committee's had to say with regard to child rights impact assessments.

I particularly want to give our support to recommendation 3. It's really important that Welsh Ministers, right at the top, understand the implications of the Measure for them and for their work, and understand what 'due regard' is intended to mean. It is always a risk in any institution that we lose institutional memory, that we forget why we needed this legislation in the first place, that we forget how much it matters. This recommendation goes a long way to addressing that, and I hope that whoever forms the next Welsh Government will embrace that with enthusiasm.

The recommendations about redress are also very important. I won't attempt to go through them one by one, but I've long believed that rights in themselves lack value unless those rights can be enforced. In the end, there is little point, Llywydd, in having a law if nobody gets into trouble if the law is broken. That's what laws are for, otherwise we can achieve policy objectives with budgets, with policy documents. But if it's a law, there has to be a way for somebody who feels that that law has been broken—and in this case, particularly for children—to be able to say, 'No, my rights were not addressed, my rights were not respected, and this is what I want done about it'. That is a particularly important part of this report, and the evidence was very clear to me.

I want to briefly mention recommendation 15, that all devolved public bodies must be placed under the same 'due regard' duty. I think those of us who were part of the process of passing the original legislation perhaps assumed that if that responsibility was placed on the Government, that due regard would trickle down to the public bodies for which the Government is responsible. The report evidences that, while there is excellent practice, this has not happened everywhere. I have a particular concern that it has not happened everywhere in education and that there are still some of those working in our education field, hopefully a minority, who think that talking in terms of children's rights means allowing children to do exactly what they want to do, which, of course, is not the case. So, I strongly hope that the Government will support this.

And finally, if I can just mention recommendation 16. Our children's commissioners have done sterling work, but it is an anomaly that the commissioner is answerable to and appointed by the Government. It arises from historical time when the commissioner's role was created. It's important now that we move to a point where the commissioner is appointed by and answerable to the Parliament, and I believe that we could get cross-party consensus for that in the next Assembly.

Llywydd, there has definitely been progress in turning children's rights into reality in Wales. It was a particular privilege for me, and made me particularly pleased, to be back in this Senedd to vote for the removal of the defence of reasonable chastisement and give all our children equal protection with adults, but this report does show how much further we have to go. I hope that Welsh Government will accept all its recommendations and the need for root-and-branch action to turn these rights into reality. The cross-party groups will continue to work with and support the committee to scrutinise the Government in this regard. Diolch yn fawr. 

Can I call on the Deputy Minister for Health and Social Services to reply to the debate? Julie Morgan. 

Thank you very much. I'd like to extend my thanks to the Chair and to all the members of the Children, Young People and Education Committee for this very comprehensive report on children's rights in Wales. The full Government response to the recommendations can be found on the committee's web pages. In addition to the responses to the Children, Young People and Education Committee, I've also held a roundtable discussion with key stakeholders from the children's sector to hear their views on children's rights in Wales, and I was delighted that the clerk of the committee was able to attend on behalf of the committee and that some Members were also able to come.

Of the 16 recommendations, I am very pleased that the Welsh Government is accepting 11 of them, and accepting in principle one further recommendation. We have rejected four of the recommendations. I'll use this time to go through the recommendations.

Recommendation 1 asks that we reiterate the importance of children's rights at every opportunity, something that we take seriously and, of course, have accepted. I think there have been quite a few comments today about when the Measure was first passed and the enthusiasm that there was there at the time, and I think what we want to do is to get that enthusiasm back again. We do want to reiterate the importance of children's rights, and we accept recommendation 1. 

Progress has already been made in taking forward a number of the recommendations. Five of the accepted recommendations have been incorporated into the newly revised children's rights scheme, which was published in December and is currently being consulted on. These are recommendations 3, 4, 5, 10 and 12. The consultation closes on 26 March, and I look forward to receiving the views of the committee and Members on our revised scheme. 

Work is also under way on recommendation 8. We will develop a national awareness-raising strategy in partnership with key stakeholders. A number of Members, and the Chair certainly, mentioned a lack of awareness amongst people of children's rights. We are fully committed to fulfilling the legislative requirements of all impact assessments, including where these relate to the assessment of our financial decisions, as set out in recommendation 6. 

Recommendation 9 has been accepted, as developing an awareness of human rights will be a mandatory part of the curriculum for Wales. The Welsh Government is currently preparing our strategic response to the UN Committee on the Rights of the Child's 2016 concluding observations, which is recommendation 13. In addition, we are preparing a response to the UK Government on recommendation 11, and I intend to publish both updates before the end of the Senedd term. We've also accepted recommendation 14, and we will provide an update on progress on an annual basis. 

Recommendation 3, to provide training to Ministers, has been accepted in principle, and I absolutely accept that this is the right thing to do, because many Ministers would not have been around when this Measure went through. I think Helen Mary Jones referred to the historical knowledge of the history of this legislation. So, we are developing a training approach for bringing in training for Ministers.

That leaves the four recommendations that we've not been able to accept. That's recommendations 2, 7, 15 and 16. Recommendation 2 is about having a specific Minister. The due-regard duty under section 1 of the Rights of Children and Young Persons (Wales) Measure 2011 makes it clear that this duty is placed upon all Welsh Ministers when exercising any of their functions. In addition to this, we already have a Minister responsible for the specific work that Welsh Government does in promoting children's rights, and I'm that Minister. But I do think it's absolutely right that we don't confine the work on children's rights to one particular Minister. I think the due regard duty does make it clear that it's all Ministers that must accept this responsibility for children and for children's rights. So, that's why that is being rejected.

Recommendation 7: we welcome the committee's views, however, our position is still that we believe that taking an integrated approach to impact assessments of the draft budget through the strategic integrated impact assessment better reflects our responsibility to consider our decisions in the round, through a number of lenses, to understand their impact, including consideration of children's rights. But I do intend to have further discussions about that with the Trefnydd.

Recommendation 15: in January 2020, Welsh Government commissioned a research consortium led by Swansea University to undertake research into strengthening and advancing equality and human rights in Wales. And the final report, including the main findings and recommendations, will be submitted to the Welsh Government by the end of February 2021. So, we need to wait for the outcomes of this research before we make any further decisions about recommendation 15.

Recommendation 16: I understand the views of the committee and the commissioner on this topic. However, on balance, I believe that the current arrangement for all the commissioners—because obviously, this wouldn't just include the children's commissioner—which include a cross-party appointment panel of Senedd Members for appointments, it is working well, and we don't really see the need to change the arrangement, and in addition, any change in appointment and accountability arrangements relating to the Children's Commissioner for Wales will require primary legislation, and there's no legislation time available in this Senedd term, so that's a practical reason why we can't do it, but on balance, I believe it is working well.

So, that's a quick run-through of the recommendations, and I'd like to thank very much Laura Anne's view and Helen Mary's contribution, and to thank the Chair for leading the committee to make such good, clear, practical recommendations, which is certainly urging us to do all we can to promote this area of children's work. The Chair said at the beginning of her remarks that never have children's rights been so important as in this pandemic, and I would just like to end, really, by saying how I absolutely agree with that comment. Certainly, in deciding the measures to take in the pandemic, children's rights have been right up at the top of the list for the Government. We also have been able to work with the children's commissioner and other partners to have what I'm told by UNICEF is the only Government of any country that has produced the extensive children's questionnaire that we produced that reached 24,000 children. So, I do think that producing that does show our commitment to children's rights. And also, I'd like to draw the Senedd's attention to the fact of the number of meetings that have been held directly with children during this period. Certainly, I've held a number of meetings; I know that the First Minister has consulted children during this period, and I know that the committee has been very involved in consulting children. So, thank you very much to the committee for this report, and I look forward to furthering its recommendations.

Can I now call Lynne Neagle to reply to the debate?

Thank you, Deputy Presiding Officer, and thank you to everybody who has contributed to the debate. I'll try and pick up on some of the points that have been made. Can I thank Laura Jones for her contribution and for her kind words about the committee that she made? I think it was very valuable that Laura highlighted what the committee had said about the importance of having a dedicated ministerial role for children, and notwithstanding what we've just heard from the Minister, that remains the committee's position on this, as I think the committee has seen that it is difficult sometimes to get a cross-cutting approach to children without having a kind of structure in place, as we did have when there was a children's Cabinet sub-committee. So, we are very keen that some structures are put in place and I hope that we can continue further discussions on that. 

As Laura said, the complaints mechanism is vitally important, and that was echoed by Helen Mary Jones, who said that rights are meaningless unless you've got a form of redress, and that is absolutely right. That's why we think this needs to be taken forward as a matter of urgency, so that we can ensure that children and young people are able to enact their rights.

I'd like to thank Helen Mary Jones for her contribution. I know that Helen Mary has had a very long-standing commitment in the area of children's rights. I think it was really valuable that she reminded us of the genesis, really, of the very first children's commissioner, which was in that really sobering Waterhouse report. I think it is crucial that we remember that these are not additional extras, these rights—these are absolutely about safeguarding children and young people. 

Thank you for your focus on the child rights impact assessments, and the committee will be continuing to pursue those. We do feel also, like you, that strategic impact assessments are not good enough, and we've been having that ongoing dialogue with the Welsh Government about the need for a separate child rights impact assessment on the budget. Because it's vital that we remember that children are a unique group, and they don't have a vote, and therefore they don't have the same voice as other groups in society, so it is incumbent on us to make sure that those crucial decisions absolutely take into account their needs. 

Helen Mary also echoed the point about training, and I know that that has been accepted in principle, the recommendation on training. I do hope that that can be taken forward. I know that everybody is busy, but it is absolutely crucial that everybody in Welsh Government has a clear understanding of what the expectations are under the children's rights Measure. 

Thank you, Helen Mary, for your support on the need for all public bodies to be placed under a due-regard duty. I hope that that is something that we can continue to have further discussion with the Welsh Government about, and I just wanted to say that one of the most powerful evidence sessions we had during the inquiry was with the Noah's Ark Children's Hospital, who came and told us how the lack of CRIAs, child rights impact assessments, on research spending in Wales was having a really huge impact on their work, and that we weren't seeing the research that we should be seeing in children's health, and that actually—as a very concrete example—children were having to be sent to London for certain types of cancer treatment because that research wasn't taking place in Wales. So, I think we should never forget that these are not abstract ideas, they're actual concrete things that impact on children and young people's lives. 

I agree entirely in relation to the children's commissioner's role. I note the Welsh Government's continued response on that, and obviously the lack of time now for primary legislation. But I do hope that that is something that will be considered in the next Senedd, because it is an absolute no-brainer, in my view. The children's commissioner's post as it is at the moment was established when the Assembly was a very different body, when we had no separation of powers, and it is now, I think, right to move to a much more robust model that ensures complete freedom for the children's commissioner. 

Can I thank the Deputy Minister for her response and for her continued and ongoing engagement with the committee, and what I know is a very heartfelt, personal commitment to children's rights? I welcome what you've said about having a continued dialogue on some of the issues where you weren't able to fully accept the recommendations, and the committee very much looks forward to having that dialogue with you, and feeding in to the new children's rights scheme.

And I'd just like to close by thanking again everybody who responded to the committee's inquiry, all the staff in the committee team that, as always, have worked so hard, but the final thanks, I think, have to go to the children and young people who fed into the inquiry, who took their time to tell us what children's rights mean to them. And it is a duty on us now to make sure that we press forward and continue to make those rights an absolute reality. Diolch yn fawr.

Thank you. The proposal is to note the committee's report. Does any Member object? I don't see an objection, therefore under Standing Order 12.36 the committee's report is agreed.

We now move on to the Independent Alliance for Reform group debate: future measures to prevent and tackle the spread of COVID-19, and I call on David Rowlands to move the motion. David Rowlands.

Diolch, Dirprwy Lywydd. I'd like to begin my contribution to this debate by restating my continuing thanks to all those in our NHS and other essential services, who are working so hard during these critical times. I also preface my contribution by apologising for the plethora of statistics contained in it, but statistics are being used to enforce the lockdown, so these statistics must be scrutinised and challenged. 

What amazes me is the current restrictions are the inevitable reaction of the Welsh Government to those enacted by the UK Government, yet Plaid Cymru has been complicit in the lockdowns, never questioning the UK Government-led policies, never once questioning the figures upon which these policies are based. Welsh Conservatives are, of course, working with hands tied because they cannot criticise the UK Government policy. So, both these parties confine their criticism to an unfortunate comment by the First Minister about the instant vaccines plan, quite understandable given the pressure he's under, and the slightly tardy roll-out of vaccines in Wales, which I believe the Welsh Government is rapidly correcting. It appears it is left to my group and some independents to be two oppositions to the lockdown strategy.

Contrary to the assertions of the First Minister in previous debates, I and my group do acknowledge that COVID-19 is a dangerous disease. What we contend is that this is no more dangerous than any other COVID infection, and let me explain here that COVID is a generic term for many infections of the respiratory tract, common flu being one of them, as was the SARS virus in 2003, which, incidentally, had a death rate of one in 10. What we therefore contend is that the measures undertaken for each—[Inaudible.]—COVID-19 are wholly disproportionate to the danger it represents to 99.9 per cent of the population. The rate of infection is cited as the reason for the draconian measures the population is being subjected to, but the testing regime used to detect infections, the polymerase chain reaction test, is increasingly being challenged as a suitable or even reliable tool. Indeed, there are a number of lawsuits being initiated around the world challenging the legality of lockdowns based on these tests.

Can I now turn to the accuracy of the deaths from COVID statistics, which, of course, lie at the core of the lockdown measures to which we are being subjected? And if true figures were depicted, this virus would be seen to be little or no more dangerous than other infectious diseases that are prevalent in the population every year. I repeat again, the Office for National Statistics figure for deaths from infectious diseases in 2018 was 92,000, a figure all UK Governments choose to ignore. However, if we do accept the figure's been promulgated, we are told there have been 90,000 deaths from COVID-19 and 3.6 million have tested positive for the disease. This means that even by these exaggerated statistics, we have a death rate of just 2.5 per cent. However, recent expert estimates say that at least one in eight of the population have or have had coronavirus. In a population of 68 million, that is double those tested positive to date, so the death rate can be calculated at just over 1 per cent.

However, if we look further into the statistics, this figure of 90,000 does not make the distinction for deaths where the underlying cause was COVID, and where there is a mere mention of COVID on the death certificate. We can therefore extrapolate the real deaths as a direct result of COVID from these figures is likely to be around 60,000, which means the actual IFR—infection fatality ratio—less than 1 per cent. This figure is in accord with scientists at Imperial College London and echoed by many other eminent institutions around the world, who estimate IFR for COVID-19 to be just 0.66 per cent. The broader picture shows total figures for deaths in England and Wales in 2020 was 538,000. The figure for 2019 was 599,000 and the figure for 2018 not much lower than 2020. These figures raise the fundamental question: are we being faced by a deadly pandemic compared to other years? And the answer is patently 'no'. In addition, the vast majority of the deaths from COVID are in people over 75 years of age. Against this, the UK Government itself has estimated that, over the coming years, at least 200,000 people will die as a direct result of lockdowns, many of whom will be much younger than 75. What these figures—again, all based on Office for National Statistics figures—show is that there is no real pandemic and that the undue harm lockdowns are having on both business and people's overall health is totally disproportionate to the threat of COVID-19. Thank you, Dirprwy Lywydd.

Thank you. I have selected four amendments to the motion. In accordance with Standing Order 12.23, amendment 5 has not been selected. If amendment 1 is agreed, amendment 2 will be deselected. I call on Russell George to move amendment 1, tabled in the name of Darren Millar. Russell.

Thank you, Deputy Presiding Officer. I move the amendment in the name of my colleague Darren Millar. I'd like to thank the IAR group for the debate today. The motion is very wide ranging, but I'm going to focus my comments on support for businesses and the economy. I think, to do that, I'm going to put some context here in terms of the support that the UK Government has already provided to the Welsh Government—that is, £5.2 billion extra as a result of consequentials by the UK Government to England. That's led to £5.2 billion for Wales to protect lives and livelihoods, and that's on top of £1.4 billion already as an additional budget, and £1.3 billion for next year as well. I think it should be agreed that that's an unprecedented level of support by any UK Government to Wales, and, of course, this is to protect lives and livelihoods here in Wales. What I would say is that the Welsh Government do need to do much more to ensure that financial support is allocated quickly and when needed to businesses. 

This morning, in the Economy, Infrastructure and Skills Committee, there was some discussion about the unspent £1 billion, so I asked the obvious question of the economy Minister: 'Have you asked the finance Minister here in Wales for additional business support?' The answer was, 'Well, we have to effectively put a cap on what we're asking for, because we haven't got the capacity to design schemes in time to get that money out before the end of the financial year.' This surely can't be right. I thank the civil servants who are working on business support, and thank all the staff within Business Wales. They need to be further supported. There does clearly need to be some change within Welsh Government to ensure that there's the right capacity to be able to get money out to businesses as quickly as possible. Of course, delays to that financial support sadly mean that businesses will close. Any business that was viable in 2019 should certainly be viable and be supported to be so in 2021.

Now, our amendment calls on the Welsh Government to allocate funding quickly and on a rolling basis—that's really important here—on a rolling basis, because we have got the ongoing lockdown restrictions, and when restrictions are introduced, in order to properly support businesses. Businesses also need to be prioritised as well. We need to have money allocated based on need, rather than on a first come, first served basis. I support, and I would of course highlight my own scheme, in terms of the Welsh Conservative scheme, in terms of the COVID recovery fund, which we would promote to ensure that money gets out to businesses and communities that have been most adversely affected by the pandemic. I would like to say a lot more, but I'm aware that my time has gone, Deputy Presiding Officer.

Thank you. I call on the Minister for Health and Social Services to formally move amendment 2, tabled in the name of Rebecca Evans. Minister.

Formally move, Deputy Presiding Officer.

Thank you. I call on Mark Reckless to move amendments 3 and 4, tabled in his name and that of Gareth Bennett. Mark Reckless.

Diolch, Dirprwy Lywydd. I move amendments 3 and 4 formally. 

May I congratulate the Independent Alliance for Reform group on securing this debate? May I also thank them for pushing it forward a week from last week, which gave me the opportunity to have my short debate on constitutional developments in Wales in prime time, for which I'm grateful? I'd also like to say that we're supportive of their motion. Others may find reasons not to support it, or vote against so they can vote for their own amendments, but, notwithstanding our later amendments, we support the motion, so we will be voting for it.

I had thought that in our amendments we might add a favourable reference to motherhood and apple pie as point 5, because I think the motion, as is, is uncontroversial and I think we can all pretty much agree with its content. The introductory speech from David Rowlands, though—there were significant parts of that that I really didn't agree with. Firstly, I think the idea that it's not a real pandemic, I just don't—. I think that's wrong, and, if you look at the excess deaths for the past year, they're very significant—in the 100,000 region. And if you compare back to the past five years, as is normally done, they are really quite significant—perhaps a sixth or so higher than they usually would be. I don't know about other—. Coronavirus has clearly—. SARS had a high death rate and a higher one than this does and I accept that the death rate on this is not up to that level, but it's clearly a lot worse than the common cold, which is a coronavirus, and, in my view, at least, significantly worse than we usually see with flu. So, to that extent, I have supported restrictions where it's about flattening the curve, and I was against the failed suppression strategy, particularly when Welsh Government was keeping stuff locked down for longer, through into the summer. But, overall, I support the concept of flattening the curve to protect the NHS and keep to capacity and be able to deal with the situation. And yes, there are issues in terms of capacity and beds, but also it's very much staffing that I put the focus on, rather than the beds.

Similarly, I think, the issue with the PCR test. I think, when rates were lower, yes, the false positives on PCR were perhaps an issue worthy of an investigation, but I think when prevalence is anywhere near as high as it now is—that becomes now a much smaller issue, when many, many more people are positive. So, I can see why we might have talked about that some months back, but I just don't see it as a material issue in assessing the overall problem now.

Overall, I just think the problem with what Welsh Government has done and why we say we want a UK approach is firstly in terms of communication, because I think it's much clearer if people have a consistent approach, and I think compliance with restrictions would have been higher if that were the case. Secondly, I think there have been issues—I mentioned the failed suppression strategy through the summer, but, even more, I think, when we had the two-week firebreak in Wales and then that was lifted, with quite a lot of self-satisfaction, I think, from Welsh Government about how they'd done it so much better than in England. Yet then they lifted the internal travel restrictions and, at the time, I criticised them for having this border with England. Their key thing—enforce a border with England and everything will be okay—was actually allowing people from Merthyr in my constituency to travel to Monmouth, from high-infection to low-infection, yet blocking travel between Monmouth and Ross-on-Wye. It made no sense, and we then saw Wales have, I think, virtually the highest prevalence in the world coming out of that period. So, I think we'd have been much, much better with a UK-wide policy, a single national health service tackling COVID across the United Kingdom, with people coming together. Now we've got the vaccination on stream, there's not long to go. Get on with that vaccination in Wales. Let's lift these restrictions as soon as possible and look forward to the rest of our lives. Thank you.

Thank you. Can I call the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer. I'd like to thank most Members for their contributions to today's debate. I think that's only really one and a half, perhaps. I didn't agree with much of the fake news and reality denial and what I thought was a highly irresponsible opening from David Rowlands. When we talk about 'the pandemic', it is very real. We have 16 per cent excess deaths in Wales, compared to the previous five years. It's even worse in England—nearly 20 per cent of excess deaths. We have the highest excess death rates across the UK since the second world war. You cannot underplay the crisis we are facing, the harm that is being done, and claim to be responsible. The pandemic has affected all of our lives in so many ways. It is primarily, of course, a public health crisis and, to many, a personal tragedy. I'm afraid that David Rowlands's opening underplays the reality of that tragedy for thousands of families here in Wales.

But there are also consequences for our economy, society and communities, and those consequences are profound. In spite of all of these challenges, we have in so many instances seen the best of our people: individuals offering to help one another, organisations uniting to work rapidly in partnership to respond to the challenges of the pandemic. Communities have come together, and we've seen unprecedented numbers of volunteers stepping forward to support those who need help. Obviously, there have been a number of Welsh Government interventions, doing our part to help support our people through the pandemic.

Turning to a number of points in the motion, we of course recognise the impact of the virus on the continuity and quality of learning. We've always been clear that supporting education is a key priority for this Government. We have made and continue to make significant investment in connectivity, technology and learning resources, as well as additional staff, to help address the loss of opportunity to learn.

We acted swiftly and decisively to help protect Welsh businesses. We have the most generous package of support for business anywhere in the UK; it's worth over £2 billion since the start of the pandemic, and £1.7 billion of that resource is already in businesses' accounts. We'll continue to do all we can to support Welsh businesses through these incredibly difficult times.

As we continue to have interventions in place to support people, we're of course working hard on the levers that will help us to emerge. So, we're making real progress in the roll-out of the vaccination programme. Nearly 176,000 people have had their first dose, with thousands more being vaccinated every day. Subject to supply, we remain on course to complete the first four priority groups by the middle of February.

Our investment in test, trace, protect—this will go well beyond this Senedd term, but it has already been highly successful, with more than 2 million tests authorised for Welsh residents. Despite the surge in cases, our contact-tracing performance remains high, significantly better than our colleagues' across the border in England. Ninety-eight per cent of all cases have been reached and asked to provide their contact details since we started in June; 92 per cent of their close contacts have all been reached.

We're working with critical care services here in Wales, and I recognise the immense pressures they have been under and remain under as we speak. We've invested recurrent funding of £15 million since 2019-20 to act to strengthen aspects of critical care and to help redesign the way those services are delivered. That will need to continue in the future.

So, this Government will continue to take all necessary measures to protect lives and prevent the spread of COVID. That is why Wales is at alert level 4 and will remain at alert level 4 until we can be confident that infection rates are under control and our NHS is not at risk of being overwhelmed.

The new virus strains, though, add a new and dangerous dimension to the pandemic, increasing the risk of people catching or spreading the virus whenever they're in close contact with each other. That is why we are in a 'stay at home' period of time, not 'stay local'. The requirement of the law is to stay at home unless you have essential reasons or permitted reasons to leave the home.

The next scheduled review of our regulations is 29 January. If things over the next two weeks continue to head in the right direction, the Cabinet will then have to decide if there is any headroom to begin the process of easing restrictions. However, as I said earlier today, no-one should expect any significant easing of restrictions at the end of this month. We have to be certain that an improvement is reliable and sustainable for us to begin the journey of lifting the restrictions and not causing more harm by leaving too soon. I ask Members to support amendment 2, and I look forward to the outcome of today's debate and the votes to follow.

Thank you. I've had notification that Rhun ap Iorwerth needed to speak, and I'm sorry, it wasn't on the list, so I understand you're going to do an intervention. Rhun. 

Thank you very much, Deputy Presiding Officer. I wasn't expecting this. I'd given up on the hope of contributing. I wasn't going to speak for too long in any case, but I just wanted to say that we will be voting against this motion. I had thought that it was mostly a problem with the tone of the motion, but having listened to David Rowlands, there's clearly a deeper problem than that and we have a party of COVID deniers here in the Senedd, and I was very disappointed, I have to say, to hear that. And any party asking for a guarantee that there won't be another lockdown, although, of course, I hope that there won't be, clearly hasn't been actually taking note of the course of the pandemic over the past 12 months. There are no guarantees with this pandemic, much as we would like to have those guarantees.

We will be voting against the Conservative amendment. I don't see funding provided by the UK Government to Wales as an act of altruism; I see the UK Government doing what they have to do under the rules of this union. And in terms of amendments 3 and 4, what we have here is a group of Senedd Members who have as little respect for the people of Wales that they want the people of Wales to have as little influence over their own future as possible. And in terms of the Government amendment: a series of statements, neither here nor there. We will abstain on that. Thank you, Deputy Presiding Officer.

Thank you. I now call on David Rowlands to reply to the debate. David.

Well, can I thank everyone who has contributed to this debate? But, as usual, of course, the true facts and the figures have been ignored, especially by the health Minister. I have put the facts and the figures, and they are incontrovertible.

The lockdown's a result of the UK Government's total mishandling of the COVID-19 threat. In 2003, SARS, a far more deadly and dangerous disease, was stopped in its tracks by an immediate ban on people coming into the UK from infected areas and isolating those infected. Only now, at the eleventh hour, are we seeing those restrictions being put in place—a classic case of closing the gate after the horse has bolted.

However, what the mishandling did was to expose the inherent weaknesses in the NHS across all UK nations. Despite billions being poured into the service, year on year, COVID-19 has exposed a total inadequacy of critical care beds and facilities. As long ago as 2000, and again in 2007, reports expressed concern at a totally inadequate number of such beds in Wales. Given that we now see our NHS overwhelmed by just 200 plus critical patients in the whole of Wales, it is obvious that the shortfall identified in 2000 and 2007 has not been addressed. There are similar damning figures for England.

So, one has to ask: are the lockdowns simply measures put in place to disguise the failures of both Governments to address these issues? One also must ask: given that the spike in coronavirus victims in these winter months has been predicted ever since the lockdown in March, why was nothing done in the intervening months to accommodate such a rise? Every death is not a statistic, it is a tragedy for all those who loved or cared for the deceased. But, unfortunately, death is part of life. Current COVID restrictions have much more potential to cost lives than to save them.

Llywydd, I will begin my finishing remarks by pointing out the untold damage that lockdowns are having on both the economy and health of the nation, especially with regard to mental well-being, as witnessed by the sharp rise in suicides. All this points to the fact that these draconian lockdown measures must end as soon as possible.

My last comments are to urge everyone to obey lockdown rules in their entirety until such time that they are lifted, and to be vaccinated as soon as it is offered. It really is the only way that we shall see an end to lockdowns. The postmortem on Welsh and UK Government actions will come later. Thank you.

Thank you. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I see objections, therefore we'll defer voting under this item until voting time. 

In accordance with Standing Order 12.18, I suspend the meeting before proceeding to voting time. So, the meeting stands suspended.

And that brings us to voting time, the vote on the Independence Alliance for Reform group debate on future measures to prevent and tackle the spread of COVID-19. I call for a vote on the motion, tabled in the name of Caroline Jones. Open the vote. Close the vote. In favour four, no abstentions, 37 against, and therefore the motion is not agreed.

The next vote is on amendment 1. If amendment 1 is agreed, amendment 2 will be deselected. I call for a vote on amendment 1, tabled in the name of Darren Millar. Open the vote. Close the vote. In favour 10, no abstentions and 32 against, and therefore amendment 1 is not agreed.

Amendment 2 is next, and it was tabled in the name of Rebecca Evans. Open the vote. Close the vote. In favour 23, six abstentions and 13 against, therefore amendment 2 is agreed.

Amendment 3 is next, the amendment in the name of Mark Reckless. Open the vote. Close the vote. In favour two, eight abstentions, 32 against, and therefore the amendment is not agreed.

Amendment 4 is next, again tabled in the name of Mark Reckless. Open the vote. Close the vote. In favour two, nine abstentions and 31 against. Therefore, amendment 4 is not agreed.

The next vote is on the motion as amended. I call for a vote on the motion as amended.

Open the vote. Close the vote. In favour 25, eight abstentions, and nine against, and therefore the motion as amended is agreed.

That concludes voting time for today.

We have one item of business remaining, which is the short debate, and I call on Jayne Bryant to speak to the topic that she has chosen. Jayne Bryant. 

Diolch, Llywydd. I've agreed to give a minute of my time today to Jack Sargeant. 

It's nearly 11 months since the first COVID patient was identified here in Wales. Since then, in a year like no other, our NHS and social care workforce have strived to do all they can to keep us safe. They have faced unimaginable challenges and pressures, and for many, those stresses have been taking their toll on them personally and on their families. I wanted to use my time today to bring their experiences of this pandemic into the Senedd Chamber. We have a duty to understand the reality of the situation that our laws create, and the impact that it's having on the health and well-being of those who are doing all they can to look after us. Many of our NHS front-line staff have, after finishing their shifts, used their position to let many of us know what their experiences are, challenging misinformation and perceptions. Hearing from those on the front line is essential.

Two of those who've done so much are intensive therapy unit consultant Dr Ami Jones and theatre operator Glenn Dene. They have recently published a photo book, Behind the Mask: The NHS Family and the Fight with COVID-19. All proceeds are going to NHS charities. Many of you will have seen the images taken by Glenn in the news recently. The book details the heartbreaking reality inside Nevill Hall and the Grange University Hospital, capturing the light and the dark, both the harrowing struggle and the glimmers of hope, showing us the real truth and tragedy of this crisis. Some photographs show moments of positivity, such as staff tenderly supporting each other through difficult moments and babies being born. But more harrowing images include COVID patients on ventilators and a body on a mortuary trolley. I had hoped to be able to show the photos while I spoke this evening, but we're unfortunately unable to do this. I will, however, show some of them via my social media. In her own words, Dr Ami Jones states:

'This is probably one of the worst—and also best—times in the history of the NHS. The way that teams have come together to adapt and overcome is very positive—but it's clearly a dark time in the NHS. So sadness and happiness when you look back at the photos, really.'

Back in the spring last year, the arrival of COVID-19 saw many processes done in the NHS that would normally have taken years to implement undertaken in weeks. This is the same for staff. They have adjusted, trained and taken on new responsibilities. They have risen without question to the challenges COVID has brought. New starters have had 10 years' experience in six months. Dr Ami Jones describes the start of the pandemic response like this:

'The hospital moved swiftly. Wards were reorganised and spaces identified that could be turned into new ITUs. The hospital was divided into an area where COVID patients could be treated and areas where other patients would continue to receive medical care. Despite elective operations and routine clinical appointments being cancelled and COVID seeming to be all-encompassing, people were still going to need emergency surgery, and women still had babies to deliver. What was odd about most of these patients was that they were so young and fit compared to our usual ITU population, but we soon learned that no-one is really safe from COVID.

'Patients were quite rightly scared at the thought of going onto a ventilator, and we've always tried to make time for the patient to ring or video call home and speak to loved ones before we took them to ITU. Sadly, we know that approximately 50 per cent of patients entering ITU due to COVID won't leave again, so a precious few moments for the patient to speak to or even maybe see their families was vital, if possible. Without relatives being allowed into the hospital, having to do this over the phone is heartbreaking, and probably the cruellest twist of all. But the patient will not die alone. The nurses will always be there, holding their hands and talking to them until the end.

'The nurses have probably had the toughest time throughout this pandemic. Or, more correctly, the healthcare professionals doing the usual jobs of ITU nurses. For even if we can find more bed space, buy more ventilators, more drug pumps, we still can't buy more of the thing that sick ITU patients need the most, an ITU nurse. We have had to adapt and overcome to fill the potential gap in numbers if the surge happens. We asked our ITU staff who had left for other jobs to come back. We asked nurses who have never worked in ITU but had transferrable skills to come and help us. We asked theatre assistants and healthcare assistants from the wards to come and help us, and no-one refused; everyone wanted to help, even though they probably felt like they were putting themselves on the front line. They were the nurses who spent time speaking to the relatives over the phone or a video call, showing them their loved one asleep on a breathing machine, and holding a patient's hand if the worst happened. Sometimes these shifts broke them emotionally, sometimes the gruelling hours in PPE broke them physically, but they never lost their humour, their morale, or their professionalism.'

Other extracts and quotes from the book include Ian Brooks, operating department practitioner. Ian said, 'Thirty-one years ago, I started working in theatre. The virus is indiscriminate, ruthless and silent. The fear I felt every day was like a death sentence. I sat with my 21-year-old daughter one morning, and she asked how I was doing. I burst into tears and I just didn't know why.'

Louise, ITU nurse, 'A feeling of responsibility I've never faced before; holding a patient's hand and willing them to live for the sake of their poor family who can't be with them will live for ever with me.'

Andrew Edwards, theatre assistant, 'Nothing could prepare me for COVID. Walking into ITU was like walking into a horror movie, only this was very real. There were wires, pumps, flashing lights and alarms going off everywhere, but everyone kept their cool. It made me feel safe in the knowledge that the ITU staff had my back and we were in this together.'

Jessica Scurr, operating department practitioner, 'In my role, it's a real privilege to be there for the patients in the moments that they need us the most. We utilise our years of training and our specialised skills to provide the support they need, and do everything in our power to keep them safe and well. However, during this unique time, I've felt a compassion and empathy completely incomparable to anything I've every felt before. I try to channel those overwhelming emotions into being as kind and comforting as possible. I make sure patients have a hand to hold, I listen to what they have to say, and I hope my eyes show it. I hope they know I'm smiling behind my mask. In the darkest of moments, light has been found in encouragement and support of all my work colleagues. They have been shoulders to cry on and a reason to smile. We hold each other up through the highs and the lows, and it's a true honour to work alongside such incredible people.'

These were the experiences of the first wave in the spring. Sadly, we know that the winter has been harder. Rates are much higher than at any other point during the pandemic, and more people have died. ITU is seeing much sicker patients in this second wave, and they're seeing people in their thirties, forties and fifties. The staff continue to be incredible, but many will have not recovered from the spring. Many have been isolated from their own families to keep them safe, many are facing horrendous shifts after horrendous shifts, and tragically, many colleagues have been lost. Even if they're trained and experienced, they will not mentally and physically be prepared to go through this. Experienced staff from cleaners, porters, consultants and nurses have never seen anything like this over a sustained period of time. They're all tired and many of them have got what they've coined 'COVID fatigue'.

Sadly, it isn't just in our hospitals that staff are struggling. Our paramedics and ambulance service have been under immense pressure and they tragically lost their second member of staff to COVID on New Year's Day. The chief executive of the ambulance service trust Jason Killens has stated that at one point in December, 12 per cent of the service staff were either sick or having to self-isolate because of COVID. They've been under its highest level of alert, described as extreme pressure, since early December. This means that the staff have faced increased pressure through the normal volume of calls and workload, and then having COVID on top of that. Dr Catherine Goodwin, who is a consultant clinical psychologist, has told me, 'I think the biggest message we're hearing from staff at the moment is fear; fear for themselves, their families, and our patients, and the uncertainty that comes with the unknown.'

I believe that some staff are genuinely scared to go to work. Moral injury is certainly a risk and not being able to respond as quickly as they would like to patients or to hand over patients to hospital staff is having a toll on both our crews and call handlers and dispatchers. They feel that they're not doing their job. The increases in staff who are having to self-isolate or unwell or with long COVID, as well as stress-related difficulties, means it's increasing pressure on staff who are in work. I suspect we'll see an increase in mental ill health and physical difficulties once the pressures ease as people start to feel they're able to consider and even notice themselves, rather than keep going just to ensure the service can keep going.

We're also seeing frustration, confusion and sadness when witnessing some of the scenes that the media report of people at large gatherings or not socially distancing after the first lockdown ended, and then, more recently, as many people appear to continue to mix. And sadness that they're not able to take relatives with poorly patients as they would in the past. This is what every member of staff I've spoken to over these past months tells me: the emotional impact on them is immense. One paramedic described the pressure he and his colleagues were under. He said that at one point an incident caused him to question whether he wanted to continue working. He said, 'During the peak of the pandemic last year, I was assaulted by a member of the public when I was spat on in the face, and that's really the only time that I've stopped and gone, "Is this for me?" However, the vast majority of the public', he said, 'have been absolutely fantastic', adding, 'we've had people waving at us and buying us coffee.'

Our social care staff have also been operating under the toughest of conditions. They've seen the people they care for day in, day out pass away in devastating numbers, and without the time to grieve. The impact on them has been huge. They have strived to do their work in the most difficult of times. The fragility of the service and the pressure on staffing has been starker than ever. We've seen numerous examples of whole care homes isolating themselves like islands, separating themselves from family for weeks to protect the residents. The impact on all those in our care family—from carers to cleaners to cooks—must not be forgotten.

We've also seen front-line NHS staff speak about the reality of fighting the pandemic. Respected consultants in Aneurin Bevan health board, such as Ami Jones, David Hepburn and Tim Rogerson, have all voiced their experience and described the pressure they and their colleagues are facing day in, day out. The way that some people have chosen to abuse those people who have simply tried to tell the truth is shocking and deplorable. It deflates the staff who've come off their shift exhausted only to be treated with so little respect. Although these voices are small, the majority of us must do all we can to make sure they're heard and supported. Our front-line staff did not sign up for this, and they deserve so much better.

The COVID pandemic has underlined the challenges that the health and social care workforce face, particular those who are on the front line. Across the system, we have seen first-hand the incredible sacrifices so many have made to protect, help and support the vulnerable, not just on hospital wards, but also in the community. The full impact of this is still unknown, however recent research in England showed that nearly half of intensive care staff reported symptoms of post-traumatic stress disorder, severe depression or anxiety. Having a healthy, motivated and supported workforce is in all of our interests, but as we enter the eleventh month of COVID pressures, the NHS is facing one of the most difficult times in its history. Staff across the system are feeling exhausted and fatigued.

The impact of this will be felt by those on the front line for many years to come. It's likely to leave a legacy of long-term COVID-induced mental health issues, and people questioning whether they still want to or are able to stay in the job because of burnout. I know many of those services already have support in place, such as occupational health and well-being services who are able to listen, run drop-in sessions, workshops and signpost to additional help. However, more must be done, and more support must be given by the Government, and the recognition must come with more than warm words and our gratitude. They deserve that. All our health and social care staff have gone into work day in, day out, and worked tirelessly, caring for our loved ones with little respite from this virus. We must do all we can to support them to ensure we look after those who continue to look after us. Extensive support must be put in place to help them both now and in years to come, and as has been said many times, not all heroes wear capes, but we know where many of them work. Diolch.

Can I start by commending our colleague Jayne Bryant for bringing this topic to the Senedd? I think the way she has just delivered her speech today clearly shows the importance of this issue, and we say 'thanks' to our wonderful NHS staff and care workers.

It is impossible to say when and how post-traumatic stress disorder hits, but when it does, it can be debilitating and devastating. I say this from my own personal experience and struggles. At the moment, our NHS and social care staff and volunteers are being stretched beyond what we could reasonably expect from them, and even what we could possibly imagine. But they carry on, and they carry on for the sake of the nation.

Anxiety, tiredness and perhaps even a sense of hopelessness could be a real issue, but the future could hold an even greater risk as trauma-inflicted side effects could happen at any time. Now, this should not take the Government by surprise, and we should be planning for it now. Significant support will be needed as these mental health problems are predictable and will impact on everyone.

Deputy Llywydd, I'll finish in the words of Jayne Bryant: not all heroes wear capes, but we do know where they work, and we as Governments and as individuals need to support the heroes that have supported us and continue to support us. Thank you.

Thank you. I call the Minister for Mental Health, Well-being and Welsh Language to reply to the debate, Eluned Morgan.

Thanks very much, and I'd like to thank Jayne Bryant for giving us this opportunity to have this very crucial and timely debate. I think we've all seen the images of staff and hospital wards that can leave us in absolutely no doubt that the health and social care workforce will be changed by the experiences that they've been through, and I'd like to thank Jayne in particular for painting those very vivid images for us this evening, really demonstrating the very moving and difficult circumstances that NHS staff find themselves in. I also thank Jack, who always has demonstrated real sensitivity and understanding on this issue.

I'm sure I speak on behalf of all Senedd Members when I pay tribute to the unyielding hard work and the dedication of the incredible health and social care workforce. They are the life force of the service in peacetime, but especially now in our battle with this terrible, unforgiving virus. As Jayne illustrated, the last 11 months have been absolutely relentless for them. The pandemic continues to have a significant impact on patients and staff, and I fully recognise the extra physical and emotional demands that this places on the workforce. Many health and social care staff working on Wales's front line have spoken both online and to the media about their experiences of delivering care from the centre of the response to the virus. And I think their stories are a stark reminder of the gruelling reality of the daily fight to manage the virus, to care for our patients and to keep our people safe.

Now, we take the health and well-being of our health and social care workforce extremely seriously, and support employers to provide a range of extra support during this pandemic. Since March of last year, the Welsh Government has made a number of significant financial investments for mental health support for our health and social care workforce. The Welsh Government has built on its well-established social partnership mechanisms to work closely with the NHS, employers and health and social care unions to make available a multi-layered well-being offer for health and social care workers, because I think we have to recognise that individuals will be affected differently by the pandemic, and they might want different levels of intensity and styles of intervention, which is why the offer we've developed must include a lighter-touch listening service, as well as that in-depth therapy and even physical health service that some may need, on top of the practical and financial advice that some may need. 

There are a number of apps available free of charge that provide support and guidance in dealing with anxiety, improving sleep and meditation processes to help people to clear their minds. We've extended the SilverCloud provision, which is an online service, so that all health and social care workers in all parts of Wales can access a variety of programmes provided at any given time, wherever they may be. And these programmes are based on cognitive behavioural therapy, CBT, which can provide people with the skills to manage their own psychological well-being, to be more confident. 

To recognise the extensive strain and trauma that NHS staff have faced, more than £1 million in addition was invested by the Welsh Government in April to extend the healthcare service for health professionals in Wales. This service was available already to those working in medicine and dentistry in Wales, but there is now more provision available because of this additional funding. The service now provides an even better level of support and advice to all health professionals, including doctors, nurses, healthcare students, paramedics, pharmacists, therapists, dentists and medical volunteers working in Wales. By now, the service is also offered to administrative and clerical staff who are also facing great stresses. 

The aim of the service is to provide support for those with acute symptoms—individuals who feel that they can no longer cope, who are anxious or are having difficulty in managing the various challenges posed by the pandemic, individuals who are starting to feel the symptoms of anxiety and depression, individuals who have problems with alcohol, for example, as well as those who are suffering PTSD. We are sure to see an increase in demand for such support when we move out of this pandemic. People will slow down and think back on their experiences, as was explained by the Royal College of Physicians in Wales just last week.

During the symposium for health professionals in December, it was explained how necessary and vital this programme is, and this is particularly true because the burden of responding to COVID-19 is ongoing and will extend into the long term. The Welsh Government will continue to work with Cardiff University, who run the service, to ensure that it is fit for purpose and that it can adapt depending on changes in demand. And I'm pleased to say that we are working well with Cardiff University at the moment to draw up a model that supports the social care workforce as well as those working in health. Information about these resources and how to access them is available on mental health pages of the Health Education and Improvement Wales website.

In the autumn, we circulated a Welsh health circular to NHS organisations, noting how they were expected to support the health and well-being of their staff during the pandemic. The circular is a means of reminding employers, and sends a clear message to our workforce, restating our commitment and the employer's commitment to support their health and well-being.

Since the beginning of the pandemic, Social Care Wales have been maintaining a well-being network, which considers the use of the services already available and how it can be advertised more widely.

Following a review of occupational health services across Wales, commissioned by health boards, we'll be working with partners to consider an appropriate occupational health solution for Wales, based on the review recommendations. I understand that a partnership group has been established to look at this work, including representation from unions, employers and the Welsh Government. We're also funding an employee assistance programme, which has been procured and managed by Social Care Wales. This is going to provide longer term well-being support for people within the social care workforce, who are not yet covered by the scheme.

Now, we're not done in our fight against this unrelenting virus. The roll-out of the vaccination programme and the publication of our vaccination plan last week offers us a glimmer of hope and a path out of this pandemic, but we know that ongoing physical and mental health impacts for patients, staff and the public will be immense, and we must continue to work together, to be prepared and to be able to support our workforce to carry on supporting our patients as we navigate our way forward out of this pandemic. So, thank you, Jayne, once again, for bringing the attention of the Senedd to this really important subject.

Thank you, and that brings today's proceedings to a close. Thank you.