National Assembly for Wales

Croeso. Welcome, everyone. Bore da. Welcome to the Health and Social Care Committee meeting. This meeting is bilingual, and simultaneous interpretation from Welsh to English is available. The first item on our agenda today is introductions, apologies, substitutions and declarations of interest. We've received apologies from Russell George, who normally chairs this committee, and I'm standing in as Chair today. We've also received apologies from Lesley Griffiths, and Hannah Blythyn is with us, substituting for Lesley. Are there any declarations of interests from committee members? I see that there are not.

So, we'll move on to item 2, which is a legislative consent memorandum on the Tobacco and Vapes Bill. This Bill was introduced into the UK Parliament on 5 November last year. It aims to promote public health by reducing smoking and regulating vaping, particularly among young people. The Bill contains several provisions that intersect with devolved matters, and because of this, the Welsh Government has laid a legislative consent memorandum before the Senedd. That LCM outlines the Welsh Government's position on the Bill and its implications for devolved competencies. So, consequently, this committee has been invited to consider and report on that LCM. 

I'm very pleased to welcome here today, to give evidence to the committee to aid our consideration and reporting on the LCM, Sarah Murphy MS, Minister for Mental Health and Well-being, and some of Sarah's officials: Ed Wilson, deputy director of public health improvements and inequalities; Wallis Jones, health improvement manager; and Stephanie Barnhouse, head of risk behaviours. Croeso. Welcome to you all.

Minister, perhaps I might begin, then, with some initial questions around policy alignment. Firstly, could you tell committee what are the primary objectives of the Welsh Government in supporting the LCM on tobacco and vapes?

Thank you very much, Chair. So, as you will know, this Tobacco and Vapes Bill will bring measures that include making it an offence to sell tobacco products to anyone born on or after the 1 January 2009. It will also provide the powers to reduce the appeal and availability of vapes. It will strengthen the enforcement system by providing for new fixed-penalty notices in England and Wales for breaches of age-of-sale legislation for tobacco and vapes and other consumer nicotine products. This absolutely aligns with what we're trying to achieve here in Wales, and the main thing that I always have at the forefront of my mind, which you will also have received, is the evidence provided by the Children's Commissioner for Wales, which comes directly from children. They're actually calling on our Government to—. It says young people want more pressure from Government on making the change. They say that there is easy access to vapes, they can get them from vape shops and 24-hour shops, and young people have told us that they are being influenced by the colour of packaging, packaging marketed to children, advertising towards children, the appealing flavours, school and peer pressure, media, price, easy access, smell, older people pressuring younger people, 'it's cool', 'you get a rush', fads, to fit in, to relieve stress. These are all the things that we also want to prevent in Wales.

Okay, thank you for that, Minister. I can see that obviously the Bill does align with those objectives of Welsh Government and the broader public health goal of a smoke-free generation by 2030. There are concerns, though, as I'm sure you know, about potential unintended consequences, including those possible consequences for adult smokers who use vaping or might use vaping as a cessation tool to stop smoking, and I know that some organisations are concerned about those possibilities. So, could you tell the committee how Welsh Government proposes to maintain the promotion of vaping as an accessible harm-reduction option for adult smokers?

Of course. Thank you, Chair. In Wales we do recognise that vapes are useful to some smokers in helping them to stop, and therefore our quit service, Help Me Quit, supports people to choose the right tools for them to be successful in stopping smoking, and this can include the use of vapes. But we must be clear and decisive in the action that we need to take to tackle the worrying rise in youth vaping and stop the next generation from ever participating. That is fundamentally what this Bill is about. So, it's not intended to stop adults from using vapes if they choose to. It doesn't apply to adults. But it does provide powers to tackle those elements that we know are making vapes appealing to children, such as the colours that I've mentioned, the flavours, the packaging and the advertising.

Is there any particular evidence, Minister, that you could point the committee towards that this LCM will reduce smoking rates and promote healthier alternatives for current smokers?

Of course. Again, I think that all the way throughout this Bill, it has been extremely evidence based, because we have a lot of evidence to point to when it comes to tackling smoking, which we obviously led on hugely in Wales, which I'm very proud of, but also we have the evidence to show the difference that it made when we raised the age from 16 to 18. I think that I would point here to research, which I think is fantastic research, by the Royal College of Paediatrics and Child Health Cymru, who have said that phasing out of tobacco products to those born after 2009—we know that most adult smokers have had their first cigarette or were already addicted to nicotine by the age of 18. Ninety per cent of lifetime smoking is initiated between the ages of 10 and 20 years. We are also now seeing that with vaping.

So, there is a wealth of evidence to show that this will make a huge difference, and ultimately, we want to prevent people dying from lung cancer, the disabilities that are caused through smoking, through vaping. So, whereas we don't yet conclusively have that same level of evidence to show the damage of vaping—again, you will see, in that evidence, that the evidence based on the impacts of second-hand exposure to e-cigarette vapour is growing. And three studies were included in the recent scoping search that examined the impact of second-hand exposure to the aerosols from e-cigarettes. So, again, there is a growing body of evidence to support that we shouldn't be having vaping either.

Okay. Thank you for that, Minister. We will turn to other committee members, then. Firstly, Joyce Watson.

Good morning, Minister. I'm going to ask you about vaping among young people. The Welsh NHS Confederation and the RCPCH have raised concerns about the growing trend of youth vaping and smoking initiation. How does the Welsh Government plan to address the rising popularity, because they are becoming popular—

They are.

—of vaping among young people, particularly around the health risks?

Thank you very much. So, we know from the evidence that the proportion of young people vaping has risen substantially in Wales and across the whole of Great Britain in recent years, despite the fact that it has been illegal to sell nicotine vapes to anyone under 18 since 2015. As we heard from the evidence from the children's commissioner, children are still getting access to these. A lot of them are buying them, you know, illegally; they're illegal vapes. They have 600 puffs in them, and we've had studies show that there's sometimes nickel and zinc in them as well.

So, the Bill will enable the regulations to be made to address the elements that make these products appealing to children and young people foremost—the flavours, the packaging—but it will also enable the introduction of retail licensing for these products, which, I have to say, has huge support from the retail industry itself. These measures are important as we do not know the long-term health impacts, as I've said. And the UK Government has commissioned a review of current evidence that will be published shortly. We are exploring additional research and will set out plans in due course.

So, a big part of this will be working with our local authorities, and trading standards in Wales as well, to ensure that there is that enforcement in place to make sure that this actually happens.

Of course, the biggest concern about youth vaping is that there's a misconception that they're safe. How does the Welsh Government plan to balance that promotion of vaping as a lower harm alternative to smoking on the one hand and addressing the need to protect young people on the other hand?

Absolutely. So, we currently don't know the long-term effects of vaping that we do with smoking—we just don't have the evidence base for that—but we do know that vaping products are regularly promoted in a way that appeals to children. If the Bill becomes law, we plan to work closely with other Governments in the UK. This is why I think this is good that this is a UK-wide piece of legislation that will be going through. We need this to be consistent. And the primary motivation is to tackle that youth vaping. So, we will continue to, actually, listen to children and raise this with children and young people to point this out.

I will say, though, again, I loved the evidence that came directly from young people on this. They said, 'Do you think young people see vaping as harmful?', and they were, like, 'Yes, but they see it as an alternative to smoking.' And they've said, 'Yeah, but not how harmful.' And that's where we need to get to. So, as you've heard, we've already got three studies at the moment that will be coming through on that, and it's all about the education and empowerment for young people that this has to go with as well. But ultimately, this is going to be about nobody born after 2009 being able to buy them, and that's going to be the biggest stop that we can do to do this.

We've talked a fair bit about the flavours being attractive, the packaging being attractive, but also for adults who are stopping smoking, or have stopped smoking, there is evidence that they choose vaping and the flavours simply because they find it easier than continuing with the taste of tobacco.

Yes, and as I said, this Bill, or this LCM, will not change that, you know, for adults. Like, this is not to prohibit adults who want, who choose to do that. Although, of course, we will work with Public Health Wales to continue to update as more research comes out in this area. But, yes, of course, adults do and can choose to vape if they so wish.

Could I bring in Hannah Blythyn at this point? Hannah.

Thanks, Chair, and bore da, Minister. Just to pick up on something really interesting from the evidence from young people, and how important that is as well, because it seems like every time I've gone into a primary school in my constituency, the top issue they're worried about is vaping, and at the age, perhaps, where they haven't started but they see that a lot of other children a bit older than them have. So, you mentioned education empowerment, so is there anything you could add in terms of—? I know that what this legislation will ultimately do is prevent them from being able to start, but actually to support young people at the moment, how are we working across Government, perhaps, from an education and citizenship perspective to support those young people, because I know it's something that, when I go into primary schools in my patch, they'd definitely be really interested to hear about?

Absolutely, and I think this a role as well for Public Health Wales, who have a lot of links with schools in this area; it's absolutely vital that we listen to them. But also the regulations for those who have already started vaping—if they're under 18, it will prohibit them now from being able to access, but also for anybody who has started in that period, it will make it very difficult now to buy the illegal vapes that a lot of them are using. I think that this is actually a crucial moment in terms of that educational empowerment, listening to young people and continuing to do that work through the schools.

I've had a similar experience. Whenever I go into secondary schools at the moment, I tend to ask them, 'Put your hand up if you think that we should ban vaping', and, overwhelmingly, almost all of them do. But I also think that, again, teachers are saying that children are coming to secondary school from primary school addicted to vaping. Some of them are having to leave lessons two or three times to vape; they can't sit through their mock exams to be able to do that. So, this is right, you are right, Hannah Blythyn: there needs to be this work already in schools. This Bill will tackle prevention going forward, but we know that this is already very much a problem, and I will be working closely with the Cabinet Secretary for Education on this as well. Unfortunately, we are seeing that some local authorities have a policy that if you get caught vaping, then you get excluded. This is something that teachers are very against, and would prefer us to be able to come at this from a completely different angle and work together to ensure that that isn't happening as well. So, that's something I'm very aware of.

Okay, Hannah. James.

Very quickly, Minister, a lot of young people now are addicted to these vapes as well. They do contain nicotine, and an outright ban for some of those people is going to be very difficult because they're going to need to be helped to quit smoking, basically, and quit vaping. It could be difficult having an outright ban put in place. These people are addicted to nicotine products. I don't know what support is going to be made available to help those young people transition not to smoke. There is a risk there, then, isn't there, that a lot of those young people could start buying vapes illegally, going down the illicit trade. It could be a way of people starting the illicit sale of probably non-regulated vapes. Is that something that the Government has considered in consultation with the UK Government? Because it is something that worries me. It's very good banning something, but when you ban something that people are addicted to at a certain age, they will look for it elsewhere, unless there's a proper programme in place to help people get off what they're on.

Absolutely. So, I agree with you, because I think that we probably will have a cohort who, I'm afraid, are maybe as young as, as I was saying, year 7 up until that age of 18, who will be in that cohort that you've mentioned. So, it is really important, coming back to what I said to Hannah Blythyn, that we do have that support, and we are talking to schools as well about this, and it is an addiction. But what I would say as well is that we know that that illegal trade is already happening; that's how many are accessing this. So, we also have to put a stop to that. But in terms of the support, as I said, it's about working with the Cabinet Secretary for Education, it's about working with Public Health Wales, so that they aren't being excluded, first and foremost, and that they are receiving that support. I can see that Ed Wilson is scribbling down by here as well, and coming from Public Health Wales, would you have anything else to add on this, because you've done many of these programmes in the past, haven't you?

Thank you, Minister. Yes, absolutely, obviously, it is already illegal for anybody under 18 to purchase vapes, but we're really conscious that the evidence anecdotally, both from education professionals but also from the RCPCH, shows that, as the Minister has said, there are children and young people who are addicted to vapes, can't get through a 30-minute period without needing to go out for them, so we're really concerned about it.

Public Health Wales have worked both with us and colleagues in education on resources, both for teachers and parents, that give support and advice about how you can support children and young people to understand the risks around vaping. There is a bit of a misnomer, I think, sometimes, around the language we use around vapes, about 'safer' and 'healthier'. Our policy has always been as a Government that if you don't smoke, you shouldn't vape; it's not something we'd recommend people to take up. And those resources are available for teachers and for parents. But also, our free Help Me Quit service, which is run by Public Health Wales, traditionally is used to support tobacco-addicted smokers. Public Health Wales are working to alter that service now, so that it focuses on being a nicotine addiction service, so that regardless of the methodology that you are hooked on nicotine through, you will get that support, free and confidential advice and support, and looking at how we can support children and young people to come off nicotine as well.

Can I come back, John?

Yes, sure. Yes.

But what does that look like in practice, because people who are quitting smoking, for example—? I am a reformed smoker. A lot of people went to vaping as a way of quitting. A lot of young people who are addicted to vapes won't have that option to go down that route, to go to vaping to help them quit. There are things like nicotine patches, but I'm not quite sure how that works in terms of legislation. Are they allowed them if they're under the age of 18, because nicotine is a licensed product? There is a lot of thought that needs to go in around this, isn't there? It's very quick to be bringing these things in without the unintended consequences in terms of supporting people. You know, you can give people the support and the advice, and how bad things—. I know sugar is bad for me, but I like one in my tea. It's that type of thing. But without the support and the funding to enable this to happen, it's going to create problems, isn't it? I'm not trying to be awkward. I'm just trying to highlight the realities of implementing something of this measure.

Absolutely, and I appreciate all the comments that you've made, and agree as well. This will be crucial to the implementation, which will be the next stage, and a lot of consultation will also go on, because some of the powers are coming to us that we will then further consult upon. But, again, I met with the Children's Commissioner for Wales about this yesterday. This was a key recommendation that she had in her annual report, so this is the first step in this, but I also see it as quite a significant moment, especially as this is being done on a UK-wide basis, to have these conversations. And crucially, a lot of this is about behaviour change, which is not fast, which is sometimes difficult. Some of the evidence, which was quite upsetting, from young people, is that sometimes it's adults who are giving them the vapes. Sometimes it's the peer pressure as well. So, there's a whole societal responsibility that we need to take around this, but I want to assure you—I know that you're always the voice of children and young people as well—that this is something that we're taking very, very seriously, and will be key to the implementation as well. It gives us that wonderful opportunity, honestly, to listen to children and young people and ensure that we do that.

Minister, Steph might have some more detail on James's specific questions around nicotine replacement therapy for young people.

Thank you. It was more on the—. Yes, NRT for young people is really important, and Public Health Wales, as the Minister said, is looking to adapt the Help Me Quit service so that it can support young people who are vaping and are addicted to nicotine, so that they have got a pathway that they can access support through. But also the point on—. This isn't about preventing people over 18 from being able to access vapes if they choose to use them for smoking cessation. It's about making sure that we're not allowing the child-appealing elements of vapes, so looking at the flavours, the packaging, the placement in shops. And those powers will be through regulation, so we can adapt those and make sure they remain flexible. So, it's not about preventing people from being able to use them if they're able to, if they are over 18.

Sorry, John. I know you want to get—. My point is that it's not the over-18s that I'm too concerned about, really; it's the under-18s that I've got huge concerns about, because they're the ones who can't access a lot of these things because of their age, and that's what I worry about. It's basically saying to someone, 'You're going to have to go cold turkey, because none of the other things are available to you', and I think that's something that really needs to be considered. Sorry, John, I'll be quiet now for five minutes.

No, James, it's fine. Did you want to say anything further on that point?

No, only that I take the comments very, very seriously. This is something that is a priority for us as well, and we recognise that there will be that cohort, and we will make sure that they have that support.

Okay, diolch yn fawr. Mabon ap Gwynfor.

Yes, thank you very much. So, in terms of the enforcement and the compliance, as we know, for the measures in the Bill to be effective, there will have to be a strong approach. Existing legislation prohibits proxy purchases for tobacco products and nicotine vapes, and all of this will be able to be brought in and supported and reinforced.

In terms of raising awareness, in a way, I see today as a huge part of that. It's an opportunity as we take this through, as we take the LCM through the Senedd, to continue to talk about this and raise awareness. And then, in the answers to the questions from James Evans and Hannah Blythyn, we've touched on the crucial role that Public Health Wales will play in this, as they have when we've changed policy in this area before, like raising the age when you're able to buy cigarettes, for example. So, that will be absolutely crucial.

We also will work with Trading Standards Wales to ensure that we are supporting officers to take rigorous enforcement of the existing legislation, and also deal with the illegal market, which will not be tolerated.

Yes, I think that ASH Cymru has been vital in much of what we've already achieved in Wales, and we are currently in discussions with them about how we will take that forward.

The changes in the funding arrangements with ASH Cymru are not intended so that they no longer exist. On 1 November, officials provided a briefing to myself and the Cabinet Secretary for Health and Social Care detailing the background, issues with the grant funding and advice from the Grants Centre of Excellence. A letter to ASH Wales Cymru confirming that their grant for 2025-26 will be at least £75,000 was issued in December, and officials will work with ASH Cymru to understand what work they could take forward in the 2025-26 financial year to support the tobacco control agenda, and detailed ministerial advice be submitted to me shortly. As soon I have an update, I will share that with the committee.

Thank you very much for the question. We've had very close working with the UK Government on this, as have all of the nations. As you know, the policy in Welsh Government is not to allow that to happen and to call for consent in these areas, so that the powers do come to the Senedd and Welsh Ministers. These discussions are ongoing, so in terms of giving the updates on the specific clauses and amendments, I'm going to pass to Stephanie if that's okay.

Of course, Minister, thank you. The balance of powers in the Bill was closely looked at by Welsh Ministers and by the UK Government, and we think that the balance is the correct one in terms of where the powers will lie for Welsh Ministers to take action in regulations for areas that are within devolved competence. But if there's a specific area that you would like us to provide further advice on, then we can do so. I think that the LCM is clear in what it provides with detail around where the powers will lie. But, yes, if there's a particular issue that you would like us to provide more detailed advice on, we're happy to do so.

No, it will absolutely not.

Yes, we are.

It is my question—

It is. It is, James.

I'm just going back to a point that Mabon made about funding for ASH Cymru, just two really quick questions. What is the total budget of Public Health Wales?

I will bring Ed in on this.

It's about £140 million.

A hundred and forty million. How much of that is allocated to reducing smoking?

It's difficult to hypothecate. I can get Public Health Wales to write to you, but they have a series of programmes that they are asked to undertake on our behalf in terms of smoking reduction.

Yes, that's fine. The only reason is the UK Government allocated £3 million for a vaping taskforce, and I'm wondering did the Welsh Government get any Barnett consequentials, or is that taskforce actually helping in Wales, as well, and how is that money being spent here, because it was given as a UK taskforce, but public health is a devolved matter to the Welsh Government. So, I'm not quite sure how that feeds across, but I'm just interested, in the draft budget—and you'll forgive me because I haven't looked—how much is being allocated in terms of funding to implement some of the recommendations in this Bill, given that public health is a devolved matter to the Welsh Government.

Yes, absolutely. So, on consequential funding from the UK Government, to support the smoke-free generation and youth vaping measures, UK Government announced additional funding that resulted in Barnett consequential funding of £5 million for Welsh Government. Funding was received by the Welsh Treasury in 2024-25 and subsequent years to follow. So, the Barnett formula, as you know, is not ring-fenced for a specific purpose, and it was allocated into the general pot, so we are currently considering options to put forward to Ministers, or my officials are, to support the Bill and identify potential costs to support.

So, just so I'm clear, that £5 million, which was given as a Barnett consequential because of the vaping element, has not been earmarked yet by Government for this project—

No, we're in discussions, as with all—

That's fine. I just wanted to get that on the record.

No, absolutely.

So, that's fine. Thank you. I just want to move on to impact on the industry, if that's okay.

Of course.

Thank you. This is the industry as in the tobacco and vaping industry. There are going to be a lot of changes for businesses out there, and I'm just interested in how the Government here is working with the industry to try and adapt these things to make sure that there is a smooth transition to getting rid of disposable vapes. I'm actually in favour of getting rid of disposable vapes, and people can have reusable ones. But I'm just interested in how the Government is working with the industry to make that transition period as smooth as possible, because they do employ a lot of people and put a lot of money into the economy as well.

Yes, of course. So, as you know, that was announced by the Deputy First Minister and Cabinet Secretary that they will be banned from this year, in June. That has given time, then, to the industry to be able to adapt. Illegal products remain a significant ongoing challenge, and the purpose of the Bill is to stop children from ever starting. History shows that when we have introduced targeted tobacco control measures, they've had a positive impact, and they have always been welcomed by the industry. And this is overwhelmingly being welcomed as well, because, of course, for those who are within the rules, within the legislation, they're content with this—they don't want to see illegal vapes on the market either, they don't want to see these 600-puff very dangerous illegal vapes out there. So, there is a lot of really good will here. Trading Standards Wales, of course, is really crucial to this, working with them, but this will also involve local authorities, of course. So, on the whole, I think the main thing is that we're coming from a place where we all recognise how important it is and what a difference this will make.

So, there is going to be, as you were saying, with the implementation, a tremendous amount of work that's going to need to go into this to make this work, supporting people, but also the industry, with the changes. And the way that we always do this is through phases, through consultation, through talking to people. You can see from some of the evidence that the committee has received that there are people in these spaces, as well, so we will continue to do that. I don't know if you have anything else to add on that, as well, Ed, as you've gone through these processes before.

Yes. Thank you, Minister. You'll know that it's Government policy not to work with the tobacco industry, full stop, so we don't have any engagement with the tobacco industry. And it would be our view that, just like we have done on the healthy food environment legislation, where there is an impact on retailers or businesses, we work with them. So, with the powers the Bill will confer onto Welsh Ministers, if a decision is made, for example, to create a licensing scheme and that would have an impact on retailers, we would work with retailers from the beginning of that process to understand what the challenges are and work with them on any subsequent guidance.

It's good that you came on to a licensing scheme, actually, because I want to touch on a licensing scheme. The licensing scheme, I think, would be important and I think some of the industry itself, the tobacco and vape industry, the regulated ones, want to see that, because there are too many illicit vapes coming over from China and the middle east, which aren't regulated. There is a system in place now, isn’t there, where some vapes are regulated, to a degree. So, I'm interested, and it is Government policy, which I think is a bit naïve, not to engage with the tobacco and vape industry, but I would just like to ask, on that regulation scheme, if it is going to be implemented—. I know, as you just said, they don't engage with the organisations that represent them. I'm just interested in how you'd do that if Government policy isn't to engage directly with them. It's probably a Minister question.

No, no—of course. I think that, for clarity, what I said earlier on about the industry, I meant the retailers in that industry. We don't engage with them, because we've got a wealth of years of examples to say that they wouldn't be coming at this from the same space that we are. They have completely different objectives in this space. So, the crucial part of this LCM for us and what we're taking forward is, as you originally asked, about the retail industry. And for the retailers, the Bill provides powers to create a licensing scheme for the sales of tobacco products, which they are in favour of, and the impact assessment for the Bill sets out the impact of the measures on the tobacco and vape industry, including the impact on their revenue and upon retailers who sell these products.

The regulation of them is very important and I know that some people in the industry are very keen on regulation and enforcement. And this is the point of trading standards departments, isn't it, you know, and the role they can play in actually getting rid of illegal vapes, if there is a licensing scheme coming up, because one of the most popular vapes that is on the market at the minute isn't even licensed. We've all seen the pictures on the internet of how they're tested, as well, out in China, which shocks me, but you know—. So, there is a point here about enforcement, isn't there, the role of what trading standards departments have to do. Do you think, Minister, that this Bill is going to put increased pressure on local government, as well, at a time when they are under severe pressure? So, this Bill is basically saying, 'You're going to have to do more', but we're not providing them, potentially, with any extra funding to enable them to do the enforcement. And that's where, perhaps, the industry itself, some of the tobacco and vape industry, can help with that level of enforcement, can't they?

Of course, under the Bill, one of the key parts of it is that it will strengthen the enforcement system by providing for new fixed-penalty notices, so that is going to be crucial to this. I understand what you say about the pressure, maybe, on local authorities, but they're under tremendous pressure as it is at the moment, because it's the local authorities that work with our schools, that work with our teachers, that have parents—you know, under the UNCRC, they have an obligation to listen to children, as well. So, they are very much in favour of this. We will carry out a consultation. The LCM is providing us with the ability to do that, but all of this will go through a consultation, which will include the local authorities, which will include the retailers.

It's just something that I'm concerned about. I was a cabinet member in my local authority for trading standards, and they cover a huge breadth of areas. This area, for example, is just going to add a huge amount of extra work, at a time when they cover everything from noise nuisances to dog fouling to sheep scab and everything, and then this is just something else on top again. It is about balancing priorities. I'm interested, then, in terms of enforcement from a local authority perspective, in what direction you will be giving local authorities on where they prioritise this in their list of works. If you are saying, 'Prioritise dealing with illicit vapes and making sure that they are not sold to minors'—and they shouldn't be anyway—there are going to be other parts of the system that aren't dealt with, aren't there? So, it's just where that sits in your priorities, really.

Of course, and I wouldn't be able to say at the moment, because this will mean a consultation, which will take those views of all the local authorities into this. However, as I said, I would say that this would be a key priority. We all have young people, we have parents—. I have constituents writing to me, saying that they are really worried about the vaping stores that are popping up across our high streets, and kind of how sparkly, shiny, pretty, colourful and things they are, as well. So, I see this as a major priority. I think that the local authorities will as well. I wouldn't be able to talk now about the additional resources to do with that, but I take on board everything that you say. This would be absolutely woven into any consultation that we do.

Thank you. I will have a sip of my coffee, John, to let others have a chance.

Okay, James. Hannah Blythyn.

Thanks, Chair. The Welsh Government has made it clear that it has the necessary powers to implement and enforce the measures proposed in the Bill, including Welsh-specific provisions and regulation-making powers. But are there any potential concerns that you might have, or gaps, regarding devolved competence that could potentially affect the Bill's successful implementation?

Thank you for the question. So, the measures in the Bill will enable us to comprehensively and proportionately—and that’s key to this—tackle smoking and youth vaping. It will be done in phases, and the Bill also provides certain regulation-making powers for Welsh Ministers to introduce policy changes on tobacco and vapes. So, these powers will lie, then, with Welsh Ministers where it is suitable for them to do so—for example, the placement of products in shops in Wales, as we’ve discussed. And, where there is a clear rationale for maintaining continuity, and a consistent regulatory regime across the UK on the product requirements and safety standards, the power will rest with the Secretary of State, with the consent of Welsh Ministers, which is crucial. So, the requirement for consent of the Welsh Ministers on matters within legislative competence will ensure that the regulations take account of the Welsh perspective. So, I do not have any concerns about that.

Thanks for that. You did mention the important point about the consistent regime and cross-border consistency, because it's not just from a devolved decision-making perspective, but also, for somebody like me, who represents a constituency that is very close to the border, someone could easily get on the bus and go to Chester if they are doing something different there. So, will there be mechanisms in place to ensure that there is that consistency with the UK Government—whether those are formal mechanisms, like you said, in terms of decision-making powers, but also those relationships among Ministers and officials, which are, obviously, very important to that too?

Absolutely. So, one of the very first meetings that I had was with the Minister, Andrew Gwynne, and it was wonderful—just absolutely coming from the same perspective on this. Instantly, it was like, 'We have got so much to learn from Wales. Can we come and see how you've managed to roll out some of the bans that you already have in Wales, and see how they have worked, and show people that this is a positive thing?' So, that's always been wonderful. There has been a tremendous amount of acknowledgement and respect, I would say, for what we have achieved here in Wales through the Senedd.

Also, we have just been working really collaboratively all the way through. My officials meet with UK Government officials on a regular basis, and it is absolutely the intention that the UK nations carry on working jointly as we implement this. So, I see this as being something that, again, is going to be transformative and is going to make a huge difference to generations. I'm very confident that we will be able to achieve that smoke-free generation, which actually was, initially, very much promoted by the previous Prime Minister, Rishi Sunak.

You mentioned, I think—and colleagues mentioned previously—the support to stop vaping, and we have the support to stop smoking as well. I know the BMA has raised the need for increased resources for smoking cessation services to support the implementation of the Bill—and I know we've touched on it previously, with questions from James earlier—but are there plans to allocate any additional funding for these services, or to make sure that there is the effective support in place? You also spoke, Minister, around making sure the support's in the right place. And going back to the questions and discussion we had around young people too, they're probably not going to go to a GP surgery, or to a community clinic; there's going to have to be somewhere within their school or community setting too. So, what plans and resources are in place to enable that effective support?

Thank you very much. It's been really positive today to talk, as we have, about that particular cohort that will fall under the age 18 but have, maybe, already become addicted to nicotine. As we've said, that'll be something that Public Health Wales, my officials and the Cabinet Secretary for Education will absolutely work on. I've also mentioned as well the money that we have received from the Treasury to the Welsh Treasury with Barnett consequentials. As you know, it goes into the big pot, and we will now be looking at how that can effectively be spent in the areas that you're discussing.

I think the positive though is that, as I've said, all the four nations do share the same objectives to eradicate the harm from tobacco and to tackle youth vaping. And I think that, in a way, this will be really positive as well, because, as we know, a lot of young people, and people in Wales, take in the UK media—the media in England, the media in Scotland—so, to have that absolute consistency of message is going to be really crucial. And I think, as well, as more research and studies start to come through, we will see more to support what people already kind of suspect, and you've heard young people suspecting it: how harmful is vaping? That's what they're crying out for.

And just one final, quick point, Chair, because I can see Mabon wants to come in.

Yes, I'll bring Mabon in after your further point.

Clearly, we want people to stop vaping and smoking, but how will the Welsh Government ensure that there is effective data collection and are able to track progress and outcomes to be able to measure the success of this?

Yes, of course. I would point to—. It would be very similar to what Public Health Wales have already provided on the analysis of the impact of raising the age of purchase from 16 to 18 in 2007. So, you'll see in the evidence that they submitted there that there's already—. It's very evidence led. There's very thorough qualitative and quantitative analysis and evidence gathering that goes on in this area, and this will be absolutely crucial to ensuring that we're seeing the outcomes that we want to see.

Ultimately, the outcome is, as we know, at the moment, that lung cancer is the No. 1 cancer that people pass away from in Wales. Two in 10 deaths from cancer are due to lung cancer. Ultimately, that is what want to see being reduced. This is going to take a generation, potentially, but I think that this will go a long way—a very, very long way—to definitely eradicating any remnants of smoking, which I think that everybody now accepts and realises is very bad for you, and bad for your health, but also going that further step now with vaping. We've done so much in Wales—so much—and now we will have the ability to tackle vaping as well.

Okay, Hannah. Mabon.

Thank you very much for that question, Mabon. You've touched on a really key element of all of this policy, which is the inequalities, as you said, in almost every aspect of this. So, when it comes to people having cancer from smoking, when we see the prevalence of smoking, when we see the prevalence of vaping, and even with children and young people vaping, it is in the more deprived areas where it is more prevalent. So, this will also go a really long way with having that consistency across the UK, with children and young people under that certain age never being able to start. That's the first step that we can take and that's what we're intending to take. It will apply to all.

I absolutely agree with you in terms of having that targeted intervention, though, as well, which we already do, and which we will continue to do in those areas where we know that it is most prevalent and where people may need the right support. And, again, this will be a huge part in terms of the implementation of the Bill across the UK, and will be a key priority for us. We're very, very alive to the fact that this is also an inequalities issue.

Yes, thank you very much. As we know, this is a sector that is able to move very quickly and adapt very quickly, sometimes, around the policy and legislation that we try to put in place, as you pointed to. This wouldn't come under this LCM today. However, I am more than happy to go away and ask my officials to look into that for you, and we will be able to write to the committee with an update.

Okay, Mabon? Just to continue the points around those more vulnerable groups in terms of smoking and vaping, Minister. As well as people living in more deprived communities, there are other vulnerable groups, of course, including those with mental health conditions. So, it is a matter, I guess, of making sure that all of those who hopefully will benefit and can benefit from the Bill do so here in Wales. So, how will you tailor your approaches to make sure that that happens?

Again, this is something that I am always very, very aware of. I think that we have learnt a lot through the smoking ban, and you can see that through the phased approach that we took with that in terms of smoking in public areas, because obviously we brought it in for hospitals and around hospitals. But there has been a very, I think, understanding, compassionate, phased approach when it comes to mental health facilities in particular, and we still work very, very closely with health boards around this. We do understand, of course, that smoking and vaping are very much linked to stress, and when you are under immense stress, when you are potentially in crisis, when you are not very well, to then also have the additional, you know, trying to come off what is a very acute addiction, it is a lot. So, with this as well, that is something that we would be very compassionate and understanding towards, as we always have been. But again, just to be very clear, this would not prohibit adults from being able to buy and use vapes.

Okay. If we continue with issues around those who are suffering from health inequalities at the moment, including those in deprived areas. Asthma + Lung UK Cymru have suggested that regulating e-cigarettes as medical devices could help target smokers in deprived areas and reduce those health inequalities. Is that something that Welsh Government is considering?

As you have said, Chair, we know that smoking drives socioeconomic and geographic inequality, and health outcomes are a key part of it. Despite progress in reducing smoking, smoking rates are higher in certain groups, including people living in socioeconomically deprived areas, people in routine and manual occupations as well, people who are unemployed, people with mental health conditions, as you've referenced, people from some ethnic minority backgrounds, and people from the LGBTQ+ community. And in the UK, 230,000 households live in smoking-induced poverty and the children of smokers are three times as likely to start to smoke, perpetuating that cycle of disadvantage. So, again, very evidence based—we know all of this.

Since we published 'Towards a Smoke-free Wales: Tobacco Control Delivery Plan 2022-2024', our focus has been on reducing smoking rates and the impact of smoking, particularly to reduce smoking during pregnancy because of the significant harm. There are also specialist programmes targeted at high-risk groups, such as the JustB Smoke Free programme, which focuses on preventing that smoking, and the provisions within the Bill will help us to tackle the inequalities associated particularly with tobacco smoking. This is also a huge opportunity to do the same for vaping.

Now, to your question about whether or not we would medicalise this in any way, I will say that we do take a slightly different approach in Wales than they do in England. In England, we have heard that it's been almost promoted as a cessation tool, to switch to vaping. As a result, there was some work started to look at whether or not there could be a vape that was prescribed. One company did take up that task and has since ceased doing it is my understanding. So, currently, there is not a device that would meet the requirements to be prescribed, for example. But again, we take a slightly different look at this in Wales through Public Health Wales, and that's purely because we do not have the evidence as of yet, as the Royal College of Paediatrics and Child Health has pointed to. If you ask clinicians, if you ask people in this field, none of them will tell you that vaping is 100 per cent safe, as was started to be promoted previously. We don't have the evidence for that. So, we're not comfortable with promoting, in a way, vaping as an alternative.

And I think if you asked many people who were smokers previously—. Again, James Evans, I smoked for about a decade. I started when I was a teenager. It was really difficult to quit. I wish I'd never started. I wish I'd never started and if you talk to people who are vaping as well, because it is expensive and it is very addictive. It's like any addiction; it plays on your mind throughout the day. It distracts you. It becomes a crutch. I think most people would say to you they wished they'd never started smoking, they'd never started vaping, and that's where we're trying to come from with this.

Absolutely, Minister. Okay. Sorry, James. 

Just one final question. It's a legal question. 

Okay. 

One element that has been raised is around the human rights element of this Bill and the impact on people's freedoms and personal choice, and the rest of it. I'm just interested in what legal assessment the Welsh Government has made about the challenge this could have in the courts in respect of article 8 on respect for private and family life—that's about pro choice and people having the right to choose—and article 14, which is about the prohibition of discrimination. By saying that younger people born after 2009, when they become of legal age to buy it, won't be able to buy it, you've got a legal discrimination on age of people who can and cannot, inadvertently creating age discrimination. I'm just interested, from a legal perspective, in what risk the Welsh Government thinks there is of this being challenged in the courts, because of the impact that it can have on people's human rights, and their right to personal freedoms. 

Yes, of course. I will bring in my officials in a moment to go over the technical aspects of this, but what I would say is that we also have a requirement, according to the United Nations Convention on the Rights of the Child, to listen to children and young people, and overwhelmingly they are saying 'Please bring in the enforcement, we need Governments to do more.' So, from where I am at the moment, I feel that I am respecting children and young people's human rights, which is that they don't want this. In terms of whether or not that could happen, I will pass over to Ed. Is that a possibility? 

So, the UK Government, obviously, who are taking this piece of legislation through, have done impact assessments and an understanding of its compatibility with human rights legislation. There is also a separate school of thought around whether addiction is a choice. So, nicotine is a highly addictive substance. If you ask most smokers if they wished they could stop smoking, they would agree. And so, actually, being addicted to nicotine through any method takes a lot of choices away from you. But in terms of the actual question around the legality of it, UK Government have looked into that issue and are confident that it is compatible.

Because it can't be implemented in Northern Ireland because of European Union law. 

We'd have to write to you on that. 

Okay, James? If there are no further questions then, may I thank you, Minister, and thank your officials for coming in to give evidence to committee this morning? You will be sent a transcript to check for factual accuracy in the usual way. Diolch yn fawr. 

Thank you very much, Chair. 

Okay, committee, we'll break briefly until 10:45. 

Welcome back to committee, then. We resume with item 3, another legislative consent memorandum, this time on the Mental Health Bill. The UK Government introduced that Bill on 6 November of last year. It aims to modernise the Mental Health Act 1983, to provide patients with greater autonomy, enhanced rights and improved support. The Bill contains several provisions that intersect with devolved matters. Consequently, the Welsh Government has laid a legislative consent memorandum before the Senedd. That LCM outlines the Welsh Government's position on the Bill and its implications for devolved competencies. A supplementary LCM has also been laid, which takes account of changes to the Bill, during its passage through the UK Parliament.

This committee has been invited to consider and report on the LCM and the supplementary LCM, given our responsibilities for health. I'm very pleased to welcome, to assist the committee in considering the LCM and reporting on the LCM, Sarah Murphy MS, Minister for Mental Health and Well-being, and also some of the Minister's officials: Alex Slade, who's director of primary care, mental health and early years; Matt Downton, who's deputy director of mental health, substance misuse and vulnerable groups; and Elizabeth Lockwood, who's in charge of delivery and the oversight board implementation. Thank you all very much for coming in. Welcome back so quickly, Minister.

Perhaps I might begin again with some initial questions around policy alignment: why has the Welsh Government chosen to submit a legislative consent motion for the Mental Health Bill, rather than introducing its own legislation? How does that Mental Health Bill align with the Welsh Government's vision for mental health services and support here in Wales?

Thank you very much, Chair. So, as you know, the Mental Health Act was brought in in 1983, so it's 42 years old now. It was always an England-and-Wales piece of legislation, and I think that it's been a long time coming to have this reform. As we know, in the previous Westminster Parliament, they did a tremendous amount of work on this: engagement with stakeholders, people with lived experience, there have been reviews, the joint committee have taken evidence and presented recommendations, some of which have been added in to the new reform. I think that this a huge—. I feel, actually, very proud and privileged that I get to be the Minister for Mental Health and Well-being as this reform is implemented in Wales.

So, specifically, as you know, we do follow the principle that primary legislation in devolved areas should be enacted by the Senedd. But we've been working so closely with the UK Government on this—my officials meet with UK officials on a weekly basis—what we’ve asked for has always been accepted, and the Mental Health Bill reflects the principle that, with close collaboration, we can develop the provisions in the Bill. Utilising UK Bills does not equate to Welsh Government needing the support of a different Government and different Parliament to deliver the legislative objectives. So, I feel very pleased that this is now happening.

Okay, Minister, in terms of that importance, then, of the Mental Health Bill, and applying some of its provisions here in Wales, what would you say are the key provisions of that legislation that are particularly important to Wales, and why?

Absolutely. So, the independent review of the Mental Health Act 1983, which happened in 2018, led to a White Paper in 2021. There were 154 recommendations for improvement, and the key issues that were mentioned in it were the misuse of detention, especially for learning disabilities and autism, and also discrepancies in care quality between detained patients and those in community settings.

So, the Bill then proposes several key reforms, which have been, on the whole, very, very welcomed. So, that includes revisions to detention criteria, to ensure it is only used when absolutely necessary; enhancements to patient representation, including allowing patients to choose their advocates—this is something that James Evans has always spoken so passionately about—reducing detentions of individuals with learning disabilities and autism, with a strict 28-day assessment limit; introducing duties on commissioners to monitor and prevent crises among vulnerable groups; revising community treatment orders to ensure appropriate oversight; removing police stations and prisons as places of safety for individuals in a mental health crisis; creating a 28-day time limit for transfers for individuals from prisons to hospital for mental health treatment; and, of course, introducing supervised community discharge for certain criminal justice patients who no longer benefit from hospital care, but need conditions to manage their risks.

And also, of course, as I mentioned, the joint committee presented other revisions that they would like to see made, and these, then, included the removal of a requirement to consider how soon harm might occur in detention criteria; adjustments to the nominated persons, as I’ve mentioned, so reducing the practical concerns for approved mental health professionals; modifications to advance choice documents; and updates to the code of practice to incorporate the four guiding principles of the independent review.

Thank you very much, Minister. James.

Minister, you mentioned places of safety, and it’s positive that police stations and prisons are taken away as places of safety, because we know that’s not the best place to put somebody in a mental health crisis. I’m just interested in what discussions the Welsh Government has had, actually, around hospitals in that as well, because A&E departments are also not the best place for somebody who is having a mental health crisis; it's actually probably one of the worst places you can place somebody—they’re just put in a chair and tend to be forgotten about, and could be left there for hours and hours and hours, not seen in crisis. So, I’m just interested in what discussions you’ve had with the UK Government around A&E departments in particular not being classed as places of safety, because all the front-line professionals that I speak to, who work in A&E departments, are not trained to deal with mental health crises. They don’t know how to deal with these people, and they’re not getting the best care.

So, I’m just interested in what discussions you’ve had around, in the Bill, having certain hospital places not classed as places of safety, because what will happen is—. If the police can’t take them to the police cells, or they can’t take them to a prison, what will end up happening is all those people will end up in A&E departments, which isn’t the best place for them.

Absolutely. So, in terms of what you initially said about the place of safety, we know from people with lived experience, and just from our own kind of empathy for these situations, how traumatising and long-lasting that trauma is, actually, when you’re put maybe into a police cell or a car, or anything like that, when you’re in that crisis. So, I completely agree with you, and I’m really pleased to see that that’s been incorporated.

When it comes to where people should go, in that case, in a hospital, we already have the requirement within health boards and for hospitals that they always have a crisis bed that is available. And that is something that we have to ensure is being taken forward and implemented. Again, this will give us that opportunity now to insist, because it will actually be illegal to not have that, to not have that opportunity to have that.

I’ll come back later because I could spend ages on that.

Okay. And Hannah Blythyn. 

I’m actually going to come in on what James said there—

Yes, of course. 

—because, sadly, I've had a very tragic circumstance in my own constituency of somebody who went to A&E, it wasn’t the right place for them, there wasn’t the support, and then it had a tragic outcome afterwards, and I've been kind of supporting people close to that person through that. I think it's about provision of support and services, isn't it, and people knowing where to go for them. So, how is this legislation going to support that, and actually what plans, alongside it, is the Welsh Government doing to improve that access to support and provision? Because a lot of the time it's at capacity, or people just don't know where to go either.

Yes, thank you for that question, because so much of this is actually about prevention. We never want anybody getting to the point where they need to be in this position, where they need to be detained, and that is why the mental health strategy that we have coming this year is going to be absolutely crucial to this. So, there will be many elements in there that will reinforce that need for the prevention. But we also, as you know, have the national helpline, the '111 press 2', for when people are in crisis, to be able to direct them to the best place that they need to go to. So, the JCC are doing a tremendous amount of work in terms of promoting that, as I know that many of us are as well, and that's been a key element of this, and we can provide you with the data as well, of how that's being rolled out. When I went to the Children, Young People and Education Committee, we also specifically looked at how many young people are also using that service, and that has also had a huge uptake in that particular cohort. So, thank you, because it does help us to reinforce that we never want anybody, really, getting to the point where this is necessary. And that's where we want to be, and that's what our mental health strategy is going to be setting out.

Okay. Well, I'm sure we'll come on further to those matters later in this scrutiny session, Minister. One further question from me. Could you tell committee what consultation you've carried out with stakeholders, mental health professionals, advocacy groups and service users?

Yes, of course. So, the previous UK Government had planned to introduce the Mental Health Bill, as you know, and to deliver the recommendations of the Wessely review, which actually again specifically looked at inequalities and how they felt that people from the black, Asian and minority ethnic communities were being disproportionately impacted. The draft Bill, then, was published, and the Welsh Government worked with the UK Government, even then, to ensure that the voices from Wales were heard as part of the consultation on the Bill, with the consultation being publicised widely with stakeholders in Wales. So, then, whilst the consultation responses to the White Paper were received directly by the UK Government, responses from Wales were shared with the Welsh Government, so that we could consider responses in relation to these devolved matters that we're discussing today. So, whilst the Bill didn't progress, we had good engagement with stakeholders in Wales through a public consultation, who broadly welcomed the proposals, and as you'll see as well from your written evidence today—you've had Mind Cymru, you've had the Royal College of Psychiatrists as well—in a way, the beauty, sometimes, of the stakeholder engagement is that they are across all of the nations. They have this perspective, which is invaluable, as well, so having their evidence is really crucial and very welcomed, and all of them have support for this very, very long needed refom.

Okay. Thank you very much, Minister. Mabon ap Gwynfor. Mabon.

Thank you very much for that question, Mabon. It echoes a question that I've received in writing from the Legislation, Justice and Constitution Committee as well, asking if we're piggybacking onto England proposals and trying to fit them into Wales. I would actually say that it's very much the opposite. So, as I've said, this is and has always been a piece of England-and-Wales legislation. It was always going to require for us to work together to be able to do the reforms. As you said, so much work has been done on this. I've read through all of the reports that have been done by the UK Parliament on this, I've read through the review, through the White Paper; there has been huge stakeholder engagement. I think that the community were extremely sad when it wasn't progressed by the previous UK Government, and I think that we have to grab this opportunity. 

In response to your point on what James Evans was proposing to do, which had support from Government as well, Welsh Government, that was to amend the Mental Health (Wales) Measure 2010, because we could not amend the Mental Health Act ourselves, on our own. So, of course, I have tremendous respect for Jonathan Morgan, who brought in the mental health Measure in Wales, which attempted to bring in that more community, holistic, prevention element to what we try to achieve here in Wales. And many of the things that James Evans, as you have said, was trying to attempt with that are also now in this mental health reform. But specifically, in terms of are we piggybacking on it, well, no, because, again, the mental health Measure brought in that key element of advocacy, of patient voice and of it being patient centered. And this is something that we've been doing in Wales for a very long time. It's interesting now that this reform is going to bring in that advocacy element. So, I would actually say that England, in many ways, is looking to Wales, and we're certainly not piggybacking. We've been a crucial part of this all the way through, and it's important, as we've heard today, that we have that consistency across a lot of the cross-border working that we do as well. 

'significant amount of cross-border provision'.

'risks increasing divergence',

In answer, no. I think that what would be really dangerous is if we didn't now take the opportunity to have this LCM to right many of the wrongs that have come about because of the mental health Bill that goes back over 42 years. I think that what I've heard from people, especially people with learning disabilities and autism, is that what they've experienced has actually been quite dangerous. Because we have to think that, 42 years ago, there was a very different landscape in terms of mental health and our understanding. You'll see now in the mental health strategy that we have coming forward and from our stakeholders that we much more, now, understand that mental health has that parity with physical health. There is a life course. You can't expect people to be physically well all their lives, and you can't expect people to be mentally well all their lives. 

With respect, I understand what you're saying, that is absolutely true, but we could have developed our own legislation on this many years ago. Simply because the Westminster Government is doing it now is not a reason to say that we have to follow Westminster's lead because people in Wales are suffering; people in Wales have been suffering for the last 40-odd years because of poor legislation. We could and we should have done this earlier. What I'm asking about is the principle; not the need—we know there's a need— but the principle of not developing our own legislation and hanging on the coat-tails of England and waiting for the Westminster English model to come forward first for us to then say, 'Yes, let's do something.'

Okay, so, just to be very clear, no, we could not have—this has always been an England-and-Wales piece of legislation, so, no. And I don't think it's setting a dangerous precedent. I think that, at times, we have to be able to work together and we have to be able to bring forward what is in the best interests of people. I think what's happened in the past is that—and if you let me finish this time—there's been a long period of changes in the mental health landscape. We now understand trauma; we are trauma informed. We understand complex needs, we understand adverse childhood experiences. And I think that, back in the time when this was first formulated, it was done with a very top-down approach—we had no understanding of listening to people with lived experience; we still had asylums in parts of the country. It’s extremely different, and it was a way, in a way, of potentially seeing it as a way to manage people in these crises.

What this should be seen as, and what it was always meant to be and what this reform will bring about, is, actually, that this is fundamentally a piece of human rights legislation—it is actually to ensure that that person knows what their rights are under the Mental Health Act and under the mental health reform. And the Measure and the Act do have an interface, and you will see that, in the mental health strategy, we will actually be committing to updating the Measure to go alongside this as well. But, fundamentally, they are different—under the Mental Health Act you are detained, and that’s why we have to ensure that people’s human rights are absolutely upheld. I do not believe that we should lose this opportunity—and bearing in mind that I am also the Minister for people with learning disabilities and people who are neurodivergent as well—to ensure that they have the human rights that they require and that they deserve when they are detained under the Mental Health Act in England and in Wales.

Just before you go on, Mabon, I'm just going to bring in James Evans. James.

Thank you. I have sympathy with Mabon's argument, but I also know the realities of the situation as well. I'm just interested, Minister, or perhaps your officials could give a bit of background, perhaps, in why this couldn't be taken forward on a Wales basis. I think it's more to do with the legal context and actually the complexities of the devolution settlement here in Wales. And I'm just interested if you or your officials could perhaps highlight that just for the record, I think, because I think it would be useful to get that out—why we can't do it here, because of some of the legal contexts around the issues of why—. You know what I'm going to say.

Yes, absolutely, and, of course, James Evans, you know this better than anybody. This is why I thought it was very clever in what you were proposing with your Member's Bill, because you had to navigate each of these areas. So, you are right—when I say that it would not have been possible, it would not have been possible. I will bring in Alex Slade, though, to go into more of the narrative around that, as you said.

Thank you, Minister. As the Member knows, the challenges we encountered with your private Bill were around the cross-border issues. They turned into very complex, legal aspects in terms of how we progress those, and even within the competence, in Wales, in terms of detention criteria. So, clearly the England-and-Wales legislation is much broader in terms of what it is able to deliver and aligns—. Clearly, this process is about how it fits with our policy intention, the direction of Government, and the focus has always been about the individuals and the focus on Welsh population rather than how we achieve those, and in this situation, as the LCM states, we're supportive of the components within the Mental Health Act. 

There are specific provisions within the document that would constantly create cross-border issues where we had disparity in the legislative frameworks—detention being one of those, and aftercare being another one of the components. And thinking about the individuals who live with those border issues, who could find themselves in a different legislative territory for what are very serious areas, for which we’d want robust safeguards in place, the alignment is for both the competence of the Welsh Government to be able to pursue those areas, but also for the individuals in terms of the way they are treated by a number of different agencies.

Lovely, thank you. I thought it would be useful to get that on the record.

Yes, okay. Diolch yn fawr. Mabon.

Yes, that's correct.

I would point to the answer that I gave on funding that we will receive from UK Government when it comes to the Tobacco and Vapes Bill as well, so it will be part of Barnett consequentials, and then it will be decided how that is used. It’ll be very phased as well. As you know, the mental health budget on an annual basis in Wales is £820 million, and £425 million over 20 years will be added in, so I’m very confident that that will continue, because that is a requirement that we have in Wales for our funding.

Yes, of course—hypothetical, but I’m afraid I can’t really answer. I would hope that that would not be the case. However, it would never be prohibitive to us ensuring that people’s human rights are upheld under the Mental Health Act reform.

Okay, Mabon. If we move on, then, we have Hannah Blythyn next.

Diolch. So, Mental Health Matters and the Welsh NHS Confederation have called for some clarity in the Bill regarding the roles of independent mental capacity advocates and rule 1.2 representatives in the context of the new detention criteria, particularly to make sure that vulnerable individuals aren’t deprived of their legal protections. Do you have any views, Minister, on those calls for clarity, and what assurances could you give to those organisations around those concerns?

Yes, of course, and both, of course, we work very closely with. These are people who are supporting people and see this very much up close. So, it’s worth adding that there will be a code of practice that goes along with this, so any additional clarity that is sought will be done collaboratively, will be done to ensure that there isn’t any ambiguity in what we’re expecting to be rolled out. It’s been really helpful to be able to go through this process, receive that evidence and be able to take that on board. So, absolutely, we don’t want any ambiguity here, and that will be confirmed then in the code of practice.

So, that will be supported with the workforce too, so they’re fully informed and trained-up to deal with these changes?

Yes, of course.

Just on another point, then, how does the Welsh Government plan to address—we’ve heard about this—the potential overlap between the Mental Health Act and the Mental Capacity Act, and what steps are being taken to ensure people don’t end up falling under the wrong framework when it comes to detention?

Thank you. This is a really important question, and I know that this is something, from my stakeholders in the learning disability ministerial advisory group and the neurodivergence ministerial advisory group, that they want assurances on as well. So, as you know, currently there is overlap in the interface between the MHA and the MCA, and it is covered in the existing code of practice that we have, and the narrowing of the detention criteria under the MHA should make the interface clearer. That is our hope, but this will need to be addressed within that code of practice that I mentioned.

My understanding is that the interface between the two regimes only occurs in a very small number of cases at the moment, but professionals are already working closely to ensure the appropriate legal frameworks are used, and there are a number of safeguards in place to ensure the legislation is applied appropriately, and this includes the tribunal services that we have in Wales, and all health boards have legislation committees to ensure appropriate use as well.

And there have also been some concerns raised by the Royal College of Psychiatrists and Adferiad. So, do you agree, or what is the Welsh Government's view, on the suggestion that advance choice documents should be made a statutory right for patients, and, if so, how could this be incorporated into the legislative framework to improve patient autonomy and, hopefully, reduce detentions?

Thank you. This is a question that I've discussed with stakeholders. So, the Bill will place a duty on the health board to provide people at risk of detention with that opportunity to set out their wishes—so, it's that prevention work, again—choices and values, should they become too unwell to protect them. Clearly, as we move to implement the Bill, we will need to ensure that we have the strength and the data to monitor that implementation, and the Bill will enable us to ensure that all those individuals that are eligible for that ACD receive one. As you know, then, you've got the CTPs, which are a statutory right in Wales, and compliance is good on that, and they all work together. So, at the moment, we wouldn't be looking to do that.

So, you just referenced it—is it care and treatment plans?

That's right, yes. Sorry.

Are you able to clarify the relationship between advance choice documents and the care and treatment plans as set out in the mental health Measure and how they would potentially work together?

Yes, of course. So, we have got work at the moment going on to look through the detail, because there are links between the two, and that is already included in the information about the patient's views and wishes regarding their treatment, so they should all be carried through. Again, I actually see this as a really important opportunity to strengthen what we already have in Wales, with more opportunities for patients to share their views, and that's what's absolutely crucial here. This was not part of people's real understanding or commitment years ago, but now we really understand that need for that patient-centred, holistic, having a say in how they're treated if they end up becoming too unwell, and also then, as people go back into the community, that they get that support that they really need to make that recovery. 

Absolutely. As you say, the world has changed and understanding has changed in the last 40 years dramatically. So, just one final question from me, on safeguards: what safeguards will the Welsh Government implement to ensure that the nominated person role is accessible to all individuals, particularly those groups that may currently be under-represented, as well? And how will it prevent undue influence in decision making for more vulnerable individuals?

Thank you. Again, as I've referenced before, this was something that James Evans, I think, really championed and brought to the attention of the Senedd. In the past, unfortunately, it's just been assumed that the next person of kin—sorry, I can't—. What is it—the next kin?

Next of kin.

Next of kin—that the next of kin would automatically be that person, and, of course, as we know, that's not always the best thing for many people. So, having that nominated person is really, really crucial. The provision then aims to give individuals a greater say and choice in selecting that person, and it does replace the more restrictive process, as I've mentioned.

We are aware that some groups are concerned that these changes could lead to increased abuse of the deprivation of liberty orders, and we will work really closely to monitor this. That's when, maybe, they wouldn't be able to choose. And then, the Bill will provide further clarity for clinicians and individuals, which, in itself, will also act as that additional safeguard as well to ensure that that is absolutely the case, and also for children and young people.

Thank you.

Okay, Hannah. James.

On nominated persons, there always was that conversation around when that person can nominate somebody—you know, when they're well or in plenty of time. I'm just interested in if you think how it's worded within the Bill gives enough provision for somebody to have time to nominate somebody, because it's very difficult for somebody to nominate somebody when they're in crisis, because sometimes that might not be the best thing for them because they're not making the right decisions. So, I'm interested if you think the Bill is sufficiently worded to give people enough choice around nominating someone when they're well. You know what I'm trying to get to.

Of course. I think that it is as far as it can go, but I also think that this is something that's going to be crucial in that code of practice as well, and the monitoring and ensuring that this is happening. It comes back to what I was saying before, which is that we want that prevention work, through that mental health strategy, to really change and revolutionise the way that we provide mental health support in Wales. So, I believe that by doing that through the code of practice, through this legislation, which makes it very, very clear what people are entitled to be able to do, we will be able to achieve that.

I'll just bring in Mabon ap Gwynfor at this point. Mabon.

Yes, of course. So, as I've mentioned, with the mental health strategy that we have coming, many of those issues that you've raised will be incorporated into that. As you know, I was a member of the Health and Social Care Committee for a number of years; we did a number of very important pieces of work, including the mental health inequalities piece of work that we did. All of this has informed the mental health strategy that we've done.

We're doing a tremendous amount of really good work in Wales already, and I think that we're actually at a very exciting point where we're going to have this reform coming through at the same time as we will have a mental health strategy, which will not just be like any other one that we've maybe had before; this is really going to look, now, at a different approach and at people getting the support that they need as quickly as possible, and really trying to achieve that parity that we have with other parts of the health service. So, I'll be more than happy to come back and answer many more detailed questions, Mabon, on how we're trying to address all of that. But I really do see this reform as being a really crucial part.

And if I can say, as well, which we haven't touched on so much today yet, what this means for people within the learning disability community is everything. It's absolutely tremendous to have this real recognition of how the Act has been misused, which, in my view, has been sometimes cruel—'cruel' I think is the word that I would use. This is absolutely what we're trying to achieve here; we're trying to make sure that this doesn't happen, that this mental health reform really makes it a human rights Act—that's what we want to see. But, coming back to your questions, I assure you that, within the mental health strategy—. And we also have the suicide prevention and self-harm strategy, as well, coming imminently, Chair, and I would be more than happy to come back and answer many of those questions.

Thank you for that, Minister. We're just about to, actually, come on to vulnerable groups.

Oh, good.

But, first of all, James. James Evans.

Yes, just really quickly. Minister, I'm just interested—. As Mabon said, we've got numbers of different strategies, the Measure, the Act and different Acts that have come in subsequently since the original Mental Health Act 1983. I'm just interested, because, when you talk to clinicians on the front line, there seems to be a priority of which legislation or Acts they follow, and it tends to go: the main Mental Health Act, a few other things that have come from Westminster, then the Measure. And I'm interested, with the discussions that you and your officials have had with the UK Government, in how many of those elements of the Measure you're trying to slip into the mental health Act in terms of amendments that may come forward at the House of Lords stage or Government amendments that the UK Government might make. Part of my Bill, for example, was around the reassessment of children, which is in the Measure, but could quite easily be part of the mental health Act, which would actually improve outcomes for children in England as well. So, I'm just interested in what work you're doing inter-governmentally and with Members of the House of Lords, perhaps, to insert amendments into this legislation, ways in which you can beef up in respect of the mental health Measure and pull things across to give them more prominence, really, in the legislative framework that professionals work under.

Yes, of course. Yes, I mean, the Mental Health Act is about when people are detained and obviously, the Measure, then, is meant to be for people who aren't. And the purpose of that was meant to be for ensuring that, if you aren't at that crisis point, and you aren't going to be detained, your capacity won't be looked at and your deprivation of liberty, that you still get all of those things that you should get, isn’t it? That’s what it was about. And that advocacy and that person-centred and holistic and listened to—. So, I think, honestly—. Of course, we’re having these discussions with UK Government, but a lot of this has come from stakeholders, a lot of this has come through lived experience—you know, a very, very thorough review that was done, White Paper, consultation. We’ve consulted with people in Wales as well. So, they’ve really tried to put all of those things through as well.

I can bring in Liz, who is the expert on each of the clauses. But I would say that we have had some kind of success with some of the asks that we’ve had. So, for example, there have already been amendments. And the Government amendments were largely aimed at clarifying and improving the drafting, but it has also included the drafting of a new clause at our request, which is 51A, and that provides, then, the Welsh Ministers with equivalent powers to the Secretary of State’s powers under the Bill to make consequential provision to amend primary legislation in relation to the Welsh devolved areas. So, as well as ensuring that those elements and many of them that you called for are in the Act, we’ve also, of course, been having to be very, very focused on the powers too, as Mabon referred to earlier on. But Liz, are you able to give an answer—or Matt—on more of what James is saying especially around children and young people?  

I think the main thing for us has been around how we continue to develop the Measure alongside the Act, because a big part of the Measure looks at a different part of the population. It’s for people with mild to moderate mental health issues, it’s about accessing primary care, whereas, as the Minister said, the Mental Health Act is around the more serious mental illness and admission to hospital et cetera. So, in the strategy, we’ll be setting out the changes that we'll be looking to do within the Measure to continue to develop it, but alongside, because we see them working alongside each other, as opposed to confusing each other, if you like.

Can I quickly come back in, John, just on what the Minister said? You said that you’ve asked for an amendment—and rightly so—that Welsh Ministers can amend things that are in the devolved competence area, which is in, but what sort of power is that going to be for the Welsh Ministers? I’m just interested. Is that going to be an affirmative, if we want to change things? Is that going to be done by regs or is that going to be done via a vote? I’m just interested. It’s quite a broad power that is, that you’ve asked to be included, which I think is right. I’m probably getting into the Legislation, Justice and Constitution Committee stuff, I do apologise, but—

No, that's fine. 

—I’m just interested in how Ministers will enact that power. Is it going to be by ministerial direction, by regulations, or is it going to be things that we'll have to pass here in the Senedd? I’m just interested in how that’s going to work. Because, on the scrutiny element of it, which we’re here to do, that’s very important, that we get oversight of where you’re going to amend things for a Welsh context, and that we’ve got the right to, as Senedd Members I believe, scrutinise those in an appropriate manner, being the policy committee here that looks at health and mental health in particular.

Yes, of course. As you know, James, I was the Chair of the LJC for four weeks—four whole weeks—so I completely understand the point that you’re making and where you’re coming from. I am going to bring in Liz though, particularly, on these. But it does relate obviously to the consequential powers that we will have and whether or not those all each individually come through the Senedd.

Yes, the point that I’d make in general about that is that that particular clause of the Bill is an overarching piece at the end, as you are aware. It mirrors the same thing for the UK Government, so it would apply to the whole edifice, if you like, of the Act. It’s not like we’ve got a consolidating Bill that’s bringing everything together and we can list all those different regulation-making powers or whatever. We’re going to need to go through—. As part of the next stage, we’re going to need to go through and map out where we want to make those changes and what the different levers will be for doing that. So, I would imagine that some will be in front of the Senedd and some will be a narrower Order, perhaps. But the power is exactly equivalent to what the UK Government will be doing and they’ll do exactly the same process.

I don’t dispute that. My view is on the scrutiny role that we play here, to make sure that, if there are amendments that the Government will make, which are right for Wales, that we get, as a policy committee, the opportunity to scrutinise those. And I think, it would be useful perhaps if Sarah—the Minister, sorry—if Government could keep the committee updated properly on that process, because I think it’s really important.

Absolutely, I concur. I think at the moment our concern obviously with any LCM is to ensure that we have the powers for the Senedd, for Welsh Ministers, to be able to do that, and that's what this is about. And then, as Liz mentioned, that work then, in terms of how each of those will progress forward and where the need for votes will come in, will be determined in the next phase, and we will absolutely keep the committee up to date with this, as we will the LJC.

Okay. Thanks for that. Joyce Watson.

Moving on to safeguards for individuals with learning disabilities, autism and other vulnerable groups, how will the Welsh Government ensure that new provisions for individuals with learning disabilities or autism under the Bill don't lead to unintended consequences, like pushing individuals into the Mental Capacity Act framework, which could reduce protection?

Thank you very much. I think, as I've mentioned, being the Minister for learning disability and people who are neurodivergent has taught me so much. I've spent so much time with people, with their families, to really understand the implications and, as I said earlier on, how traumatising it can be, this experience, if you are detained under the Act. So, I know that those people will be here, and they will be listening today, and they will be watching. This is something that's very, very close to them, in particular. I think that, from the stakeholders I've spoken to, like the National Autistic Society, they very much want us to use this again as an opportunity to talk about this and to talk about their rights and to talk about their human rights.

So, I actually share your concerns about the capacity assessment as well and the capacity framework. What we absolutely do not want to see is that, because of this new reform, because you cannot be detained under the Mental Health Act, you are then detained under the Mental Capacity Act instead. We know that, already, as I mentioned earlier on, there is that kind of interface and we monitor it very closely. However, what I would say is that, in a very similar way that the UK Government did the work around reforming the Mental Health Act, that work has also taken place for the Mental Capacity Act as well, and I would be very, very keen for the UK Government to also bring that forward in the same way.

What I would say as well, though, is that, as I've already mentioned, in the mental health strategy, we will be updating the mental health Measure, and we would be in support of having that reform for that Act as well. But it is my absolute commitment, as it is the commitment of all of Welsh Government, that that does not happen—that that unintended consequence does not happen. It is imperative.

Excuse me. There is—. I'm really pleased to hear what you're saying and I don't doubt your intentions. But, underneath this—and it's not part of the Act, of course—is the understanding, particularly of neurodiversity. There is a lot of evidence of where neurodiversity and mental health get confused. Individuals seeking help for either their neurodiversity in and of itself, or their mental health in and of itself, get pushed back and forth and are told that it's one or the other, and nothing happens for those individuals, who clearly need help.

Of course, the other thing with neurodiversity is waiting for it to be recognised. I know that it’s not part of the Bill, but I think that what people who are listening would want to be reassured about is the recognition and the aim to help them—I know you've outlined some of that, but it’s about giving recognition to what I've just said; and I've said it because I have been informed by people who experience this—that that those intricate but necessary changes are going to happen.

Absolutely, and thank you for giving me the opportunity to be absolutely clear on this. A learning disability or neurodivergence is not a mental health condition, and we do not view it like that. However, of course, those people will sometimes have mental health needs and issues, and it is appropriate then that they may be detained under the Mental Health Act. The reform, though, makes it very, very clear that that is only if they are experiencing mental health issues, and if they are going to be detained in a way that is going to give them the support to recover and be able to get better, just like anybody else. 

In terms of what you were saying about the waiting times for neurodivergence and diagnosis, as you know, this is something—the assessment—that I'm absolutely committed to. We are really now making strides in bringing down those waiting lists for children and young people. My goal is to ensure that 99 per cent of people have their assessments when they're a child. I still have people, I'm sorry to say—even last week—who will say to me, 'This didn't exist in my day', and imply that it's made up, which it's not. We just have increased awareness, and I think we will probably all know adults who have struggled without that assessment—not only maybe they haven't received the appropriate medication and support, as you've referred to, but also it's such a huge part of their own identity as well. So, that is something I'm absolutely committed to.

And then, when it comes to the community for learning disability awareness, you will have heard me give a statement in the Chamber recently, where I've said that one person who is in a bed and not a home, who shouldn't be, receiving that care at that time, is one person too many. One person being detained under the Mental Health Act, or the Mental Capacity Act, who should not be, is one person too many. And that's why I'm working so closely with my learning disability ministerial advisory group, and I also now have the invaluable input of a group that includes members from the Stolen Lives 'Homes not hospitals' campaign, who will be making recommendations to me this summer as well, and that's going to be much more focused on that community provision.

Although I would like to point out as well, which I think is also going to be a positive in this space, that, of course, we recently had the new GP contract, and they have agreed to do the annual health checks for people with a learning disability, which is something that that community has been calling for for a really long time. Hopefully, we'll be able to incorporate that very much, like making every contact count, and do a bit of prevention work there as well. So, it's all very much intertwined. They're always very, very much at the forefront of my mind.

Thank you. There have been stakeholders who have raised concerns about a care gap for individuals—this is the other side—with learning disabilities or autism, who might not meet the new threshold for detention. So, it's the other side now. So, how are you going to ensure that those individuals aren't left without the appropriate care or treatment?

Absolutely. Again, as I was saying, we have the mental health strategy that will be coming through, and one of the things in that will be looking at the updating of the mental health Measure, which would be, again, as Matt Downton was saying, for people who should be, really, accessing primary care support, and that would also include people with a learning disability. Again, that annual health check now will hopefully also incorporate that as well. It's very much coming back to our ethos around the life course. You're not going to be physically well all your life, you're going to struggle with your mental well-being. We know the trigger points for this as well. So, that's going to be absolutely crucial, and it will absolutely be incorporated into that prevention space. Again, I don't want anybody, really, ever reaching this point, and especially without having those advance conversations, having a nominated person, it's even more important for those people. 

And focusing on, again, children and young people, how will the Bill ensure that individuals admitted informally have clear care and treatment plans and access to advocacy to support their autonomy and ensure their voices are heard?

Absolutely. Thank you very much. So, overall, we are seeing a reduction in the number of admissions to mental health units for children and young people, and this reduction does reflect our investment in those community services and in that early intervention, which I'm really pleased to see. It also points to an overall reduction—a steady reduction—in those informal admissions. So, that's really positive. Whilst informal patients are not subject, as you said, to the Mental Health Act, in Wales, informal patients still have the right to an independent mental health advocate—the Measure—and should be at the centre of their care and treatment planning. I'm a big advocate for advocates and that active offer that children and young people should have. We have advocacy services for young people at both our CAMHS in-patient units in Wales too.

How does the Bill address concerns regarding the lack of safeguards for children and young people? What measures will be implemented to ensure they receive the same level of protection as adults under the Mental Health Act, particularly in terms of the nominated person provision and decision making for those under 16? And I would refer to what James said earlier in terms of a nominated person here.

Absolutely. Thank you very much. The changes will apply to adults and children, and aim to strengthen those safeguards, and so more say in the care and treatment, more choice, more autonomy will absolutely apply to all. We do need to work through the detail as part of the implementation, but 16 to 17-year-olds will have the same rights as adults. As I think James Evans was referencing, for some under 16, they will have the right to choose a nominated person if they are Gillick competent. If they don't have the necessary competence, there will be a process for a nominated person to be appointed to them. 

And finally from me, we hear all too often about children and young people ending up on adult wards and out-of-area settings. So, how is this Bill going to ensure that any placement decisions are made in the best interests of the child, not the provision that's available? 

Absolutely, thank you. I will say that this always really impacts me, because as I've talked about before with my experience as a child, I wasn't detained under the Mental Health Act, fortunately, but if I had been, I would have been sent to an adult in-patient facility, and that still really triggers me, to think about that. So, I take this extremely, extremely seriously.

All health boards do have a designated bed on an adult ward for use in emergencies to admit a young person if other beds are not available. However, that designated bed means that, whilst on the adult ward, the person will be cared for by CAMHS and appropriate staff. We can do better, of course, but that's where we are at the moment.

It is absolutely unacceptable for them to ever be taken to a police station or a police cell as a place of safety. And our aim is also—. This very much comes back to that our aim is to reduce admissions through new services like the ‘111 press 2’ for mental health and our alternative to admission pilots, which have now been introduced in all health boards. I've been to visit some of them, they're absolutely superb, and really have that person-centred wraparound support for the child and young person. That's where we need to get to. I'm really pleased that it has started to reduce. We want to continue on that path, and the pilots will be evaluated, but early operational data is showing that young people are being well supported and actually diverted away from accident and emergency. So, I'm more than happy to give the committee an update on that as soon as we can, as well.

Yes, that would be useful, Minister, thank you very much. Okay, Joyce? Yes. James, it’s over to you now.

Yes, sorry—I was writing notes down. Really quickly on two of the issues that Joyce was raising, we know, and evidence has always proved it—it was proved through the Wessely review as well—about the treatment of people from ethnic minority backgrounds in the system, that they're actually treated a lot worse by the system, that they're more likely to be detained, more likely to have worse outcomes. I'm just interested: do you think, as the Welsh Government, that the Bill goes far enough to recognise the needs of and sometimes the prejudices that are faced by ethnic minority groups within the mental health sphere?

Yes, thank you very much. I think that was so crucial to the Wessely review that came out. I think it shocked people, but again, having done the mental health inequalities review that we did here in this committee, this is something that came out very strongly as well, and just absolutely has to be addressed. So, it is a priority, and it is an underpinning principle in the new strategy that we'll be coming forward with. We will be looking at this across all mental health services and not just those for people with serious mental health disorders, which is really crucial, and the clearer criteria for detention and more opportunities to challenge detentions will also help to ensure the legislation isn’t used inappropriately, because that's really where it was being misused, in the evidence that was given.

I did want to reassure the committee, though, that where we do have ethnicity data, we don't see significant disparity here in Wales. So, for example, under the section 135-136 data, in the last two quarters, the published data show around 4 per cent of people detained were from a black and minority ethnic group. And what I think needs to strengthen is our mental health data, if I'm really honest. I think that's what I would say, and that's something that we need to do here in Wales, and that's something that, of course, we're already progressing with the Betsi health board's electronic mental health record, which is currently being led on by them. Cwm Taf Morgannwg health board are also participating in that. A lot of this will make a huge difference, so I would say that that's more on us to strengthen the data that we have.

That's good to hear. One thing that Joyce mentioned was advocacy for children as well. Minister, you'll have to forgive me because I'm not aware, but I don't think the Bill gives a statutory right—I don't think so; I might be wrong—for children to have access to advocacy. I may be incorrect, but if you could prove me wrong, I'd be grateful, because I think it's very, very important that children are given that statutory right to advocacy. Because what we do see—and we've seen in it in other areas, haven't we, with looked-after children as well—is that where young people should have a right to advocacy—it tends to be put in codes of practice—it doesn't actually equate to it on the ground, and people aren't offered that independent advocacy. I'm just interested: if it isn't on the face of the Bill, is that something that the Welsh Government—with the Welsh Government's commitment to children and young people—would look to have included in the Bill, if it's not there currently? 

I also share your passion, really, for advocacy. I think it's absolutely crucial and also children having that active offer. It's not everywhere it should be in Wales. I've been part of lots of campaign teams trying to push that forward. A lot of this, though, comes under the Minister with responsibility for children. So, I think this is something that I would have to go away and discuss with her, but I will bring in Matt just to clarify. 

For mental health services, it's advocacy, as you know, in the Measure, so young people would get that if they're in contact with secondary care services. So, they already receive that through the Measure in Wales. 

I know it's in the Measure, but do you think it would be useful to have it on the face of the Bill? You can write to me. 

I can write to you, but, yes, I think there's not just this area, but I think there are other areas where it should be a statutory requirement, personally. 

That's fine. I just want to move on to community treatment orders. There are different views across whichever organisation you speak to about the effectiveness of community treatment orders. The Bill has changed the system to make it more clinician based, a bit more beefed-up. You talk to certain organisations that want them completely abolished, that don't think they work, that don't think they're right. You speak to some of the royal colleges, perhaps, who think we need to have more reviews into community treatment orders, their effectiveness and how they actually work in practice. I'm just interested: do you think that the way it's been beefed-up within the legislation—and I think has improved on community treatment orders—do you think it goes far enough? And this is something that does sit within the devolved competence of the Senedd.

It's something that, perhaps, when these changes could come you could look to review it and see how it works. Is that something, perhaps, the Welsh Government would look to do after this Bill is introduced, with those powers that you have, because an awful lot of organisations, including clinicians, are saying it's not working? This new, improved model might not go far enough. It may be something. But I'm just interested: is that something the Welsh Government will look at when it comes through?

This is something that I've been keeping a close eye on because, of course, the UK Parliament joint committee recommended that they should be abolished completely. I know that some of the stakeholders who provided evidence agree with that. I can understand why, when I read through the evidence that they gathered. However, the Wessely review said that we need the reform, and I think I would agree with that, because without knowing what would be in place, I don't think we should be abolishing them. People really need them, sometimes. They really, really do need that support. Really, they should be used as a mechanism for people to go home earlier and to be able to be back out in the community. I think it was a mistake that there wasn't a more person-centred approach, sometimes, in that, and I think that's why having the community clinician now having to play a role is really, really important, as well as being very person centred. 

But I think, again, the beauty of this is that it has highlighted and given clinicians and people with lived experience a voice to say, 'This is how it worked and this is how it didn't work', and we are absolutely committed to monitoring closely the changes as they're implemented. All health boards have mental health administrators and mental health committees to oversee the operation of it as well, and so this is something that will be a really critical element of it. But I welcome the attention that has been drawn to it, the debate that has been had around it. I'm content with where we are at the moment in terms of what is being proposed, but this is something that will have to be closely monitored. Yes, Matt.

I was just going to add, Minister, that you talked about improving the data, and one of the things we will be doing is getting patient outcome and experience measures, which are not routinely measured now in mental health services. So, that will help us when we're looking, both alongside the strategy and the Bill, in terms of implementation and looking at outcomes for individuals in terms of monitoring the impact.

Lovely. I know we're over time, Cadeirydd, and I've got a couple of questions I'd like to ask on implementation, but I'm not sure if the Minister's—

If the Minister and the Minister's officials are able to remain with us a little longer, then—

Absolutely. I'm content. I will be honest, though—in terms of the implementation, the code of practice is to come and the mental health strategy is to come, so I will do my very best.

Yes, and on implementation, I'm interested in how this is going to work in practice, because we have a lot of layers of government, and bureaucracy—I always like to call it—within the NHS in Wales. I'm interested what role the NHS executive is going to play in this, actually, about the roll-out of the code of practice, how it's going to be disseminated across, because there's an awful lot of work that needs to go in to making sure that clinicians are up to date on this, the time, and everything that's required with the new rules. So, I'm just interested what role the NHS exec is going to play in this.

I'm so glad you mentioned them, because I almost went the entire session without mentioning them. We're actually very fortunate—we've got wonderful people on the NHS executive that we work with in this space. So, already they've established an acute and crisis care board. They've suggested and are going to be working with me to do a ministerial summit on patient safety. There's so much happening in this space, and they're really the ones who have really plugged in with all of the health boards. I think that everybody wants to be providing the best care that they possibly can. So, the NHS executive will play an absolutely crucial part in the delivery aspect of this, and whenever I meet with them and discuss this, they're very confident that they will be able to do this. It will be phased, and it will very much come down to, as well, the mental health strategy, which they've had huge engagement with and feed-in to as well. So, yes, absolutely, the NHS executive is really crucial to the delivery of this.

One thing that I know has been called for—. You know, updating this piece of legislation is a very positive step; the Measure is outdated. That was found through my Bill—the Measure needs to be updated. There are an awful lot of things in there around data, around children, around different things. So, I'd just be interested where you see that now being updated. We haven't got long left for this term of the Senedd, and there's an awful lot of work to do around that. If the new mental health Act is going to work, it has to work with other pieces of legislation we've got, and it has to be updated, in line with what's going to be brought through in Westminster. So, I'm just interested in what the timetable is that the Welsh Government have for updating the Wales mental health Measure, along with the mental health strategy as well, because you can't have a new, updated piece of legislation with an outdated piece of legislation here in Wales; it all needs to be coming forward at the same time, in the best interests of clinicians and patients, I think, and I'd just be interested in what the timetable is going to be on that.

Yes, of course, and, as I said before, the Measure was brilliant. What I do hear a lot, from people who work across all the borders, the stakeholders who work across all the nations, is that, in Wales, we do listen to lived experience particularly well and we work in partnership really, really well. I think that what you were trying to do with updating the Measure was to bring that through. So, to be clear, the strategy will be with us by the end of the financial year. In the strategy, there will be a commitment to update the Measure. I do not have a timescale for that at the moment, but I will be able to write to the committee as soon as we do.

I think we need to see that sooner rather than later. I'm not telling you what your ministerial priorities are, but, when this piece is done, I really do think it'd be important to bring this forward before this Senedd term is up, I would imagine.

Yes, of course. I'll bring Alex in here, if he would.

Yes. From an official perspective, we recognise and we've discussed that the Measure needs changes, and, I suppose, we are focused on the implementation of the legislation we're discussing today, and the Minister described some of the role of the NHS executive. Of course, we've got changes in tribunals, we've talked about the alternative pathways around LD and ND, and so there's a lot of work in that space. If you look at the impact assessment that the UK Government have tabled, and the money that we were touching on earlier, all of that will need to take place, and so the focus is on that. The question about the changes to the Measure is probably a decision for the next Senedd term, as to the timing for that to be tabled, given where we are with the legislative programme. That's not to say we're not supportive of doing so, but, as you know yourself, in terms of the programme heading up over the next year, 14 months, it's not currently tabled. So, we would then need to make a decision with the Government at that point about pursuing that, and we will be in the implementation stage for mental health Act implementation.

Okay. I think it's quite useful for us to know that as a committee. My final question—it's probably the million-dollar question, really: all this stuff requires resources, requires staff, it requires clinicians, it requires expertise across the board. Mental health, as Ministers quite proudly will say, is the biggest spend in the health budget, but you know as well as I do that a lot of that money goes into dementia care, it goes into Alzheimer's care; it doesn't actually go on this type of the mental health element, which we're more familiar with. I'm interested in how the Government is going to ensure that, to implement these changes, it's adequately resourced properly, because you can have the best Act, the best strategies, the best code of practice, but if the money doesn't follow it, it's worthless. I'm just interested, from the Government's perspective, in how you're going to allocate money to this to make sure that health boards are prioritising mental health as I see it within this Bill, and not having that money going into other areas, which diverts away from the aims and objectives of this piece of legislation. Cadeirydd, I think you'll be glad to know that's it from me.

It's a really important question to end on. So, of course, as I've mentioned, the mental health budget in Wales is £820 million. It was before my time, but the people who are sitting either side of me have always fought for that parity, that ring fence, to ensure that we have that. The majority of it does go directly to health boards. So, it comes back to what I was saying before about the NHS executive working really closely to help us to achieve those deliveries. I wouldn't say that we ever really have an issue with health boards not being able to or not wanting to spend the money on mental health. I think, sometimes, what we've seen, though, is that it's very difficult to sometimes shift the funding more towards the prevention and the lower tiers, because you kind of need the modelling to show that, and you need to be able to then work really closely with those health boards to ensure that you minimise that risk as we start to make that shift, and that's ultimately where we want to be. So, for example, within eating disorders, we want to see more of that money moving from tier 4 into tier 3, but that's not something that can happen overnight, so that we can mitigate any risk. So, that's what I would say for each of those parts of it.

We are investing, of course, way more in prevention. You can see that with the '111 press 2'. So, that's the space, I think, that we're in at the moment. So, yes, I do believe that it is important as well that you have the funding in place. But, I would also say that the NHS and the workforce itself are crying out to be able to deliver a much more face-to-face, stepped approach, and not having to say to people, 'We'll see you in three months'. People want to be able to give that service at a primary care level that is addressing those needs as soon as people come forward with them.

So, honestly, it's really exciting. I'm really excited about the mental health strategy coming through. I can't wait to come back, and I hope you will have me back so that we can discuss it further and you can ask me more questions about it. But I just wanted to end, I guess, by saying that the reform of this Mental Health Act, as I've said before, has been a really, really long time coming. It's had huge support. It is about human rights. It is about ensuring that people have their human rights protected and that we update it, from a time when—. It was such a long time ago, and the landscape has changed so much in mental health. I come from a place where, with support and care and having that advocacy and empowerment, all people can live healthy lives and people can recover.

Okay. Diolch yn fawr, Gweinidog, and diolch yn fawr to your officials for coming in to give evidence to committee this morning. Thank you for staying with us beyond the allocated time. You will be sent a transcript to check for factual accuracy in the usual way. Diolch yn fawr.

Thank you very much. Diolch yn fawr. Thank you.

Okay. The next item on the committee agenda today, item 4, is a motion to resolve to exclude the public from the remainder of today's meeting, under Standing Order 17.42. Is committee content to do so? I see that you are. We will move to private session.