Y Cyfarfod Llawn - Y Bumed Senedd

Plenary - Fifth Senedd

27/09/2016

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

1. 1. Questions to the First Minister

[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

The first item on our agenda this afternoon is questions to the First Minister, and the first question is from Leanne Wood.

Promoting the Welsh Language

1. Will the First Minister make a statement on promoting the Welsh language? OAQ(5)0161(FM)

Our vision of a million Welsh speakers by 2050 demonstrates our ambition concerning the language. Promoting and normalising are essential components of our draft strategy, which is currently out to consultation.

First Minister, I note that you declared support for the goal of doubling the number of Welsh speakers by 2050, but there was little substance behind that announcement. I wonder if you can inform us exactly how you intend to meet that commitment. What are your targets and timescales for making sure that we are making progress towards that goal? For example, by when can we expect to hit the milestone of seeing three quarters of a million Welsh speakers? I’d be grateful if you could give us a date for that, please.

Bear in mind, of course, that the strategy is actually out to consultation at the moment, and that contains our proposals in terms of the way forward. One area, of course, which is hugely important, is to make sure that the local education authorities have proper Welsh in education strategic plans, and we have made it absolutely clear to them that we will reject any plan they produce—any of those authorities—that isn’t sufficiently ambitious.

As you’ve said in the past, First Minister, it’s important that we do ensure that the Welsh language is a living language in our communities. Therefore, it’s extremely important that we encourage people to use the language in all parts of their lives, including using the Welsh language online, for example. The Welsh Language Commissioner made it clear in the summary to her five yearly report, back in the summer, that there is potential for technology to facilitate communication through the medium of Welsh, because English tends to be the medium used online now. So, under these circumstances, can you tell us how your Government is going to promote the use of the Welsh language online over the next few weeks and months?

There are a number of things. First, of course, this is part of the strategy in terms of looking at ways and means of supporting and promoting the language in the digital sphere. It’s also very important to change the behaviours of young people. We have been funding certain Urdd projects over the past few years so that they can develop apps and so on to ensure that children and young people do see the language as a digital language, rather than thinking that English is the only language that they can use on social media.

Given this commitment to 1 million Welsh speakers by 2050, and a universal acknowledgement that bilingualism is best achieved by immersing children in a second language as early as possible, what arrangements have been made by the Government to implement Welsh learning in preschool classrooms?

[Inaudible]—have been the Welsh-medium education strategies that we expect local authorities to produce, some of them are more advanced than others, but it is hugely important that a proper pathway is identified by local authorities to ensure that access to Welsh as a language to be learnt or, indeed, to be taught through is as available in Wales as possible.

Tourists who Visit Wales

2. What are the Welsh Government's priorities for increasing the number of tourists who visit Wales? OAQ(5)0156(FM)

Our tourism strategy, ‘Strategy for Tourism 2013—2020: Partnership for Growth’, sets out our priorities for developing and promoting Wales’s tourism offer both at home and overseas.

Today is World Tourism Day, as I’m sure you know, First Minister, and it’s so important that we highlight what is on offer in all parts of our country to visitors. My own constituency, the Cynon Valley, possesses world-famous attractions like the Penderyn whisky distillery and unique events like the Nos Galan road races, which commemorate the memory of Guto Nyth Brân. So, how does the Welsh Government ensure the wealth of similar opportunities throughout the south Wales Valleys are highlighted within its tourism strategy? In addition, as the theme of World Tourism Day 2016 is ‘tourism for all’, how is the Welsh Government engaging with partners to ensure attractions are accessible to all possible visitors?

The Visit Wales website does list a wide range of events being held throughout Wales, including many in the Valleys, and the annual Nos Galan road race in Mountain Ash is listed in Visit Wales’s main annual tourism brochure, ‘This is Wales 2016’.

She asked, of course, as well about accessibility. The Visit Wales website does include a filter for the provision of disabled visitors to allow visitors to search for attractions that cater for those with disabilities, and that information is based on the details provided by the attractions themselves, while exact facilities can be confirmed by visitors at the enquiry or booking stage.

You’ve been First Minister for seven years, so every day you pass the dilapidated Cardiff Bay train station. You also pass the crumbling yet magnificent façade of the Corys building opposite the Wales Millennium Centre. Do you not realise how embarrassing it is for Wales that those buildings are the first things that many tourists see when visiting Cardiff Bay? A Westminster Government would never allow such eyesores literally within a stone’s throw of the UK Parliament. So, what are you going to do about these eyesores in Cardiff Bay?

I don’t know what he did when he was deputy leader of Cardiff, because, of course, the council does have a responsibility, not for the railway station, I accept, but certainly for Central Square, now being developed, of course, by a Labour-led council in Cardiff. So, the new bus station is being built and the city has a proper gateway. He raises an important point about central railway station. I’ve certainly met with Network Rail. They have plans for the station, and we’ve been urging them to develop those plans as quickly as possible, keeping the character of the station, of course, whilst, at the same time, modernising the facilities available.

First Minister, Visit Scotland spends over £50 million on promoting Scotland. In Wales, Visit Wales, £8.3 million was spent on Wales as a whole. But none of that spend is spent specifically on promoting mid Wales as a specific destination to visit. We have the coastal path, we have beautiful market towns overlooking fantastic scenery in mid Wales. Can I ask, First Minister: is it good enough that we do not promote mid Wales as a specific destination?

He makes a strong case for the area that he represents, which I appreciate. We do look, of course, to promote all areas of Wales, including areas that traditionally have not been seen as areas that have traditionally attracted tourists. I can say that expenditure by staying visitors in Wales in 2015 was over £2.3 billion, well above the target that we set in place. We know that tourism is a major employer in Wales as well, and we’ll continue to look to increase the number of visitors, both day and overnight, to all parts of Wales, so that those who don’t have the good fortune of living here can enjoy what we have to offer.

First Minister, I welcome the successful summer for tourism in Wales in terms of day visits and also the recent Welsh Government investment in my constituency, including improvements to Flint castle, and the exciting Let’s Skate initiative, which is coming to Theatr Clwyd later in the year. Can you give assurances that this investment will continue to be built upon so that we can continue to grow our crucial visitor economy in north Wales?

Yes, of course. In response to the point I made earlier on, we want to encourage tourism to all parts of Wales, not just the areas that have traditionally been the areas that have attracted most tourists. And we’ll continue to look to provide investment to improve those facilities for visitors in the years to come.

First Minister, many businesses in north Wales are dependent on tourism and have long been disadvantaged in north Wales, partly due to the failure to adequately advertise local attractions along the A55. It’s an ongoing problem experienced by local attractions—visitors get on the 55, stop at their destination, having no idea of the diverse activities off the 55 and which aren’t signposted. The opportunity to use the 55 as a means of generating income for local businesses is being missed. Could you explain to us please what you’re going to do to address this problem?

Of course, working with local authorities, we’re able to investigate, for example, the provision of more brown signs. We see those going up across Wales. It is right to say that we are working on making sure that we get more capture of the visitors that are travelling along the A55 to Ireland, many of whom have said to me in the past, ‘Well, we’ve travelled to Ireland that way but not really stopped on the way.’ I can say though, when it comes to international tourists, that figures continue to go up, and, for them, of course, many of them will visit Ireland and travel through north Wales in order to get there. But, working with the local authorities, we believe that we can continue to provide information to visitors both digitally and in terms of the signposting.

Questions Without Notice from the Party Leaders

We now move to questions from party leaders, and first this week is the leader of the Welsh Conservatives, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, very often at First Minister’s questions you talk at length about what the UK Government is doing. So, for this question, I’d like to focus on what you think would be the best outcome from Jeremy Corbyn’s leadership. Do you think that the best interests of the United Kingdom would be served by having Jeremy Corbyn as the next prime minister?

It’s nice to see that you’re going to play your part in the trilogy, then, of the demise of the Labour Party by having him as the Prime Minister, because the longest suicide note possible was written in 1983 for the Labour Party, and, by having a Prime Minister who delivers for Wales, it’s vital to have that person in No. 10. You also went to the conference—[Interruption.]

Can we hear the leader of the Conservatives’ questions, please, in silence, without any attempt by Ministers to help the First Minister?

He needs all the help he can get. [Laughter.] First Minister, you also went to the Labour Party conference in Liverpool and launched a strategy there—the Healthy Child Wales programme, something that we fully support on these benches, because, when you look at the indices around child health, they are pretty appalling, to say the least, here in Wales. And, actually, most major indices have not moved since 2007 here in Wales. Can you tell us how the Government will take this strategy forward and, importantly, what budget lines you have agreed—I appreciate there was a statement issued yesterday, but there wasn’t a lot in that statement, First Minister—what budget lines have been agreed to take this policy forward, and how many extra community nurses will be there by 2021, because we know the number of community nurses is declining in Wales?

This will be examined, of course, when the budget is produced, and, as part of the promises we made to the people of Wales back in May, we intend to continue the situation where health inequalities close. What we’ve seen, of course, with the bedroom tax and with cuts in welfare benefits is that inequality has risen in Wales and we will do what we can to combat that. I’m grateful to him for mentioning my own party’s conference. If he wishes, of course, to play a greater role in that, then he can apply to join, though I can’t guarantee his application will be accepted.

First Minister, the Labour Party are doing all the favours they can for the Conservatives and other parties at the moment—long, long may it continue. As I say, we are now into the trilogy stage, we are, because we had the sequel in 2015, we did.

But the other point that was raised last week, by my colleague, David Melding, on Government policy—because we didn’t get an answer to my second question from you, so clearly there’s no budget line identified yet, or the development of a community nurse strategy to increase numbers—was on housing. And, in the programme for government, you, to your credit, identified you wanted to bring 20,000 social housing units forward by 2021. But that didn’t have any answers to what the current housing crisis faces, of the new-starts in the housing market, where we saw a 7 per cent decline in new-starts in Wales last year. So, how is your Government going to deliver on its social housing targets, and, importantly, how is it going to generate more activity in the overall housing market so that, by 2021, we can be hitting the target of 12,000 units a year, rather than the 8,000 we’re hitting at the moment?

Well, he mentions the budgetary issues. Again, they will be part of the budget when it’s published for all Members to see. We have our target of 20,000. The Minister will be explaining to the Assembly how that target will be achieved. We have achieved those targets in the past. We stand on our record. He talks of a trilogy. The second part of the trilogy, of course, was the defeat and backward pedalling of the Conservative Party in the elections in May.

Diolch yn fawr, Lywydd. In the Government’s document, ‘Taking Wales Forward’, the section on health says,

‘We are committed to helping improve health and well-being for all.’

But, as the First Minister will know, there are lots of parts of Wales where that remains just an aspiration. And, in Gwynedd in particular, in the area around Blaenau Ffestiniog, the record is exactly the opposite. In the seven well-being areas defined by Gwynedd Council, there is a community hub hospital in every one apart from Blaenau Ffestiniog. And, since 2013, we’ve seen the closure of the memorial hospital, a loss of hospital beds, the closure of the x-ray service, the closure of the minor injuries unit, the closure of teledermatology clinics and therapy services, two rural branch surgeries have closed, and the GP practice in Blaenau Ffestiniog was supposed to have four full-time doctors, but it’s only got one salaried doctor and a variety of locums. As far as Blaenau Ffestiniog is concerned, they haven’t got a national health service, but a notional health service. What is he going to do about it?

Well, first of all, we have been investing, as we will in Blaenau Ffestiniog, in brand-new health centres across the whole of Wales. Simply keeping old buildings going for the sake of it is not how we see the future of the health service. It’s hugely important that Blaenau and other communities have access to the most up-to-date, modern facilities possible, and there are examples of that around Wales, and that’s precisely what we want to offer the people of Blaenau.

Well, each of the other six well-being areas has got a hospital that is open for 24 hours a day. The health centre in Blaenau will be open for only 10 hours a day. That is unacceptable. The aspiration is to meet the needs of the local population and ensure that services are provided as close to patients’ homes as possible. To get to Ysbyty Gwynedd from Blaenau Ffestiniog is an 80-mile round trip, or journey, and, for a lot of elderly people, and people on low incomes, this means that the national health service is not actually free at the point of delivery to them because they have to pay to get there. Ministers, unfortunately, have declined to intervene in this case—both the current Cabinet Secretary and his predecessor, Mark Drakeford—because they say that the decision to close down local services was agreed locally, but that, of course, was Betsi Cadwaladr that agreed to do that locally. When local people were asked by means of a community referendum, nearly 100 per cent of people voted against those closures. So, I’m asking the First Minister now, will he encourage his colleague the Cabinet Secretary to personally intervene in this case?

He seems to be making a case for the establishment of a district general hospital in the area if he says that travel is a problem. Yes, it is. We know that travel in some parts of Wales means that people have to travel further than normal, but that’s because they get a better service than a district general hospital. What we have, of course, is Ysbyty Alltwen, which is about, I think, 7 miles away from Blaenau Ffestiniog, and indeed the promise of investment into new health facilities, so that people don’t have to go into hospital in the first place. For many, many years, we’ve had a health service in this country that was hospital focused. We intend to make sure that more and more people can stay at home, get the support that they need at home, without having to go into hospital.

The litany of closures that I’ve just read out shows that that’s merely an aspiration—what the First Minister has just said. People in Blaenau feel that they’re actually being discriminated against amongst all the well-being areas that are identified by Gwynedd county council. What is it that Tywyn has got, for example, that Blaenau Ffestiniog lacks in terms of the health needs of the people? I’m asking the First Minister just this simple question: will you encourage the Cabinet Secretary to meet a delegation from Blaenau Ffestiniog in order that we can argue the toss on the claims of this important area to better treatment as part of the Government’s overall objective stated in its high-flown document last week?

It’s absolutely essential that the area gets better treatment; that’s why we’re investing in health facilities. He needs to go and talk to people, for example, on Deeside, where a brand-new health facility was opened there, or people, indeed, in Port Talbot, in Baglan, with the Neath Port Talbot Hospital—the brand-new health centre there—or Builth Wells, with the brand-new health centre there. We are providing the facilities that people need for the future, and importantly the facilities that shape the future as far as the health service of the twenty-first century is concerned, ensuring that fewer and fewer people have to stay in hospital, rather than doing things in the same old way, where people stay in hospital when they don’t need to.

Diolch, Lywydd. First Minister, how many children are waiting for more than four months for a first appointment with child and adolescent mental health services?

With child and adolescent mental health service, we’ve invested heavily—£6.6 million into the service. Demand outstripped supply, that much is true, which is why, of course, we’ve matched that with the extra investment that has been put in. It means, of course, that the numbers waiting and the times that youngsters are waiting have gone down.

First Minister, I asked you for a figure, and the exact number that you were looking for is 1,174 children waiting for four months. And it’s not true to say that that figure has gone down, because that figure has almost trebled in the three years since 2013. We all know that investment in early years is crucial for positive outcomes in education and health, and in particular in preventing some of the problems that can arise later on in life. Developments in neuroscience are showing that the early teenage years can be just as crucial for a person’s development as the early years.

I visited my old school last Friday, and I was told that the rates of self-harm are going through the roof at Tonypandy Community College, and I don’t think for one minute that that is an isolated case. Depression, anxiety and self-harm have become too common amongst a generation that have many worries about things like zero-hours contracts, massive student debt and endless austerity. Those young people are not covered by the interventions that are available for children under seven years old. The things that can go wrong in the teenage years can cause problems for life, and I saw that only too well in my former role as a probation officer. First Minister, will you establish a programme for pre-teens and teenagers to go alongside your Healthy Child Wales programme, and would you be prepared to look at what role mindfulness could play in such a programme?

Well, first of all, mindfulness was mentioned in the Welsh Labour manifesto as something that could be looked at. When we talk about the health of a child up to seven years old, that must include all types of health, including mental health as well. That is something that will be taken into consideration when developing the programme.

The second point is this: she’s right, we do see instances where young people do find themselves under a great deal of stress. Cyber bullying is one area, particularly, that she and I didn’t have to cope with that is something that is a real issue, and the education programme in schools to deal with that is important. The fact there are counsellors in the secondary schools—that’s important in order to help young people and, of course, ultimately, making sure the resources are there for CAMHS. The resources have been put in and I fully expect the waiting times and the numbers to go down as those resources work through the system.

First Minister, your Government’s record on helping young people with poor mental health is appalling, and that’s without mentioning the children and young people who don’t even make it into the system. The mortality rate for teenagers between 15 and 19 years old is higher in Wales than it is in England, and there has been no reduction in deaths from intentional injury among that age group, between 10 and 18 years old, in three decades. A national case audit of children’s deaths has suggested that many young people who died from suicide had not had any contact at all with mental health services, and, for those who had, there were problems with services failing to follow up on patients who did not turn up for their first appointments. You once admitted, First Minister, that your Government took its eye off the ball when it came to education. Will you now accept that your Government has taken its eye off the ball on children and young people’s mental health? Will you now accept that this is a crisis and will you tell us what, after 17 years of leading the Government here in Wales, you intend to do about this?

I have to say to the leader of the opposition, I had experience, as did my constituents, of this when the town that I represent was branded as some kind of suicide capital, where we had predatory journalists arriving from London who were trying to question young people outside the local college and trying to suggest to them that it was better to be dead than to live in the area. Those are the exact words that were used. Those youngsters who took their lives, in the main, did not know each other, despite what the press suggested. To come to the point that she was making, many of them had no contact with mental health services. They were a surprise—what happened was a surprise to their families. They’d had no warning. In some ways, that’s the greatest tragedy of all, because people—[Interruption.] It’s an important point: this is the greatest tragedy of all, where you have young people who are not known to the system and have not identified themselves to the system.

She asked what’s being done. I’ve already mentioned the money that’s been put into CAMHS. It is true to say that demand for CAMHS was significant, and that’s why, of course, we’ve provided more resources for CAMHS in order to make sure that more young people are identified. On top of that, of course, we do have counselling services in the secondary schools in order that young people can go and talk to people early on. That takes us well beyond what used to be the case in Wales.

Promoting Health and Well-being

3. What assessment has the First Minister made of the role of allied health and social care professionals in delivering Welsh Government priorities of promoting health and well-being throughout life? OAQ(5)0160(FM)

I’m grateful to the Member for this question, because they are the unsung heroes of the health service in many ways. They work in the community and in primary care, and, of course, they deliver a lot of preventative care, which is difficult to measure in itself, because how do you measure something that prevents something that would have happened in the future? Of course, they help to deal with admission avoidance, so that more people don’t have to go into hospital, but have the support to stay at home.

I thank the First Minister for that answer. I had better declare an interest, as my wife—it’s in the register of interests—is a radiographer. She also has very cold hands, so I warn people in advance. [Laughter.] In Wales, 50 per cent of people—[Interruption.] She does. [Laughter.] Fifty per cent of the population of Wales will be over 65 by 2037. There is now a higher proportion of people aged 85 plus as we speak. The increase in chronic conditions and comorbidity, resulting in complex health needs, is documented and is there for all to see. This will require a real determination to deliver the Welsh Government’s strategy and to align that workforce toward primary care and picking them up where we can actually keep people in a well-being service, not a rescue and an illness service. So, will he congratulate my wife and all of those who work in allied health and social care professions, and congratulate also Dave Rees for hosting an event last week at which all of those professions were there? They deserve our thanks and our gratitude. They have a huge role to play.

I will join, of course, the Member in congratulating the Member for Aberavon. I am not sure that harmony will reign in his house over this evening given what was revealed to us in terms of information. But he’s right: the challenge that faces us in the future is, as people get older—yes, many of those people will be fitter when they’re older, but, inevitably, people get a number of small conditions that, taken together, make it difficult for them to live their lives in the way that they would want. It’s rare for somebody to have one very serious condition that disables them. Quite often, it’s just a combination of different things. What, then, can the AHPs do? Well, early recognition of problems and timely intervention so that things are dealt with early on; admission prevention; facilitated discharge; rehab and reablement—very important, obviously; support for chronic conditions as well, so that people with chronic conditions don’t have to continually go back to hospital in order to deal with a particular flare of a chronic condition; and, of course, what they do in terms of being able to add to a multi-agency and multidisciplinary team to help the individual. We know that, in the future, there will be more pressure as people live longer—something to be welcomed—but also there is still a frailty of the human body that we can’t legislate for, and more and more people, as they get older, will need help with what may be a number of smaller conditions, but nevertheless are significant for them as an individual.

Thank you, Llywydd. Over the past few weeks I’ve visited two pharmacies in my constituency—the Rowlands pharmacy in Llanfair Pwllgwyngyll and the Boots branch in Llangefni. Pharmacies, of course, play a crucial role in the wider provision of primary care, and I would certainly want to see that provision extended. Does the First Minister agree with me that we need to do away with some of the barriers that prevent pharmacies from playing their full role, including actually putting aside the ban on advertising some of their services, for example flu jabs and services in terms of smoking prevention and so on?

Yes, that’s right, and that will be part of the public health Bill. It’s important that any nonsensical obstacles are done away with. But we know, of course, that pharmacies play a vitally important role in ensuring that people receive advice without having to go to see their general practitioner, and also, of course, we would wish to extend the services available from pharmacies ultimately, bearing in mind, of course, that more and more of them have received clinical training so that they can actually work in those areas.

First Minister, I also share the admiration mentioned here for the jobs that our health and social care professionals undertake throughout the country. The multidisciplinary approach provided to patients by doctors working closely with such professionals has proven to be very effective, particularly in the health boards where they have a director of therapy and health sciences on their boards. You can see that by the examples of some of the ones that are recognised good examples throughout Wales. So, First Minister, what could you do to embed this role, given the ever-changing nature of healthcare provision, and will you review or undertake to discuss with your colleagues the review of the continuous performance development training for these people so that we can better identify and prepare for the next generation of directors of therapies and health sciences?

Yes, but first of all we would expect local health boards to see what works in other health boards and then use that best practice, and apply that best practice, in their own areas. Where there’s evidence of that practice working well, then clearly we would want them to look at it to see if it’s appropriate in their own area and, if so, to implement that. When it comes to CPD, many professionals, of course, are governed by professional bodies that are, of themselves, not devolved, if I can put it that way, and have their own requirements for CPD. But if that is an issue, then it’s something, of course, that the Minister might be able to look at in order to see how the position of the directors that you’ve referred to can be strengthened in the future.

Small Business Rates Relief Scheme

4. Will the First Minister set out the next stage of the Welsh Government’s small business rates relief scheme? OAQ(5)0158(FM)

Gwnaf. Rydym yn ymestyn y cynllun rhyddhad dros dro, a oedd i fod i ddod i ben ym mis Mawrth y flwyddyn nesaf, am flwyddyn arall. Yna, byddwn yn datblygu cynllun parhaol newydd, a fydd ar waith o fis Ebrill 2018 ymlaen.

Thank you for that answer, First Minister. The Welsh Government’s decision to stick with its existing business scheme hasn’t received the reception you might have liked in your own constituency, First Minister. Traders are already vocal in the criticism of the highest business rates in my region, and perverse rates incentives to keep shops empty. In Bridgend town, in particular, they’re not very happy with the council that did its best to ignore the views of traders on how to increase footfall. Some now feel misled into believing that the Labour rates relief scheme would be different from business as usual, so what reasons can you give us for making the current system permanent instead of adopting Welsh Conservative policies around a differentiated multiplier and tapering relief to £15,000?

Well, I have to say first of all, with regard to my own town, which I know very well, there are at least three different groups of traders who don’t agree with each other, and that is one of the weaknesses the town faces. Secondly, she mentions empty premises. The biggest problem with empty premises in Bridgend is the intransigence of landlords—landlords who will not rent, or are only offering rent at ridiculous rates. I have heard examples of businesses who have said to me they are only being offered leases of 10 years with rents of up to £25,000 a year. That’s ridiculous. Some of the landlords in Bridgend need to get real and understand that the way of things 40 years ago is no longer right.

She asked me why we would not adopt Conservative policy. Quite simply, this: there are over 70,000 businesses in Wales, more than 70 per cent of them receive support, and over half of all eligible businesses pay no rates at all. In England, only a third pay no rates at all. So, actually, the scheme in Wales is significantly more generous than the penny-pinching scheme implemented by the Conservatives in England.

First Minister, I’ve been contacted by a number of constituents who have expressed concern over the level of their business rates, which is putting a strain on their business finances. As they fall outside the threshold for small business rate relief, they have to pay the full business rates, irrespective of the affordability. Unless these small business owners find smaller, cheaper premises than these properties they are stuck with huge rates bills. What plan does your Government have to raise the rate relief threshold and ensure that rate relief has an affordability consideration?

Well, we’ve already put £98 million into the rate relief scheme. There is bound to be a threshold, unfortunately, and those who are, as they would see it, at the wrong end of the threshold, yes, they will have to pay business rates. What we cannot do is introduce a system where everybody gets business rate relief and nobody pays business rates. Like any business, businesses have to take decisions as to the size of their premises in order to understand what is affordable for them as a business.

Abertawe Bro Morgannwg University Local Health Board

5. What support is the Welsh Government providing to Abertawe Bro Morgannwg University Health Board following the decision to escalate its status to 'targeted intervention'? OAQ(5)0169(FM)

We are working closely with the Abertawe Bro Morgannwg University Local Health Board. Support will be directed by the Welsh Government in agreement with the health board as to what assistance it requires.

Thank you for that response, First Minister. Further to that, may I ask whether you are confident that you have the capacity within your department in the Assembly to provide the necessary support to this health board in Swansea, given that other health boards are also under special measures?

Only one health board is under special measures, namely Betsi Cadwaladr. We are most confident about the way in which we have ensured that Betsi Cadwaladr can turn around. So, what we have targeted in terms of the other health boards will ensure that we see improvements to those, in order to avoid, of course, any situation where they would have to go in the same direction as Betsi Cadwaladr.

Before I start, can I declare an interest in that my wife’s a radiographer in ABMU, but I won’t discuss the warmth or the coldness of her hands? First Minister, ABMU’s in targeted intervention because of cancer services and unscheduled care. Both parts of those rely upon diagnostic services. We have seen problems with diagnostic services in the past, with waiting lists being perhaps of a length that was unacceptable to everybody, but will you join me in congratulating ABMU and the staff, in particular, who have actually seen those waiting lists come down, and therefore we’ve seen diagnostics getting better in ABMU?

Yes, I will, and at the end of July there was a reduction of 78 per cent in the number of people waiting over eight weeks for one of the specified diagnostic tests, compared to July 2015.

First Minister, the health board’s integrated performance report of July 2014 states, and I quote, that

‘The Health Board continues to experience significant challenges in the delivery of the Urgent Suspected Cancer referral target in particular.’

At that time, they were reaching 86 per cent of the target rather than the 95 per cent that the Government was looking for. Notwithstanding the point made by David Rees now, being that those issues were reported two years ago, what support did you give ABMU at that time? What is different about the support that you’re giving them now, and if it was needed two years ago, why wasn’t it given then?

Well, if you look at the figures, if we look at the 62-day performance for cancer, more people are starting their treatment within the target time of the 62-day pathway for cancer. The same thing applies to the 31-day pathway—80.4 per cent higher. If we look at 12-hour waits in A&E last year, those figures have reduced by 63 per cent since March of this year. So, we are seeing great differences in terms of not just diagnostics, but in terms of cancer treatment, and indeed in terms of A&E performance.

First Minister, the reason ABMU are to receive targeted intervention is due to poor performance in unscheduled cancer care. The most recent figures show that just 83 per cent of patients diagnosed via the urgent suspected-cancer route start treatment within 62 days. We all know that timely treatment and intervention reduces the risk that the cancer will spread and increases the chances of survival. What support is the Welsh Government giving to ABMU to enable them to eliminate delays in treatment and to improve the cancer survival rates in my region?

I think I’ve already answered that question when I gave the statistics in terms of the 62-day performance and the 31-day performance. Sometimes, of course, clinicians tell me that it’s not that easy to start treatment within 62 days because of the nature of the cancer itself, its position in the body and, indeed, the need to look very carefully at having the most targeted treatment for the individual. If you’re an individual with cancer, of course, well, yes, you need to have certainty as quickly as possible. I understand that—the very human need. That’s why, of course, we’re seeing the improvements in the performance of ABMU in that field.

Helping the NHS Prepare for the Forthcoming Winter

6. Will the First Minister outline how the Welsh Government is helping the NHS prepare for the forthcoming winter? OAQ(5)0162(FM)

We’ll continue to support health and social care organisations in Wales through our quarterly national seasonal planning meetings, which support their seasonal planning arrangements. And, of course, as part of that, preparedness for the forthcoming winter period is paramount.

Thank you, First Minister. Last winter, we saw unprecedented levels of demand on unscheduled care. People struggling to get access to a GP over the winter months put enormous strain on our A&E departments as patients go there to seek medical treatment. According to the RCN, our hospitals are so full all year round that the system cannot cope with the seasonal spike in demand. We have to address the GP-access issue if we are to avoid the scenes we saw last winter with ambulances stacked up outside hospitals. What plans does the Welsh Government have to improve the out-of-hours GP service and make greater use of community pharmacies in treating minor ailments this winter? Will you be running a publicity campaign highlighting the role of pharmacies in treating minor ailments?

We do; the Choose Well campaign has been doing that for many years and, indeed, there’s an app available for people who want to access it. We encourage people to look, in the first place, at a pharmacist, then to look at a community nurse, and then to think about the GP. It’s quite right to say to people, ‘Don’t default to the A&E department first or, indeed, to a GP first.’ So, that’s already in train. In terms of out-of-hours, it’s available in our DGHs and elsewhere. The issue in the winter is not the numbers of people coming through A&E, but the conditions that they have: there are many more, older people with respiratory conditions that are more complex, who need more time in A&E and, ultimately, admission. Last year, the preparedness plans worked well. It can be difficult, of course, to predict the demand on the NHS in the winter because of the weather, basically. But, nevertheless, we scrutinise the preparedness of each local health board to make sure that we can be satisfied that they are ready for the winter.

Under the children’s health plan that you published, First Minister, every child under seven is supposed to be given the same consistency of service in winter and summer. So, how do you respond to the Royal College of Paediatrics and Child Health’s report today on babies born prematurely, which shows that they are given a second-rate service here in Wales? Only 31 per cent, for example, of premature babies are given a crucial second appointment by their second birthday. That is half the percentage across the rest of the UK. Having centralised the service for premature babies—the closure of the unit in Withybush and moving it to Glangwili—they are still given a second-rate service as compared to the best services throughout the UK. Is it empty rhetoric, therefore, when you are unable to provide what is crucially important and fundamental today?

No, not at all, bearing in mind that, according to the report itself, approximately 90 per cent of the services are working well. There are some parts of the service that need improvement—that’s true—and that’s why we welcome such reports, so that we can identify where there is room for improvement. But we know, according to the Nuffield report, that there is very little difference between the health services across the United Kingdom. We will continue to ensure that the best treatments are available and that where things are good but could be better that they improve.

First Minister, winter pressures haunt us every year: we have these kinds of conversations and it’s always the same groups of people—the elderly, the young and the chronically ill. However, in Pembrokeshire, the community resource teams, which are a joint collaboration between the health board and local government, have been incredibly effective in working together to ensure that people have access to the right services and in preventing hospital admissions. They focus on preventative care and they reduce the need for complex care packages. Basically, their job is to be out there to avert crises. They work in the community, in tandem with doctors. There’s no coincidence, First Minister, that this is a health board that actually has a director of therapies and social sciences—a former occupational therapist. They’re stopping people getting into hospitals, particularly the elderly and particularly those with respiratory problems.

First Minister, would you, first of all, welcome the work they’re doing, because they’re one of the leading practitioners of this in Wales—them and Neath Port Talbot? Secondly, would you come to Pembrokeshire to, first of all, see them in action and also understand a little bit more about the benefits that a director of therapies and social services—allied healthcare professionals—can bring to the changing face of NHS healthcare, particularly over these next 10 to 15 years, when we need more of these people, not fewer?

How can I refuse such an offer? In principle, I’d like to accept that, because I’m interested in the work that the Member has described. I can see the passion that she displays in advocating the work that she has seen them do. I’d like to see it for myself.

Question 7 [OAQ(5)0166(FM)] was withdrawn by the Member, so question 8, Llyr Gruffydd.

Shortage of Doctors in North Wales

8. Will the First Minister make a statement on the shortage of doctors in North Wales? OAQ(5)0164(FM)[W]

Well, as regards the numbers, there isn’t a shortage. There are more doctors now than we had in 2005.

Aelod o'r Senedd / Member of the Senedd 14:12:00

That’s not true.

Don’t say that it isn’t true; I’ll give you the figures so that the information is correct. In 2005, there were 1,849 GPs in Wales and now there are 1,997. In the Betsi Cadwaladr area, there were 422 in 2005 and 437 in 2015. And the same is true in terms of the significant increase in the number of doctors in hospitals. Having said that, of course, there will be a campaign launched at the end of next month in order to attract more doctors to work in Wales.

Well, I’m not sure if I want to thank you for that response because it’s a very different picture painted if you count the number of doctors that correspond to full-time equivalents. But, the question I wanted to ask you is this: one of the problems with the recruitment of GPs to rural areas is the lack of wider health facilities that are available to them. GPs don’t want to fail in their duties because they can’t access beds for patients, x-ray machines, diagnostic services and so on and so forth. Can I ask you, therefore, would you be willing to commission research with rural GPs, including those perhaps who have given up their posts, to acknowledge their problems in terms of access to local facilities and to take action as a result of that?

I would argue that we’re already doing that through the collaborative group in mid Wales, which has worked extremely well. I would expect the work that has been done there to be work that could be transferred and disseminated throughout the whole of Wales. So, that work has already started.

Thank you, First Minister, for that question. I listened very carefully. One thing that you didn’t refer to, of course, is the innovation in GP care, in particular in north Wales, in terms of the work that’s going on in Prestatyn, with a multi-disciplinary team approach to patient care. What work is the Welsh Government going to do to evaluate whether that model is a successful model that can be applied elsewhere across Wales in order to alleviate the pressure on GP numbers in the country?

He will know—he’s seen it himself—how it works. The reality is that we saw in Prestatyn GP practices—two of them, if I remember rightly—close. But, the local health board took over the provision of primary care services, and the services are better and are certainly wider than what was available before. So, it does show that the contractor model is not always the best model for delivering medical services. For some, that’s what they’ll want; for more GPs, increasingly, it seems to me, the contractor model is less attractive to them. What we’ve seen so far in Prestatyn has been excellent in terms of the width and the depth of the service that’s been provided and, of course, the local health board will continue to evaluate what’s been done there in order to make sure that it’s a model that can be adopted, potentially, around Wales.

Improving Mental Health Services

9. What plans does the Welsh Government have to improve mental health services during the fifth Assembly? OAQ(5)0155(FM)

We’ve made a number of commitments around mental health and well-being in the programme for government, and we will shortly be publishing the next three-year plan to deliver our mental health strategy, ‘Together for Mental Health’.

Thank you for the reply, First Minister. In 2014, the Children, Young People and Education Committee published a report of the inquiry into child and adolescent mental health services. The committee found that there was a 100 per cent increase in referrals for these services, but that the provision was insufficient to meet this increase. In recent meetings with the committee, the Children’s Commissioner for Wales said that the Together for Children and Young People group, dedicated to reforming mental health services for children and young people, has only met once since the group’s inception. Even though the Welsh Government increased funding by £7 million to the services, there is no explicit commitment in the programme for government to reform CAMHS. Throwing money at the problem won’t make it disappear. Will the First Minister commit to reforming these services and explain how he will do it?

I disagree with the Member. It did need an injection of money; that’s happened. We are seeing the benefits. Fewer children are being cared for out of the area. The waiting times for specialist CAMHS services are down by 21 per cent. And, of course, new services for attention deficit hyperactivity disorder and autism are being established across Wales. There’s more to do, of course, but we are seeing real improvements for children with mental health problems.

Tariff-free Trade

10. What are the implications for the Welsh economy as a result of Japan's statement on the potential loss of tariff-free trade with the UK due to Brexit? OAQ(5)0163(FM)

The Japanese Government’s statement covers a number of potential adverse economic implications of the UK’s exit. It’s for the reasons that are outlined by that Government that we want businesses in Wales to have full and unfettered access to the single market.

I’m sure we all do, but unfortunately many members of the UK Government seem to be pushing in the opposite direction, which is extremely worrying for the some 6,000 people who depend on jobs that have resulted from Japanese investment, including Panasonic in my own constituency up in Pentwyn. So, I just wondered how we are going to be able to influence the UK Government to ensure that we will continue to have free trade with the European Union, because otherwise the future for inward investment looks extremely bleak.

To me, agreeing that fundamental point is essential before we can move on to anything else. That is the basis—the building block—on which any deal can be built. Unless we get progress on that, it’s very difficult to see progress on anything else.

I’m certainly concerned that the UK is now seen as not wanting to engage with the EU. There are issues. I met with the chief commissioner of Gibraltar two days ago—the worry that Gibraltar has is that Spain will veto any deal of any kind with the UK unless the issue of Gibraltar is resolved to Spain’s satisfaction. It’s an opportunity that Spain has that wasn’t there before, which Brexit has delivered. So, there are many, many factors still at play here, some of which will not yet have been identified.

2. 2. Business Statement and Announcement

The next item on the agenda is the business statement and announcement, and I call on Jane Hutt.

Diolch, Lywydd. I’ve made some amendments to this week’s business. I’ve expanded the title of the oral statement on the establishment of the new treatment fund and the independent review of the individual patient funding request process, and I’ve added a statement on the Rio Olympic and Paralympic Games homecoming 2016. I’ve reduced the time allocated to tomorrow’s questions to the Counsel General in line with the number of questions tabled, but business for the next three weeks is as shown on the business statement and announcement found among the meeting papers available to Members electronically.

Minister, can I call for a statement from the Cabinet Secretary for Economy and Infrastructure on Road Safety Week, which is coming up in November? There’s been some concern that many motorists across Wales, and, indeed, other parts of the UK, are not having their eyes tested frequently enough and that this is leading to an increase in the risk of motor traffic accidents. I’d like to hear from the Cabinet Secretary what he’s going to do about that and whether there might be an opportunity to use the signs—the messaging signs—across the A55 in north Wales and the M4 and other trunk roads across Wales to actually encourage people to have their eyesight tested during that week in order to take advantage of some of the free tests that are available.

Well, the Member raises a very important point and the Cabinet Secretary will be prepared to make a statement on this point, so thank you for raising it.

Could we have a debate on setting up the constitutional convention that’s long been proposed by the First Minister? Now that we are going to possibly lose 11 MPs in Wales when the numbers go down from 40 to 29, and, with the vote to leave the EU, it’s likely we will lose four MEPs, isn’t now the ideal time to acknowledge that there are too few Assembly Members to do the job properly here in this Chamber and that all these items should be considered together? Wouldn’t having had a constitutional convention have been the ideal opportunity to look at all these representation issues in the round?

Well, Julie Morgan raises a very important point and she’s raised this on previous opportunities. I think—of course, the boundary commission proposals are out for consultation—it will have a major impact in terms of how our Welsh communities will be represented and we will be making our views in terms of disadvantage that could be caused by proposed changes. Of course, it has an impact on the Assembly and on us as Assembly Members and elected representatives in terms of how our constituents are represented in Parliament. Of course, those issues are going to be—in respect of Assembly elections—included in the Wales Bill currently before the Lords and should come into effect from Easter 2018, if that Bill becomes law. But I think the issues around political representation and around—and you raised issues about our representation in this Chamber—changes to parliamentary and European representation as well, the loss of MEPs, and significant expansions of our responsibilities as well from the Wales Act 2014 and potential changes from the current Wales Bill, all make this a very worthy and important area for debate and discussion.

Leader of the house, is it possible to have a statement from the First Minister as to how he conducts his press arrangements? Last week we had a rather bizarre scenario where a rogue press release seemed to correct—or not, as the case may be—Government policy on the free movement of people. We were told that the six points that were put out were the key points for the Government, and then after 40 minutes they needed changing by another press release. I do think that in most democracies that would be laughed out of town, but, sadly, in Wales, it didn’t seem to get laughed out of town, because it now seems to pass for Government policy. Could we understand exactly how these checks and balances are put in place so that there can be a semblance of credibility restored to the Government’s position when it comes to the Brexit negotiations?

This is a matter that I’m sure the vast majority of the people of Wales are not only unaware of, but, in terms of what they want to know and what they want to hear, it’s what the First Minister actually said. I think the important point is what the First Minister actually said was released as delivered by the Welsh Government press office at 10.04 a.m. last week, on the twenty first.

Leader of the house, this morning I attended the funeral of Ann Wilkinson from Usk. Many Members of the fourth Assembly before will remember Ann and her tireless work and dedication to the case of cancer patients, cancer sufferers, across Wales. She very sadly died two weeks ago, but she leaves behind a legacy of which she and her family can be proud. Members of the last Assembly will remember her sitting in the gallery above through many debates, and she delivered a petition to this Assembly calling for a cancer drugs fund and better access to drugs. Would you agree with me, leader of the house, that the best tribute that this Chamber and this Assembly could pay to Ann Wilkinson and other cancer sufferers across Wales would be to develop a fully-fledged cancer treatment fund? I notice that there is a statement later on developing a treatment fund. Can we see that that does include access to those very important cancer drugs at the earliest opportunity for the memory of Ann, but also for other cancer treatment victims across Wales, who really do not want to spend the last few months and weeks of their lives fighting for what really is their basic human right?

Of course, Nick Ramsay, this is a very important point that you’ve brought to us today in terms of recognising and giving our deepest sympathies to the family of Ann Wilkinson. That’s the important point from what you’ve said today, what you’ve brought to us today, and that you were at Ann Wilkinson’s funeral. Of course, we do wish, I’m sure, as a whole Assembly, to recognise her and her courage, and the fact that she made a stand and has sadly lost her life. But I think the most important thing to come from that will be made very clear in a statement shortly by the Cabinet Secretary for Health, Well-being and Sport, because he will be announcing a new treatment fund. I’m sure she would welcome that. It is important that that’s a new treatment fund that will ensure that people in Wales have fast access to new and innovative treatments for life-threatening and life-limiting conditions. And, of course, that, I think will be an important point to the Member and recognised today.

The Welsh Government has been vocal in calling for an end to free movement of people and labour between the UK and the European Union, and, of course, one of our most important trading partners, and one of the countries where movement occurs most between Wales and another country, is Ireland. Can we have a statement by the First Minister as soon as possible on whether the Welsh Government wants to end free movement of people between the UK and all EU states? Or, if not between Wales or the UK and all EU states, how do they practically envisage an open border between Wales and Ireland?

Well, of course, the First Minister and the Welsh Government’s view on freedom of movement has been articulated a number of times, not only by the First Minister, but by other Ministers as well. This is a very serious issue, it’s a sensitive issue, and it’s an issue where we have to look at this in terms of fairness, proportionality, and also recognising the views of people in Wales. I think you raise an important point, and, in fact, it’s an important point that the First Minister responded to very clearly last week in terms of questions on these issues.

I thank the Minister for her statement. Further to that, may I ask the Cabinet Secretary for business for a full debate, in Government time, on Historic Wales? This is the proposed body by the Cabinet Secretary for culture to reorganise activity in this area and to establish a new body to take over the business-side activities of organisations such as the National Museum, Cadw and so on. This is a crucially important issue and I would urge the Government to table a full debate in Government time on this issue. Thank you.

The Member does raise an important issue and it is something in terms of Historic Wales and where we can move forward on that, obviously with full consultation and opportunities for committee consideration; I’m sure there will be an appropriate time to bring a statement to this Chamber.

3. 3. Statement: The Diamond Review of Higher Education and Student Finance in Wales

The next item on our agenda is a statement by the Cabinet Secretary for Education on the Diamond review of higher education and student finance in Wales, and I call on the Cabinet Secretary, Kirsty Williams.

Thank you, Presiding Officer. Today, I have published the final report from the review of higher education and student finance in Wales, chaired by Professor Sir Ian Diamond. I am very grateful to Professor Diamond and to all the panel members from across the political parties, the sector and industry for the time and effort that they have dedicated to the review since it began in April 2014.

The panel has considered a huge amount of evidence in the course of its work. This is reflected in the range and complexity of the issues that the panel has presented in its final report and in the level of detail involved in its recommendations.

The panel’s work was guided by the long-standing Robbins principle that entry into higher education should be on the basis of ability alone and not on the ability to afford it. Staying true to this principle, the report’s overarching recommendation is that the focus of grant finance shifts towards maintenance support across levels and modes of study, overcoming the real financial challenges associated with a period of higher education study. It proposes that maintenance support is improved for all Welsh-domiciled students, with the highest level of grant support directed towards those who are most in need, but that a non-means-tested universal maintenance grant of £1,000 should be available for all students. The report also proposes the implementation of a unique and innovative approach for part-time and postgraduate support, which will encourage a flexible approach to higher education. The report recognises that, given the context of austerity in the UK, these recommended improvements can only be achieved by releasing funds currently used to provide tuition fee grants for full-time undergraduates.

Cabinet colleagues and I endorsed the principles contained in the report. These proposals represent a radical overhaul of how we support those who want to go to higher education, as well as outlining a fairer, sustainable system of student support and higher education funding. The proposals would mean that Wales would be the only country in the UK to implement a system that is consistent, progressive and fair in its support for undergraduate full-time, part-time and postgraduate students.

The fear of not being able to meet the cost of living on a daily basis puts many off—not the prospect of paying back loans after they are in work. The report refers to the strong consensus amongst students, student representative bodies and widening participation professionals that the current maintenance support is inadequate and that this is a bigger issue for students than the level of fees and fee support. This system addresses that issue head on, but will also mean making tough decisions to ensure that the system is sustainable in the long term.

Having endorsed the underlying principles contained in the report, I now need to consider the practical implications of implementing its recommendations. The Welsh Government will therefore discuss our approach with Her Majesty’s Treasury and the Student Loans Company before finalising our formal response. I can confirm that the response will build on the following key principles: maintaining the principle of universalism within a progressive system will, for the first time anywhere in the UK, ensure a fair and consistent approach across levels and modes of study; will ensure shared investment between Government and those who directly benefit, enhancing accessibility and reducing barriers to study such as living costs—and that student support should be portable for Welsh students anywhere in the United Kingdom. In my agreement with the First Minister, we recognised that high-quality education is the driving force for social mobility, national prosperity and an engaged democracy. To enable this, Wales needs a sustainable and progressive higher education funding settlement that supports students when they need it most and enables our universities to compete internationally. Colleagues, I started by referring to the famous principle of the Robbins report. It is often overlooked that, in setting out the aims of a higher education system, the report also said, and I quote,

‘The system as a whole must be judged deficient unless it provides adequately for all.’

Sir Ian and his panel have today brought forward a report that recommends a fundamental shift so that Wales can indeed develop a higher education funding and student finance system that really does provide for all. Thank you.

May I thank you, Cabinet Secretary, for your statement? I also want to endorse the thanks that you’ve given to professor Diamond and his panel, and, indeed, the wider sector and everyone who’s contributed to this lengthy process, but a process I’m sure that will be valuable as we move towards creating a better and improved regime. In my view, this does offer a more sustainable model. You’ve stated that you support the principle underpinning this. I’m not sure if you made it entirely clear that you also agree that this moves us towards a more sustainable model than the model that we currently have. I’m sure you would want to make that clear in your response, if you wouldn’t mind.

Professor Diamond, of course, has made it clear consistently throughout this debate on these recommendations that what is proposed is a comprehensive package and that we shouldn’t pick and choose various elements of it as we implement. In looking at it in its entirety, would you acknowledge that this is a comprehensive package? A comparison was made with Assembly Members by professor Diamond that this isn’t a clothes line where you can actually pick a few items of clothing and leave the rest hanging there—that you have to look at it as one piece of work. So, while you do talk about considering individual recommendations, looking at the whole package should be your priority, and I hope that you’d be willing to do that.

Likewise, there is a question on funding. Do you accept that the current budget allocated for student support should remain and that you would work within that budget as a Government, or are you going to be seeking savings here? Because that clearly will have a great influence on how much of the holistic package that you as a Government will be able to implement. I think it’s important that you make it clear in terms of the basis that you’re working on, in financial terms.

I certainly welcome the support on part-time and postgraduate study, and also on promoting the links and the progression between FE and HE. I would like to ask you, perhaps, to say a little about how you feel these recommendations can assist Government in promoting that equality that we all want to see between vocational and academic education.

There is a need for a regime that is portable too, so that, wherever you study, the support can follow you. Diamond is entirely clear, whether it is in Wales, the UK or, in the current climate, within Europe. Plaid Cymru in our manifesto wanted to go a step further and ensure that there was support for you if you decided to study outwith Europe. I understand that that is also one of Diamond’s aspirations. Perhaps you could actually express support for that in principle, if it is something that you would be eager to support and promote.

There is also another clear recommendation contained in the report, namely recognition of the need to encourage students either to stay in Wales with their skills, or to return to Wales with their skills once they’ve graduated, and to do so, as Professor Diamond says, for the benefit of Wales. The suggestion is that one could look at doing that by actually scrapping some of their debt, or writing off some of their debt. That is certainly in keeping with what Plaid Cymru had put forward as a central element of our own policy. So, clearly we would welcome recognition of that concept proposed by Professor Diamond.

He also said this morning, in discussing these recommendations with Assembly Members, that the Government needs to do that with urgency—those were his words—because the benefits for the economy here in Wales and for wider society is entirely clear to everyone. So, will you confirm that you fully intend to take action on that recommendation, and intend to do so with urgency?

I’m sure that we all look forward to reading the report in detail. Of course, we as a party are more than willing to play our part in order to implement what’s contained within the report, as long as it does move us towards ensuring a regime that is more sustainable, which closes the funding gap also across post-16 education, and does more to attract talent back to Wales in order to create a stronger basis for economic growth in Wales, and social growth also, which I’m sure is something that we all want to see.

Thank you very much, Llyr. Can I thank you for the courtesy that you have extended to Sir Ian? Sir Ian and his colleagues on the review panel, I think, have done an impressive piece of work, and I’m grateful to the Plaid Cymru representative on the panel for his assiduous work with Sir Ian. I’m grateful, indeed, for that.

Sustainability is a key element to the Government’s response to this package. We want to be absolutely certain that this is affordable, in terms of support for students, and provides sustainability and a vision for funding for the institutions in Wales. The issue of sustainability is certainly one that’s key to me and key to the finance Minister in the discussions that we’ll be having. I recognise, very clearly, that Sir Ian sees this as a complete package, and I will be looking to implement the review in the round. With regard to finance, you will be aware that the recommendations within the report mean that we need to shift the balance of where current expenditure is going, especially if we are to be able to offer the support to part-time students and to postgraduate students that Sir Ian envisages within the report. You will also be aware, in my agreement with the First Minister that brought me into Government, that we said that we would implement Diamond as quickly as possible, and not to the detriment of the HE budget. This report is not just a report about support for individual students, but also outlines how we can release resources to ensure that funding for such things as expensive courses and research can be put on a sustainable footing also.

You raise some points regarding FE. You will be aware that a sub-group was set up as part of the Diamond review to look at the issues of FE. Sir Ian recommends that there should be a focus on vocational and technical education, and how we can create stronger links between FE and HE, so that people can have an opportunity to study more readily HE level courses in the FE sector, but also make the transition from FE into HE, especially in the development of employer-sponsored programmes. So, there’s a role for employers here as well in making sure that we’ve got the skills that we need for the economy moving forward.

With regard to portability, I think it is a very important principle that the student support package will be available to students regardless of where they study in the United Kingdom. Sir Ian does make recommendations with regard to access to European study opportunities, and indeed I understand this morning that he was talking about access to study opportunities across the world, and I certainly would want to look to see how we can practically deliver that. I don’t want to put a cap on any Welsh student’s ambitions, and if they are successful in gaining access to the world’s top universities, then I want the Welsh Government to play their part in allowing them to reach those aspirations. We’ll be looking to see how we can extend those opportunities to both European and worldwide study.

With regard to incentivisation, as the Member says, the Diamond report puts forward a recommendation that we could look at incentivisation schemes that would get Welsh graduates to return or stay in Wales. I will indeed consider how we can do that, so that we can bring skills and retain skills within Wales. We need to look very carefully at the proposals, which could be very complex to administer, and would require Her Majesty’s Treasury agreement in our ability to write off the loan book, because they’re in charge of the loan book. But as you said, this was a key plank of Plaid Cymru’s policy, so I’m sure the party has thought very carefully about some of the complexities involved in delivering such a scheme. For instance, if someone lives in Newport but works in Bristol, or if someone lives in Chester but works in Alyn and Deeside—the nature of the work, the nature of the skills that people are bringing to Wales—these are complex issues. So, I’m very grateful, and I will be taking the Member up on his offer to work with Plaid Cymru, to look to see how we can introduce a scheme as recommended by the Diamond report, and I look forward to working with you on overcoming some of the complexities that Sir Ian has identified with such a scheme. But I’m very interested in taking up that recommendation.

Thank you, Minister, for your statement. I would also like to put on record the thanks of the Welsh Conservative group to Professor Diamond, and indeed all of the panel members, especially our nominee, Professor David Warner, for his contribution to the excellent work that they have done. We certainly welcome the publication; we welcome wholeheartedly the recommendations that have been made to move away from tuition fee support, and towards a system of means-tested maintenance grants. This is something, of course, that our party has been advocating for some time, and I’m pleased that you’ve referred to the fact that there are some planks of each individual party’s commitments that are embedded within the recommendations that have been made. We as a party, of course, have always believed that no-one should be denied the opportunity to go to university on the basis of their background. We want as many young people who want to go to university to be able to access a university education.

One thing that I’m very keen to hear from you on, though, Minister, is—obviously, there are people who are already embarked upon their university education, embedded within the current grant system. There’s a very clear recommendation from Professor Diamond to continue to allow those individuals who’ve already embarked upon their education in university with the current support package to still have that maintained for them throughout and not be disadvantaged, perhaps, by any changes as a result of any new arrangements that come into force. Can you confirm that that will be the case for those individuals in order that they are not disadvantaged?

Some of the areas where there was clearly a discussion still ongoing within the panel and no firm conclusions reached were in respect of support for parents who want to attend university—people who might be single mothers or single parents or have other caring responsibilities. I just wonder, Cabinet Secretary, whether there’s been any consideration in advance of the publication of the report by the Welsh Government as to what sort of support might be available to help individuals with caring responsibilities to access university education. I note and welcome the recommendations that have been made around part-time support. I think they’re very welcome indeed, in order to give a more level playing field and, indeed, encourage more people into part-time study. We all know that part-time students are more likely to pay their loans back, for example, so there’s a good financial incentive to encourage people to study part-time, and, of course, they play a very active role in contributing to the Welsh economy while they are studying, if they’re working alongside. So, I’d particularly like to hear from you, Minister, about how rapidly you hope to be able to implement the part-time study proposals.

I was also very interested in the recommendations that have been made around investment in knowledge transfer. There’s a significant recommendation about increasing investment on that front. We know that there’s a note in the report about—every £1 invested in the higher education innovation fund at the moment returns £7 to the Welsh economy. I think that’s very good value for money and, therefore, I would hope that you would take fully on board the recommendation that has been made about further investing in knowledge transfer.

There was no specific reference to the current bursaries that have been made available to nursing students here in Wales. You know that there’s all-party support in the Chamber for the existing arrangements to continue at present, but I wonder, Cabinet Secretary, whether you might give consideration, as you’re looking to see what skills might be retained in Wales and how to attract people, particularly into those parts of the public sector where we’ve got skills shortages, such as the NHS, whether there might be other bursary options that could be considered and extended, particularly given that the figures in the report seem to suggest that there’s going to be a net saving as a result of the implementation of this package of reform that is being proposed by Professor Diamond and his team.

And just finally, you’ve made an indication that you, obviously, want to go away and consider the recommendations more fully before announcing a full response on behalf of the Government. There’s a clear indication that Professor Diamond feels that these are recommendations that can be implemented in 2018, for the start of the academic year in 2018. I wonder whether you feel that you’re able to hit what I think is quite an ambitious target, given that all of the ducks have got to be in a row in terms of the discussions that you’ve got to have with the UK Government, the Student Loans Company and others in order to embed what is a significant change into the system without any big problems.

Thank you very much, Darren, for that. Can I, too, join you in thanking the Conservative nominee for his participation in the work of the review? Again, I’m very grateful for that. You raise a very good point regarding cohort protection, and I want to make it absolutely clear today that students who are already in the system and enter into the system on one specific student support package will complete their educational journey on that support package. It would not be fair to change the rules of the game for students who are halfway through their course. So, we will offer cohort protection to those people who are already in the system and, indeed, who apply under a system. Because if you make an application to a university and then, halfway through that year, you find that, actually, the circumstances have changed again, that would not be fair. I want to make that very clear to people today: that there will be cohort protection. That’s the only fair way to manage the change from one system to another.

With regard to people with caring responsibilities, the ability to support part-time students in a fair way hopefully gives those people for whom perhaps it’s simply not feasible, practical or affordable to go to full-time study, the opportunity to engage in part-time study. That’s what’s really important about this package: yes, we need to ensure that we look after traditional undergraduate students but, actually, the nature of higher education is training—the nature of our workforce and our population in training. People want to be able to be flexible in how they acquire higher level skills. It’s vital to the future of our economy. Therefore, being able to provide support for part-time students is really important. It’s also important to state that this package looks at the support for looked-after children, or children who have experience of the care system, to put in place a maintenance system for them, which will allow them to be able to go on to university without being fearful of upfront living costs—how they pay for their rent, their food, their books. I know that issues around carers are of particular interest to the National Union of Students. In my meetings with the Wales NUS, I have given a commitment that I will look, indeed, to see what the barriers are to carers in accessing higher education, and if possible I want to make some progress on that because I know that it is of particular concern to NUS Cymru.

With regard to timing, as you’ll be aware, there are a number of steps that I need to go through, the first of which is Her Majesty’s Treasury. Perhaps Darren Millar could use the auspices of his party to ease those negotiations. The Treasury is in charge of the loan book, and therefore we cannot make progress on this until I have clearance from the Treasury. You will also be aware, from reading Sir Ian’s report, that there are actual constraints within the Student Loans Company, of which we are a minority shareholder. I have to be absolutely confident that, in moving forward, the Student Loans Company will be able to cope and administer this system. I do not want Welsh students falling foul of the new system because of a lack of capacity within the Student Loans Company. I will only move forward when I have those absolute guarantees that the Student Loans Company can move to accommodate our systems. Otherwise, that would potentially only cause difficulty for Welsh students, and I want to avoid that.

Knowledge transfer is absolutely key. We’re not waiting just for the implementation of Diamond. I, Julie James and my Cabinet Secretary colleague, Ken Skates, are already looking at what more we can do in the field of knowledge transfer in universities. Some of the processes are very complex, and we’re not getting the biggest bang for the current buck that we’re spending. So, we really need to look at that system, not just in the context of Diamond, but what we can do more in terms of higher education and knowledge transfer.

Nursing bursaries are a matter for my Cabinet Secretary colleague who is in charge of health, and I’m sure he’ll have some interesting things to say in response to the Plaid Cymru minority party debate tomorrow afternoon with regard to nursing. So, I don’t want to pre-empt anything that he may say in the debate tomorrow.

I’d like to thank the Cabinet Secretary, Professor Diamond and his team for the report and her statement. There are elements of the report that my party welcomes—the sensible postgraduate arrangements, making them equivalent to undergraduates, support for part-timers and support for carers. One small part we had in our manifesto was the suggestion of pilot schemes for Welsh students to study globally at the best educational institutions. So, we’re delighted to see that taken forward. I wonder, though, whether the Cabinet Secretary would agree that she has become the Government’s most expensive Minister. I had thought that there was a consensus that the tuition fee grant at £237 million last year had become unaffordable, and that savings would need to be made. The Labour manifesto referred to having a student support system that was at least as generous as that available in England. That could have allowed savings from that £237 million. It could have allowed savings from the maintenance grant not having to be paid back in Wales. But all those potential savings, we are now told, are going to be spent. I asked Professor Diamond this morning whether there’d be any savings and he said, ‘No, it was going to be broadly equivalent’. I referred him to his terms of reference, which said one of his focuses should be

‘the funding of higher education in the light of continuing constraints on public expenditure’,

but he told me that he hadn’t applied that; there’d been a more recent statement from the Welsh Government, and that had led to him producing a package that had no negative effect on the higher education budget. Now, of course, that phrase was included in what on her website the Cabinet Secretary initially styled as the coalition agreement. It’s still searchable, with various lines of Latin underneath it. But that was then restyled ‘the progressive agreement’. But I would like to ask the Cabinet Secretary: what is progressive about handing £1,000 to every student, however well off they are, no questions asked? What is progressive about increasing a maintenance grant that was £5,161—part of which was paid up to family incomes of £50,000—increasing that to over £8,000 and making that payable to households with incomes over £80,000, receiving at least part of that?

Now, students, on account of graduating, will earn more over their lifetime than those who don’t have the privilege of going to university. They come on average from significantly better-off families, yet we propose to give £132 million a year in increased maintenance grant to this group. Now, some in my party, and perhaps some Labour Members, might wish to spend that on the Welsh NHS or on our most deprived communities, but instead of that, it will go in maintenance grants that get paid, including to families earning up to £80,000. How is that progressive?

I wonder—the Cabinet Secretary also mentions rent—how this is going to assist in paying rent. What analysis has the Welsh Government, or Professor Diamond and his team, done of the extent to which this extra money will go to reward landlords? Does she consider that that will be progressive? I also wonder why she thinks it benefits the Welsh economy to transfer over £30 million a year in maintenance grant to students who will be studying in England. Now, Plaid came up with a proposal that they want a potentially complex system that would forgive some of those loans. But, listening to Professor Diamond this morning, there seemed to be at least half a dozen hurdles on the way to that, not least that the Treasury may not agree. Listening to the Cabinet Secretary now, she emphasises the difficulties of that. There is £74 million that’s been put in as a holding sum in the report, supposedly for those costs, but it’s not included in the summary of the costs of the recommendations. Does the Cabinet Secretary really believe that this differential loan forgiveness scheme is ever really going to be implemented? Is not a better way to encourage students to stay in Wales, to support and expand the higher education system here, the provision of a more generous settlement to students who stay in Wales compared to those who choose to go to England and benefit from the loans, as English students have there? We could support the worst-off with some help while still supporting the Welsh education system in that way. Why will she not do that?

Could I also ask her—? She mentions this ‘no detriment’. Is it the case that the terms of reference of the Diamond review were changed two years in and replaced with her progressive agreement? Please tell us how that is progressive.

One final matter: there is a recommendation from Professor Diamond that students may continue to be paid and funded to study elsewhere in the EU, but he states that recommendation is

‘subject to the UK remaining in the EU’.

Is he not aware there was a referendum on 23 June, or does he agree with her party that we should be made to vote again?

Thank you to Mr Reckless for his series of questions. I know that you are relatively new to Wales, but there is an honourable tradition in Welsh public policy of the principle of universalism in a progressive system. It is one that has enjoyed a consensus of many of us in this Chamber, and I am delighted that Sir Ian has continued with that principle in the report today. I firmly believe that higher education is a shared investment—a shared investment, yes, with those who will directly benefit from pursuing a higher education—but, there is benefit to our society also in people deciding to choose at a higher education level. It is a shared investment and I for one am very pleased that Sir Ian has recognised it in his work and it is a principle that I fully endorse.

Mr Reckless asks how this is a progressive system. This is a progressive system because it will address the No. 1 concern for students in the here and now—that it is upfront living costs that is the biggest barrier to going on to study at higher education. It is the ability to survive from week to week, to sustain yourself in university, that is the biggest barrier. And in this system, students from our poorest backgrounds, or those who have been in the care system, or those who are estranged from their parents will have a maintenance grant, non-repayable, that is equivalent to the minimum wage. That is the essence of a progressive system. If he can’t recognise that, then there’s nothing I can do to help him. There is nothing I can do to help him. Nothing at all.

I think it’s also an important principle, which has been endorsed by Sir Ian today, that this system should be truly portable. As I’ve said in earlier questions, I don’t want to put a lid on the ambition of Welsh students. There are fantastic higher education institutions in our country that people can study in, and many in this Chamber have benefitted from them. But, there is also a wider world out there and if students want to take the opportunity to study in institutions in the rest of the UK, the European Union or other parts of the world, then I want a system that allows them to fulfil their dreams and their ambitions. If they are good enough to get into whichever institution, then this system should be there to support them. I will be looking to see how we can make that a reality for students.

With regard to incentivisation, it is a recommendation within the report. I welcome that recommendation. I think that there is merit in looking to do what we can to incentivise students to remain, to practise their work in Wales, to keep those skills in Wales, or to bring those skills back to Wales. It is not without its problems; that is outlined in the report. But it is not beyond the wit of this Government, working with others, to come up with a system that can achieve those goals. I have made a sincere offer to the Plaid Cymru spokesperson to work with them to see what scheme we can come up with that will do just that. There are practicalities to overcome. But, as I said, it’s not beyond the wit of us to be able to come up with a scheme, and that is what I intend to do.

Can I thank the Cabinet Secretary for her statement today and also add my thanks to Sir Ian and his team for his report? I’m really looking forward to them coming to the Children, Young People and Education Committee on the twelfth for us to discuss it in detail. I think that there is a great deal to welcome in this report. Particularly, I welcome the fact that it has so clearly taken on board the views of students about the need to address the pound in their pocket. I welcome the change for postgraduates, which will be vital for our economy, the changes for part-time students, which will have a huge impact on our ability to deliver on social justice in Wales, and I also agree with the Cabinet Secretary that portability is extremely important.

Probably for me, though, the most welcome thing is that this will provide the most generous package of support to the neediest students that we have ever seen—the commitment to provide the equivalent of the living wage, which is enormously welcome. I would just like to specifically ask about young people who’ve had experience of the care system, which the Cabinet Secretary has already referred to. The report makes specific recommendations in relation to those young people. Is it the Welsh Government’s intention to fully implement those recommendations?

Could I thank the Chair of the Children, Young People and Education committee for her warm welcome of Sir Ian’s work? We will be unique in the entirety of the UK in offering a system that is both portable and equal to all modes of study. We’ve already talked about the importance of part-time students, but it’s also right that we should be in a position to assist postgraduate study. It’s very important for our economy and to recognise that for many students now, the ability to move on to postgraduate study is almost becoming a prerequisite in many of their fields of work. It’s a source of regret to me that, at the moment, we’re not in a position to operate a support system for postgraduate study. It’s a missing link—it is absolutely a missing link—in the system that we currently have at the moment, and I receive a lot of correspondence from Assembly Members across the Chamber about that issue. This proposal will help us address that.

We know that for looked-after children we have a mountain of work to do, and that starts at primary and secondary school. We can have the most progressive higher education student support policy for looked-after children, but, as we’re often reminded by David Melding, if those children don’t get the GCSEs and the A-levels they need, it is worth nothing. So, our support at the HE level will be seen as a continuum of the work that we’re already doing with the pupil deprivation grant and with specific intervention programmes for looked-after children in our schools, so that we can increase the numbers that would indeed benefit from the proposals in Sir Ian Diamond’s work, which I intend to honour and implement.

Can I say to the Cabinet Secretary for Education that she, like Plaid Cymru, at least had the courage to go into an election with an alternative to the current system and to call out the emperor’s new clothes around the tuition subsidy? It costs too much, and it’s unsustainable, and I’ve been saying that for four years. The silence from the Labour benches, for not having the courage to go into an election to say what they believed in, is something that you can hear here today. [Interruption.] You certainly did—it was a useless policy, but you certainly had one, so that’s fair enough. [Laughter.] That’s fair enough.

So, the Cabinet Secretary knows, and she understands and appreciates, the depth of the challenges facing her. She will know as well that Professor Diamond has made a very valiant report that covers just about all aspects of the issues, apart from the one that Llyr Gruffydd in particular has highlighted: the need to attract more students to study and stay in Wales in order to strengthen our universities and in order to make that link with a developing economy in Wales. I think she does, and I welcome the fact that she’s reached out to look at how we can work together on that, but I think that she must acknowledge as well that that is a weakness in the current system. Nothing in Diamond immediately addresses that, although it is, of course, highlighted.

Can I just say that I was unable to attend Professor Diamond’s briefing this morning, so I’m very grateful to Mark Reckless for telling me that Professor Diamond did not, in fact, carry out one of the remits that he was given and that it changed because of instruction from the Welsh Government? I distinctly remember negotiating the remit with your predecessor, Huw Lewis, line by line, as an agreement between two parties of how we could address this funding issue. It now seems that the remit agreement was changed, without any reference to the original parties that made that agreement, and was changed in a way that could have influenced the way that Professor Diamond produced his report. So, I put on notice, unless you can reply immediately, that I will be examining how that came about.

Can I also ask the Cabinet Secretary whether she has any schadenfreude at all, as a Liberal Democrat in a Labour Cabinet, in introducing the element of means testing that was the only thing that the Labour Party actually ruled out in their manifesto—the means testing that I think, based on universality, is an inevitable consequence of going down the line of market testing within higher education? I’ve fought against that all my political life—voted against it in the House of Commons time after time when Labour was all lined up to vote it through. We have to deal with the situation we have and the limited resources we have. Therefore, the principle that she’s set out is one that I support and one that I welcome.

However, there are two elements of the principles that you said in your statement that I thought were missing. I don’t disagree with the ones that you set out as the way forward, but there were two that I thought were part of Diamond and are no longer there. One is to equalise the playing field between FE and HE—to have a more level system of choices so that people can genuinely choose an FE future, and that we do see that the resources that we spend as a nation are as supportive of FE as they are of HE. In that context, could you just—because I haven’t had time, I’m afraid, to read the detail of the report—reiterate the reasoning for linking student support to the living wage, and which living wage—John McDonnell’s living wage, Boris Johnson’s living wage? Which living wage? It seems wonderful, doesn’t it? It seems like a good socialist principle to link student support to living wage. But why are we linking Welsh student support to a living wage we have no control over, and a living wage that is not related to our economic circumstances? Why are we linking student support to a living wage when apprenticeships and apprentices do not get that kind of support? This, again, I’m concerned can skew us down to over-supporting HE at the cost of FE, and I think the future for Wales and the future for many of our communities is actually to increase the number of people going to FE and get those higher level apprenticeships. So, I’m really questioning what the basis for that is—not the principle, because I accept the principle, but what the basis of that is—and whether the true affordability is built into that. And I think students would get a very generous—. As Lynne Neagle said, it is very generous, but is it commensurate with our economic investment—that co-investment that she talked about?

And the second element that I would like to ask about—because that’s the level playing field—and the second principle that I thought was missing was one that said that we want to use this system now to close the HE funding gap in Wales. She stood on a manifesto commitment to restore part of the teaching grant. That’s no longer part of Diamond and it’s no longer part of her statement, but if we’re not going to restore the teaching grant, then how can you tell us how the released resources, which you mentioned in reply to questions, will flow back to investment in higher education? We know the funding gap is real—it’s about £90 million at the moment in HE. It’s grown over the years. We were unable to address it when we just funded students and we didn’t fund universities. In what way does Diamond now enable us to address that funding gap, and is it indeed a principle that she will hold dear to?

Thank you, Simon, for your questions. Can I absolutely assure you that I in no way at no point had any conversations with Sir Ian Diamond or the panel about changing its remit? You really, really should know better than to believe everything that is sometimes stated. So, I can assure you. So, by all means, FOI as much as you like. There was no instruction to Sir Ian Diamond to change the remit of the report.

But I do recognise this issue about getting a better balance between how we have traditionally funded HE in the round, and the emphasis has very much been on funding the individual student. That has led to some very real challenges for the HE sector and the institutions themselves. What this report does do, and what my agreement with the First Minister seeks to do, is to ensure that, in moving resources, we will be able to achieve that balance and be able to get to a position where HEFCW, or as a result of maybe a response to the Hazelkorn review—something that maybe comes after—is able to put resources back into HE institutions. I think that that, actually, is one of the ways in which we need to make the Welsh HE offer as good as it could be to potential students, because I think there has been, if I’m honest, a challenge for Welsh HE institutions to keep apace with some of the developments across the border. Therefore, some of the things that may be attractive to students have been developed in England, and we haven’t had the resources to do that here in Wales. So, that’s one of the building blocks that we need to do—a better balance in how we fund HE in the round, and I think that Sir Ian has given us a very good blueprint on how we can take that forward.

With regard—. Look, I didn’t write the Labour Party manifesto—[Interruption.] I didn’t write the Labour Party manifesto, but I am aware what that manifesto did say—that any new regime for funding students in Wales would be more generous than that in England, and this system today delivers on the Labour Party manifesto in the same way it delivers on my manifesto, when I said very clearly that we had to move to a system of maintenance grants for upfront living costs. So, I think that, actually, this proposal today keeps faith with what the Labour Party said in the election and what my party, the Welsh Liberal Democrats, said in the election.

The Member does raise some very serious points about FE. Just like the HE sector, there have been significant pressures on the FE sector. Now, much of the evidence that was given to Diamond highlighted the need for a more joined-up approach and enhanced progression routes between FE and HE. It was agreed, therefore, that it would helpful if the review panel were able to consider more closely these matters as part of its remit. It was assisted in doing that by a sub-panel, and that considered how best to enhance the opportunities for students pursuing work-based or occupation-related higher education course, because I do think the needs of the modern economy demand that from our system. The FE-related recommendations focus, as I said, on vocational and technical education, because the sub-panel felt that that was where the area of greatest need was, and we’ll be looking forward to how we can implement the recommendations that have been made with regard to that.

With regard to the living wage, the approach taken by Sir Ian is one of, ‘What is an adequate amount of money that is needed for people to sustain themselves?’ He’s made that link to the living wage, but the point is well made that there are other people who are pursuing training and skills development that would not be subject to that. What is really important is that those upfront living costs do not become a barrier, especially for our poorer students, in pursuing higher education. That’s the underlying principle that I will look to take forward in looking how we can implement the recommendations here. But, the points about FE are well made and this Government is cognisant of them.

Can I thank the Cabinet Secretary for the statement and can I join others in thanking Sir Ian and his panel for the work they did? Can I also thank her predecessor, Huw Lewis, who actually was one of the leading instigators of this? We’ve got to recognise the work he put into that as well.

Cabinet Secretary, you’ve answered many questions today, so I’ll try and keep mine as short as possible. My constituents in Aberavon are faced by very many difficulties. In fact, we undertook a survey of those who’d applied to higher education in Neath Port Talbot and we found that, in Aberavon, there were far fewer students going to HE than in Neath. It could be a consequence of some of the challenges they would have faced in living costs. I very much appreciate the work that’s gone on to actually support those students from more deprived areas to have that ability to go in.

But, can I move on to part-time study, which is one of my concerns? I’ve always been interested in part-time study. I very much appreciate the move into supporting part-time study. I think it’s important that we help those in work and those who are seeking to go into work or change to a different direction to actually get those qualifications. But, can you clarify a couple of points for me, please? Will it be part-time based upon modules or credits, on that basis? Because it is important, as some only do certain modules per year, or you, for example, may only do one module per year. Are we looking at that? Will existing part-time students who have never had any support in that sense, unlike full-time graduates, be able to benefit from this straight away? So, if they’re already in a programme, will they be able to benefit from that straight away? I’m a little bit concerned in case we also perhaps give some unscrupulous employers opportunities to say, ‘Ah, you’ll get funding from the Welsh Government now for this.’ Will you be monitoring closely the former employer contributions to make sure we don’t, sort of, cover their costs that they’re now backtracking on, to ensure that they still continue to support their employees who are going through part-time study?

Also, it says in here, in the executive summary,

‘The more moderate fee for part-time students should be topped-up with institutional learning and teaching grants for universities and higher education providers’.

Could you indicate what the allocation will be actually to provide that top-up support?

‘The overall funding system for part-time students should not be restricted by credit thresholds’.

Can you clarify again what you mean by ‘credit thresholds’ in that sense?

It also indicates that a part-time student should not be penalised for any prior study. Will that apply to full-time students as well? Because many full-time students may actually go back. I know of an individual who graduated as an engineer, spent 10 years working as an engineer, decided to go and change pathways, went back to study medicine and has been practising as a GP for many years since. Again, that applies, you know—. So, if you apply it to one route of part-time, are you going to apply it to full-time as well?

I appreciate also the emphasis on part-time taught Master’s and part-time research, and I note again that there are discussions as to the tripartite approach to supporting 150 research students. Have you had discussions with industry, because they’re one of the ones discussed as a third party—Welsh Government, universities and other funders, which I assume will be industry? What discussions have you had with industry to be that third party in funding those research students? I also welcome and support the continued emphasis on HEFCW putting money into research, because greater research is important. We know, many times, we have not worked to our level in the funding grant we’re receiving from our funding councils. This is important, that we continue to fund our universities, so that we can get to that level and get more funding from the research councils.

Can I thank the Member for his questions? He asked whether we will be able to make the scheme available for part-timers straight away. I’m now caught in a dilemma: Members expect this to be delivered as a package and now some Members want little bits of it to be delivered earlier than others. I think the issue is, David, that we see this package in the round and I want to be able to move forward on that basis, introducing support for students across all modes at the same time, because I think if we start doing bits earlier than others, we’ll be in danger of perhaps being accused of not keeping faith with this principle that this is a package as a whole.

But with regard to credit thresholds and previous study, you’ll be aware that the report is newly published and these are some of the details that we will need to work through in the coming weeks, before we’re able to go out to consultation on a detailed Government response. So, issues around credit thresholds, previous study, how many times you can go into the system and whether you can be a perpetual student in the system, all need to come out in the further consideration around sustainability and around the finer details of the package.

You’re right: industry, employers have a role to play here. You’ll be aware of a speech I made recently with regard to how I want a closer working relationship between higher education institutions and their local economy—their local employers. Those discussions are ongoing with Julie James and other Cabinet Secretary colleagues about how we can make those linkages, which are absolutely crucial. You raised the issue of moral hazard: if we do this, will we actually then create a problem elsewhere in the system? I believe there is a genuine desire, both in the HE sector and with employers, to work together to deliver on this agenda. Employers see the benefit of having well-skilled workers who they can support. They can retain those skills, increase their productivity and increase the productivity of that business, which has been one of the things that have dogged the Welsh economy—low productivity levels. This is an opportunity to address that.

For the benefit of Simon Thomas, I’d just like to remind him that, when the Welsh Labour Government sets up a Diamond review, it is not a good idea to second guess what its recommendations are going to be in our manifesto beforehand. All stakeholders were represented and therefore it was—. You know, let’s hear the evidence and then we discuss what we’re going to do about it.

Thank you very much for your statement. I’m particularly interested to pick up on this issue of carers. I’m particularly thinking of those who have their children very young and haven’t completed their education, but will want to go back to university once their children are in full-time education themselves. What discussions, if any, have you had with the Department for Work and Pensions about if somebody is a part-time student? Could they also therefore be eligible for part-time benefits on the grounds that they are only part-time students and, therefore, could they be eligible for other benefits, part-time? Because, otherwise, this part-time allowance is simply not going to work for them. It’s extremely difficult to work and care as well as study, if they’re lone parents. So, that would be useful to know about.

My other concern is around the Student Loans Company. I’m interested to know that you’re having discussions with them, because unlike your reassurances about existing students, they have changed the rules of the game in the middle of the story, because those who’ve taken out loans to pay for their education are suddenly finding that the Student Loans Company has been privatised and that their debts have been securitised and are being sold off to the highest bidder. And the escalator of debt that students are facing is extremely worrying, and is what is most likely to discourage people from low-income families to want to take on debt where they can’t quantify it. When you take on a mortgage, you know what the end game is going to be, but it appears to be the case at the moment, the way the Student Loans Company has gone, that the student has no idea the extent of their debt and how much it is going to increase as soon as they cease to be a student and start working.

Can I thank Jenny Rathbone for her questions? As I stated earlier, I believe the recommendations and the principles endorsed by the Cabinet keep faith with the Labour Party manifesto, in that the Labour Party said that the system would be more generous than in England, and if we implement this, that will be the case. With regard to people who are looking to study part-time, this is one of the most attractive features of the Diamond report—that we will be able to support properly, for the first time, those who are studying on a part-time basis. But we should not forget that for those people who are going back to education, especially in the field of FE, Welsh Government does provide resources to FE colleges—in fact, I’ve just signed off the allocations for this year—so that they can help those students with childcare, with travel costs. So, we do already have programmes in place to try and support those learners to maintain their places, especially in the FE sector.

I have not had discussions with the DWP. With regard to the Student Loans Company, my priority in my dealings with the Student Loans Company is to secure assurances from them that they can change their systems to allow us to move to this new system of student support. The report does have some quite harsh things to say about capacity within the Student Loans Company. We cannot move forward on any of this unless we know that the Student Loans Company can accommodate the new system. That’s one of the reasons why we have found ourselves in the position of not being able to offer postgraduate loans this year, because the Student Loans Company could not change their systems in time to allow us to do that. This is a real barrier to the implementation of any of these reforms. I have met with the chair and the chief executive of the Student Loans Company, and officials continue to have dialogue with the chief executive of the Student Loans Company, because that is the priority that I have at this stage—that they can flex their system to allow us to implement this change because, without that, we will not be able to do any of the things that I’ve outlined today. I need to be able to do that with confidence that we will get, and Welsh students will get, a good service.

Overseas students make a direct contribution, a valuable contribution, to our universities and the economy. For every five European Union students that come to Wales, one job is created and £200 million comes in payments from international students to universities in Wales. Bangor University in my constituency is collaborating with 100 partners in 20 countries in Europe, and with many other countries across the world as well. All of this, of course, helps to strengthen links with overseas countries and is an important tool in our efforts in trading overseas. Following the referendum, there is a duty, of course, on this Government to ensure and safeguard public money for research and development after leaving the EU, for example, the Horizon 2020 scheme. Projects in Wales received about £12 million in funding from the Horizon 2020 fund in 2014 alone, and Wales has also received over €140 million from the EU framework programme during the funding round of 2007 to 2013—that is, the previous funding stream on research and innovation.

The Diamond report does underline the importance of these funding sources for Welsh universities. Now, if I understand correctly, the Welsh Government policy is to allow Westminster to decide on the conditions for leaving the EU. The Chancellor has confirmed that funding from schemes such as Horizon 2020 will be safe until 2020. But, in recognising the importance of this funding for Welsh universities, what efforts have you personally made to ensure that the interests of our universities are safeguarded in this? And will you now be using your role within Welsh Government to ensure the best possible settlement for the higher education sector, as a result of Brexit?

Can I thank the Member for her questions? International students are vital to the health of Welsh higher education, and they are very welcome here in Wales, whichever part of the world they come from. I issued a statement to that effect immediately after the referendum. We welcome international students to our universities. They contribute to the rich tapestry of people who gather together to think big thoughts, to research, to work together, and they are very welcome here.

I’m acutely aware of the challenges that the higher education sector have as a result of the Brexit vote. That is why I have set up a higher education and FE group, which will advise me, as education Minister, with regard to these challenges, and why there is a significant level of HE representation in the First Minister’s European reference group. We are looking very carefully to ensure that any applications that Welsh HEIs already have in the system are approved as quickly as possible, if that’s possible, to ensure that we have a safeguard of funding.

We continue to look at what networks will be available to Welsh universities as and when we come out of the European Union. We may end up out of the European Union, but what is important is that we do not turn our backs—[Interruption.] We do not turn our backs on our European neighbours. I will be looking to see what opportunities are available, despite that changed status, for continued collaboration and working across the European Union, and, indeed, internationally, with HE institutions here in Wales and with HE institutions across the world, and including Europe.

You will be aware, unfortunately, that the Westminster Government have announced a pilot with regard to people who can stay after the period of study has ended. That has been made available to Cambridge and some other cities in England. It is a source of great annoyance to me that we were not asked about that. We were not offered the opportunity to offer some Welsh cities to take part in that pilot scheme. I have written to Jo Johnson, the higher education Minister in the Westminster Government, to express my concern, and to reiterate once again to the Home Office that there are places in Wales that would very much like to be part of these pilots for post-study visas. It’s a great shame to me that the Westminster Government did not afford either Wales or Scotland the courtesy of being part of that pilot.

Diolch, Lywydd. I’d like to declare an interest as a visiting lecturer at Cardiff Metropolitan University. Indeed, on Saturday, 10 September, I was there teaching executive MBA students—a very, very small group of part-time students, who were largely funded by their organisations. When I was full time—when I was back as a senior lecturer—often I’d be teaching groups of 100 students, but they were almost all international students, and, Sian Gwenllian, from outside the European Union. So, I welcome this extension of opportunity to students—domestic undergraduate students—to learn at postgraduate level.

But would the Cabinet Secretary be clear about the careful monitoring of domestic full-time postgraduate numbers, given that the Diamond projections are growth at an optimistic level of 20 per cent? If that growth becomes greater than that, then there will be funding implications. So, can we have an assurance that there will be monitoring within the system? And, also, the universities will likely want to maintain their international numbers as well, so there’ll be staffing implications for that too.

And the other question, separate to that: would the Cabinet Secretary explicitly endorse Diamond’s findings on the value of the Coleg Cymraeg Cenedlaethol, which was one of the success stories of the last Welsh Labour Government? The Coleg Cenedlaethol lecturers have a great deal of knowledge grown from experience, and I urge the Cabinet Secretary to draw on that.

Yes, I can confirm that we will monitor issues around postgraduate numbers very closely. The Member is absolutely right, the Coleg Cenedlaethol has been a great success. It has been wonderful to see the opportunities afforded to students across Wales to be able to study law in Welsh, journalism in Welsh, and a range of other courses. As you will be aware, we are in the process of setting up a task and finish group that will look at the future of the Coleg, its funding arrangements, and also extending its remit not only to look at HE, but also to develop work and opportunities in FE, which are lacking in many parts of Wales at the moment.

4. 4. Statement: Establishment of the New Treatment Fund and the Independent Review of the Individual Patient Funding Request Process

I thank the Cabinet Secretary. We now move to the next item on our agenda, a statement by the Cabinet Secretary for Health, Well-being and Sport on the establishment of the new treatment fund and the independent review of the individual patient funding request process. To make the statement, I call on the Cabinet Secretary, Vaughan Gething.

Member
Vaughan Gething 15:35:00
The Cabinet Secretary for Health, Well-being and Sport

At the Plenary session on 12 July, I set out my plans for establishing a new treatment fund and undertaking a sharply-focused, independent review of the individual patient funding request process, commonly known as IPFR. I am pleased to have this opportunity to provide Assembly Members and the people of Wales with an update on the progress that we have made over the summer.

I’ll begin with the new treatment fund. Work is progressing well to set up the fund, which will make £80 million available over the life of this Government. It will provide these extra funds for new medicines that represent a significant advance in treatment for life-limiting and life-threatening diseases. The fund will support the introduction of medicines that fit these criteria that are recommended by the National Institute for Health and Care Excellence, known as NICE, or the All Wales Medicines Strategy Group, the AWMSG. I expect this additional financial support will be for up to 12 months, giving health boards time to factor in future spending from within their budgets.

We rely on the expertise of NICE and the AWMSG to assess the effectiveness of a new medicine, taking account of clinical opinion and the patient perspective. Both of these highly-respected organisations base their recommendations on the most up-to-date evidence. Basing our access to new medicines policy on the authoritative guidance of NICE and AWMSG reduces the risk of inequalities and variation in access. It will ensure patients across Wales receive treatments proven to be clinically effective, with a price in balance with the benefits. The new treatment fund will support our evidence-based approach, providing health boards with additional funding to ensure innovative, new medicines are introduced as quickly as possible. Options for the operational set-up of the fund are being developed and we are on target to establish the fund by December this year. I will, of course, make a further, detailed announcement later in the year.

Turning to the review of the IPFR process, there is a good deal to report. The NHS Wales IPFR process is the mechanism used by all health boards across Wales to make a decision at an individual patient level on access to a treatment not routinely available. Following the 2014 IPFR review and the implementation of its recommendations, I agreed the time was right for a new, independent review of the IPFR process. This will concentrate on the number of panels, the clinical exceptionality criteria, and take account of the patient’s perspective.

I am pleased to announce today the membership of the group that will take forward the review. Mr Andrew Blakeman will chair the review group. Mr Blakeman is a chartered accountant and has worked for BP for over 20 years in a variety of senior financial roles. He will bring a solid customer-focused background to the work of the group. There are five more members comprising the rest of the group. Mr Irfon Williams is a retired senior nurse, who will provide the review with valuable insight based on his recent experience of the IPFR process. Professor Peter Littlejohns is an independent medical academic and professor of public health, being an honorary consultant at King’s College London. Professor Littlejohns has extensive experience and understanding of the medicines appraisal process and the equity issues arising out of treatment decisions. Professor Phil Routledge is a former chair of the AWMSG and director of the All Wales Therapeutics and Toxicology Centre; that is the executive arm of AWMSG. The review group will benefit from his extensive experience of the medicines agenda in Wales, and the ethical and safety considerations associated with access to new medicines. Dr Ben Thomas is a consultant nephrologist and will provide expert input into medical ethics and law. Professor Chris Newdick is a barrister and professor of health law at the University of Reading. His special interests are the rights and duties arising within the NHS, including medical ethics and prioritisation.

So, I hope Members will see that, from its membership, the group is independent of Welsh Government and comprises a range of relevant expertise and knowledge. I want to reassure Assembly Members that the review group will have sole responsibility for the content of their report, their findings and their recommendations. I’ve circulated a short note detailing their biographies and the terms of reference I agreed with opposition health party spokespeople. I would also like to take this opportunity of thanking the review group members for agreeing to give us their expertise and time to undertake this challenging work.

In broad terms, the review group will examine the evidence of current good practice in Wales, the UK and elsewhere for making individual funding decisions on treatments that are not routinely available. It will consider the advantages and disadvantages of retaining eight IPFR panels or moving to a smaller number, including the possibility of a national IPFR panel. The review group will examine the criteria that an IPFR panel will use to make their decisions, including clinical exceptionality. It will consider options for improving how the IPFR process and subsequent decisions are communicated to patients. The end result will be a report with practical recommendations for next steps.

Assembly Members will know from my earlier announcement in July that I want this review to be sharply focused. I have therefore asked the group to work towards producing their report by end of this calendar year, and I will, of course, keep Members updated. Last week I met with Andrew Blakeman, and he also took the opportunity to brief personally the health opposition spokespeople and other parties, reassuring them of the independence of the review and how he intends to ensure patient views are fully reflected during the process.

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

The review group have begun their work and will meet for the first time together on 6 October. I will publish the report and announce actions arising from the review group’s recommendations early in the new year. Taken together, the new treatment fund and the review of the IPFR process will lead to a real change in how patients in Wales gain access to innovative medicines, and I expect a real improvement in the service that patients rightly expect from the NHS here in Wales.

May I welcome this statement? We are talking here about two elements of weaknesses in health provision, which at the moment do lead to frustration among patients and their families, and where there is a real feeling that there is some unfairness in the system. I will first of all cover the announcement of the independent review of the IPFR. We in Plaid Cymru certainly felt strongly that it was time to review this area, that it was an area where a solution was required, a sustainable solution was required. I was pleased that we had been able to include the pledge to go ahead with this review in our post-election agreements, and I’ve been pleased to be able to work with the Cabinet Secretary to ensure that we do make progress in this area.

It is not fair that consent can be given in one geographical area of Wales whilst it is not given for treatment in another part of Wales. The process of exceptionality isn’t fair. Too many seriously-ill people have had to fight bureaucratic battles when clinical issues and the individual’s well-being should have been the priority in taking any decision. Now, of course, I don’t need to continue to make this case, because we do now have this independent review.

I was very pleased to have an opportunity to meet with Andrew Blakeman. I was certainly convinced that he would be entirely independent in undertaking this work. I wish him well. He will have to do this work in a very brief period of time, and I know that will be a challenge. I do wish the other members of the panel well also. May I particularly welcome the involvement of Mr Irfon Williams, who is going to be a member of this panel? I was very eager to see that happen. He brings professional experience within the health service, of course, but he will also ensure that there is a patient voice in this process, as someone who has been through the process and has felt these frustrations himself.

Now, in terms of the new treatment fund, we and the party of Government here have had some sort of fund as an objective in our manifestos, and I’m pleased that we’ve been able to move towards a statement in this area. There are few references in this statement today from the Cabinet Secretary to that new fund, and I think that reflects the fact that there is some work still to be done in deciding on a few practical elements of how this is to be implemented. The Cabinet Secretary admits that in his statement, but he does set out a tight timetable.

So, the few questions that I have relate to the decision that will need to be taken in terms of this new treatment fund over the next few months. Will there be a brief consultation during that window, as we work on the details? Can we be given an assurance that data will be released in full in terms of how the new system would be used? What process will be in place to ensure that local health boards do actually adhere to what is expected of them, according to the Act, to fund treatments that have been approved by NICE, once they cease to be new treatments? That is an important point. Also, NICE, these days, not only can approve or reject treatments; they can say ‘maybe’. What will the Welsh Government’s attitude be towards NICE’s decisions that are in that ‘maybe’ category?

Thank you for the questions. I want to begin by welcoming the constructive conversation, both with Rhun and with other opposition health spokespeople, up to this point, on the terms of reference of the review. I hope that other opposition spokespeople found it useful to meet Mr Blakeman as the chair of the review group. I think we have an excellent appointment, not just of the chair, but of the whole group. I look forward to receiving their work.

Just a point on Irfon Williams and the patient voice. We wanted to make sure that membership reflected that for the review group, but equally—to be really clear—this isn’t just that Irfon Williams is on the group, and therefore the patient voice is sorted. There is a recognition that, in the way that they conduct the evidence, and the way that they listen to people, they need to talk to both the wider third sector and with a range of campaign groups who can help to give a patient’s perspective, but equally to look directly to some patients who have been through the process—both those who have had successful applications, but equally to those who have not as well. It’s important that they get some direct experience from a wider group of people. I’m pleased to see that that is going to be taken on board in the way that they conduct their work.

On the new treatment fund, as you’re aware, it’s a manifesto pledge that is being implemented. I will update Assembly Members on the detail of how we expect that to work, and the criterion that will be used. When it comes to the attitude of this Government, if health boards take the money but don’t want to ensure that access is provided, well, then they won’t get the money. It’s very simple. The money will be provided for particular drugs to be made available, and we expect them to be made available. The whole point about this is to make sure that there is an evidence base for the effectiveness of medication, to make sure that, once there is approval for them, within a limited period of time, it is available consistently across Wales. Because we recognise that there is, sometimes, an inequity in having medications available in different health boards and the way they are able to manage their position. It’s also important to make sure that that innovation and that evidence base is available on an equitable basis across the country. I think, when we get to announcing how the fund will work—the practical detail of it, and its implementation by the end of this year—I think a range of the questions you have will be satisfied.

On the point about ‘maybe’ drugs, there’s a challenge in England about looking at the cancer drugs fund, which has come to an end after fairly universal criticism, at the end of it, about its value for money and the equity that it provided. The Public Accounts Committee in the House of Commons said that there was no evidence of improved patient outcomes. Well, there’s a different approach that they’re looking to take, but there’s still a challenge of working that through practically, because with the idea of having a ‘maybe’ category, or a ‘promising’ category of drugs, NICE need to be able to work through and understand what that is. There has to be some clarity around that so that NICE understand what they’re working to, and equally, then, the public. To be fair, the industry that will want to come to NICE for appraisals of new medicines need to understand what their category might mean as well. As there is clarity around that, we need to then understand what we want to do here in Wales as well, rather than inventing a new category ourselves. I don’t think that that’s very helpful. What I will say is that, just as with the cancer drugs fund, we took, I think, the principled and correct view that it was unethical to say that cancer patients—that their lives were of greater value than other patients in the national health service and in this country. We will not proceed down the route of wanting to advantage a particular cohort of conditions. It must be a properly equitable access to new and innovative medication and we want to be able to make sure that there is a proper evidence base for that. That will continue to be the approach that this Government takes.

Minister, thank you for this statement. I’m very pleased to welcome both elements of it on behalf of the Welsh Conservatives. I do have a couple of questions to ask, though, and I’d like to turn in the first instance to the new treatment fund that you speak of here. You have said previously that the new treatment fund has been developed from Welsh Government experiences of managing high-cost treatments. Last year, for example, Welsh Government funded four new treatments for hepatitis C and a rare genetic disease, atypical hemolytic uremic syndrome. I’m so glad I got that out. Those were just going to be funded by Welsh Government. Can you confirm, in light of your treatment fund, that those particular four new treatments—all high-cost and innovative—have now all been absorbed by the health boards? The reason I ask this is that all my questions do revolve around the funding issue, because I have a bit of concern, given the £75.5 million deficit that we have throughout the joint health boards, as to whether they’re going to be able to absorb the cost of these without Welsh Government funding.

Now, you answered Rhun’s question by saying that you would be seeking for them to do that, but what I wasn’t clear on is: once you’ve withdrawn the funding for a drug, you will expect the health board to pick up that cost. You mention in other evidence that you’ve given on this subject that you would expect the health board to follow the Welsh Government priorities. What would happen if a health board said, ‘Yes, that is a good drug, yes, we’ve had it for a year, yes, it has been effective in some areas, but we can’t afford to prioritise that in the way that you would wish it to be prioritised’? You were funding it when you were funding it, and it was fine, but you’re now no longer funding it. Therefore, it’s become a financial cost to the health board. Will you either be giving them additional funding—and that’s what I couldn’t quite work out from your answer to Rhun—or will you be issuing a very strict set of guidelines that say, ‘Now that this new drug has been trialled by us, has been accepted by us, has been part of the new treatment fund, and is now going to go into mainstream’—although, obviously, rare use, because otherwise it wouldn’t be in this fund—‘you have simply got to find the money for it yourself and prioritise it’. Some clarity there would be really helpful. I’ve used the previous treatments that you funded last year for the hepatitis C and aHUS to understand where they’ve gone. Have they been absorbed by the health boards? Will they still be in the new treatment fund? Will some drugs always be in the new treatment fund for funding, because they are so rare and/or so expensive, even though they do have a good outcome? Will Welsh Government always be putting forward some money, or do you actually see that £80 million being redeployed every year, year after year, on completely different drugs?

Finally, my final question on the new treatment fund is that, when you are looking at using that £80 million, will you be looking at any weighting between the health boards? So again, I’m not quite clear whether the funding will go to the health boards for the new drugs, or whether you will only give the money to the health boards once they’ve used the drugs. Because I would suspect that some health boards, particularly those such as Cardiff and Vale, where they hold more of the rare and specialised clinics, will end up dishing out those drugs and authorising those drugs far more than, perhaps, Withybush hospital in my patch, because they don’t have the very rare and unusual clinics. I’m just trying to understand where the responsibility for that money will lie. Will there be any weighting amongst the health boards on the use of that?

Turning to the independent patient funding programme, I’m really delighted about this. Do you know, First Minister—Cabinet Secretary—

Aelod o'r Senedd / Member of the Senedd 15:54:00

Not yet.

Not yet. Probably shortly, but not quite yet. I’m really pleased by the way you’ve set this up. We’ve had a number of conversations, with Rhun, with Caroline, between us. I’m really pleased with the collaborative manner in which you’ve approached this. I’m really pleased that we’ve been involved. But above all, I’m really pleased about two things. One is the absolute independence of the chair, and the fact that the chair has got commercial experience of running a people-centred organisation, and has not just come out from our small pool of talent within Wales, because we do need fresh ideas, fresh blood and a fresh perspective, and that individual certainly brings that to the party.

The second thing that I’m exceptionally pleased to hear is that you are making the patient voice an overarching theme for this review. Because, at the end of the day, this is all about the patient. They are first, second and last in this. And I’m very, very pleased to hear that they are going to be the overarching theme—it’s not just going to be the members of the panel, but all of the evidence that you take. So, absolutely, hats off to you. Congratulations. I’m really pleased about that.

I was delighted to meet Andrew Blakeman and we had a very useful conversation. There was only one question I asked him that he wasn’t clear on. I’ve asked him to go back and check the remit with you. It comes from some of the cases that I have dealt with in my constituency, and that is over whether or not he’ll be looking at the issue of co-funding. It’s a very difficult issue. It can be very contentious. But, some of the times, when I’ve dealt with patients who’ve been desperate to try to access a drug that they haven’t been able to access—and they want to go through the independent patient system that we have now—when they’ve had a no, they’ve sometimes asked, then, if they can go off and do other types of funding. All I wanted to know was whether or not he’s going to look at it. I suspect not, which is fine, but I just wanted that clarity, because I pointed out to him that that is going to be one of the outcomes that comes out of this whole process and will eventually have to be an area where you as Welsh Government and the NHS are going to have to make some kind of very clear line so that patients know exactly where they are.

I certainly am. My final comment to him was that I will, certainly—and it may be something other Assembly Members may wish to bear in mind—be furnishing him with a number of case studies, because I think that will be another way of getting the patient voice to be heard loud and clear.

Thank you for the comments and the questions. I’ll try and deal relatively briefly with them. On the new treatment fund, then, if you like, the predecessor to this will help to inform where we are on hepatitis C and a range of other conditions where we’ve provided significant resources to make sure they’re available on a consistent basis. It is for the initial year, as I said before and in this statement, and we expect health boards to be able to resolve and to manage their resources thereafter. It is often the first year of a new medication coming on board that is difficult for a health board to manage and to budget for. So, it is based on our practical experience. I don’t actually think that the challenges of keeping the NHS to budget can all be laid at the door of the cost of innovative medications that are approved by NICE or the AWMSG.

That’s the second point, about this being an evidence-led process. So, it won’t simply be that, at the end of the first year, I will decide, or a health board will decide, that we actually don’t want to provide this medication any more. It will be there, it will be available. Politicians won’t decide on its effectiveness—it will come from an authoritative review from NICE or the AWMSG. That’s the point about the medication then being available.

On the money, we’re targeting at need. So, you’re right that some health boards will prescribe or deliver or lead on the treatment of a range of conditions, and tertiary centres will have a different experience of that than others. It’s really about making sure that the patient—the citizen—gains the benefit. I hope that’s helpful.

I welcome your comments about both the review group and the patient voice. I’m pleased to hear that you found the meeting with Mr Blakeman useful in giving you some confidence about the expertise and independence of this particular group and making sure the patient voice is heard loud and clear through the process and, indeed, the contact that the review group will have with Members as part of that as well.

On your point about co-funding, it is not part of the terms of reference we agreed with the group. I think there’s a broader question there. There’s more than just the IPFR about co-funding. I think it is ethically incredibly difficult to go down that route. I’ve not asked the review group to look at that. It’s not been part of the conversation that we’ve had and I don’t think I should try and introduce it after the conversations that we have had. I think it’d be the wrong thing to do. I think it is definitely a debate for another time and another day.

Thank you for your statement, Cabinet Secretary, on the new treatment fund. We look forward to receiving more concrete details in the future. Your statement mentions that the fund will provide extra funds for new medicines, but can you confirm it will also fund new treatments, for example proton beam therapy? My question on co-funding has already been answered, so I’ll move on. Moving on to the independent review of the IPFR process, I would like to thank you for the inclusive way you have approached the IPFR review. It is refreshing that you have approached the IPFR review process in a non-partisan way, and panel appointments reassure me that this will be a truly independent review.

It was a pleasure to meet Andrew Blakeman last week, and I would like to thank you also for facilitating that meeting. Mr Blakeman is an excellent choice as chair of the review panel, and he has assured me that this review will achieve what many previous ones have not, namely putting in place a process whereby patients can receive the best available treatment based on clinical needs. We have had reviews in the past, but nothing much has changed. But this time, I believe the panel has the expertise, and, more importantly, with the inclusion of Irfon Williams, the experience truly to understand the failings of the current system, and the ability to deliver suggestions on how we can reform the system.

Thankfully, Cabinet Secretary, Andrew Blakeman answered most of my questions last week. I would just like to put on record my thanks, once again, for the way you’re handling this review. I look forward to working with you to implement the review’s recommendations. Far too many are, often, let down by the IPFR process, and we must ensure that we have a system in place that works for patients and clinicians. I look forward to being a part of this. Thank you.

Thank you for those comments. Again, I am pleased that each of the spokespeople have felt able to come into the Chamber and talk about the way in which we’ve approached this issue and welcome the membership of the group. I look forward to them all being equally positive when they provide their recommendations. Although we may have different issues to deal with at times, we actually have to make choices, because this isn’t an easy area. It’s what the previous review group found as well in 2014—a range of their recommendations at the time has been implemented. There has been real progress made, but there are still real challenges, which is why we are now looking at this again, and I’m pleased that we’re doing so.

On your points about wider access to non-medicine technologies, I’m pleased to confirm that there is a new hub that is being developed to be based at Velindre NHS Trust, which will deliver a strategic and national approach to identify, appraise and then adopt new technologies into health and care settings. So, this work is not proceeding on its own. On proton beam therapy, we’re actively looking at what we can do to increase capacity and make it more localised here in Wales, and, in fact, at investment the Welsh Government is making within the private sector to make that happen.

Diolch, Ddirprwy Lywydd. Can I thank the Cabinet Secretary for his statement this afternoon? I very much appreciate the effort that’s gone into this. In the fourth Assembly, the Health and Social Care Committee looked at the cancer delivery plan, and one of the recommendations was that we needed a review of the IPFR process, with a view that, perhaps, we would have a single panel to look at the consistency better across Wales. So, I very much appreciate that that’s coming through.

A couple of quick points—I’m very pleased you answered the previous question on treatment, because I notice that the statement focuses very much on medicines and not on treatments, and we talk about treatments very much. I know you believe in treatments, Cabinet Secretary, but it is important that we get that message to the public.

One of the issues I have is the need to actually communicate with the consultants. I notice in your—. It’s in your remit, in a sense. I have constituents who are desperate for some medication, and they come and say that the consultant has said, ‘We need to apply for this, but it’s not likely we’re going to get it’. I think we need to build confidence in consultants and the clinical profession to ensure that the process is going to deliver for clinical need.

On that point, I am a little bit disappointed that we still have the words ‘clinical exceptionality’ in there. I would’ve rather seen it justified as to why it should be there than, actually, whether it is appropriate or not. Clinical need is the issue, and, sometimes, we can’t put a price on clinical need. I have a constituent—as you know, because I’ve written to you about the constituent—who needs a particular drug. That drug will prolong life, and will, perhaps, allow the one-year-old child to remember his or her mother as a consequence of that particular drug. So, it is a need more than an exceptionality question. I think it is important that we address the word ‘exceptionality’. I, personally, would like to see it gotten rid of and look at clinical need, but I appreciate that your remit actually says ‘appropriateness’. Perhaps we can go a bit further than that. The communication aspect is critical. We need to make sure our profession has confidence in the system we are delivering.

Thank you for the comments. I’ll start with the last points that you were mentioning on clinical exceptionality and/or need. The reality is that we already have a system providing evidence on what should be provided. Need is very much a part of it—whether it’s something that is clinically effective—but you can’t get away from the reality of resource as well. The NHS has a budget to work to in every part of the argument and every healthcare system. If we simply say that it doesn’t matter what the price is—. We regularly have negotiations with pharmaceutical companies about patient access schemes, and, in fact, within Wales, since it was introduced in 2012, by delivering a patient access scheme where the pharmaceutical company agree to change their price to get access, that’s meant that 36 new medicines have been available in Wales as a result of that. So, we’ve always got to be able to balance that properly, and if we’re going to have an honest debate about the future of high-cost medicines, we do need to set out—. But there are times you do have to talk to pharmaceutical companies about the price for which a medicine is provided. It was part of the reason why the cancer drugs fund failed because there was no control over pricing, as well as the lack of control over the clinical evidence that a treatment was actually going to be effective.

The reason why exceptionality is in is because we’re reviewing where we are and making recommendations for the future. We’ve been completely clear in the terms of reference that if the review group believe that exceptionality is not the appropriate criteria and there is a better formulation of that, then we want to hear from them, because I want the recommendations that I make to be really practical for us as well. And, indeed, if they say that, for all of the challenges about exceptionality, it is the right criteria, we need to understand how we deal with that more effectively.

That goes back to your first point, really, and that’s about the relationship between the consultant and the patient, because we’ve been really clear again in the terms of reference—we’ve got to understand that with that interface, when someone wants to understand what the treatment options are and what’s available, there’s got to be a way for both the treating consultant and the patient to understand what is available and why, and if you’re going to go through an individual funding request, what that really means too as well. So, we’ve got to equip our clinicians to have those difficult conversations in the most consistent manner possible, so that people don’t come out and think that it’s either the health board area they live in or the consultant they see that actually governs what their access to effective treatment is. So, that is a really important and a very difficult challenge for us to get over.

Just finally—I’ll finish on this point, Deputy Presiding Officer—I had a very constructive meeting yesterday with the Wales Cancer Alliance, and they were interested in my statement today. I indicated that I wouldn’t be giving them an advance copy of what I was going to say or the membership of the panel of the IPFR review, but they’re interested in what we’re doing and they, too, still want to see more consistency. They want it to be an evidence-led process, but there also wasn’t support for a process that advantaged their group of conditions over others. So, having that genuine equity across the piece and having a genuine evidence base to govern what we’re doing was really important to them too. So, there’s a whole range of actors in the field who are looking at what we’re going to do and why, and I look forward to hearing from the review panel in the relatively near future.

5. 5. Statement: The Rio Olympic and Paralympic Games Homecoming 2016

We move on to the next item on our agenda, which is a statement by the Cabinet Secretary for Economy and Infrastructure on the Rio Olympic and Paralympic Games homecoming. I call on Ken Skates to present the statement.

Member
Ken Skates 16:08:00
The Cabinet Secretary for Economy and Infrastructure

Thank you, Deputy Presiding Officer. I welcome this opportunity to congratulate our Olympic and Paralympic athletes who represented Team GB and Paralympic GB at the 2016 Rio games. I am especially pleased that Welsh Government and the National Assembly for Wales will be hosting a public event outside the Senedd later this week, giving people from across Wales the chance to pay tribute to all their athletes, their coaches and support staff. We can all be extremely proud of their performances and the way that they acted as great ambassadors for sport and for Wales.

Overall, 15,000 athletes competed in this year’s Olympic and Paralympic Games at Rio—a tremendous honour and achievement for all and the sports organisations, of course, that support them. The games gained worldwide attention and the athletes produced some breathtaking performances. Behind those performances, of course, is the years of training and hard work that they have put into their preparation. Their determination and desire to succeed embodies the values of sport and makes them great role models for the next generation and ambassadors for their sport and their country.

In terms of our Welsh athletes’ performances at Rio, we can say that our investment in elite sports development through Sport Wales continues to bear fruit. Welsh athletes won 18 medals across both the Olympic and Paralympic Games and in a wide range of sports, exceeding our expectations and providing some magical sporting moments for Welsh and British sport. The Rio games saw a new generation of Welsh athletes on the biggest sporting stage in the world with many debutants making a significant impact.

In the Olympics, Wales had 23 athletes competing in 11 sports, which is over 14 per cent of the Team GB total. Our athletes broke world records in the cycling team pursuit and successfully defended an individual title in taekwondo. Team GB became the first country in modern Olympic history to increase its tally of medals immediately after being the host nation.

In the Paralympic Games, we won two more gold medals than in London 2012 and we won medals in more sports. There were 26 athletes who competed, which exceeded our target, and nine of these were first time Paralympians and three medalled at their first games. That is quite an outstanding achievement. Disability Sport Wales have introduced a new campaign to identify new Paralympic athletes, called What’s Your Potential? and over 50 athletes are being monitored and developed.

Getting more talented athletes through the system and on to GB programmes is key to our future success and more and more countries are improving the service provided to medal-potential athletes, so it’s even more important that there are quality pathways in place that can help produce future medallists.

Although we are a relatively small country, we are a powerhouse within sport, continuing to aim high as our confidence and profile grows. We have a number of world champions and a constant stream of athletes who can compete at the highest level and who will now be setting their sights on the Commonwealth Games in Gold Coast, Australia, in just over 18 months’ time. This will be the next opportunity for them to compete and to represent Wales in a multisport event. I am confident that they will produce results of which we can be proud. We wish them all well.

Every successful elite athlete has to start somewhere, usually within a community setting and that’s why we are committed to ensuring that people have more and better quality sporting opportunities at a local community level. More participation helps to breed talent and success and I would like to thank all our Welsh Olympic and Paralympic athletes for helping to inspire and motivate people across Wales. Their performances symbolise all that is great and inspirational about the Olympic tradition and it is a great pleasure and privilege to have an opportunity to congratulate them all. The whole of Wales salutes them.

Diolch, Ddirprwy Lywydd. I’d like to also congratulate our Welsh athletes who’ve made our nation so proud. This really is a golden age for Welsh sport and that shows again the winning mentality that we have in Wales. It’s interesting that there was a gap between the 1972 Olympics and the 2008 Olympics where not a single Welsh person won a medal. That was 36 years. But since Beijing, the medals keep coming home to Wales and it’s so important now that we continue to build on that success.

With that in mind, I’d like to follow up on some of the points that we spoke about last time in this Chamber. Firstly, your office should have now had a formal invitation to come and meet me and the kids in Grangetown who can’t afford to play sport there, and it really does sadden me to see empty sports pitches with children who want to play on them but don’t have the money to do so. I’m also told by parents that it costs £450 now for their child to represent Cardiff and Vale schools. You may know that Wales’s first Olympic gold medallist, Paulo Radmilovic, came from Cardiff. His parents ran the Bute Dock Tavern, just down the road on Bute Street, and he went on to win four Olympic gold medals. So, I’d like to arrange this visit as soon as possible so that, in future, Grangetown and their neighbours in Butetown, can again celebrate their own future Olympian.

I’d also like to invite you again to maybe think about how we can celebrate Billy Boston, another great sportsman from the docks, as we used to say back in the day, and went on to be the record try scorer in rugby league. I think it would be really good if this Government, the Assembly and Cardiff council could celebrate that.

I’d like to revisit the Government’s failure to bid for the Commonwealth Games, because it’s interesting that you state that Welsh athletes are now setting their sights on the Gold Coast Commonwealth Games in 18 months’ time. Because, in a very short-sighted decision, your Government has turned its back on the chance for us to bring the games home to Wales. The last time we spoke, you said that local authorities were unable to contribute to the costs of the games at this stage. So, I put in a freedom of information request to ask what official correspondence you’ve had with local authorities on the Commonwealth Games and the result came back and it stated, and I’ll quote this:

‘No formal requests or enquiries have been made by Welsh Government to local authorities for financial contributions to the 2026 Commonwealth Games.’

You may remember the Tony Blair who, I’m sure, remains something of a hero to many of you on the Government side of the Chamber. He was accused of running a sofa Government. Blair came in for stinging criticism for his informal decision making in the Butler report, where the lack of minuted meetings meant that the decision-making process could not be held up to proper scrutiny after the event. All this sounds very familiar to how this Labour Government is being run in Cardiff—

Yes. You claim to have asked local authorities if they could provide potentially millions, but there’s no formal request to scrutinise that. I believe Tony Blair would be very much at home in this Labour Government. So, my question is: are you now in a position to provide me with the formal minuted requests between the Welsh Government and local authorities for financial support for the Commonwealth Games? If not, will you commit to a formal review of the Welsh Government’s decision-making procedures?