Cynulliad Cenedlaethol Cymru The National Assembly for Wales
Y Pwyllgor Deisebau The Petitions Committee
Dydd Mawrth, 20 Tachwedd 2012 Tuesday, 20 November 2012
Cynnwys Contents Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions Deisebau Newydd New Petitions Y Wybodaeth Ddiweddaraf am Ddeisebau Blaenorol Updates to Previous Petitions P-03-150 Safonau Canser Cenedlaethol—Sesiwn Dystiolaeth Lafar P-03-150 National Cancer Standards—Oral Evidence Session
Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included.
Aelodau’r pwyllgor yn bresennol Committee members in attendance
Russell George	Ceidwadwyr Cymreig Welsh Conservatives
Elin Jones	Plaid Cymru The Party of Wales
William Powell	Democratiaid Rhyddfrydol Cymru (Cadeirydd y Pwyllgor) Welsh Liberal Democrats (Committee Chair)
Joyce Watson	Llafur Labour
Eraill yn bresennol Others in attendance
Grant Duncan	Dirprwy Gyfarwyddwr, Y Gyfarwyddiaeth Feddygol, Llywodraeth Cymru Deputy Director, Medical Directorate, Welsh Government
Lesley Griffiths	Aelod Cynulliad, Llafur (y Gweinidog Iechyd a Gwasanaethau Cymdeithasol) Assembly Member, Labour (the Minister for Health and Social Services)
Dr Chris Jones	Dirprwy Brif Swyddog Meddygol, Llywodraeth Cymru Deputy Chief Medical Officer, Welsh Government
Swyddogion Cynulliad Cenedlaethol Cymru yn bresennol National Assembly for Wales officials in attendance
Sarita Marshall	Dirprwy Glerc Deputy Clerk
Victoria Paris	Ymchwilydd Researcher
Helen Roberts	Cynghorydd Cyfreithiol Legal Adviser
Naomi Stocks	Clerc Clerk
Dechreuodd y cyfarfod am 9.34 a.m. The meeting began at 9.34 a.m.
Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions
[1] William Powell: Bore da. Good morning, everyone. It is good to see you here for this formal session of the Petitions Committee. I extend a particularly warm welcome to our friends from the Scottish Parliament’s Public Petitions Committee, who are visiting the Assembly today. We will link up with them later on, after the meeting. I remind everyone that they are entitled to speak in Welsh or English, as they wish and are able. Headsets are available to hear the translation of Welsh into English, and the recording of the meeting will be available on Senedd.tv shortly afterwards.
[2] We have a full complement of Members this morning, and so there are no apologies. We can therefore move straight to our first item of business.
9.35 a.m.
Deisebau Newydd New Petitions
[3] William Powell: The first new petition is P-04-437, on opposing compulsory registration for home educating children. This petition was submitted by Wendy Charles-Warner and collected 1,614 signatures. It states:
[4] ‘We call upon the Welsh Assembly for Wales to abandon plans for a compulsory register for home educated children as part of the draft Education (Wales) Bill. The law states that parents, not the state, are responsible for the education of their children, which makes such a register both inappropriate and unnecessary.’
[5] I received this petition on behalf of the committee on 7 November in a particularly lively presentation that the clerking team will recall. The petitioners have been kind enough to supply us with a substantial hard-copy briefing document that colleagues have just received. Previously, we received some initial briefing on this issue. We have also received a research brief that has been circulated to committee members as a private paper. This is clearly an issue of great concern to this body of parents and to the children themselves, who had something to say, and rightly so, on that occasion. So, I welcome colleagues’ thoughts on how we should take this particular petition forwards.
[6] Joyce Watson: I think that we should write to the Minister for Education and Skills first to seek his views on the petition, highlighting the petitioners’ areas of concern.
[7] William Powell: Indeed. In the meantime, we will have the opportunity to familiarise ourselves with some of the background documents while we await his response. Are colleagues content with that?
[8] Joyce Watson: We also received an e-mail yesterday, inviting us to meet with the petitioners. I received it, so I am assuming that you did.
[9] William Powell: I have received it, and I sent an acknowledgement, forwarding the substance of it to our clerk so that we can consider whether that will fit in with our consideration of the petition, but thank you for flagging it up. I should have mentioned it myself.
[10] William Powell: Did other colleagues receive that e-mail? It arrived some time yesterday evening. If not, perhaps you could look out for it with your colleagues in your office.
[11] Moving to the next petition, P-04-438 on shopping access was submitted by Mencap Cymru in association with Ysgol Erw’r Delyn, and it collected 55 signatures. They call on the National Assembly for Wales to urge the Welsh Government on a series of particular measures, including: investigating the provision of off-street disabled parking; creating a law stating the minimum number and dimensions of disabled parking spaces; investigating the current minimum size for disabled spaces; setting a standard, higher fine for misusing disabled space; and making taxi companies carry the correct clamps and inertia reels for use with motorised wheelchairs. There are also a couple of other important matters that they wish to flag up from their own experience. This was another particularly memorable presentation, just recently, because of the testimonies that the individual petitioners, virtually all of whom were wheelchair users, brought to our attention. That certainly informs my consideration of this.
[12] I suggest that we write to the Minister for Local Government and Communities in the first instance, because this clearly falls within his area.
[13] Russell George: I would support that. Perhaps we could also write to the Welsh Local Government Association to get its perspective of a local authority’s point of view on this.
[14] William Powell: That makes a lot of sense. Therefore, we will write to Steve Thomas at the Welsh Local Government Association, and to Carl Sargeant, as the Minister for Local Government and Communities, flagging up these concerns, and we will then, hopefully, get a fairly swift response, because this is an issue of great concern to that group of petitioners. I see that we are agreed on those actions.
9.40 a.m.
Y Wybodaeth Ddiweddaraf am Ddeisebau Blaenorol Updates to Previous Petitions
[15] William Powell: The first is P-04-425 on Team Wales. This petition was submitted by Russell Gwilym Morris in October, and has collected 208 signatures. The petition reads,
[16] ‘We call on the National Assembly for Wales to urge the Welsh Government to seek an agreement with the International Olympic Committee to amend the Olympic Charter to recognise the devolved administrations of Great Britain in their own right, in order that the Welsh Government could form a National Olympic Committee and our athletes can compete as Team Wales / Cymru in the future.’
[17] We have received a fairly clear response from the First Minister on this issue. It is pretty clear that we need a fundamental constitutional change here. Therefore, I am not clear where we can realistically go with this, but I would welcome any views of colleagues on this matter.
[18] Joyce Watson: It is clear from the First Minister’s letter that, even if we wanted to, we could not do anything about this—it is completely outside our remit; I mean outside the Assembly’s remit, not the committee’s remit. I would be minded, in light of that response, to close the petition.
[19] William Powell: That is my instinct, too. Do any other colleagues have any observations on that? We need to be clear with the petitioner, and with the substantial group of people who have the same aspiration, that we do not think that this is realistic, and that is made pretty clear in the First Minister’s letter.
[20] Russell George: I would support closing the petition.
[21] William Powell: Do you agree, Elin?
[22] Elin Jones: Yes.
[23] William Powell: Okay, we are agreed on that. That is what we will feed back to Mr Russell Gwilym Morris and his colleagues.
[24] The next petition is P-03-294 on the Wales Women’s National Coalition. This petition was submitted in October, with 51 signatures. The petition reads,
[25] ‘We the undersigned call upon the National Assembly for Wales to urge the Welsh Government to publish firm plans which state how, in the absence of Wales Women’s National Coalition, the voice, needs and views, of women in Wales will be reflected into policy and decision-making in Wales, the UK, Europe and the UN.’
[26] That is quite a wide remit that is mentioned within the text of the petition. We wrote to the petitioners back in May, following a statement by the Minister for Finance and Leader of the House, asking whether the petitioner felt that the objectives had been met. We have not heard back from the petitioner since that time. Joyce, do you want to comment?
[27] Joyce Watson: First, I want to declare an interest because I used to be the manager of the Wales Women’s National Coalition, in a previous life. That is the first thing. Secondly, I said at the time that a reformed group was being established, which is being sponsored by the Minister. That has happened and it is up and running. Considering that the WWNC no longer exists, and considering that you have not had any response whatsoever, I would move to close the petition.
[28] William Powell: Thank you, Joyce. That is useful on a number of fronts, giving the context, and declaring your previous role. I would just like to clarify for the record that the petition was presented in October 2011, not just last month. That will be evident from the fact that the Minister made a relevant statement in May of this year. I just wanted to clarify that. Are colleagues happy that we take that step in the light of what we have heard? I see that we are agreed.
9.45 a.m.
[29] We will now move on to P-04-345, on rail and bus links between Aberystwyth and Carmarthen. There has been quite a lot of activity on this front, but this is an earlier petition than the one that was presented relatively recently.
[30] Elin Jones: That is where I got confused.
[31] William Powell: Initially that confused me as well. This petition was submitted by Craig Owen Lewis in November 2011 and collected 555 signatures. It says,
[32] ‘We call upon the National Assembly of Wales to urge the Welsh Government to restore and/or improve rail and bus links between Carmarthen in the county of Carmarthenshire and Aberystwyth in the county of Ceredigion.’
[33] At our last consideration of this petition, we agreed to write to Mr Craig Owen Lewis to seek his views on the issue. That is the point that we had got to. We have not received a response as yet, so I would welcome your thoughts on the matter. I am minded to propose that we close it in the light of the lack of a response, but we wrote relatively recently. What are your views?
[34] Elin Jones: For clarification, there is another petition about the reopening of this railway line, which we discussed in the last committee meeting and we referred that—
[35] William Powell: That was a more specific one, I think.
[36] Elin Jones: We referred that to the Minister for a response, did we not?
[37] Ms Stocks: That is correct.
[38] Elin Jones: I thought that I was losing all memory for a second. [Laughter.]
[39] William Powell: No, indeed.
[40] Elin Jones: Right. Okay.
[41] Russell George: Has the other petition been closed?
[42] Elin Jones: No.
[43] Russell George: So, it is still open.
[44] Ms Stocks: It was considered for the first time at the last committee meeting.
[45] William Powell: It was presented about five weeks ago, was it not?
[46] Ms Stocks: Yes.
[47] William Powell: That is the only thing that makes me wonder whether it would be better to hold off on closing this, until we have a little more clarity on the related petition.
[48] Elin Jones: Could we run both together?
[49] William Powell: That makes sense to me.
[50] Russell George: And to me.
[51] William Powell: Joyce, are you content with that?
[52] Joyce Watson: Yes.
[53] William Powell: Excellent. We move now to P-04-409 on Welsh names for new trunk roads in Wales. This petition was submitted by Stuart Evans in October 2012 and collected 47 signatures. It says,
[54] ‘We call upon the Welsh Government to ensure that all new trunk roads in Wales have names in Welsh. Not only does this help preserve the identity of our cities, towns and villages. It also helps non Welsh speakers learn basic Welsh pronunciation and spelling.’
[55] I need to declare an interest in a related matter. I was previously promoting the A470 as the ‘Royal Welsh Way’, which I understand has now been implemented at the very north of the A470 and is demarked on the road in the Llandudno area, although the rest of the campaign remains under way. There was also a petition in relation to the A470. This petition obviously has a broader remit and we need to consider this on its own merit. We first considered it in October and wrote to the Minister for Local Government and Communities. We received a response, which is fairly clear, but I welcome your reading of it.
[56] Russell George: We should contact the petitioners and seek their views on this. We have had a response from the Minister, so let us seek the petitioners’ views.
[57] William Powell: Indeed. I think that that would be only fair. Is everybody agreed that we seek their feedback on what Carl Sargeant had to say?
[58] Joyce Watson: We have had a very detailed reply from Carl Sargeant and we should, quite rightly, pass that on to the petitioners. It is pretty clear that the cost of doing this would be astronomical. So, we should send the information back to the petitioners and see what they say.
[59] William Powell: Yes. Hopefully we can consider that in the light of their response again early in the new year.
[60] Joyce Watson: Absolutely.
[61] William Powell: We move on now to P-04-390, ‘Designate Penrhos Holyhead Nature reserve (coastal park) a National reserve’. This was submitted by Jenny Jones in May 2012 and collected 826 signatures and an associated petition collected 1,100 signatures. It says,
[62] ‘We call upon the National Assembly for Wales to urge the Welsh Government to designate Penrhos Holyhead Nature reserve (coastal park) a National Nature Reserve.’
[63] We last considered this petition in October, and we agreed to write to the Countryside Council for Wales. We have a fairly detailed response on the matter from the chief executive of the countryside council, and it makes pretty clear that there is no provision for this designation as an NNR as CCW is constituted. That does not seem to me to be a route that will be successful. We are not necessarily that far from closing, but on the other hand, should we get in touch with the local authority in Anglesey to seek its views? I would welcome your thoughts.
[64] Russell George: In the light of what you have just said, I wonder whether we should close the petition, but advise the petitioners that we have forwarded their information to the Isle of Anglesey County Council. That would be one way of doing things perhaps.
[65] William Powell: We could probably take those actions in parallel. Elin, do you have any thoughts on this one?
[66] Elin Jones: No.
[67] William Powell: That is probably the best way for us to play it because the designation is clearly not going anywhere, but the concerns nevertheless need to be taken on board. Joyce, are you content with that?
[68] Joyce Watson: Yes. You do have to take the concerns on board. There is a lot of detail in this. I do not know whether the petitioners have misunderstood, which is implied in the letter, and think that if it was a designated national reserve it would have protected status in a way that it currently does not have. That is implied in the letter. To that end, we certainly need to pass this reply back on to the petitioners, and I am sure that that has already been done. As for writing to the council, we can do that, but we all know what is happening in Anglesey with the political representation at the moment. I just think that, for now, that is what I would do, rather than closing it. That would be my opinion. I just felt that there were still more questions within this reply and a need for some clarity, because this reply implied that there seemed to be some misunderstanding regarding what the petitioners were asking and seeking to gain and what they might actually gain. I do not think that we have had that clarity.
[69] William Powell: So, we could write back to the chief executive of CCW highlighting the response of the petitioner, which we have also received, as you say, and see whether, through clarifying it, there are other possible alternative routes. As you say, Anglesey is in a situation where things are improving significantly, as I understand it. It also has an election coming up in the middle distance, and this issue could potentially be aired in the relevant areas. That is probably the best way forward. On balance, I would recommend that we keep this petition open for the moment while this correspondence runs its course, and then subsequently that we contact the local authority to flag up the concerns with its countryside section. Are we content with that? I see that we are. Thank you.
[70] We will now move to P-04-349, regarding Welsh-medium provision in Caerphilly. This petition was submitted in November 2011 by Ben Jones, with a substantial group of others who were present at the time. It has approximately 1,200 signatures behind it.
[71] ‘We call upon the National Assembly for Wales to urge the Minister for Education and Skills at the Welsh Assembly Government to afford urgent priority to the bid submitted by Caerphilly County Borough Council for monies to finance the badly needed additional Welsh medium secondary provision by 2013.’
[72] We last considered this petition in January and agreed to seek the views of the petitioner on the Minister’s response. We have not actually received a response from the petitioners. My sense is that the issue has moved on and it is quite likely, because of recent developments and investment, that the issue has moved in their favour. Otherwise it would have been pretty clear that we would have had a response significantly earlier. I suggest that we close this petition in the light of not having heard from the petitioners. I think that they may well be content with developments. Do Members agree? Excellent.
[73] Moving on to P-03-236 on the charter for grandchildren, this petition was submitted in the previous Assembly by Grandparents Apart Wales in October 2009, and 19 signatures have been collected in support. It reads:
[74] ‘We call upon the National Assembly of Wales to urge the Welsh Government to adopt The Charter for Grandchildren and to make the Charter mandatory for professional workers who are employed in the welfare of children’.
[75] We last considered this in committee in March of this year, and we sought further details from the Welsh Government on intergenerational approaches. The ministerial response from Gwenda Thomas along with the petitioner’s response is included in our papers. The Deputy Minister has written in considerable depth on the issue, as you will have seen. The Government is expected to bring forward a social services Bill as part of the 2012-13 legislative programme, as we are all aware. At this stage, what would you propose on this one, colleagues?
[76] Joyce Watson: I think if we write to the Health and Social Care Committee asking it to consider the issues raised—
[77] William Powell: At scrutiny stage.
[78] Joyce Watson: Yes. That is as much as we can really do at the moment.
[79] William Powell: That is my sense.
[80] Joyce Watson: Of course, we will write to the petitioners to tell them that that is what we are going to do.
[81] William Powell: Yes, this issue has moved on quite a long way since the petition was brought back in 2009, and it is clear that the Minister is taking a number of these issues into her thinking. Do you have any other observations, colleagues? I see not.
[82] Moving on to P-04-366, on the closure of the Aberystwyth day centre, this petition has received quite a lot of attention from the committee since it was presented back in February by Pamela Ellis. It collected 10 signatures, but an associated high-profile petition within Ceredigion collected approximately 6,000 signatures. This petition reads:
[83] ‘We the undersigned call on the Welsh Government to consider if proposals for day care for the vulnerable elderly, to be moved from a purpose built, thirty year old Day Centre, to an unsuitable basement in an old building, previously used as the Town Hall Aberystwyth, are compliant with statutory requirements, and any relevant guidance’.
[84] When we as a committee last considered the petition we were of the view that the letter that we received from Ceredigion County Council did not actually address some of the particular issues that came up from our rapporteur visit back in the spring. We have since had significant additional clarification from Ceredigion on a number of these points, which you will have seen in the public papers, including a move on the issue of external validation of the adequacy and appropriateness of these arrangements in this particular day centre. We have a significantly better situation now on the detail of the response, but there are still issues that certainly are of concern to the petitioners. We had a recent e-mail on this, wanting to drill down into the detail of what kind of external validation or verification would be put in place to support this matter. Elin, I would like to ask you to speak on this one, because you have been very much involved in the issue, as indeed have Joyce and I in a wider context.
[85] Elin Jones: Mae hwn yn fater yr wyf yn gyfarwydd iawn ag ef yng nghyd-destun fy etholaeth i. Rwyf wedi darllen ateb y cyngor ac wedyn ateb y deisebwyr. Rwy’n credu ei bod yn werth inni fynd yn ôl at y cyngor i ofyn iddo amlinellu manylion y gwaith allanol y maent yn bwriadu ei gomisiynu er mwyn i ni gael ein sicrhau y bydd gan hynny hygrededd i’r gymuned a’r deisebwyr, fel eu bod yn fodlon fod y gwaith hwnnw â rhywfaint o annibyniaeth iddo. Nid wyf yn credu ei bod yn briodol i ni fynd yn ôl o ran y manylion y mae’r deisebwyr yn sôn amdanynt—mae’r rheini’n faterion y gallant eu dilyn gyda’r cyngor—ond rwy’n credu ei bod yn iawn inni orffen ein hymwneud gyda’r ddeiseb hon drwy ofyn am fanylion gan y cyngor ynglŷn â sut mae’n bwriadu cynnal yr ymchwiliad allanol i’r ganolfan ddydd.		Elin Jones: This is a matter that I am very familiar with in the context of my constituency. I have read the response of the council and then the response of the petitioners. I believe that it is worth our while going back to the council to ask it to outline the details of the external work that it intends to commission so that we can be assured that that will have credibility for the community and the petitioners, so that they are content that that work has a degree of independence. I do not think it appropriate for us to follow up the details that the petitioners talk about—those are issues that they can take up with the council—but I believe that it is appropriate for us to end our engagement with this petition by asking the council for details regarding how it intends to undertake this external inquiry into the day centre.
10.00 a.m.
[86] William Powell: Diolch, Elin. I would concur with that view. I was slightly puzzled on reading some aspects of the county council’s response, particularly when it talked about the extent of the works associated with the crossing and so on. When I was present as a member of the rapporteur visit, the main issues around access were not so much around the crossing of the road but around the safety and appropriateness of the ramp adjacent to the building, particularly the lack of shelter, which is of particular concern if people need to be assisted to come into the centre given the danger of getting quite wet and being exposed to the elements, rather than the wider issues. I think that it would be sensible if we wrote to the council to pick up these particular points that are of concern to the petitioners. I agree with the view that it is approaching the time for us to round off our involvement with the issue, because I do not think that there is a great deal more that we can do beyond trying to take forward those points. Joyce, I am conscious that you have been involved for some time with this issue.
[87] Joyce Watson: Yes, but I am not going to lengthen the debate just by adding more of the same. I agree with everything that has been said, I support it and I think that that is the way forward.
[88] William Powell: Thank you very much.
[89] The final update is on P-04-375, ‘Stop Opt-Out Organ Donation’. This petition was submitted by Dr Bablin Molik in March 2012. It collected 98 signatures. It begins by saying
[90] ‘We call on the Welsh Government to stop proposals for its opt-out organ donation system.’
[91] We last considered this petition in May 2012, when the committee wrote to Dr Molik indicating our intention to close the petition. Elin has referred to the fact that Dr Molik has had other preoccupations recently in relation to the Cardiff South and Penarth by-election, in which she was a candidate. We have not had a response, and it has not been raised by Dr Molik with me either in my recent contact with her. In the light of that, we will go forward and close the petition.
[92] Given how things have gone this morning, I propose that we adjourn the meeting under Standing Order No. 17.47 and reconvene shortly before 10.30 a.m. for our evidence session with the Minister for Health and Social Services, Lesley Griffiths.
Gohiriwyd y cyfarfod rhwng 10.04 a.m. a 10.28 a.m. The meeting adjourned between 10.04 a.m. and 10.28 a.m.
P-03-150 Safonau Canser Cenedlaethol—Sesiwn Dystiolaeth Lafar P-03-150 National Cancer Standards—Oral Evidence Session
[93] William Powell: Good morning and welcome to Lesley Griffiths, the Minister for Health and Social Services, who joins us this morning together with her team, Grant Duncan and Dr Chris Jones. We are here for an evidence session on petition P-03-150 on cancer standards. I would like to thank you very much for the evidence that you have submitted. Minister, if you would like to introduce your team and make an initial statement, we will get under way.
[94] The Minister for Health and Social Services (Lesley Griffiths): Thank you very much, Chair. As you said, on my right is Grant Duncan, and on my left is Dr Chris Jones, who are here to support me today. Thank you for inviting me to come this morning to give further evidence on cancer standards following the petition that was received back in 2008. I am very happy to answer any questions that you feel remain unanswered about the petition on cancer standards. Obviously, it is my first time in this role, but I know that a lot of evidence has been gained from my predecessor.
10.30 a.m.
[95] The written evidence that I submitted provides you with an update on the national cancer delivery plan, which is obviously different from the cancer standards. I would like to say a few things about that in my opening remarks. Cancer policy is broadly an area for the Health and Social Care Committee, but I recognise that the cancer delivery plan has overtaken the cancer standards. I hope that we can provide committee members with the necessary assurance on the petition in hand.
[96] There has been a lot of evidence over the past four years. Good progress has been made since the initial petition, as you have acknowledged in correspondence with the previous Minister. All health boards have committed to achieving the cancer standards by next year. The building blocks of the service are in place. However, I do not want to continue to focus on process. I would rather focus on delivering the continuous improvement in quality care that we have seen over the past few years.
[97] I have brought a copy of the cancer standards document with me. I do not know whether you have seen it, but there are over 700 cancer standards. That is why I feel that it is not appropriate for the Welsh Government to continue to monitor those 700 plus standards. At the time, it was a very good document, but, as you can see, it is a very large document. ‘Together for Health—Cancer Delivery Plan’, which is the cancer delivery plan I referred to, was prepared in consultation with a wide variety of professionals, patient representatives and the third sector. It draws together all the core issues of cancer policy in Wales and concentrates on what I said that I think we should be concentrating on: driving quality and patient-centred outcomes forward, not the mechanics of service delivery.
[98] I want to reassure Members that we will hold health boards to account for the delivery of the cancer plan. We have put in a very robust mechanism to monitor the plan. At a national level, we will shortly publish the first annual report on the delivery plan. We have the all-Wales cancer implementation group, which supports local health boards to deliver the outcomes asked of them and monitors progress. As I said, in summary, the national cancer standards have served, and continue to serve, as good-practice guidance for our clinical work. However, my focus now goes beyond that to the broader agenda of improving population outcomes, which we have set out very clearly in the national cancer delivery plan.
[99] William Powell: Thank you for those comprehensive opening remarks, Minister. What is the basis for your confidence, now that local health boards no longer need to report on compliance with the standards, that those standards will be adhered to?
[100] Lesley Griffiths: I remain confident that cancer standards are being delivered by health boards. They are responsible now for monitoring delivery. We have set up the peer-review process, established by Health Inspectorate Wales. The audits of cancer services will similarly highlight to boards if there are issues with compliance. So, I get that reassurance.
[101] The standards are valuable to local health boards, I think, to support the delivery of consistent services and in monitoring services. However, they do not provide an assessment of the quality of the services, I believe, and, as I said, I think it is not appropriate that the Welsh Government continues to monitor so many standards. I referred to the cancer delivery plan and the fact that it will drive the quality and patient-centred outcomes forward. It is not just about the mechanics of service delivery.
[102] William Powell: Could you give us more detail about how the peer-review process, implemented by Health Inspectorate Wales, works in practice?
[103] Lesley Griffiths: Yes. Health Inspectorate Wales has worked with stakeholders in the NHS to research and test peer-review approaches. A rolling programme of peer reviews will be rolled out in 2012 and 2013. It will follow a four-stage model. The purpose of each stage is to determine whether the outcome sets have been achieved or not and whether progress is being made towards achieving the measures. So, stage 1 will be self-assessment. Each year, a self-assessment will be completed by the team delivering a particular cancer service. Stage 2 will be internal validation: the self-assessments should be validated internally by the host organisation or co-ordinating body for that service. Stage 3 will be external verification of the self-assessments, when an external check of a sample of internally validated self-assessments will be undertaken by cancer peer-review co-ordinating teams. That is basically a desktop exercise. That process will ensure that every service team is externally verified at least once every five years. The final stage will be the peer-review visits: there will be a targeted schedule of peer-review visits taking place to further verify the internal assessment process.
[104] William Powell: Is there also provision in any way for unscheduled visits, outside the cycle, to ensure compliance alongside that?
[105] Dr Jones: No, that is not part of the peer-review programme. We have started the programme. It has kicked off in lung cancer services across Wales, but unannounced visits are not part of that, although I think that HIW can do an unannounced visit for any cancer service.
[106] William Powell: Okay. Thank you. Russell George is next.
[107] Russell George: Good morning, Minister and colleagues. In your opening remarks, you mentioned that the Wales annual report will soon be published. Are you confident that it will be published before the end of 2012?
[108] Lesley Griffiths: Yes. All the LHBs and Velindre NHS Trust have now produced their annual reports. They are getting them cleared by their boards at present. We are now in the middle of November, so I am confident that they will be published by end of this year.
[109] Russell George: What level of funding has been identified to ensure the effective implementation of the cancer delivery plan? Perhaps you could detail that for the short term, medium term and long term.
[110] Lesley Griffiths: There has been no additional funding provided to health boards specifically for the delivery of the cancer delivery plan. Obviously, we give health boards large budgets and they use those budgets as they deem suitable. With the cancer delivery plan, we have set out the outcomes that we want to see, and it is for the LHBs then to allocate the resources to meet the outcomes for the population that they serve. In 2010-11, we spent 6.5% of the Welsh NHS budget on cancer care—if you want to compare that with spend in England, it spent 5.4% of its budget on cancer care. So, it is absolutely right that we set clear outcomes for health boards to adhere to.
[111] Joyce Watson: Good morning, Minister. Talking about outcomes, that is what my questions are about. It is evident from the most recent Welsh Government quarterly release on cancer waiting times that not all LHBs are reliably achieving the cancer waiting-time targets that were introduced in 2006. To that end, could you tell us, Minister, how the cancer delivery plan will improve that particular situation?
[112] Lesley Griffiths: You are right to point out about the targets. We have the two targets: the 31-day target and the 62-day target. We are meeting the 31-day target. With regard to the 62-day target, although it is not being met as I would want it to, it involves very small numbers only: even one or two patients can skew the figures, because we are talking about such small numbers. However, it is unacceptable that we are not meeting the 62-day target. I have made it clear that, by the end of this financial year, I expect the 62-day target to be reached in all cases.
[113] The cancer delivery plan has a focus on the number of performance measures that I believe will improve cancer treatment for the people of Wales. One of the targets is achieving waiting times. Each health board has to produce its own cancer delivery plan. Within that plan, the LHBs need to set out how they will achieve that target. They will have to report progress on a quarterly basis to their boards, and, obviously, then to the public, because that information is out in the public. There will also be the annual report, which will show progress over the year.
[114] Joyce Watson: You are right: the plan sets performance measures, and one of them is that, by 2016, 100% of people with cancer will have an assigned key worker and care plan in place. What percentage of people currently has a key worker assigned to them and a care plan in place?
[115] Lesley Griffiths: I cannot give you the exact figure as to what percentage it is. As I say, every health board will provide an update on where it is in the implementation process, so that, when we get the annual report at the end of the year, we will know where we are in relation to meeting that target. They are making progress towards it. The deadline for reaching that target is 2016, and they are making excellent progress to ensure that that target is met. We will publish progress against the performance target next autumn, in line with the commitment in the cancer delivery plan. However, it will be much more transparent with the cancer delivery plan than the standards document.
[116] Elin Jones: Bore da, Weinidog. Gwnaethoch ddweud yn eich ateb i Joyce Watson bod pob bwrdd iechyd yn mynd i fod yn gyfrifol am greu a chyhoeddi ei gynllun canser ei hun. Pryd ydych yn rhagweld y bydd y cynlluniau hynny yn gyhoeddus?		Elin Jones: Good morning, Minister. You said in your response to Joyce Watson that every health board would be responsible for creating and publishing its own cancer plan. When do you expect that those plans will be made public?
[117] Lesley Griffiths: Bore da. They will be published at the end of the year, so I would imagine that they will go into the public domain straight away.
[118] Dr Jones: Yes, by the end of the year.
[119] Elin Jones: Yn eich adroddiad, ym mhwynt 10, rydych yn sôn eich bod fel Llywodraeth yn mynd i weithio gyda’r trydydd sector i ganfod agweddau anghlinigol ar ofal canser ar gyfer cleifion a’u teuluoedd. A allwch adrodd i ni a’n diweddaru: ble rydych arni o ran comisiynu’r gwaith hwnnw ac ar adrodd yn ôl arno?		Elin Jones: In your report, in point 10, you mention that, as a Government, you are going to work with the third sector to identify non-clinical aspects of cancer care for patients and their families. Can you report to us and update us on where you are at in commissioning that work and on reporting back on it?
[120] Lesley Griffiths: We are currently working with Macmillan Cancer Support to finalise the national cancer patient experience survey. We are developing that jointly with Macmillan Cancer Support and co-funding the project; in fact, I signed off the funding for that just this week. Procurement is under way, and we have a steering group, including the third sector, clinical experts and the Welsh Government, which has been established to oversee the development of the survey. I want to see that survey taking place in the springtime of next year.
[121] Elin Jones: Mae gennyf un cwestiwn olaf. Mae llawer o achosion o ganser yn awr lle mae angen gofal arbenigol ar bobl. Beth ydych chi, o bosibl gyda’r ddeoniaeth, yn ei wneud i wneud yn siŵr bod cyflenwad digonol o feddygon a nyrsys canser arbenigol yng Nghymru?		Elin Jones: I have one final question. There are now a number of cancer cases where people require specialist care. What are you, possibly with the deanery, doing to ensure that there is an adequate supply of specialist cancer doctors and nurses in Wales?
[122] Lesley Griffiths: Specialist nurses have a very important role to play. It is up to local health boards whether they employ specialist nurses and it is up to them to ensure that they get the right skills mix. I do not work with the deanery in relation to specialist nurses. The deanery works closely with health boards to make sure that we have the right number of doctors. I do not think that we have a problem with recruiting cancer specialists at this time; that has not been flagged up with me. I do not know whether Chris knows any more about that.
[123] Dr Jones: I think that that is right. It is health boards’ responsibility to advertise and fill consultant posts when they need to, and I am not aware that there is a sustained difficulty with that. The deanery is responsible for doctors in training, and I do not think that oncology training posts are hard to fill at all in Wales. So, at present, we are not in a bad situation from that perspective.
[124] Elin Jones: Minister, you referred to the employment of specialist nurses being the responsibility of local health boards in commissioning their services. We know that in some areas of Wales there are specialist nurses, but in others there are not, and that is not necessarily a reflection of the need of the local community, but rather of practical decisions that local health boards have had to take. Do you consider that you have a role as a Minister to discuss with health boards how they can ensure that everybody in Wales, for a particular service, has equal access to specialist care and specialist nurse care?
[125] Lesley Griffiths: Yes, I certainly have a role when I discuss issues, particularly with chairs. Interestingly, yesterday, I met the Royal College of Nursing, and we discussed specialist nurses. As a Government, we do not keep a register of how many specialist nurses we have in Wales. However, that information is available to me, and I asked not long ago to see information on the number of specialist nurses in each health board and in which specialties those specialist nurses worked. I keep a close eye on that and discuss it with the chairs.
10.45 a.m.
[126] William Powell: How are you and the department developing, improving and enhancing public health campaigns with the aim of reducing the occurrence of cancer in the future, especially in areas of lower socioeconomic status?
[127] Lesley Griffiths: That is a good question, because we know that the occurrence of cancer, particularly specific cancers, is higher in deprived communities. There are a couple of things going on in public health at the moment. You will be aware that we have the new Chief Medical Officer for Wales and we have the obesity pathways. Dr Hussey is very focused on obesity and the rising incidence of obesity and all the problems that that causes us in Wales. A review of health improvement programmes is going on at the present time, because we want to make sure that our health improvement programmes have the biggest impact. We have our tobacco action plan, the Fresh Start Wales campaign, which is trying to encourage parents and carers not to smoke in cars carrying children and young people—we are 18 months into that—and the obesity pathway. Chris, do you have anything that you want to add on public health?
[128] Dr Jones: It is worth emphasising that the delivery plan was different from what had gone before, because it very much affirmed a commitment to the public health dimension around cancer. It is interesting that a lot of the public health risk factors for cancer are common to other major diseases in Wales—smoking, alcohol and obesity are common factors across the board. As the Minister said, Dr Hussey is committed to reducing the inequalities that we know exist, both in the incidence and the outcomes, for people with cancer and other conditions as well, and some of the work that the Minister describes specifically focuses on inequalities. The issue of smoking in cars with children, for example, is differentially important in the lowest socioeconomic groups. So, we are committed to significant progress in this area.
[129] William Powell: We now move on to an issue that is a regular discussion point in the Chamber and elsewhere, which is the current local health board reconfiguration plans. How will you ensure that the necessary cancer treatments and services are available to patients close to their homes and their support structures—their family and those who are important to them—as they undergo their treatment?
[130] Lesley Griffiths: My priority and the priority for the NHS is that we have those safe, sustainable and high-quality services for people as close to their homes as possible. Following a meeting with Tenovus, we have helped fund a mobile cancer support unit, which means that chemotherapy treatments can be delivered in local communities across south Wales. It also provides the social care and support to cancer patients and their families that they very much need. It acts as a drop-in facility for patients and carers if they have any queries or concerns about cancer, which has made a huge improvement, particularly in rural areas. It has also reduced travel times and the costs, which have been highlighted through Macmillan’s Counting the Cost of Cancer campaign. If you have been given a diagnosis of cancer, it is not just the treatment that you have to consider—you might not be able to work and travelling for treatment can have huge financial implications. So, the Tenovus mobile unit is a huge improvement.
[131] William Powell: How will you ensure that a comprehensive information and support service is in place for people with cancer and their families, which is also so critical?
[132] Lesley Griffiths: I mentioned the survey that we are currently looking at with Macmillan, which I hope will be done at the beginning of the year; it is important that we get feedback. I know that we are getting away from standards, but the cancer delivery plan is important. A friend of mine who, unfortunately, is currently receiving treatment has said that the cancer delivery plan really worked. It is good to get that feedback, too.
[133] William Powell: Finally, what is the level of engagement with the third sector, which provides so many important services?
[134] Lesley Griffiths: I mentioned Tenovus and its mobile unit and Macmillan; those are probably the two main ones. The ‘Counting the Cost of Cancer’ report published by Macmillan earlier this year was very good and made us think. My message to the health boards is that they have to think about these things when they are providing treatment. The patient survey, which we have co-funded with Macmillan, will give us a huge amount of feedback. Those are the two main ones.
[135] William Powell: Excellent. Thank you very much. Colleagues, are there any other points that you would like to raise that we have not covered?
[136] Russell George: Chair, I think that Chris Jones wanted to add something.
[137] William Powell: I am sorry.
[138] Dr Jones: I would like to add another comment about third sector commitment, namely to emphasise that the delivery plan was produced in close collaboration, following a manifesto commitment, with the third sector, particularly Macmillan. The third sector is represented on the cancer implementation group.
[139] William Powell: So, it is represented at the highest level.
[140] Dr Jones: Yes. There is also a sub-group of the cancer implementation group that focuses on the patient experience, care plans and key workers in this area. The third sector is key to that group as well. We have been very grateful to the third sector for its willingness to engage and support the process.
[141] William Powell: Thanks for that clarification. Minister, thank you for being with us this morning and answering our questions very fully. I also thank your team for being there in support.
[142] Lesley Griffiths: I apologise for my voice.
[143] William Powell: Not at all. It is getting better. Thank you.
[144] On the point of considering the evidence, we will have a transcript available for our meeting on 4 December so that we can consider that in the round and reflect upon what the Minister and her team have said. That will be our final meeting this term.
[145] There are a number of important matters for me to raise. First, I would like to put on record my thanks, on behalf of the committee, to Annette, who is leaving the Petitions Committee and who has served us in a sterling way for over a year. She is moving to a new role within the Assembly, and we wish her and her family well. I would like to welcome Siân Giddins who is joining us today. There will be another opportunity to speak of Sarita Marshall’s great role, but this is her penultimate meeting of the Petitions Committee. It is good to see Kayleigh Driscoll here as well, who is to step into that role to support the work of the committee. So, thank you for attending today.
[146] We have the lunch for our guests from the Scottish Parliament from 12.30 p.m. in dining room 3. As I indicated, our next meeting is on 4 December.
[147] I would like to make a couple of important points relating to forthcoming petition presentations. On 21 November, we have the presentation of the petition on the closure of Tenby’s minor injuries unit; on 27 November, we have the rescheduled presentation of the petition on CCTV in slaughterhouses; we talked about ash dieback earlier and, on 28 November, we have the presentation of an important petition in relation to the ancient, veteran and heritage trees of Wales; and I have recently been advised that, on 4 December, there will be a petition presentation by Mr Michael Eccles and his colleagues on Bronllys Hospital in Powys. That concludes the roundup of presentations that I am aware of. I look forward to seeing you later on at the lunch and to joining our friends from the Scottish Parliament. I hope very much that they enjoyed their tour. Thank you.
Daeth y cyfarfod i ben am 10.54 a.m. The meeting ended at 10.54 a.m.