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. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
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Dechreuodd y cyfarfod am 09:15.
The meeting began at 09:15.
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Cyflwyniad, Ymddiheuriadau, Dirprwyon a
Datganiadau o Fuddiant
Introduction, Apologies, Substitutions and Declarations of
Interest
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[1]
Dai Lloyd: Croeso i chi gyd i
gyfarfod cyntaf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
o’r tymor newydd. Gallaf egluro ymhellach bod y cyfarfod
yma’n ddwyieithog. Gellir defnyddio’r clustffonau i
glywed cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar
sianel 1 neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar
sianel 2. A allaf atgoffa pobl i ddiffodd eich ffonau
symudol—ac mae hynny’n cynnwys y Cadeirydd—ac
unrhyw offer electronig arall achos maent yn gallu ymyrryd
efo’r systemau electronig yn y lle yma? Nid ydym yn disgwyl i’r larwm tân
ganu, ond os bydd yn canu, dylem i gyd ddilyn
cyfarwyddiadau’r tywyswyr a’u dilyn nhw. Gallaf hefyd
nodi ein bod wedi derbyn ymddiheuriadau gan Dawn Bowden a
bydd Huw Irranca-Davies yn dirprwyo yn ei lle hi. Croeso, Huw,
i’r pwyllgor yma.
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Dai Lloyd: Welcome to you all to the
first meeting of the Health, Social Care and Sport Committee of
this new term. I can explain further that this meeting is
bilingual. You can use the headphones to hear the simultaneous
translation from Welsh to English on channel 1 or to better hear
contributions in the original language on channel 2. Can I remind
people to turn off their mobile phones—and that includes the
Chair—and any other electronic equipment because they can
interfere with the electronic systems in the building? We
don’t expect a fire alarm, but if it does go off, we should
all follow the directions of the ushers and follow them. I can also
note that we have received apologies from Dawn Bowden and Huw
Irranca-Davies will be substituting on her behalf. Welcome, Huw, to
this committee.
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09:16
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Cynnig o dan Reol Sefydlog 17.42 i Benderfynu
Gwahardd y Cyhoedd o'r Cyfarfod ar gyfer Eitemau 3 a 4
Motion under Standing Order 17.42 to Resolve to Exclude the Public
from the Meeting for Items 3 and 4
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Cynnig:
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Motion:
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bod y pwyllgor yn penderfynu gwahardd y cyhoedd
o’r cyfarfod ar gyfer eitemau 3 a 4 yn unol â Rheol
Sefydlog 17.42(ix).
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that the committee
resolves to exclude the public from the meeting for items 3 and 4
in accordance with Standing Order 17.42(ix).
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Cynigiwyd y cynnig.
Motion moved.
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[2]
Dai Lloyd: Eitem 2 yw cynnig o dan Reol Sefydlog 17.42 i
benderfynu gwahardd y cyhoedd o’r cyfarfod ar gyfer eitemau 3
a 4. Rwy’n eich gwahodd i symud mewn i sesiwn breifat ar
gyfer y ddwy eitem nesaf i’w trafod, cyn i’r Gweinidog
ddod yma am 10 o’r gloch pan fyddwn yn mynd yn ôl at
sesiwn gyhoeddus unwaith eto. Rwy’n cymryd nad oes
gwrthwynebiad inni fynd mewn i sesiwn breifat yn awr. Diolch yn
fawr i chi.
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Dai
Lloyd: Item 2 is a motion under Standing Order 17.42 to resolve
to exclude the public from the meeting for items 3 and 4. I invite
you to move into private session for the next two items to be
discussed before the Minister attends at 10 o'clock and we will
return to a public session after that. I take it that there’s
no objection to us going into private session now. Thank you very
much.
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Derbyniwyd y cynnig.
Motion agreed.
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Daeth rhan gyhoeddus y
cyfarfod i ben am 09:17.
The public part of the meeting ended at 09:17.
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Ailymgynullodd y pwyllgor
yn gyhoeddus am 10:01.
The committee reconvened in public at 10:01.
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Ysgrifennydd y
Cabinet dros Iechyd, Llesiant a Chwaraeon a Gweinidog Iechyd y
Cyhoedd a Gwasanaethau Cymdeithasol—Trafod
Blaenoriaethau
Cabinet Secretary for Health, Wellbeing and Sport and Minister for
Social Services and Public Health—Discussion of
Priorities
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[3]
Dai Lloyd: Croeso yn ôl i chi gyd i’r adran
gyhoeddus o’r cyfarfod yma o’r Pwyllgor Iechyd a
Gwasanaethau Cymdeithasol a Chwaraeon. Yr eitem nesaf ar yr agenda
ydy eitem 5, ac rydym yma i drafod ac i graffu ar waith
Ysgrifennydd y Cabinet dros Iechyd, Llesiant a Chwaraeon, ac hefyd
y Gweinidog Iechyd y Cyhoedd a Gwasanaethau Cymdeithasol. Rydym yma
i drafod eu blaenoriaethau nhw, ac felly, mae’n bleser gen i
groesawu, am y tro cyntaf, i’r pwyllgor yma, Vaughan Gething,
Ysgrifennydd y Cabinet dros Iechyd, Llesiant a Chwaraeon, ac hefyd,
Rebecca Evans, Gweinidog Iechyd y Cyhoedd a Gwasanaethau
Cymdeithasol, yn ogystal ag Andrew Goodall, y cyfarwyddwr
cyffredinol ar gyfer iechyd a gwasanaethau cymdeithasol a phrif
weithredwr y gwasanaeth iechyd gwladol yng Nghymru; Albert Heaney
yn ogystal, cyfarwyddwr gwasanaethau cymdeithasol ac integreiddio;
ac hefyd, Frank Atherton, y prif swyddog meddygol.
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Dai Lloyd: Welcome back to you all to
the public part of this meeting of the Health, Social Care and
Sport Committee. The next item on the agenda is item 5, and
we’re here to discuss and scrutinise the work of the Cabinet
Secretary for Health, Well-being and Sport, and also the Minister
for Social Services and Public Health. We’re here to discuss
their priorities, therefore, it’s a pleasure to welcome for
the first time, to the committee, Vaughan Gething, Cabinet
Secretary for Health, Well-being and Sport, and Rebecca Evans, the
Minister for Social Services and Public Health, as well as Andrew
Goodall, the director general for health and social services and
NHS Wales chief executive; Albert Heaney as well, the director of
social services and integration; and also, Frank Atherton, the
chief medical officer.
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[4]
Felly, sesiwn graffu ydy hon, ac
rwy’n bwriadu mynd yn syth i mewn i graffu gyda ‘bore
da’ i’r Gweinidog ac, fel Cadeirydd, mi wnaf ofyn y
cwestiwn cyntaf. A allwch chi ddylunio eich blaenoriaethau
a’ch disgwyliadau, fel Ysgrifennydd y Cabinet dros iechyd, ar
gyfer y pumed Cynulliad? Diolch yn fawr.
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Therefore, this is a scrutiny session, and I
intend to go straight into scrutiny with a ‘good
morning’ to the Minister and, as Chair, I’ll ask the
first question. Can you outline your priorities and expectations,
as the Cabinet Secretary for health, for the fifth Assembly? Thank
you.
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[5]
The Cabinet Secretary for Health, Well-being and Sport (Vaughan
Gething): Thank you for the introduction and the opportunity to
meet you at the start of the term, with the committee being in
session. I’m happy to set out what I hope will be a fairly
consistent message with those that I gave shortly after I was
appointed. The context in which the health service operates is
obviously important. That context is rising demand and complexity:
so, more coming through the door. It’s also a context of real
and undeniable financial challenge. That’s an issue across
public services right across the UK. We can have arguments about
why that is, but it’s an unavoidable reality. So, it’s
therefore about how we meet that demand with less money, and, at
the same time, a growing realisation and acceptance, which I think
was helpfully set out yesterday in the debate, that we need new and
different models of care. So, it’s partly about the
workforce, but it’s actually about asking, ‘What models
of care do we need to be able to deliver against that rising tide
of demand?’ That is, bearing in mind that we will have,
overall in public services, less money.
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[6]
The public service point is important because, regardless of the
budget context, we know that part of the change that we need to see
is not just service reconfiguration, talking about hospitals, but a
broader change in the way that we do our business in health, so
within the relationship between primary and secondary
care—more services being dealt with and delivered within the
community, and not in a hospital setting—and, at the same
time, integration with care services, but also with other parts of
the public service as well. So, we need to do more in a more joined
up and constructive way, for example, with housing and education as
well. So, those big challenges around integration really matter,
because, ultimately, our priorities are to not compromise on
quality, to deliver better outcomes, and that means a different way
of working.
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[7]
So, not just doing the same things in a different way; it will
require us to do different things as well. So, those really big, if
you like, broad balancing themes set the context for where we are.
My expectations for the service are that we need to be able to
confront and take on some really difficult challenges, and I want
those to take place in the earlier part of this term, because I
think it’s important that that debate isn’t one that we
leave. It isn’t really about election cycles, it’s
actually about the ability to change where we’ve got control,
what we can do and having this whole term to be able to deliver
some of that change.
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[8]
Part of what I’d be really interested in this committee
taking a perspective on is being part of a really mature and
constructive debate about the future of health and care services in
Wales. Part of the difficulty we have seen previously is in the
fact that, when difficult choices are made, there are always people
who, understandably, are concerned and have worries. So, it’s
really about how we make sure that we are doing this on the basis
of improving outcomes and acting on the best available evidence,
then we have that engagement with the public and then actually do
what we know will work and work best, and has the best chance of
working with a greater level of consistency and pace. Because
that’s part of the frustration for anyone running any part of
the service—not me, in a sense, but chief executives and
other leaders, but, from my point of view, with my
responsibilities, how we deliver more consistent change and
improvement and the pace of dealing with that as well. So, really
significant challenges for us to take on, and many of those are
reflected in Rebecca’s portfolio as
well.
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[9]
The final thing that I’d say about
what I think part of our agenda has to be in this term, as well as
the continuance of prudence, who has not left us, is the point
about how we get the public to be more engaged in their healthcare
choices; how we get them to take a different perspective on the
choices they make as to the way they live their lives and the
choices they make about that, as well as how they interact with
health and care services.
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[10]
Dai
Lloyd: Diolch yn fawr, Weinidog, am agor y drafodaeth. Roedd Lynne
Neagle eisiau gofyn cwestiynau penodol nawr. Lynne.
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Dai Lloyd: Thank you very much for
opening the discussion. Lynne Neagle
wanted to ask specific questions now. Lynne.
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[11]
Lynne Neagle: Thank you, Chair. I wanted to ask about the review of
individual patient funding requests. The Cabinet Secretary will be
aware that I’ve had very long-standing concerns about the
current system. So, I’d be interested in having an update,
but also specifically to ask how the work you are doing is looking
at the area of exceptionality, which, in my experience, many
clinicians particularly disagree with, and also generally how you
are ensuring that there is good buy-in from clinicians to any
changes that come forward.
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[12]
Vaughan Gething:
Thank you for the question. As
you’ll know, we announced early on in this term that there
would be a review of the IPFR process. We’ve had a range of
very constructive discussions between the Government and political
parties, and I have already made a statement on this in the
Chamber. I also expect to be able to provide a fuller statement
within the next few weeks, in the Chamber as well, on where we are,
because I’m pleased to say that we’ve got agreement on
outline terms, and I hope to be in a position, when I make that
statement, to confirm membership. So, how that panel’s going
to be taken forward. It’s still my ambition that the review
itself will be taken within this calendar year, with
recommendations for us to respond to, within this, if you like,
financial year. So, we’ll have a report, we’ll then
need to consider what that says. The report will be made available
to Members—it won’t be kept a secret—and we then
have to make a choice about what we do. Exceptionality is one of
the key parts of that review. You’ll know this came partly
from the agreement reached with Plaid Cymru, but, like I say, we
have had sensible conversations with the other parties in the
Chamber as well.
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[13]
So, I think you can take some reassurance
from the fact that the review is going to take place. I’ll be
able to provide a fuller update in the Chamber, and I’m happy
to answer questions then, or even afterwards in this committee
again. We will have a membership that will ensure that the patient
voice, in the way the review is undertaken, is properly taken
account of, and exceptionality will be a key part of that. In
whatever we decide in making these very difficult choices, the role
of the clinician in having a conversation with their patient is
really important. Part of the challenge that we have is some
clinicians who don’t agree with the criteria or it’s
about understanding the explanation. So, there’s got to be
some consideration through the review that there probably
isn’t—.
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[14]
We aren’t going to be able to
rehearse it enough now, I don’t think, but the fact that that
is going to be part of the review will be important, because,
whatever happens, if there is going to be a new criterion to be
used—and I’m open to that—we’ll be clear
about the fact that, if there are alternatives to exceptionality
that make sense and are better alternatives, then I certainly do
not, and the Government does not, have a closed mind to that.
There’d be no point having the review and talking about
exceptionality otherwise. But, whatever happens, whether it’s
exceptionality or a different term or criterion that’s used,
we’ve got to be able to have a more sensible and consistent
way of clinicians understanding their role and how that
conversation takes place with the patient. For every Member in this
room—and newer Members might not have had it yet, but you
will do—there’ll be people coming to us with
concerns in this area, and in each of those instances, there are
people who are genuinely concerned and worried, and there’s a
real sense that ‘something should be happening, but it
can’t, and surely, you can unblock the log jam, and surely,
you can make it work so that I can have this treatment that
I’m told will help to improve either my life chances or my
outcomes’. So, there’s nothing easy about this, and the
review should help us to get into a place where—again, a
difficult choice—we’ll have the best available evidence
and advice on what we could and should do, but that won’t
take away from the fact that we’re still likely to get
difficult representations from individuals.
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[15]
There’s something also about taking on board the all-Wales
cohorts, because I’m also concerned—I know this will be
part of the review about dealing with some of the potential
inconsistency in where decisions are made as well. So, that is very
much in my mind, and it will be part of what the review does, and I
hope that you can take some confidence from what I’ve said
previously, today, and also when I make a fuller statement to the
Chamber outlining and, hopefully, finalising in public the names of
the people who will take part in the review, the timescale for it
and the terms it will work to as well.
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[16]
Lynne Neagle: Thank you for that answer, which is very
encouraging. I mean, consistency is really important. One of the
things I’ve called for previously was for there to be a
national panel. I know that that’s something that’s
been rejected previously by Welsh Government. Can you just confirm
that that is something that is on the table to be looked at as part
of this review?
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[17]
Vaughan Gething: We don’t have a fixed position that
says we want this review to tell us we’ll definitely have a
national panel, or that we definitely won’t. We’ll be
asking the review to look at the issue of the panels that we have
and to tell us whether it is feasible and it’s the right
thing to do as well. That’s what I’m interested in: how
do we improve the system so that it works, and works at its most
effective? Because, previously, the advice was that a national
panel would slow down decision making, and it would not be in the
patient interest to do that. Well, if there is now a different way
to operate that can actually deliver the consistency that all of us
would wish to see, then, again, that is something that the panel
would be specifically charged to look at and to give us advice
on.
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[18]
Lynne Neagle: Thank you.
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[19]
Dai Lloyd: Julie.
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[20]
Julie Morgan: I wanted to ask you about the new treatment
fund. I certainly agree that access to drugs has been one of the
big issues as an Assembly Member, and, obviously, we often feel
very impotent in helping people. So, I wonder, could you just
briefly confirm exactly what the new treatment fund is?
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[21]
Vaughan Gething: So, again, I made a statement in the
Chamber in July, before recess. We expect to provide £80
million over the term of this Government to fund these new
treatments. The fund is there to ensure that, in the first 12
months of new treatments being available—and these are
treatments where there’s an evidence base and there’s a
recommendation that they should be made available—to make
sure that that is made available more rapidly and more consistently
across Wales. There’s been a recognition that, with new
treatments that are recommended, they’re not always available
as rapidly or as consistently across the country. So, this should
improve equity and access to evidence-led treatment. So, it’s
different from the IPFR review, because that’s talking about
those where there isn’t an evidence basis that would be more
generally available, but there may be an individual case to be made
for treatment outside those terms. It’s based on our
experience in the previous term of making available, for example,
the medication on hepatitis C, and so, it’s about
understanding when that comes up—and there are often
expensive new treatments available—how do we help health
boards in the first year, as it’s often more difficult to
plan in. Then, after that, our expectation from previous working is
that, thereafter, we expect them to be able to manage that within
their resources. So, we’ve got a particular sum of money to
deliver on access and to deliver on consistency for these new
treatments that are coming forward, and, you know, it is not
something that is tied to a particular condition. This is about new
treatments; it’s not about looking at one particular area,
because we’ve had that conversation through most of the last
term for one particular basket of conditions. This is something
that is available on every particular indication. It’s really
about whether the new medication is there and available and is
evidenced.
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[22]
Julie Morgan: So, the new medications will all have been
approved by NICE or the all-Wales group.
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[23]
Vaughan Gething: Yes.
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[24]
Julie Morgan: There have been some changes in NICE, the way
it operates, recently. I think they can now not only say
‘yes’ or ‘no’, but they say
‘maybe’, and I wondered how that would affect the way
that this fund would work.
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[25]
Vaughan Gething: This is difficult—
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[26]
Julie Morgan: Awkward, I know.
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10:15
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[27]
Vaughan Gething: Well, it’s difficult because there
isn’t clarity, and I don’t think NICE fully understand
what they’re being asked to do yet, to be honest. The UK
Government wants to have this ‘promising’ category, and
those are things where they’re looking at the
evidence—they haven’t reached a formal conclusion but
they know it’s likely to be approved thereafter. So,
we’re looking to understand, with NICE, what this really
means for them. We don’t want to have a position where
we’re either duplicating what we’re doing in the new
treatment fund and equally we don’t want to get left behind
in the sense that we simply haven’t considered what’s
going to happen.
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[28]
But I expect that, with the architecture that we’re designing
here in Wales, we’ll be able to match that. Also, what the
Government in England are doing is having a ‘promising’
indication for cancer-related medication. I don’t want to get
drawn into having one group of conditions that are seen to be more
important than others. I think that’s the wrong thing to
do.
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[29]
Julie Morgan: Is that because they’ve got the cancer
treatment—what replaces the cancer treatment fund?
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[30]
Vaughan Gething:
Yes, and they’ll look at this new
‘promising’ indicator. NICE is going to be involved in
reviewing those treatments, so it won’t simply be going back
to the old cancer drugs fund, which, as you know, has ended. But I
don’t want to get drawn into having simply a process that
only affects cancer patients, and other people with life-limiting
conditions are left in a different position. I don’t think
that’s equitable and that isn’t the way we want to
operate here.
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[31]
Julie Morgan: No, I can imagine people would come to us about those
issues. A last question; the new treatment fund, is it or has it
been consulted with patients—the setting up of it? I know
it’s a manifesto commitment.
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[32]
Vaughan Gething:
It’s a manifesto commitment, so we
had—. It comes from the significant engagement we’ve
had throughout not just the last term, but previously, about how
we’ll make sure that evidence-led treatment is made available
on a rapid and equitable basis across the country. There was a
recognition that there was an issue here for us to address;
that’s why it was in the manifesto and that’s why
taking it forward is one of our early commitments. It was in our
headline top six commitments to actually try and address this if we
were re-elected. So again, we’re getting on and doing what we
said we’d do.
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[33]
Julie Morgan: Thank you.
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[34]
Dai Lloyd: Okay. Angela.
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[35]
Angela Burns: I notice that it’s called the ‘new
treatment fund’. Do you have any anticipation that, in the
future, it might include technological advances, or is it simply
medicines based? If it is simply medicines based, do you propose
putting in some alternative form of being able to help with new
technological advances that are coming on stream, because of course
they are eye-wateringly expensive, but have the opportunity to
change things enormously for people?
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[36]
Vaughan Gething:
The focus of the new treatment fund is
going to be on medication, but we recognise there’s a need to
ensure that broader treatments are available in a way that, again,
is equitable. We’re taking proper account of what new
technology can deliver in terms of improving outcomes for patients.
We’ve had a process about access to new technology, but part
of this is about understanding the pace at which that new
technology is made available, and the areas as well. We’ve
often talked about SBRT—stereotactic body radiation therapy.
That got interesting when they came up with the term
‘CyberKnife’ so that people could understand about a
different way and a more precise way to deliver a form of
radiotherapy. So that was an example of a new treatment, a new
technology, as opposed to medication. So we’re aware—.
And sometimes, new technology is much more simple. It can be about
wound dressings. So different things are there and available. The
treatment fund will focus on medication, but I’ll ask Andrew
Goodall to come in to explain some of our approach more broadly
about new technology.
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[37]
Dr Goodall: And I’d hope that there are areas where
actually we can be seen to be pioneering and leading in Wales. The
Cabinet Secretary has mentioned about wound healing. One of our
approaches to establishing the wound innovation centre, which is
just over in Llantrisant, was actually a recognition that Wales has
got some internationally leading research that attracts a lot of
attention. We had an opportunity to ask ourselves the question,
‘How do we engrain that more in the service across Wales as
well as share the broader thinking?’
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[38]
We’ve continued with the technology
fund that was established in the previous Government. That’s
been maintained. There’s a £10 million sum of funding
that’s available, so that actually what we can do is get
alongside not just very expensive products but actually some
smaller-scale developments as well. We’ve also been using,
Cabinet Secretary, links with the life sciences sector as well to
see whether we’re able to get alongside Welsh companies and
organisations that are developing products here. We would have a
general expectation, though, that clinicians in health boards are
also supported. I think our whole approach to research in Wales
becomes quite important in this arena as well.
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[39]
We re-launched Health and Care Research
Wales last year. That was deliberately intended to actually raise
our opportunities. I hope that a whole series of different funding
streams will come through just from research moneys that are
available not least in Wales but actually more broadly in the UK as
well.
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[40]
Angela Burns: Do you rely upon the universities, et cetera, to go
out and find—or do you actually have a group within your organisation that
keep an eye on what—? There have been some amazing advances,
and I saw the other day that they miniaturised a tiny camera that
you can just swallow in a pill and all this. Do you have people who
look out for those kinds of things so you can evaluate them, or do
you rely on the universities to do that task for you?
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[41]
Dr Goodall: It’s a combination of both, actually. All
of our health boards in Wales are university health boards or have
a teaching responsibility, and I think there’s much more that
we can do to grow with that sector. But yes, every health board has
its own research department. They have clinical directors who are
leads in that area and they have funding that is allocated through
Welsh Government and out through the organisations, actually, to
spend in these different areas. But I do think the academic links
are a strong part of where we take NHS Wales for the future.
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[42]
Angela Burns: Thank you.
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[43]
Dai Lloyd: Diolch yn fawr, Angela. Os nad oes dim
cwestiynau eraill ar yr adran yma, fe wnawn ni symud ymlaen i
gysidro materion yn ymwneud â’r gweithlu,
sydd yn dod mewn tair gwahanol ran: gweithlu’r gwasanaeth
iechyd yn y lle cyntaf, wedyn gweithlu megis meddygon teulu, ac
wedyn, yn drydydd yn y rhan yma, y gweithlu gofal cymdeithasol, yn
eu tro. Felly, fe wnawn ni gysidro yn y lle cyntaf unrhyw
gwestiynau sydd gennych chi ar weithlu’r gwasanaeth iechyd yn
ei hanfod, cyn symud ymlaen at feddygon teulu. Rhun.
|
Dai Lloyd: Thank you, Angela. If there
aren’t any more questions on this section, we’ll move
on to consider issues relating to the workforce. That will be in
three parts. We’ll have the health workforce in the first
instance, then the GP workforce, and then, thirdly in this section,
the social care workforce. So, we’ll consider, firstly, any
questions you have on the NHS workforce, in essence, before moving
on to GPs. Rhun.
|
|
[44]
Rhun ap
Iorwerth: Bore da iawn i chi. Un o brif argymhellion yr adolygiad o
fuddsoddiad mewn addysg broffesiynol iechyd yng Nghymru oedd
sefydlu un corff ar gyfer cynllunio’r gweithlu ac ati. Mi
gafodd yr Athro Robin Williams ei benodi i fynd â’r
gwaith yn ei flaen. A allwch chi ddweud wrthym ni ble’r ydym
ni arni efo’r gwaith yna erbyn hyn?
|
Rhun ap Iorwerth: A very good morning
to you. One of the main recommendations of the review of investment
in professional health training in Wales was to establish a single
body for workforce planning and so on. Professor Robin Williams was
appointed to take that work forward. Can you tell us where we are
with that work?
|
|
[45]
Vaughan Gething: We’ve received Robin Williams’s
report, and it’s being read through by myself and officials.
I’m expecting some advice and I expect to be able to update
Members within this calendar year on our expectation to respond.
What was interesting is that the previous Evans review, and also
tying into the review that David Jenkins led as well, in looking at
the area of how we have a single body—I’m pleased
there’s a consensus about there being a single body, and
it’s really about how we try and implement that to make it a
more consistent and joined-up approach. Different funding streams
and different criteria are coming into this; it is a more unified
approach to this area. So, I think you’ll have—within
this calendar year, there’ll be advice that I’ve
received, and I will then inform Members about the approach the
Government is taking.
|
|
[46]
I think this is a decision that we should be making and not putting
off until the parliamentary review, because you’ll know from
our previous discussions that there are some things that we need
the review to look at and others—and I think this is one of
them—where we should not wait for the review, because
that’ll take probably at least another year before we get
recommendations. I think we need to be able to set a direction of
travel in terms of what we’re going to do, because my concern
is, otherwise, we’ll lose too much time. We’ve had two
reviews to try and help inform where we are. But, obviously,
information from the Williams review and the advice we get will
need to be fed into the review as well.
|
|
[47]
Rhun ap Iorwerth:
Can you identify now, in your mind, the
areas where you are able to move ahead, where you’re seeing
the urgency as such that you cannot wait until the results of the
parliamentary review, within the area of workforce planning, in
particular—you know, the things that we can do
now?
|
|
[48]
Vaughan Gething:
Well, this goes a bit into part of the
debate we had yesterday. We are already going to be making progress
on recruitment and retention for GPs. We are looking at the broader
primary care workforce as well. So, in those areas, we’re
going to be launching a recruitment campaign this autumn. In the
next month, we will launch part of our GP offer. We know we also
will be doing work with the ministerial task group that I’ve
brought together on the broader primary care workforce as well. So,
some of those challenges can’t wait, even though part of the
context has to be there, in terms of what the review will do, but
if we said we weren’t going to do anything other than
‘steady as she goes’ on this area, I don’t think
that would be acceptable. I think yourselves and colleagues in all
parties would, quite rightly, be saying, ‘You can’t
wait to do some of this, you have to get on.’ So,
that’s a concrete example of what we will be
doing.
|
|
[49]
Rhun ap Iorwerth:
You can set, in a way, perhaps,
recruitment and retention, which is a response to an acute problem,
with workforce planning, which suggests a more strategic approach
to making sure that we have a sustainable workforce now and in the
future. In order to do that, you need to have experts in workforce
planning. Do you have the capacity within the NHS? How many
workforce planners do you have in NHS Wales?
|
|
[50]
Dr Goodall: I couldn’t report the number of workforce
planners, but, yes, we have very significant workforce departments.
There’s a director of workforce on every board of every
health board and trust in Wales. Historically, I think sometimes
it’s been difficult to make sure that the commissioning
numbers that we put in the system for the range of training posts,
ranging from doctors right through to community-based staff are
accurate. It probably has been difficult because I think the
numbers have generated almost by rolling over individual years. I
think the challenge that we introduced over the last three years
with the integrated medium-term planning process and the three-year
plan cycles was to try to make sure that we could be much clearer
for the future. We’ve put a real emphasis around the services
and the nature of them and defined them in order that we could
start to track the workforce that we need, hence prompting a
development around some of our numbers in different ways: I think
an acknowledgement that, for example, we need to take more
oversight responsibility around the care home sector and some of
the nursing needs there, an emphasis around mental health, in
particular, that maybe has lost out, traditionally, over the last
number of years, and certainly a development around community staff
needing to come into the system in a different way. I’ve seen
development of that to a high level of detail over the last three
years or so as we’ve introduced those plans, but I think it
would be right to say, Minister, that we’ve still got some
work to do to continue to improve that at this stage. As one
example, we’ve already increased the number of nurses during
this year, which was through your agreement, by an extra 10 per
cent. In fact, they had gone up by 20 per cent last year as well.
So, we have tried to take some genuine steps forward.
|
|
[51]
Rhun ap Iorwerth: On that
point, can I bring in the nursing bursary issue, if you could share
your thoughts on that? Because, clearly, it is going to be key to
sustainable recruitment of nurses in the future.
|
|
[52]
Vaughan Gething: As I’ve indicated both to Members
that have asked me this previously and to the Royal College of
Nursing as well, we need to take account of the review on student
finance and support that is being carried out. Also, we need to
understand where we are on the budget as well. I’ve indicated
that there’s no change through this calendar year, so nursing
bursaries will still be available here in Wales. We’ll then
need to make a decision once we get through understanding what the
Diamond review tells us and where we are from a budget point of
view as well. It’s difficult because I’d like to be in
a position to set out now where we’re going to be—the
sooner the better. I do understand that but I’m not going to
be in a position to do that, so I’m not going to try and do
it on the hoof or just give a flier because I am going to give
certainty when I can give it. So, we won’t be able to do that
properly until we get to the autumn—this autumn—and
that’s where we’re going to be. But we’re
expecting to have this autumn both the student finance and the
report from Sir Ian Diamond, and we’re also expecting to
have, obviously, the budget and publish a draft budget then. We can
then do some more serious work on what we think the system could or
should look like here in Wales.
|
|
[53]
I recognise the broad point you make that nursing bursaries help a
range of people with responsibilities in broader life. The average
age of nurses going into training is 29, I understand, so
it’s often people with wider responsibilities. The support
that they have to be able to enter the nursing profession is
important, and there’s also—we’ve got to think
about, for example, the way in which healthcare support workers and
a range of those who move into nursing to make sure that they can
do it whilst they’re still working, so they don’t lose
the ability to work and earn at the same time. So, those things are
all in my mind as we think about how to take this forward to make
sure that we can recruit and retain more nurses in Wales in the
future.
|
|
[54]
Rhun ap Iorwerth: And
reflecting on the fact that they work, of course, during that
training period.
|
|
[55]
Vaughan Gething:
Yes.
|
|
[56]
Rhun ap Iorwerth:
Another update that would be
useful for the committee: the ‘Shape of Training’, a
review, and the Welsh Government’s response to that. Where
are we at?
|
|
[57]
Vaughan Gething: We’re taking forward a work stream in
Wales. It is relevant to some of the earlier areas you touched on
as well.
|
|
[58]
Dr Goodall: Obviously, it’s a UK-wide review that was
welcomed by all of the four countries at the time, in terms of the
shape of training. I think we would be disappointed with some of
the progress we made on a UK basis, and we need to continue to link
with the other areas. I think it’s important that we focus
the agenda on what our needs are in Wales, however, as the Cabinet
Secretary has said. The last meeting of the group, I think, took
place in June. They’ll be meeting again in November, and
we’re just trying to continue with our momentum. Certainly,
we’re aware in Wales that we obviously have many of the same
pressures that are there. So, there is a need to look at some of
the critical mass of doctors numbers and some of the issues around
specialisms and specialties that perhaps are more short-staffed at
this stage. But I think it’s really important to make sure
that we have a strategic approach here. There’ll be some
alignment with some of the other reviews, like the work that was
recently being done around the HPEI review as well, but we’ll
be very happy to keep Members informed for the future.
|
|
[59]
Vaughan Gething: Yes, of
course.
|
|
[60]
Dr Goodall: But certainly there’s more disappointing
progress, maybe, on a UK-wide basis at this stage, and we’ll
be looking to pick up the pace and momentum.
|
|
[61]
Dai Lloyd: Y cwestiwn nesaf gan Angela Burns.
|
Dai Lloyd: Next question, Angela
Burns.
|
|
10:30
|
|
[62]
Angela Burns: Thank you. I just wanted to continue exploring
this theme a little bit more. I’m very grateful for the
response that you gave to yesterday’s debate, and I totally
understand that there is much effort being made to try to resolve
the recruitment and retention issues with GPs.
|
|
[63]
We talked about the wider workforce and I just wanted to highlight
that again, because I think one of the concerns I have is that, in
terms of workforce planning, are you getting a good oversight or
are health boards—is it, you know, getting stuck at health
board level? When you look at some of the enormous pressures that
are going to happen over the next five years—Hywel Dda, 30
per cent of practice nurses have indicated that they intend to
leave within the next five years—those kinds of issues, are
they filtering through to Government level so that you can look at
this national workforce planning model? That would be my first
question.
|
|
[64]
I suppose the ancillary one would be looking at all the other
professions that tie in, because I know, in previous committee
reports that we’ve done, we know that there’s an
enormous shortage of speech and language therapists and educational
psychologists, there’s a huge shortage of eating disorder
clinics, or the ability to access eating disorder clinics, because
the people just aren’t there; we’re not training up
enough of them. So, I think I just really want to have total
reassurance that you get that whole picture and it’s not
being filtered through the various levels of the NHS.
|
|
[65]
Vaughan Gething:
I think there’s a clear
understanding of the range of challenges and the range of different
areas of staff. It isn’t just about GPs, it isn’t just
about hospital consultants, it isn’t just about nurses:
there’s a whole range of different professionals who make up
the service where there are particular challenges, either
geographically or within some of those specialist areas.
That’s why, for example, when we look at the GP workforce, we
set it in the context of the whole primary care workforce itself.
So, we need to understand how we’re going to have models of
care running. So, the role of the pharmacist is important and the
role of advanced nurse practitioners, and the work already under
way, for example, with physiotherapists and occupational therapists
too. It’s about making sure—and this again goes back to
prudence—who is the right person to give you the right care
at the right time and how do we make sure that person is available?
So, how do we make sure that GPs only do what only they can do, and
physiotherapists do what only they can do as well?
|
|
[66]
We’ve already seen, for example, in
north Wales, that physiotherapy has made a really significant
difference in reducing pressure on GP appointments, with the
musculoskeletal assessments and work that they’re able to do.
Also, it’s about avoiding people then going onto an
orthopaedic waiting list as well on a range of things. This goes
back to my earlier comments about the workforce we need having new
and different models of care to be able to deliver a different sort
of NHS to meet the needs that we have now and in the
future.
|
|
[67]
The pressures that we face aren’t
going to disappear, so, again, how do we plan that and then how do
we deliver that on a consistent basis, I think, is one of our
bigger challenges, and you’ll see that, once we launch the GP
and the doctor recruitment programme, we will also then be working
on a programme for other professionals as well, because we’ve
already, in primary care clusters, seen significant recruitment of
different professionals to come in and work with the GP
workforce.
|
|
[68]
What’s been encouraging is that there’s been some
reflection on the role that other professionals can do, so it
hasn’t simply been that a bid for more GPs is the answer and
the only answer, but it is about recognising that there are other
professionals who can do things to make sure there is less pressure
on GPs and more time for them to see the patients they need to.
That’s happened within clusters at a local level, and
clinical pharmacists are a good example of where people are
recognised and where they have a particular role that is helpful
for GPs as well, but also in the way that the conversations have
taken place with stakeholders—both the British Medical
Association and the Royal College of General
Practitioners—there’s a clear recognition that they
need different professionals to be part of the primary care
workforce, and it goes into a whole range of different issues then
as well, of course. So, what sort of primary care estate do we
want? Well, actually, we understand what sort of model we want and
what sort of workforce. So, that’s why the newer developments
that we’ve approved—whether it’s in Blaenau
Ffestiniog and Flint, and I’ve been to Hope Family Medical
Centre, to name three in north Wales, where, actually, that’s
a better working environment for staff, there are different
services that are available as well and it’s actually better
for the patient too. Actually, GPs who were previously a bit
sceptical there now reckon that, actually, ‘This is better
for us. We have a better environment, a better model of working and
our patients are in a better place’. There’s some
recognition that, whilst there are still GP workforce challenges,
other professions are already making a real difference.
|
|
[69]
So, there is that recognition, and you’ll see that in the way
that we deliver not just workforce planning, but our own objectives
about training as well, and the money we’ve given and the
uplift for a range of different professions to be trained, in the
decision that the previous Minister made as well.
|
|
[70]
Angela Burns: So, going forward do you actually see a place
over the next, say, five years for there being more general
practices owned and run by health boards rather than by private
individuals, especially given some of the commentary recently that
some of those that have gone into local health board control have
ended up being run better and more efficiently than they were
before?
|
|
[71]
Vaughan Gething: Well, this is part of the challenge about
service reconfiguration in its broadest sense, because I would
expect that, over these next five years, there will either be more
federations of private care practices or there will be
amalgamations. Some of that will come where people talk to each
other, and sometimes that happens when practices can no longer run.
The examples we’re likely to get are the smaller practices or
practices that can’t recruit in, and sometimes that is linked
to models of care, and sometimes that is linked to estate; there
are a range of different challenges that are local. Health boards,
it’s a positive to say, have always been able to maintain an
appropriate primary care service for the population, but there is
always real concern and uncertainty, when a practice hands back its
contract to the health board, about what will happen.
|
|
[72]
But some of this is about how we work with the GP workforce and
health boards to re-model primary care. I think this goes back to
some of the maturity in the debate that I’d like us to be
able to have, not just in this committee but more generally,
because the easiest thing to say is it’s the
Government’s fault or the health board’s fault if a
single-handed practice closes, rather than being able to say,
‘Well, what do we do to make sure that primary care in this
area can properly serve the local population, and what could and
should that look like?’ It goes back to this point about not
just simply saying we’ll invest in the same model of care,
because that may not be sustainable. It’s about how we have a
conversation that is honest about what evidence we have about how
we recruit people and what we can provide for a population with a
different model of care.
|
|
[73]
So, health boards need to be proactive in that conversation with
their clusters and with individual practices. They need to
understand the risks that currently exist within their local
primary care workforce, and to have a proactive approach to trying
to deliver that. Otherwise, we’ll have a fairly predictable
circle of practices under pressure, practices not being able to
recruit, but if they hand back their notice it will almost always
be, in someone’s mind, the fault of the Government and/or the
health board, and there’ll be demands that I personally do
something about it. That isn’t me trying to avoid
responsibility; it’s actually about saying, ‘Well, if
we’re going to resolve these challenges, there’s got to
be a different form of conversation about what is sustainable and
what will deliver the high-quality primary care that we want to see
in each part of Wales’.
|
|
[74]
Angela Burns: But actually I want to turn it on its head
more, slightly, and flip it round the other way, because I have
seen instances where we have practices that are failing and there
appears to be—not an unwillingness, but a legal inability for
the health board to actually say, ‘Look, you’re not
performing, you’re not doing what you said’, and
because of the constraints—and this is stuff I don’t
really understand—about the contracts and all the rest of it,
they can’t put in extra GPs in a different building just down
the road to pick up the slack because these other guys are failing.
That gives me concern and I would like to know if there are any
plans to review the contract, review the guidance, or wherever that
decision sits so that health boards can step in and say to
GPs—. Because, you know, not all general practices are great,
and not all general practices perform the services they could
perform. Some can’t because they don’t have the
facilities, but others can’t because they’re just, to
be frank, not prepared to do it. And it’s not helping the
population, so the population are incredibly disadvantaged. So,
I’m interested to know what you can do to give the health
boards a little bit more ammo so that they can go out there and
say, ‘You’re not performing, so I am going to withdraw
your contract’, because it seems to be such a long-drawn-out
process, and I’m not going to name them, but I have areas in
my constituency where people have been terribly,
terribly—
|
|
[75]
Vaughan Gething: I could probably have an informed
guess.
|
|
[76]
Angela Burns: You could indeed. They’ve been terribly
disadvantaged, and it’s been going on for years. I’m
not talking about the practices, I hasten to add, where they simply
can’t recruit but are actually good practices; I’m
talking about the practices where they’re not good and the
population is suffering, and there seems to be nothing we can do
about it. So, what ammunition do you have to change that?
|
|
[77]
Dr Goodall: I do
think that the GMS model—the contractual model—has
served us well over the years on the NHS, but I think it’s
right to say that we need to be adaptable, with choices that GPs
coming into the profession will want to make these days, and
certainly in response to some of the pressures and challenges. Even
with the number of GP practices that have had to be taken over by
health boards, people always take quite a balanced approach about
where they may look to locate it. Some of those practices have been
maintained by health boards on a very good basis, going forward.
Some of them, actually, may choose to be taken over by other
individuals who want to come into an area and actually run it under
the contractor model, and others may look to merge it with their
existing practices. But, we’re certainly seeing an emphasis
on larger practices coming together and sharing some of their
resources in different ways, and there are some interesting models
emerging in Wales, not least the federation approach that is being
established in Bridgend, which we are just keeping an eye on.
|
|
[78]
I think it’s necessary to have quite an open discussion about
the pressures and challenges that the GP profession and primary
care are facing. I’ve been pleased, just over recent weeks,
and this is through the Royal College of General Physicians, that
they have actually facilitated some sessions in the evenings with
senior colleagues from Welsh Government and officials, not least
because we’ll be able to give some proper advice, I think, to
the Cabinet Secretary about the way forward on these areas.
Actually, the contract is being raised there. I think, personally,
that we’ll end up, probably, with a bit of a mixed set of
arrangements, going forward, but as time passes over the next 10,
15 or 20 years, it feels quite clear to me that people will start
to make some different judgments about what they want. Certainly,
some of our younger GPs are looking for different roles and greater
flexibility. They’re interested in working across pathways in
a bit of a different way, at this stage.
|
|
[79]
On the challenge of what health boards can do, on the one hand,
we’ve tried to be realistic that maybe some elements of the
contracts have perhaps become a bit over-bureaucratic at times, in
terms of monitoring. What we don’t want to do is to distort
professional and GP time that’s on the ground. But, there are
mechanisms in place for health boards actually to challenge within
the existing contracts. I think we need to reinforce some of those
messages on a national basis as well. Certainly, I think what
I’d like to avoid is a reaction to a set of local intentions
when a practice has been struggling. So, over this last 12 months,
for example, we have offered a scheme whereby GP practices are able
actually to indicate that they are struggling, and it does give the
health board an opportunity to get alongside them in a different
way. But, I have to say, the take-up at this very early stage
hasn’t been quite as much as we thought, and we’re just
emphasising to health boards that we really want them to use that
machinery. But, they are, in overall terms, responsible for the
health of their population, and that includes making sure that the
contracts work.
|
|
[80]
Angela Burns: My final question, actually, is about patient
choice. I understand and, I think, probably ultimately agree with
the clustering model, but of course that can, in some ways, take
patient choice, especially if the clusters then actually become
fully integrated and become these mega super-practices. What impact
do you think that could have on patient choice and about the
perception of patient choice by patients? What steps would you
consider taking to try to, perhaps, mitigate that, or will you be
looking at that? As we go forward over the next five years,
I’m assuming we’re going to probably get more and more
of these as the smaller practices eventually retire and just get
absorbed into some of these larger ones.
|
|
[81]
Vaughan Gething: I
wouldn’t expect to see clusters becoming a single practice,
but the clustering model is very deliberately aimed to promote
joint working, so GPs understand what each other is doing.
There’s something about sharing challenges, and it’s
also about being able to get alongside other actors. So, social
care, housing and others are part of arranging the clusters as
well. So, it’s actually about improving the service that
those GPs provide, and they’ll be able to agree with each
other about the services to be provided across different practice
areas, but to do that together in a sensible way. The money has
been really helpful in delivering that as well. They’ve had
control over some resource together to try to deliver that.
|
|
[82]
I think the point about having larger
groups running services goes back to the point about amalgamations
and federations, which I don’t think are likely to be seen.
From my point of view, I’m interested in the quality of the
service that people have, and whether they are getting the right
services and access to services in a way that is appropriate for
primary care. I’m not clear, to be honest, where you’re
coming from in terms of patient choice, because this varies
according to where you are. If you live in the city of Cardiff,
you’ve got access to a range of different GP practices within
a radius of where you live. If you live in Solva, then, actually,
the reality of choice is very different. So, my focus is on how we
improve what primary care does, how we get the right model to make
sure that we have the right services available and make sure that
people are working in a much more collaborative way. That’s
why we’ve got a national primary care cluster event coming up
in October—to bring together people to talk about
what’s worked and worked well, and equally to be able to
identify what hasn’t worked so well and why, because
it’s important to learn from both of those instances
and to make sure not just that clusters learn within a cluster from
each other, but from neighbouring ones as well.
|
|
10:45
|
|
[83]
And there’s got to be some space to be able to take a step
back and say, ‘What are we doing and why, and is it
delivering the sort of change that we think we need, given the
populations we already serve within primary care, and how do we
learn from people down the road who have a very similar population,
to work within health need terms, and what can we learn from each
other?’. And, sometimes, that doesn’t happen unless you
take the opportunity to do that. So, we’re committed to
making the cluster model work to improve the way that primary care
works, in the context of our recognition that it will need to
change, it will need to be different. And it will be different in
different parts of Wales, as you would expect.
|
|
[84]
Angela Burns: Thank you.
|
|
[85]
Dai Lloyd: Lynne Neagle sydd nesaf.
|
Dai
Lloyd: Lynne Neagle
is next.
|
|
[86]
Lynne Neagle: I wanted to ask about the nurse staffing
levels legislation, which I’m very enthusiastic about. But,
one of the things I’m really keen on is seeing it extended to
adult mental health wards at an appropriate time. When the Bill was
going through, your predecessor said that he had commissioned some
work on that. Can you just provide an update on that, and also
confirm that that extension is something that you are looking to do
at the earliest opportunity?
|
|
[87]
Vaughan Gething: Yes. The Nurse Staffing Levels (Wales) Act
2016 is leading the way in the UK, and it’s actually largely
drawing on work that the chief nurse started before, as well. That
work of the chief nurse in Wales is leading the way across the UK
as well, in having a professional judgment of what is an
appropriate level of nurse staffing. I’ve indicated, both
publicly and in meetings with the Royal College of Nursing, that
the commitment that the Government has made, that we want to see
the extension of the Act, will be based on evidence. And, so,
we’ll have evidence from the Act being implemented, and, in
terms of where it can then go next and what evidence we have about
the right area, to say that we can now say, ‘There is an
appropriate provision to be made and this is an area where we can
extend the Act’.
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[88]
So, what we’re doing on implementing the Act, on the
consultation we’re having on the new model, will be really
important for further areas of extension. I’ve been really
deliberate in not giving a commitment to a timescale for further
extension, but I’ve always been really clear that it is the
intention to extend the Act based on the evidence that we have on
where it is the right thing to do. And you won’t be surprised
to hear that the Royal College of Nursing are keen to see the Act
extended as well, but, equally, they understand the point about
having evidence where it is, and they want to try and help us in
terms of saying, ‘Here’s where we think the evidence is
that this is the right place to say that you can now implement
something similar.’ So, at the earliest opportunity, and it
depends on when the evidence is available that it’s the right
thing to do. It could be in whichever area—will it be adult
mental health wards or will it be in children’s services? We
need to understand that evidence first, and for me to have that
advice from the chief nurse about when is the right time and where
is the right area. So, no definitive timescale, but a clear
commitment to extending the Act when the evidence tells us it is
the right time and place to do so.
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[89]
Lynne Neagle: Your predecessor did give assurances about
adult mental health wards when the legislation was going through
and said that he was undertaking work to gather that evidence. Is
that work still ongoing for adult mental health?
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[90]
Vaughan Gething: Yes, the chief nurse is still leading that
work.
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[91]
Dr Goodall: Yes, just to confirm, absolutely it’s
carrying on, and, in fact, it would reinforce the same methodology
that we used around looking to increase the nurse staffing on the
acute wards. What was really important was that we’d done all
that background work—it will help the transition and also the
implementation of these measures. But, yes, it’s all in hand
and in train.
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[92]
Lynne Neagle: Thanks.
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[93]
Dai Lloyd: Huw sydd nesaf.
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Dai Lloyd: Huw is next.
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[94]
Huw Irranca-Davies: Just to add to that, Chair, or to ask
for some further clarification, we’re very aware of the
complexity of this, both internal factors within the NHS, within
social care, but also external factors of recruitment as well. The
Cabinet Secretary has been very, very clear on that, and it
sometimes seems a little bit like whack-a-mole—you have to
get everything whacked down to make this work, quite frankly. So,
we get the complexity. I’m impressed by the strategic
thinking and the rethinking that’s going on to bring the
workforce planning together. What I want to ask is on the issue of
measurement and metrics, because of the old adage ‘what you
don’t measure, you don’t manage’, and also
accountability, and the role of people like the schools within
this—the school of nursing et cetera, and all the royal
colleges. Do you feel that you’ve got the right metrics so
that you can judge that everybody’s delivering their part of
it, that you can hold them accountable and responsible for
delivering that in 12 months, in three years, in five years, and
that, similarly, from the scrutiny perspective of this committee,
we’ll be able to look at you and say, ‘Well, we can see
not just the plans and the strategies, but we can actually see the
outcomes—things fit. With the workforce planning now, we are
fitting people into the right places, doing the jobs that we need,
because we know how critical this workforce planning is to the
whole of the transformation that the Cabinet Secretary wants to
see.’ So, on metrics, performance, accountability—those
hard-edged things—are they there?
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[95]
Vaughan Gething:
In terms of the extension of the
implementation of the Nurse Staffing Levels (Wales) Act 2016, then,
yes, we’re in a place where we’ve got evidence of what
to do, from the consultation, and about how that’s done and
giving health boards time to make sure that they can and then will
do that. I was really clear, when implementing the Act, that
it’s not optional. It won’t be, ‘Try and do this
if you want to’, but it is, ‘No, this is a
requirement.’ The same approach will be taken if and when we
extend the Act.
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[96]
On the broader point about understanding
what we measure and how we measure it. There’s a conversation
for the health service to have, and for all of us to have, about
what to measure within the NHS anyway. Because, head count is one
thing we can measure, but then that tells us only part of the
story, and time and activity we can measure as well. So, lots of
our measures and targets are about time and activity. They tell us
something but not everything. So, there’s something about the
outcomes framework that we’ve introduced in health, but also
building on the outcomes framework in social care as well, because
I’m interested in getting us to shift to look at the outcomes
that we deliver. So, there is the quality of care and the patient,
but then there is the actual outcome itself and how we have
achieved an outcome that is real and meaningful and how we measure
that and are able to describe it in a way that has real
purchase.
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[97]
I think that it’s really important
that we have that conversation and we’re able to provide for
you as a committee, but more broadly, that someone says,
‘These are the outcomes that the health service is achieving
and that social care is achieving’. I think that the nurse
staffing levels is an area where you can say, ‘You can tell
us something about that, but it’s got to fit in within a
wider whole, so that we’re looking at the targets and
measures that we have more broadly’. So, that is what I think
we need to do within this term.
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[98]
We’ve already done it, for example,
in the ambulance service, where we had an evidence-led approach to
it and now the targets make sense and there is much more context
actually for the care that is being delivered. So, we’ve got
an improving organisation with a different range of measures to
look at and different information for the public. So, you will now
be able to scrutinise the service and the Government on a much
wider range of issues and will be able to understand, from your
constituents’ point of view, the care that they’re
receiving from the ambulance trust. I think that’s an
approach that we could and should take more broadly across the
service. But it will require some maturity in that conversation. To
be fair, the Conservatives had something on this in their
manifesto. I don’t agree with lots of what was in their
manifesto, but they had something about looking at targets again
and having an evidence-led review involving clinicians.
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[99]
Huw Irranca-Davies:
We know that targets can skew things as
well, so they’ve got to be the right ones. But what I’m
interested in is this issue of best practice within workforce
planning. With the most complex organisation in the world—the
NHS and social care and all the ancillary workforce issues around
it—it may be something that at some point we return to, but
it’s about the ability of a Cabinet Secretary to turn to the
whole of that and say in any one piece, but also in the whole,
‘Are we delivering exactly those outcomes on workforce
planning that we need to make this service work?’.
Conversations—I think you’re absolutely right in
getting to that point, but it’s just a hard-edged management
thing of being able to say—as an old retired manager, I was
told week by week, year by year or
whatever—‘Here’s what you’re accountable
for, this is how you need to match it up and this is what you need
to align for.’ So, I don’t underestimate the
complexity. But I think, as to that issue of what we are looking
for precisely, right across the royal colleges, right across GP
recruitment, nursing and everything else, is everything bolted
down, who’s responsible and do we hold them
accountable?
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[100]
Vaughan Gething:
I don’t really want to get on to
‘everything is bolted down’ because I think
that’s setting us up to a level of performance and
undertaking that I don’t think is honest. But there is
clarity about the ambition and the expectation. Also, where does
accountability lie within the system for me and chairs, and for the
chief executive of NHS Wales and the chief executives themselves as
well? There is this point about health boards being much clearer
about their responsibility and their accountability for
whole-population health, and not simply about being hospital
organisations first. That’s partly what we need to see
delivered more consistently over the course of this term as well.
But there are important messages for us about outcomes from social
care as well and the work that they‘ve already
done.
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[101]
Dai
Lloyd: Mae hynny’n dod â ni ymlaen yn hyfryd iawn achos
roeddem ni’n mynd i drafod materion yn ymwneud efo gofal
cymdeithasol, a chyfle i’r Gweinidog Iechyd y Cyhoedd a
Gwasanaethau Cymdeithasol, Rebecca Evans, i serennu.
Mae yna gwestiwn gan
Lynne
Neagle.
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Dai
Lloyd: That brings us very
neatly on to the next issue because we were going to discuss issues
related to social care, and so an opportunity for the Minister for
Social Services and Public Health, Rebecca Evans, to shine
now. There is a question first of all from Lynne Neagle.
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[102]
Lynne Neagle: Thanks, Chair. The Welsh Government launched a
consultation back in January on how we can retain social care
staff, particularly looking at domiciliary care staff. The
consultation closed in April. Are you able to provide an update,
and specifically comment on the fact that there was particular
concern about how we can reduce the use of zero-hours contracts for
the workforce in recognition of the fact that we were losing staff
because of it?
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[103]
The Minister for Social Services and
Public Health (Rebecca Evans): Thank you, Lynne. Good morning, Chair, and good
morning, committee. Developing, supporting and professionalising
the social care workforce in Wales is one of my priorities within
my portfolio. The background to the consultation to which you refer
comes from a recognition of the real challenges that there are in
this particular sector, such as the high turnover of staff, for
example, and the perceived low status of what is incredibly
important and valuable work as well. So, the background there was
that we asked, via the Care Council for Wales, the Manchester
Metropolitan University to undertake a piece of research to
establish whether or not there was a demonstrable link between the
quality of care that somebody receives and the terms and conditions
of the person providing that care. The reason we did that was to
better understand what we might be able to do in Wales under the
terms of the Government of Wales Act 2006 and the powers that we
have here, based on the understanding that we had after the
Agricultural Sector (Wales) Act 2014 went to the Supreme Court and
so on. I’m really pleased that that piece of work did
demonstrate that there was a clear link between quality of care and
terms and conditions.
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[104]
So, the consultation then went on to look
at, as you say, zero-hours contracts, but also other areas such as
minimum wage compliance, health and safety at work, travel time and
call clipping—so, issues that people in receipt of care had
raised with Government, but also people who were delivering care as
well. As you say, that consultation has been undertaken. I will be
publishing a statement alongside a report on that in the very near
future, in the coming weeks. And then that will outline the
direction of travel as we move forward, including our approach to
zero-hours contracts, because, of course, it was a commitment in
our manifesto to tackle particularly the abuse of zero-hours
contracts in the social care sector.
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[105]
Lynne Neagle: Thank you.
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[106]
David Lloyd: Julie.
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[107]
Julie Morgan: What about the cost of the sector—the
increasing demands and the national living wage, and all of these
issues? I know that they have written in to the Government. How are
we going to cope with the increasing financial demands that
importantly need to be there?
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[108]
Rebecca Evans: Well, we’ve continued to support and protect
social care budgets in Wales. In the last financial year,
we’ve provided an additional £21 million to local
authorities in Wales in recognition of the fact that this sector is
an expensive sector that puts a great strain on local government
resources. We have also invested significantly through our
intermediate care fund—£50 million. That’s really
transforming the way in which we deliver services, and the
experience that people have of services. I’m happy to talk in
more detail about that and give some examples as well. You did
mention specifically the national living wage. I met with Care
Forum Wales, and I know that there is a great deal of concern
amongst providers in Wales that they will really struggle in order
to be able to pay the national living wage to their members of
staff. Of course, we have to remember that it’s good news
that we are paying low-paid workers more, but equally, at the same
time, recognising the complications that that does give to the
sector.
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[109]
The previous Minister established a group
to look specifically at the national living wage—I think it
has met on three occasions—to explore the kind of challenges
it might pose, but also the kind of response that the Government
and the sector itself might be able to give to that. Would you like
to add anything on this?
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11:00
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[110]
Mr Heaney: Yes. Thank you, Minister, and thank you, Chair. I
think in relation to the social work and social care profession,
they provide invaluable, complex service support for people who
have care and support needs in Wales. So, getting a strong, healthy
workforce is absolutely crucial. Some of the challenges that we
have to overcome have been mentioned by the Minister, but it is
clear that, over a substantial period of time, whilst the
Government has sought to support financially the social care
sector, it’s important to have a healthy, strong health and
social care sector. Part of that
relationship for us—. You’ll be well aware of the
legislation that has gone through the Senedd this year. The
Regulation and Inspection of Social Care (Wales) Act 2016 has
established Social Care Wales. I think it is worth mentioning today
that there are distinctions between what Social Care Wales will do
in relation to the workforce and what the Care Council for Wales
did. The Care Council for Wales did some excellent work, but the
additional transformational responsibilities, I would say, are in
relation to improvement—working to improve the
workforce—and in relation to, as was mentioned earlier,
research—to better co-ordinate our efforts around social care
research and research around integration so we can develop a
stronger, professional workforce.
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[111]
We’ve got to establish in Wales
more prestige. We see Social Care Wales helping us with that. As
part of our relationship this year, the Minister has remitted Care
Council for Wales, in its last year, before it changes in April of
next year, to develop a five-year strategic plan to assist in
relation to planning strategically for the domiciliary care sector.
That plan will seek to support the delivery of the registration of
the domiciliary care workforce in Wales, but also will assist us in
taking forward, from the Minister’s work, the consultation
findings, and how we can develop a stronger, healthier domiciliary
care workforce.
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[112]
My last comment is that it’s
important to see the scale of the workforce in Wales. We have over
70,000 in the social care workforce. So, it can be part of our
well-being-of-future-generations thinking in terms of a prosperous
Wales. Increasing the conditions and strengthening the conditions
for our workforce can have a much added bonus in terms of both them
and their local communities. And in the scale, we have over 14
million domiciliary care hours commissioned by local authorities
with the sector each year.
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[113]
Julie Morgan: It seems, as you say, absolutely crucial that the
status and standing of the workforce is improved, for all the
ambitions the Assembly has, basically. I just wondered, Minister,
you did mention you had some outstanding examples that you could
tell us. Was that from the intermediate fund?
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[114]
Rebecca Evans: That’s right. The intermediate care fund, as I
say, represents an investment of £50 million this year and
we’ve committed to continuing our support for the
intermediate care fund in our manifesto as well. This really is
about changing the way in which we deliver services. It’s
about health and social care working side by side but also with
housing and the third sector as well. I’ve spent some time
over the course of the summer visiting schemes both in south Wales
and in north Wales, looking at the difference that it’s
making in individual people’s lives and in the lives of
communities as well. There’s a range of different models
looking at different aspects of social care, from preventative and
reablement services, single points of access, housing and telecare
improvements, rapid response teams, dementia care and seven-day
social care work as well. So, responding in different ways to the
different kinds of needs of communities.
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[115]
People working in this area have told us
that they see a difference in the way that they’re working
already in terms of much improved communication, quicker decision
making, collaboration and a greater understanding of what partners
can offer as well. So, health have now a greater understanding of
what their social care, housing and third sector partners are able
to offer.
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[116]
In terms of a specific example,
there’s an extended reablement for people with dementia
scheme operating in Cwm Taf at the moment and they’ve been
able to demonstrate already that over 103 hospital bed days have
been saved, just in terms of preventing people from having to go
into hospital in the first place or helping them return home with
that reablement package in place as well. Obviously, through that
we’re offering telecare as well; 94 per cent of those people
who were questioned as having received that service said that they
were now remaining to live independently at home and 91 per cent
said that they had achieved their own personal goals. So, I think
that demonstrates, in terms of bed days saved, real success in
terms of the NHS, but also people’s own reflections on the
way it’s helped them to stay at home and achieve their own
personal goals. Really, what it’s all about is the outcomes
for the individual.
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[117]
Julie Morgan: How are we going to get that to operate all over
Wales?
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[118]
Rebecca Evans: The intermediate care fund, as you say, is operating
across Wales in different ways and
there are mechanisms in place for
information sharing, best practice sharing and so on across the
different groups, so we can see what’s really making a
difference and what we’d like to roll out further as
well.
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[119]
Mr Heaney: And just to add to what the Minister was saying in
terms of the sharing, they had been all-Wales shared learning
events. The regional partnership boards that have been established
are taking a lead role in developing in accordance with their
population need. And, in terms of a wider cross-Government
approach, the Cabinet Secretary responsible for housing has also
added to the £50 million fund available £10 million for
capital this year.
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[120]
Julie Morgan: Thank you very much.
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[121]
Dai Lloyd: Roeddwn i ddim ond eisiau pwysleisio, cyn inni
adael y materion i wneud â gofal cymdeithasol, ac yn benodol
felly y gweithlu gofal cymdeithasol, o dan y ddeddfwriaeth newydd
yr ydych newydd fod yn sôn amdani, a’r ffaith y bydd y
gweithlu gofal cymdeithasol yn cael ei gofrestru am y tro
cyntaf—wrth gwrs, mae meddygon a nyrsys wedi cael eu
cofrestri ers canrifoedd bellach—. Hoffwn jest roi cyfle i
chi bwysleisio unwaith eto fod hwn yn rhywbeth newydd i’r
gweithlu gofal cymdeithasol a sut mae hyn wedi datblygu nawr dros y
misoedd diwethaf.
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Dai Lloyd: I just wanted to emphasise,
before we leave issues related to social care, and specifically the
social care workforce, that under the new legislation that
you’ve just been mentioning, and the fact that the social
care workforce are now to be registered for the very first
time—of course, doctors and nurses have been registered for
centuries now—. I just wanted to give you an opportunity to
emphasise once more that this is a new initiative for the social
care workforce and how this has been developing over the past few
months.
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[122] Rebecca
Evans: I’ll ask Albert to give the very latest
developments over the last few months, but I would also add that
we’ll be including domiciliary care workers in the
registration as well, in 2020, and this very much is about
increasing the status of the role as well. You know, it’s
being a registered role, and when you’re registered then, it
will give the people receiving care the confidence that you have a
certain set of skills that will enable you to meet the needs of the
person who is being cared for as well. Is there anything else to
add?
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[123] Mr
Heaney: Just very briefly, Minister, in relation to the fact
that social workers have been registered for a number of years, as
you will be aware, but, in terms of taking forward domiciliary care
workers, Social Care Wales will be working very much alongside
Government officials and the Minister to deliver those changes
successfully, both in preparing the workforce in terms of then
moving into the registration, as the Minister has outlined
today.
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[124]
Dai Lloyd: Grêt. Mae yna gwestiwn gyda
Jayne.
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Dai Lloyd: Great. Jayne has a
question.
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[125] Jayne
Bryant: [Inaudible.]
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[126] Dai
Lloyd: Yes, that’s the next slot.
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[127] Jayne
Bryant: Over the summer, I had the privilege of visiting the
neonatal unit in the Royal Gwent Hospital and at Singleton
Hospital. The staff there are doing an absolutely amazing job, in
both hospitals. But you’ll know that there is much
uncertainty at the moment around the deanery consulting on neonatal
training and I wonder if you can comment about this a little bit
further, and also on what plans specifically are in place to
attract neonatal nurses to work in Wales.
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[128] Vaughan
Gething: Okay, thank you for the question. This is an issue of
obvious interest to Members not just in this committee, but, if you
like, your sister, overlapping committee, the Children, Young
People and Education Committee, as well as Members generally. The
recommendation about having two training sites and a third site
that runs a different model, if you like a hybrid model of not
having training allocated, the Welsh Health Specialised Services
Committee and the neonatal network are working this through, and my
expectation is that they will have a recommendation for what will
happen in the future of the network within this half of the term.
There are always going to be challenges in delivering the right
care, and delivering this really specialist care, to make sure that
we prioritise outcomes for children, and whatever decision is made
about which site is not going to have trainees in the future, I
would expect there’ll be some local concern about that that
will find its way to me in the form of questions or letters.
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[129] But I just want
to set out what I said yesterday, in that I won’t look at
this in the context of a local solution; it’s got to be seen
in the context of what is going to work—and were talking
about south Wales now; there are three sites across south Wales,
two of which are going to be training, and a third which will run
this new and different model. It will have to be seeing about what
makes the best sense for that whole population, and how to make
sure that each of those decisions is linked to the others, to make
sure that we continue to have a focus on improving outcomes,
because the good news is that the most recent survey we’ve
had about outcomes for children is that we compare well with the
rest of the UK, and better than some other areas with comparable
levels of deprivation. So, my focus is going to be on those
outcomes, but I do appreciate that, within this, as with in a range
of other areas, having had that indication that the deanery’s
recommendation has been for, of the three sites, one not to have
training, there’s going to be a level of uncertainty, and the
sooner I get an indication of the services that will happen, and
the sooner the service can confirm what it is going to do and talk
to staff and the wider public about what that means, the better,
because it’s about trying to end some of that uncertainty and
get back to focusing on having the right service model to deliver
the best possible care.
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[130] Jayne
Bryant: Would you be able to give assurances that the quality
of the service would still be there for people, with any
changes?
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[131] Vaughan
Gething: We’ve been really clear and we need to be really
clear that our expectation is the service meets the neonatal
standards, the updated ones that tell us something about both
staffing levels, but also, crucially, about outcomes. I think
it’s the perinatal health survey that gives us that
confidence and that assurance about our outcomes being comparable
with the rest of the UK and better than some other areas with
similar levels of deprivation. So, that’s what’s really
important for me. There is a challenge about having the right
levels of staffing in each of those areas and we’ve got to
recruit into each of those models of care, regardless of where they
are geographically based. So, that’s our
expectation—that we will be able to do that. There’s
some evidence that we should be able to do that, based on the most
recent evidence we’ve got. Also, at this point in time,
they’re undertaking a capacity review to understand where we
are on staffing, and I think that we should have the results of
that at some point in the autumn. I’d be happy to share the
results of that with committee, if that’s helpful, Chair, to
give some reassurance about the progress that we are making on
staffing on this particular and really specialist service.
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[132] Jayne
Bryant: Thank you.
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[133]
Dai Lloyd: Ie, byddai hynny’n werthfawr iawn. Rhun
nesaf ac wedyn Angela.
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Dai Lloyd: Yes, that would be most
valuable. Rhun next and then Angela.
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[134]
Rhun ap Iorwerth:
Un cwestiwn penodol yn y fan yna o
ran gosod safonau neu leiafswm safonau yn y maes yma yn
gysylltiedig â
lefelau o staffio hefyd. Un lleiafswm
safon y gallech chi ei osod, wrth gwrs, fyddai pellter teithio i
uned mamolaeth wedi cael ei harwain gan arbenigwr. A fyddai gennych
chi ddiddordeb mynd ar ôl gosod y math yna
o safon? Yn amlwg, yng nghefn fy meddwl i mae gwasanaethau mewn
ardaloedd gwledig yng ngorllewin a gogledd-orllewin
Cymru.
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Rhun ap
Iorwerth: There is one
specific question there in terms of setting a standard or a minimum
standard level in this area in relation to staffing levels too.
Now, one minimum standard that you could put in place, of course,
would be the distance of travel to a consultant-led maternity unit.
Would you be interested in setting that kind of standard?
Obviously, at the back of my mind are services in rural areas in
west and north-west Wales.
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[135] Vaughan
Gething: There’s actually been some work done on how much
of a difference does distance to these specialist services make,
and there isn’t a great deal of evidence about how much of a
difference to outcomes distance makes. But this goes back to the
conversation we had yesterday in the Chamber and at the start of
today as well about some of the challenges about what we do with
really specialist services and how much of that is local and how
much of that is going to be concentrated in a smaller number of
centres to deliver better outcomes. I’m talking more
generally. I know you’re talking about
consultant-led—
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[136]
Rhun ap Iorwerth:
I wouldn’t put consultant-led
maternity services in the really specialist services category.
Would you?
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[137] Vaughan
Gething: It is a specialist service. It’s not the same
as, for example, the neonatal service that we’ve just been
talking about, but, again, we have to understand what our evidence
tells us, and when we’re talking about maternity services,
you have to see them as a whole. So, for example, we know that
midwifery-led care, and there’s lots of evidence and NICE
guidance and recommendations about the number of midwife-led units
we could and should have and about the safety of midwifery-led
care. It should not be seen as bargain-basement level—that
provides high-quality care. It’s about having proper access
to consultant-led care where it’s appropriate. So, those
people who are with higher risk pregnancies and if they are going
to have consultant-led care, well, that should happen at an earlier
stage. If there are people who need transfers at a later stage in
pregnancy, it’s about how we do that.
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[138] There should be
some confidence from the model in west Wales, because they’ve
got a specific resource to take people from Withybush to Glangwili
there, if there is a need to transfer women. The evidence has been
that, in more than a year of that service being in operation, the
care of women and their babies has not been compromised, and each
transfer that has taken place has been done safely and there are
good outcomes for mothers and their babies.
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11:15
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[139]
The ongoing consultation about what
could and should happen in north Wales is one where, again, there
has to be evidence about what is the most appropriate form of care,
how that gets staffed and how that is developed around the SuRNIC
as well, which is a fixed point within the future of services
within north Wales. There’s good news on the SuRNIC.
We’ve had the business case, and I expect to be able to
receive advice and to make an announcement more broadly within this
calendar year on that. Then, if there are future options about the future of
consultant-led care, I’m interested in the service being able
to discharge that properly, so that it’s something that is
clinically led and has an evidence base, there’s a
consultation with the public about what those options mean, and
that the health board actually discharges that properly with their
local population. I don’t think it would be helpful for me to
say that I am setting an entirely different criteria on a
geographic route or otherwise, because that doesn’t always
take account of the realities of geography, and that doesn’t
always take account of what we are going to be able to do to
deliver the right care for people when they need it. So, I
understand why you raise the point, but I don’t think
it’s appropriate for me to say there is a rule that I will
implement and expect to see delivered on physical proximity to
consultant-led maternity care. I’m interested in the quality
of care that’s provided or people’s ability to access
that when they need it.
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[140]
Dai Lloyd:
Okay. Angela—your
question.
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[141]
Angela
Burns: My
question is not entirely dissimilar, but concerns neonatal
capacity. You talked about the fact that you’re doing a
review to look at the capacity of the nursing and other
professional staff who are involved in neonatal care, which
I’ve interpreted as for the beds that we currently have. So,
my question to you is: do you intend to do a review of whether or
not we actually have enough neonatal beds, wherever they may be,
within Wales? Too many west Wales patients do end up further and
further down the M4 corridor. My last constituent from Carmarthen
had her baby in Rhyl. It was very premature, at 26 weeks, and is
doing well, however, as you know, with a baby it is very difficult
to repatriate them back. That baby was—they tried to find
spaces in Swansea, then they went to Cardiff, then they went to
Bristol, then they went to Swindon, and there were no spaces
anywhere. So, I just wonder about the actual capacity. Do we have
enough beds in south Wales and/or north Wales to be able to manage
that situation? I think the point I want to make is I don’t
think it’s a one-off, but I can only tell you the two or
three instances in my patch, so I wondered if you might do a review
to see how many babies are in premature care very far away from
where they are, because it puts such an immense strain on the
family and there’s great difficulty in repatriating them. A
baby born at 22, 23, 24 weeks actually usually has to stay there
until it’s pretty much full term, so that can be, sort of,
two months or so that somebody’s got to do those kinds of
journeys.
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[142]
Vaughan
Gething: I
understand exactly why the question is asked and the impact it has
on individuals. The capacity review where we’ll look at our
ability to meet neonatal standard is a regular review that
we’ll do to update people on what’s being done and how
close we’re getting to meeting each of the different
standards, and, of course, as we reshape services, we need to
understand what capacity we need, and the reasons why there are
times that that capacity will be shifted. There have been
infection-control issues that have affected Cardiff on a temporary
basis, and that may well have affected your constituent. But
I’ve met some of your constituents, and others from further
west in Wales, in Carmarthen, describing their journey from Cardiff
back to Swansea back to Carmarthen. They’ve all been
interested in the quality of care they’ve received, and
they’ve had nothing but praise for it. The unfortunate
circumstances you’ve described when someone goes to north
Wales is unusual. It is not, if you like, a regular and frequent
occurrence. But it is that we want to try to plan that to make sure
we have the right capacity within our system, as well as
understanding, if people do need to go elsewhere, the reasons for
that, to make sure that we minimise the instances where people are
going outside, if you like, their normal, expected
area—whether it’s to north Wales or further into
England—where that is not for a clinical reason. So,
that’s what we need to do in designing and delivering our
system. It might help if Andrew gives some detail on how this is
being worked through.
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[143]
Dr
Goodall: As
the Cabinet Secretary has outlined, we require the network to
undertake a capacity review every six months. It’s right to
say that that information therefore gives us a baseline to know
that we are improving both staffing arrangements and also looking
to increase establishments. They have improved, even over the last
six to nine months or so, which shows that the funding is going
into the services. But there is a shortage of specialist neonatal
staff on a UK-wide basis, and we obviously have to compete in that
arrangement. I think therefore that it’s really important
that we do have links across the border, not least with English
organisations and some other local provision. We also need to make
sure through the review that we look at some of the transport
arrangements. So, as an example, we’ve had 24-hour access
seven days a week up in north Wales to support the provision.
Actually, south Wales has been able to manage on a 12-hours basis,
and then just making exceptional arrangements as necessary
overnight, not least with some of the arrangements, for example,
air ambulances and the emergency medical retrieval service.
There’s a current recommendation that, maybe, south Wales will need to alter some
of those areas and we’re looking for that to be decided on by
the network at this stage. But I think it’s important that we
do have an opportunity to know what the future needs
are—certainly the phase 2 proposals from Cardiff in what they
can fit into their own space. They are giving some flexibility for
additional cots that can be introduced into that area. There is
already £7 million that’s gone into the phase 1
development, which is actually taking place on the University
Hospital of Wales site. But I’m sure that the review will
draw it out on an all-Wales basis, not just these regional issues
as well.
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[144] Angela
Burns: Thank you.
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[145] Dai
Lloyd: Lynne.
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[146]
Lynne Neagle: Just quickly, to go back to Jayne’s point about
the review of the training places, obviously the fear with a
reduction in training places on a particular site is that that then
diminishes the configuration of the cots in a particular area. Are
you able to offer any assurance that you will be taking steps to
ensure that, whatever happens with the training, you will try to
maintain the quality of service on those particular
sites?
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[147]
Vaughan Gething:
That’s our expectation: that we
will maintain the quality of provision. The last thing I would want
to see is that we implement a model of care that diminishes the
quality of provision and people’s access to the right quality
care at the right time. So, that’s our ambition. There are
challenges with any new model of care and with any changes that are
made, but that’s our clear expectation. That’s what we
expect the service to work to and deliver.
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[148] Dai Lloyd: Andrew.
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[149] Dr Goodall: If I could just say,
it’s really important that we make sure that that’s not
only for Aneurin Bevan health board to resolve. It’s really
important that the health boards all work together. I think there
is a particular role for Cardiff to make sure that it’s able
to support some of the ongoing recruitment for what will be a new
model of care for any of the sites. But there’s a process
that’s being gone through at the moment, anyway, to determine
which site would end up being of training-unit status or not.
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[150]
Dai
Lloyd: Diolch yn fawr. Mae’n bryd symud ymlaen i’r
adrannau nesaf o adroddiad Ysgrifennydd y Cabinet. Mae adran yn fan
hyn ar dderbyn triniaethau gwrth-seicotig. Nid wyf yn gwybod a oes
cwestiynau. Gallwch chi feddwl am hynny. Mae gan Caroline gwestiwn
ar ddementia. Caroline.
|
Dai Lloyd: Thank you very much.
It’s time to move on to the next sections of the report of
the Cabinet Secretary. We have a section here on the use of
anti-psychotic medication. I don’t know if there’s a
question on that. Whilst you’re thinking about that,
Caroline’s got a question on dementia. Caroline.
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[151] Caroline
Jones: Diolch, Chair. Cabinet Secretary, people with dementia
often require support for their families as well as themselves. How
will you ensure staff are adequately trained to give this advice
and also that nurses are fully equipped to deal with people
suffering from dementia who need hospitalisation, perhaps for an
unrelated illness? Thank you.
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[152]
Vaughan Gething:
We’ve actually got some good news
on where we are with our dementia strategy. I’ll ask Dr
Atherton to come in to explain some of the work that’s
ongoing—that has taken place this week, actually. In drawing
up our strategic action plan for dementia, we had the first meeting
of stakeholders this week, and there are a range of the issues you
mentioned that are part of what we are already looking to take
action on and what we want the new action plan to take forward as
well. I was able yesterday to set out, when I went to the
University of South Wales, some of the steps already taken to make
sure that there is further training and support for professional
staff. We’ve invested not just in nurse training, but also
occupational therapists and in different settings as well to
provide support and meaningful activity. So, there are a range of
different things that are happening, and some of that does include
the support that is provided to and with families as well, because
it’s not just an individual themselves, it has an impact on a
whole family, which we recognise as part of what we want to see
happen and resolve. So, the third sector and dementia patients and
their families and carers are very much part of helping us to
design our new plan. There’ll be a consultation this autumn,
and we’ll then hopefully announce what will be our final
action plan later in the year. But I think Dr Atherton, it would
certainly be helpful to talk about the meeting that took place at
the start of this week.
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[153]
Dr Atherton: Thank you very much, Minister. Good morning, Chair,
and good morning, committee. It’s a pleasure to be here.
I’m Frank Atherton, I’m the new chief medical officer.
It’s my first meeting with this committee, and I look forward
to working with you in the future.
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[154]
As the Minister said, there was a meeting
earlier this week of a very interesting group that came together to
start to think about a dementia strategy for Wales, as part of our
commitment to making Wales a dementia-friendly country. We had an
excellent turnout. We had people from the voluntary sector, people
from Government, of course, and from primary care. We didn’t
have a representative from the private sector, but we’re
looking to expand that. We had carers, as well,
represented.
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[155] So, we’ve started to make progress and, really,
we started to think about how we develop a strategy over the next
few months. We had an excellent presentation from the
Alzheimer’s Society, and some of the points that they were
making were that we do need to think about those aspects
that you mention around care, and how we provide care effectively
for people suffering from dementia. We need to look at the whole
pathway. We need to think about early diagnosis, so, what can we do
to identify people early? Because there are interventions that can
help if we find people and identify them early. How do we provide
care and keep people in their homes as long as possible?
That’s obviously a critical issue, but when people move
beyond that ability to stay at home, what kind of care should we
provide in a secondary care environment? And, also, we started to
think about end-of-life care and how we can provide the same sort
of services to people with dementia that we currently provide, for
example, that we aspire to provide, for people with cancer? So, the
whole pathway was under consideration.
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[156] In terms of
process, the first meeting was a brainstorming, was a getting
together, thinking about the areas and the domains that we need to
think of, in terms of both care and prevention. And from a public
health perspective, I was delighted to hear people talking about
that, because the evidence is building that those things that we
do, that we think about in terms of keeping our hearts healthy,
also keep our minds healthy. So, some of the work around smoking
prevention, around exercise, that will be built in as well.
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[157] We’re
looking to produce a draft strategy and to consult on that with the
group, and then, more widely, with carers, with users, as we go
forward into the early part of next year, and then to produce a
strategy perhaps towards the middle of next year. That’s the
intention at the moment, but it’s a very good group, great
engagement, and a pleasure to engage with them.
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[158] Vaughan
Gething: Part of your question, Caroline, was on carers as
well, so it might help if the Minister answered, as she’s got
responsibility for the carers strategy.
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[159] Rebecca
Evans: Yes, just to remind Members that, under the new Social
Services and Well-being (Wales) Act 2014, carers now, for the first
time, have the same rights as the people that they care for. So,
they have the right to have a support plan, should they need one.
So, I hope that that will transform the care that we give to carers
as well. Now, carers have to identify themselves as carers; they
don’t have to provide evidence of providing substantial
amounts of care either, so that should make it easier for carers to
self-identify and to seek the support that they’re entitled
to.
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[160] In terms of
support for carers, we are refreshing our carers action plan at the
moment, and the Alzheimer’s Society will be consulted as part
of that, because we’re keen to ensure that we support carers
who look after older people. And finally on that, I attended the
British-Irish Council earlier this year, where a specific item of
discussion was carers, and as a collective we identified that older
people, and older people who care, should be a new focus for action
in the future as well.
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[161] Caroline
Jones: I’m pleased that there is support for carers,
because I think the term ‘carer’ is so general and so
vast really that we need to know that they are comfortable in
dealing and helping people with dementia, as much as they are in
any other field that they come across—people with physical
ailments. So, that’s comforting to know. Thank you.
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[162]
Dai Lloyd: Diolch yn fawr. Rwy’n ymwybodol iawn
o’r amser sydd yn ymdreiglo ymlaen, felly buaswn yn gofyn am
gwestiynau cryno, ac hefyd atebion cryno, am yr hanner awr nesaf.
Felly, dechrau gyda Lynne.
|
Dai Lloyd: Thank you very much.
I’m very aware of the time that is passing, so I would ask
you to ask brief questions, and also to answer briefly, in the next
half hour. So, we begin with Lynne.
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[163] Lynne
Neagle: Thanks, Chair. When I had the short debate on the
national dementia strategy, I called for everybody with dementia to
be given a support worker. The proposal that the Welsh Government
published in ‘Together for Mental Health’ suggested one
support worker per two GP clusters, which the Alzheimer’s
Society have estimated will be about 32 for the whole of Wales,
which clearly isn’t going to be enough. Can you confirm that
that is something that you are looking at again to try and get more
coverage for these new support workers?
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[164] Vaughan
Gething: It will be something that we consider as we develop
the strategy, and that’s part of the point about the
consultation, about understanding what the needs are, and how we
best support people living with dementia. So, it will certainly be
something that will get considered as we develop the action plan,
and you’ll see there will then be a formal consultation on it
as well.
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[165] Dai
Lloyd: Diolch yn fawr. Julie.
|
Dai Lloyd: Thank you very much.
Julie.
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[166] Julie
Morgan: Two quick questions. I was very pleased to have the
Alzheimer’s Society train my staff a couple of weeks ago, and
we were all very impressed and certainly learnt a lot. I wonder
what opportunities there are to encourage training at every level
of life really, because to make a dementia-friendly society, it
needs to be everywhere, doesn’t it? That was the first
question. And the second one was that I was very pleased to visit
REACT—the community response enhanced assessment, crisis and
treatment service—in St David’s Hospital in Cardiff
over the summer period, where they work with older patients with
dementia, and take the hospital to the home almost, in order to
keep people at home. I was tremendously impressed with the work
that they were doing there, so I wondered what opportunity there
was to extend that type of work.
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11:30
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[167]
Vaughan Gething:
You’ll have heard from the chief
medical officer that a part of what we want to do, and we recognise
we should do, is about providing more care at home, and how we take
services out of one particular setting and take them into a
community or home setting as well. So, that’s definitely part
of our direction of travel. I think Rebecca will deal with the
first point.
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[168]
Rebecca Evans: The training you would have had would have been part
of the Dementia Friends scheme, which is something that I had the
pleasure of launching as a backbencher two years ago. So,
it’s great to see now that we have more than 2,000 dementia
friends across Wales—2,001 now. [Laughter.] It’s a fantastic scheme in
terms of changing the way that communities respond to and recognise
the needs of people with dementia. I’m absolutely keen to
continue supporting it and I’m keen to encourage other
Members to take up that training opportunity as well.
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[169]
Dai Lloyd: Frank, did you want to wrap up on dementia before we
move on?
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[170]
Dr Atherton: Just a couple of points on the last two questions.
First of all, on the question of support workers, that was
discussed at the meeting and we recognised that the number was
relatively small. It was recognised also that support workers work
in different ways—there are many different models emerging
and we need to see what works best. There is also recognition that
there are other people in the system who could perhaps take on that
role, as well as dedicated support workers. So, there is definitely
a capacity issue, but there are different ways of getting around
that.
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[171]
Then on the point about information and
getting information and education more generally, I’m sure
that will be part of the strategy because making circumstances
where people with dementia can go out into the community and not be
subject to difficult circumstances, and how they can interact in
society, is a really important point going forward. So, that will
certainly be in the strategy, I’m sure.
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[172]
Dai
Lloyd: Diolch yn fawr. Symudwn ymlaen at yr adrannau nesaf o’r
adroddiad llawn iawn gan Ysgrifennydd y Cabinet. Yr adran nesaf ydy
ad-drefnu ysbytai. Mae gan Lynne gwestiwn.
|
Dai
Lloyd: Thank you very much.
We’ll move on to the next section of the very full report
from the Cabinet Secretary. The next section is hospital
reconfiguration. Lynne has a question.
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[173]
Lynne Neagle: Minister, your report highlights the fact that
you’re still considering the full business case for the
specialist and critical care centre for Cwmbran. As you know, the
business case has been in with Welsh Government now since October
last year, which is a long time. The development is hugely
important, not just for communities in Gwent, but the whole of the
plan for the south Wales programme is based on it. So, it is urgent
now that we get a decision. When do you expect to make that
decision?
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[174]
Vaughan Gething:
Thank you. I do recognise that this has
been an issue that you have consistently and persistently raised,
to be fair to you, over more than one term, because I know this has
taken a significant period of time. I’m grateful to you and
some of the other Gwent AMs, who I’ve had the opportunity to
meet with in this term as well.
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[175]
You’re right to point out that this
development is part of the south Wales plan, so it isn’t just
a Gwent issue. It’s important for the delivery of services
right across south Wales, so it’s got to fit within that
context. If I can be as helpful as I can, we’ve had an
independent review through the summer of the business plan
submitted. I’ve asked the chief executive to do some further
review work, which will take us to a point where a decision can be
made, because I recognise there’s a point here about
certainty and about being able to confirm that we can proceed with
something that will fit in with the whole south Wales programme and
the way we want to redesign healthcare delivery. So, I’m also
keen to make clear that I think this has gone through three
previous health Ministers and it’s absolutely my ambition to
be the last health Minister to have to make a decision on this, so
that there is real certainty provided, and I recognise that
it’s the sooner the better. So, I can’t share
everything until I’ve got that advice, but that advice is in
train and I expect to have it within this half of this term. As
soon as that is available, I will of course update and inform
Members.
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[176]
Dai
Lloyd: Diolch yn fawr. Hapus? Reit, rŷm ni’n mynd i symud
ymlaen at yr adran nesaf. Eto, ar dalu am ofal; nid wyf yn gweld
cwestiwn. Beth am gynlluniau dyfodol gwasanaethau cymdeithasol? A
yw pawb yn hapus gyda’r rheini? Ar faterion ariannol y
gwasanaeth iechyd, a yw pawb yn hapus? Byddwn yn symud ymlaen i
sôn am isafswm pris uned o alcohol. A oes unrhyw un eisiau
sôn am hynny? Rwy wedi eich tawelu chi yn awr yn amlwg.
Rhun.
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Dai
Lloyd: Thank you. Happy? Okay,
we are going to move on now to the next section. Again, on paying
for care; I don’t believe there are any questions on that
section. What about social services’ future plans? Is
everyone content with that? On NHS financial issues, is everyone
content? We’ll move, therefore, to minimum unit pricing for
alcohol. Are there any questions on that? I’ve silenced you
all now, clearly. Rhun.
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[177]
Rhun ap
Iorwerth: Dim ond diweddariad ynglŷn â lle rydych yn
tybio y gallem ni fynd yn y
maes yma mewn cydweithrediad efo Llywodraeth y Deyrnas Unedig, am
wn i.
|
Rhun ap
Iorwerth: I’d just like
an update on where you think we could go in this section in
co-operation with UK Government, I assume.
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[178] Rebecca
Evans: Well, as I said in the debate on substance misuse
earlier on this week, Welsh Government still believes that we are
very keen to introduce minimum unit pricing, because we know the
evidence is there that the price of alcohol matters and that
introducing minimum unit pricing could be a high-impact proposal
for improving public health and tackling the health harms
associated with alcohol abuse in Wales. As you’ll probably
know, the matter’s currently with the Scottish courts, and
so, when we understand what the position is there in terms of
legislation, we’ll understand better what our opportunities
would be to legislate on it in Wales. We are keen to do it.
However, there’s that as the first stumbling block. The
second would be, of course, the Wales Bill, which might mean that
powers are taken away from us in this regard, and we would be
unable to achieve our ambitions on minimum unit pricing. We are
lobbying the UK Government hard to ensure that we are able to do
it. Any support that individual Members or, indeed, the committee
would be able to offer on this issue would be much appreciated,
because I know it enjoyed cross-party support in the previous
Assembly.
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[179] Rhun ap
Iorwerth: And it’s very pertinent, in that we have, as a
committee, considered the implications of, of course, the Bill and
are concerned about it. Could you give us an idea of the kind of
work that you’re doing in order to try to ensure that the
Wales Bill doesn’t end up being a barrier to what could be
the implementation of a very useful policy in terms of public
health in Wales?
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[180] Rebecca
Evans: Well, it’s a case of lobbying UK Government, but
also taking other opportunities, because the House of Lords is
currently looking at alcohol at the moment. So, we took that
opportunity again, in terms of submitting our evidence, as making
the case that this is what we would like to do. And the issues that
you raised in the Chamber, also earlier this week, in terms of
licensing as well, they were very much front and centre of our
evidence presented to the House of Lords committee.
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[181] Dai
Lloyd: Huw.
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[182] Huw
Irranca-Davies: I’m assuming from what you’re
saying, Minister, that the intention would be that, when this comes
to the House of Lords, you would like it resolved there, and it
isn’t far off.
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[183] Rebecca
Evans: Well, you make a good point in terms of timing being
very important, because, if there was an opportunity for us to take
action within our public health Bill in a timely way, in a way that
would allow it to be passed before the Wales Bill, then that would
be great, but it’s very unlikely. So, it would be better for
it to be resolved in the Wales Bill, and then we can get on with
our ambitious plans for minimum unit pricing.
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[184]
Dai Lloyd: Diolch yn fawr. Symudwn ymlaen i’r adran
nesaf. Bydd dilynwyr cyson y pwyllgor yma’n ymwybodol bod
chwaraeon hefyd yn dod o dan ein cylch gorchwyl ni. A oes gennym ni
gwestiwn ar y mater yna? Angela.
|
Dai Lloyd: Thank you very much.
We’ll move on, therefore, to the next section. Regular
followers of this committee will be aware that sport is now also
within our remit. Do we have any questions on that issue of sport?
Angela.
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[185] Angela
Burns: I’d just like an update, actually, if possible, as
to what the national physical activity director is undertaking in
his or her remit. I’m not quite sure who the person is. We
discussed in the debate yesterday about the levels of inactivity,
and I thought Suzy Davies made some interesting comments about how
we could soft sell some of this. Sometimes, if you come out and
say, ‘No, Government thinks you shouldn’t eat the
doughnuts’ or eggs, or whatever it is—you know, all
fads—people tend to sort of think it’s all that ebb and
flow of contrary opinion. So, I wanted to understand a little bit
more about the role of the physical activity director, and also
understand a little bit more about the fact that, I know that the
bumph that comes through my door is very much aimed at me and my
kids, you know, our age bracket, but, of course, we are an older
population in Wales and older people will have different ways of
being able to access physical activity, and they will be very
limited. They’re not going to go out and run the five-mile
run on Pendine sands tomorrow, necessarily—some might. I know
I’m not, but some might. But I’d like to understand how
we’re going to actually get across the piece. And especially
I do feel for older people, because they will often have things
that are not working as well as they used to. They are often
waiting for treatment. They’ve got bone issues, et cetera.
And, of course, the more infirm you become, the more unable you are
to move, the greater everything else starts going wrong. So, I do
think it’s really important that we make it more available in
a very gentle and non-judgmental way, the ability to access
different ways of keeping fit and just be a little bit broader. I
just wanted to have an overview of what this individual intends to
do. Will they look at the whole piece?
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[186]
Rebecca Evans: The national director is somebody called Jonathan
Davies and he’s been producing a report, which is called
‘Getting Wales moving’. His role is a joint
collaboration, funded by Welsh Government, Sport Wales and Public
Health Wales. I think that’s really important because it does
reflect where we are now with bringing public health and sport and
physical activity within the same portfolio. His report is—.
Currently, we’re asking stakeholders to look at the report.
He’s got many recommendations in it, so we’re asking
stakeholders: ‘What is it within the report that you think
will make the real difference? Where do you think our priorities
should be?’ Because Welsh Government have been so closely
involved with it, being a tripartite collaboration, it did inform
some of the work that we’ve already done and it will
certainly be informing our healthy and active strategy, which
we’ll be publishing later on this year. So that’s where
you’ll see, I suppose, the fruit of that piece of work in
particular.
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[187]
With regard to older people, I met with
the older person’s commissioner and raised exactly this
point—that I wanted to see how we could work closely together
on what we could do to make sure that we build in physical
activity—it doesn’t have to be sport as such, but there
are things like walking football and things that are becoming very
popular now—and to see how we can work together on the
physical activity agenda for older people. She’s already
given me some good examples of things that we can look at that are
happening elsewhere, but I’m really keen to establish
what’s already going on here in Wales and what we can do more
on in this field as well.
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[188]
Angela Burns: Okay, thank you.
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[189]
Dai
Lloyd: Rhun, nesaf.
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Dai Lloyd: Rhun, next.
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[190]
Rhun ap Iorwerth:
Can I invite you to really share your
vision, both of you perhaps, about how far you’re willing to
push this agenda? I’m very pleased that sport is included
along with health. I think this is key to the long-term health of
our nation. I’d like to know from you—I’m sure
the committee would like to know—how innovative you are keen
to try to be in order to push this agenda forward, working, for
example, with other Government departments, with the education
department, on increasing sporting hours at school, on physical
testing at school in order to highlight potential health issues, on
use of NHS funding for infrastructure investment in order to boost
sport. Whatever it might be, how ambitious are you?
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[191]
Vaughan Gething:
There’s a clear ambition to have a
healthier and more active nation. Activity is a big part of that.
Some of that isn’t about money, it’s about what we can
do together. The curriculum review in education will be important
in terms of not just sport but physical activity, because lots of
children and young people love sport, but there are others who
don’t. So, how do we make sure that everyone gets a message
about the importance of activity?
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[192]
And there’s an importance to
working with Carl Sargeant as well, because an awful lot of this is
about how you work with whole communities so the messaging that
children and young people get is complemented and supported by the
parent and carer communities, rather than getting very different
messages on all sorts of public health messages and
activity—diet, exercise, smoking and alcohol being the four
big things that we know we could and should do something more with.
That’s why the First Minister decided to bring this
department together. You’re right about sport. It’s the
community and the participation end of sport that we have in this
department. Ken Skates has, if you like, the major and professional
end of sport as well. So, this is about how we get a healthier
population.
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[193]
We are open-minded about what we could
and should do and how we want to work with other departments. What
I don’t think we should do is to try and set an ambition
saying, ‘We have ambitions to do three or four different
things with other departments’, as opposed to saying,
‘See what comes up with our healthy and active
strategy’, and you’ll then see something more about
what we think we can do and will then do, working with other
partners within Government and outside as well, because a lot of
this is about changing the way the public think about their own
health. It’s what I mentioned earlier and about what you can
do to be more active and make a real difference to your own health.
It doesn’t have to be going for a five-mile run on Pendine
Sands, as you say; it can be a different form of physical activity
that really does make a difference. For those of us who work in
this building, and I work as an elected representative, we all know
that lots of our life is very inactive until you get a big spurt of
activity around election time. Even if you’re campaigning
throughout the rest of the year, this job is sedentary. So, we have
examples to set ourselves in the choices we make as well.
There’ll be similar choices for the rest of the
country.
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[194] Part of our challenge is that lots of people
understand healthy choices; it’s about how we make them
easier and not to be judgmental about them. Lots of people
understand the message about five fruit and veg, but it’s
about how we make it easier and more accessible for people to want
to do that and change some of the cultural norms, about
whether that actually really does take place on a regular basis,
and that’s the same for activity as well. That’s why,
for example, Rebecca’s leading the work for the Government on
active travel. Because it isn’t just about sport; it is that
broader physical activity, and the norms of the way we live our
lives as well.
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11:45
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[195]
Rebecca Evans: I’d add, also, that there is a broader role for
the NHS in Wales. We often, in committee—. I was expecting to
come today and not actually have any questions on the public health
agenda and the physical activity agenda, because it’s often
the case that, when we are talking about health, it’s always
in terms of response times, NHS configuration, GPs and so on. It
very rarely actually comes down to the public health aspect, so
it’s really encouraging to have these kinds of questions
today. I do think there’s a wider role for the NHS, and
we’re meeting later on today with the chairs and chief execs
of all the NHS organisations in Wales, and I will be making it
clear to them that we do see a significant role for them in
physical activity and that public health agenda there as well. So,
we’ll have those conversations today.
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[196]
Dai Lloyd: Huw.
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[197]
Huw Irranca-Davies:
I welcome that very much, and the point I
wanted to make reinforces what Angela and Rhun have both said. I
mentioned yesterday on the floor of the Senedd the Spirit of Llynfi
community woodland. Yes, it’s trees. Yes, it’s
development footpaths or whatever. But what is fascinating about it
is that it’s in one of the areas of most significant health
disadvantage within Wales, not simply within my constituency.
It’s designed, with gateways into that area, for those light
walks, as well as heavy-duty cycling up into the mountains, and so
on, and it’s working with GPs and with the schools, and so
on. I’d prefer that we were talking, in some ways, in three,
four or five years’ time more about this and less about the
repair costs, because this is the stuff that can do it. But I just
wonder: we have gone a world now from in the 1980s, when I think
the first ever GP referral scheme was there in Swindon at the Oasis
leisure centre, and now we’re into this sort of
thinking.
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[198]
To pick up on Rhun’s point, I think
we do need to, as much as we can, push this right across
departments in a very ambitious way, and connect not with
expensive, high-duty, elite sport—important though that is in
some ways—but more with how easy it is to walk out from your
house, take exercise and socialise—the mental health benefits
of socialising as well. So, please push hard on this, and I look
forward to the strategy coming forward, but we’d love to see
ambition, I think.
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[199]
Dai Lloyd: Lynne.
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[200]
Lynne Neagle: I recently joined a walking group in my constituency,
for them to show me what they’re doing. I was absolutely
amazed at how many people went out walking, and also the really
inspiring stories that they told. It wasn’t just about
exercise. Some of them had stopped being diabetic as a result of
this walking that they were doing, but also it was a social thing.
They’d made friends. Somebody had even met a new partner
doing it. It was absolutely fab. Now, I understand that
there’s money coming from Welsh Government for that scheme.
Is it your intention to continue with those kinds of initiatives?
Obviously, with the budget pressures, that is a concern.
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[201]
Vaughan Gething:
These take place through a range of
different parts of Government. That’s why I mentioned Carl
Sargeant, particularly, because a lot of this takes place in
Communities First areas, where they have support groups to
undertake this form of physical activity. Walking is very much part
of what a range of clusters are doing in terms of trying to improve
activity. That’s why the healthy and active strategy will be
a cross-Government strategy. It won’t simply be about what we
can do within this part of the Government. It is about looking
across the Government, about who’s got an influence, where it
works and how we try and meet those ambitions to be a more healthy
and active nation. I’m really pleased that you’ve taken
the time to go and meet one of these groups as well. It can seem
like a fringe activity. Sometimes people are very disparaging about
ramblers. Actually, there’s all sorts of ways to enjoy
different parts of our country, and it really can be something that
reinforces those points, and, again, there’s the point that
Huw made earlier about the mental health benefits of physical
activity, seeing other people and getting out of the house, and the
physical benefits that you see from it as well. So, I think that,
within this committee, and from our side as well, there is
acceptance of the benefits that can be gained. It is about how we
do that and how we actually try to take advantage of that, because
money is an issue. But lots of this can be done without spending
huge sums of money. It’s about a really significant cultural
change that we need to deliver.
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[202]
Dai
Lloyd: Julie, ac wedyn Huw.
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Dai
Lloyd: Julie, and then
Huw.
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[203] Julie Morgan: Just to reinforce that it doesn’t take a lot of
money to make progress in this area, I had an event in my
constituency about 12 months ago—an open event for older
people, to find out what they wanted to do. One of the top things
they had on their wish list was physical activity, and dance, in
particular. So, now we have been able to establish Rubicon coming
up to Whitchurch community centre and having a dance session
for older people. They’ve loved it, and it’s been
tremendously successful. I understand, from Rubicon, that they also
go into old people’s homes and do a lot of movement with
older people, which helps in so many ways. I was hoping that that
is something that you would also be able to take on board—the
dance element.
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[204] Rebecca
Evans: Absolutely, yes.
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[205]
Dai Lloyd: Dyna ni. Huw.
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Dai Lloyd: There we are. Huw.
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[206] Huw
Irranca-Davies: I wanted to ask something specifically on this
issue to do with your portfolio: the idea of either GPs or nurse
practitioners recommending light exercise, use of the outdoors, let
alone leisure centre stuff and all of that. How far advanced are we
on that, because my perception is that it’s a little
sporadic? There are good clusters of GPs who have really bought
into this. There are others where, frankly, it isn’t
happening. We do understand when they say, ‘We don’t
have enough time to go through the mindset change to explain to
people, ‘We’re not going to prescribe you medicinal
products; we’re going to prescribe you exercise and
socialisation’, but what’s your assessment, as
Ministers, about how far we are into this process where this is
part of people’s health and prescription?
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[207] Rebecca
Evans: Well, we’ve established Making Every Contact
Count, which is how we’re encouraging GPs and other
professionals to have those kinds of conversations that
you’ve just described with the people who come to them for
help, assistance, advice and so on. You mentioned the national
exercise referral scheme earlier on, and I’ve seen some of
the stats. I was actually quite amazed, because we’re talking
about people who have been previously completely inactive. Seventy
per cent of them, after completing the programme, are still
exercising regularly. I think that’s a real success story.
But, as you say, perhaps something that intensive isn’t for
everyone, so we will be piloting social prescriptions over the
course of this Assembly as well. Again, this is one of our
manifesto commitments.
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[208] Vaughan
Gething: Just briefly on your point about consistency, Richard
Lewis, the national lead for primary care, has taken a real and
active interest in this. He’s looking at ways to try and
highlight what we’re already doing, but also then to try and
do something about the consistency and approach of that as well so
that this is an active part of what we’re considering within
Government.
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[209]
Dai Lloyd: Diolch. Rhun.
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Dai Lloyd: Thank you. Rhun.
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[210]
Rhun ap Iorwerth:
One from me again on the urgency. I see
that you’re supportive of increasing physical activity, and
that’s good, but again it’s the urgency that I’m
interested in. There’s urgency, of course, because of the
health of our young people and the future that they have to look
forward to, but what about the financial side then, if that would
help urgency perhaps? What comprehensive assessment has been made
of the potential savings to the NHS from putting in place a real
and successful campaign to increase the fitness of our young people
through increased physical activity and sport?
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[211] Vaughan
Gething: All of us know that improving the general health of
our population, dealing with those public health challenges, will
have a significant range of savings. In almost all of the delivery
plans that we have for major conditions, I think there are major
public health challenges that underpin the rise in demand for that.
We could go and do an assessment if you like, but I
think—
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[212]
Rhun ap Iorwerth:
I would like.
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[213] Vaughan Gething: What we understand is that, in each of those
areas, there are significant savings to be made if we improve diet,
exercise, reduce smoking and have more moderated levels of
drinking. You could pick any condition, from heart disease to lung
cancer, to dementia, to diabetes, and you would see the impact in
each of those areas within that. What I don’t want to do is
to try and undertake an exercise that will appear artificial. We
know that there are significant health gains to be made that will
reduce the level of demand within the service. Andrew.
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[214] Dr
Goodall: Yes. I think it’s important to mention, on the
one hand, that we’ve put a lot of attention on the NHS as an
illness service, but we need to reinforce its role around wellness
in general terms. What might help this discussion—and we are
currently reviewing what that means internally, and again to give
advice to the Cabinet Secretary and Minister—is the economic
case around prevention generally. There is an aspect of which, of
course, where fitness and physical activity fits with that. Public
Health Wales recently put into the public domain some information
around their own evidence base that they’ve been able to
gather. We obviously have an interest in that, from the Welsh
Government. In fact, the Minister got alongside that to endorse it
coming out into the public domain at this stage. So, we can draw in
some of that information at the moment, but I think there’s a
role for the Welsh Government alongside just using Public Health
Wales as an evidence base.
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[215]
Rebecca Evans: That evidence base is called Making a
Difference. The committee might be interested in having a look at
that. It has an executive summary
report, which is quite accessible, and
some infographics. But, then, it also does have quite a robust and
significant piece of evidence work underpinning it as well, looking
at the economic case for action in a variety of areas including
substance misuse, for example, tackling violence against women,
activity, mental health and other areas as well.
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[216]
Dai
Lloyd: Diolch yn fawr. Wel, rydw i’n credu y dylwn i
gloriannu’r sesiwn yna. Jest i’ch cynghori, efallai,
Ysgrifennydd y Cabinet, nid oes raid bod yn sedentary;
mae’n bosib defnyddio’r grisiau yn y lle hwn
trwy’r amser yn lle defnyddio’r lifft-10,000 o gamau
bob dydd sydd ei angen a gallai’r rhan fwyaf ohonom lwyddo i
wneud hynny. Yn nhermau beth rŷch chi’n ei ddweud i
werthu ffitrwydd fel tabled, mae yna ddigon o waith ymchwil i
gefnogi beth rŷch chi’n ei ddweud, sydd yn enwedig wedi
cael ei wneud yn Ysbyty Brenhinol Morgannwg yn Llantrisant.
Mae’n darogan, o ddod yn ffit, fod pwysau gwaed pobl yn
cwympo rhyw 30 y cant, mae lefel siwgr yn y gwaed hefyd yn cwympo
rhyw 30 y cant, lefel y colesterol a phwysau i gyd yn cwympo rhyw
30 y cant. Petai hynny’n dabled newydd, buasai bawb yn gwthio
NICE i’w gyfreithloni’n syth, ond mae’r ateb
yna’n barod: jest dod yn heini. Felly, mae
eisiau’i werthu yn yr un modd.
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Dai
Lloyd: Thank you very much.
Well, I think we should just sum up that session. If I could just
advise the Cabinet Secretary, we don’t have to be sedentary;
we can use the stairs in this place rather than using the
lift—you need 10,000 steps per day and most of us can manage
that, I think. In terms of what you said about selling fitness as a
tablet as it were, there’s plenty of research to support what
you’ve said, and it’s been done particularly in the
Royal Glamorgan Hospital in Llantrisant. It predicts that, if one
does become fit, then blood pressure falls by some 30 per cent,
blood sugar levels also fall by some 30 per cent, cholesterol
levels and weight all fall by some 30 per cent. If that were a new
tablet then everyone would be urging NICE to make it available
immediately, but the solution is there already: it’s just
getting fit. So, we need to sell it in those terms.
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[217]
Rydym ni wedi
rhedeg allan o amser nawr. Mae yna gwpl o gwestiynau bach eraill,
ond, gyda’ch caniatâd, mi wnawn ni ysgrifennu atoch am
atebion i’r rheini. Felly, diolch yn fawr iawn i chi am
eich presenoldeb heddiw, Weinidog ac Ysgrifennydd y Cabinet, a
hefyd Andrew Goodall, ac roeddwn i’n falch i gyfarfod â
Dr Frank Atherton am y tro cyntaf, a hefyd Albert Heaney. Diolch yn
fawr iawn i chi i gyd am eich presenoldeb.
|
We have run out of
time now. There are a few other questions, but with your
permission, we will write to you with those. So, I’d like to
thank you very much for your attendance this morning, Minister and
Cabinet Secretary, as well as Andrew Goodall. It was also good to
meet Dr Frank Atherton for the first time, and Albert Heaney. So,
thank you all very much for your attendance.
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11:57
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Papurau i’w Nodi
Papers to Note
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[218]
Dai
Lloyd: Tra bod ein cyfeillion yn gadael, fe wnawn ni droi i eitem 6
yn fyr—papurau i’w nodi sydd yn fanna. Mae pethau un ai
wedi’u hymdrin eisoes, neu er gwybodaeth yn unig. A oes gan
rywun unrhyw sylw? Na.
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Dai
Lloyd: While our colleagues
depart, we can turn to item 6 very briefly—papers to note.
These are issues that we’ve either already dealt with or are
there for information only. Does any Member have any comment on
those papers? No.
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Cynnig o dan Reol Sefydlog 17.42 i Benderfynu
Gwahardd y Cyhoedd o Weddill y Cyfarfod ac o’r Cyfarfod ar 21
Medi 2016
Motion under Standing Order 17.42 to Resolve to Exclude the Public
from the Remainder of the Meeting and from the Meeting on 21
September 2016
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