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 09:17.
The meeting began at 09:17.
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Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
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[1]
Dai Lloyd: Croeso i gyfarfod diweddaraf y Pwyllgor Iechyd,
Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad Cenedlaethol
Cymru. O dan eitem 1, cyflwyniad, ymddiheuriadau, dirprwyon a
datgan buddiant, a allaf i gyhoeddi bod Jayne Bryant wedi cyflwyno
ymddiheuriadau? Ac mae hi wedi esblygu i fod yn Lee Waters, felly
croeso i Lee Waters i’r cyfarfod hwn y bore yma. Gallaf i
ymhellach egluro i bawb, yn amlwg, bod y cyfarfod yma’n
ddwyieithog. Gellir defnyddio 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 i
hefyd atgoffa pobl, yn cynnwys y Cadeirydd, i ddiffodd eu ffonau
symudol ac unrhyw offer trydanol arall sy’n gallu ymyrryd
efo’r offer darlledu? Nid ydym yn disgwyl tân y bore
yma, felly os bydd yna larwm yn canu, rydym yn cael ein cyfarwyddo
i ddilyn y tywyswyr i adael yr adeilad mewn modd
boddhaol.
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Dai Lloyd: Welcome to the latest
meeting of the Health, Social Care and Sport Committee here in the
Welsh Assembly. Under item 1, introductions, apologies,
substitutions and declarations of interest, can I just say that
Jayne Bryant has given her apologies? And she has now evolved into
Lee Waters this morning, so welcome, Lee, to this meeting. Can I
also explain to everyone that this meeting is bilingual? You can
use the headphones to hear Welsh-to-English simultaneous
translation on channel 1, or you can have amplification on channel
2. Can I also remind people, including myself, to turn off their
mobile phones and any other electronic equipment, because it can
interfere with the broadcasting equipment? We are not expecting a
fire alarm this morning, so if you do hear the alarm then please
follow the directions of the ushers out of the building in an
orderly fashion.
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09:18
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Ymchwiliad i Recriwtio
Meddygol—Sesiwn Dystiolaeth 10—Ysgolion Meddygol
Cymru
Inquiry into Medical Recruitment—Evidence
Session 10—Medical Schools in Wales
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[2]
Dai Lloyd: Felly, symudwn ymlaen i eitem 2: sesiwn
dystiolaeth 10 ar yr ymchwiliad i recriwtio meddygol. O’n
blaenau ni mae gyda ni dystion y bore yma o ysgol feddygaeth
Prifysgol Caerdydd ac ysgol feddygaeth Prifysgol Abertawe. Efallai
y dylwn i ddweud ar y dechrau fel rhyw fath o ddatgan buddiant fy
mod i yn bersonol wedi graddio un tro o ysgol feddygol Cymru yng
Nghaerdydd ac mae fy mab hynaf wedi graddio ryw dair blynedd yn
ôl o ysgol feddygol Abertawe. Felly, mae hynny ar y record.
Felly, gyda hynny o gyflwyniad, a allaf i felly groesawu Dr Stephen
Riley, deon addysg feddygol ysgol feddygaeth Prifysgol Caerdydd, yn
ogystal â’r Athro Ian Weeks, pennaeth ysgol ysgol
feddygaeth Prifysgol Caerdydd, yn ogystal â’r Athro
Keith Lloyd, sydd wedi bod o flaen y pwyllgor yma eisoes, ond mewn
rôl wahanol heddiw fel deon a phennaeth ysgol feddygol
Prifysgol Abertawe? Ac hefyd, croeso i Craig Hathaway, sydd yn
fyfyriwr meddygol yn ysgol feddygol Abertawe. Rydym wedi derbyn
eich adroddiadau ysgrifenedig, ac wedyn mae’r cwestiynu yn
seiliedig ar beth rydym wedi’i glywed yn y naw sesiwn
dystiolaeth cyn hon, yn ogystal â’ch deunydd
ysgrifenedig. Felly, heb fwy o siarad, fe awn ni’n syth
i’r cwestiynu. Nid oes rhaid i bawb ateb pob cwestiwn, gyda
llaw, achos yn y bôn, awr sydd gyda ni. Nid ydym yn mynd i
fod yma drwy’r dydd. Rydym yn mynd i ddechrau efo Dawn
Bowden.
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Dai Lloyd: Moving on, then, to item 2,
please: this is evidence session 10 on the inquiry into medical
recruitment. Before us we have witnesses from Cardiff University
school of medicine and Swansea University medical school. Perhaps I
could, as some sort of declaration of interest at the beginning,
say that I personally did graduate a long time ago from Cardiff
medical school and my eldest son graduated some three years ago
from Swansea medical school. So, that is now on record. Moving on,
then, can I please welcome Dr Stephen Riley, dean of medical
education, Cardiff University school of medicine, as well as
Professor Ian Weeks, head of school, Cardiff University school of
medicine, and Professor Keith Lloyd, dean and head of Swansea
University medical school, who has appeared before this committee
previously, but in a different role today in his role as dean in
Swansea? I also welcome Craig Hathaway, who is a medical student at
the Swansea University medical school. We have received your
written submissions, so the questions will be based on what
we’ve heard in the previous nine evidence sessions, as well
as your written submissions. So, we’ll go straight into
questions then, if we may. You don’t all have to answer every
question, by the way, because we only have an hour. We’re not
going to be here all day. We’ll begin with Dawn Bowden.
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[3]
Dawn Bowden: Thank you, Chair. Good morning, everyone, and
nice to see you again. Can I just open up with a general question
around the new single body, Health Education Wales, and what you
think in particular the impact on that is likely to be, both in
terms of the structure and the funding for medical education? Which
one of you can kick off? Anyone—
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[4]
Dr Riley: I think it’s an interesting proposal and
follows similar funding models in the UK. I think trying to bring
everything under one roof, one umbrella, is an important way to go.
As you’ve heard in other evidence, trying to have a joined-up
approach, an all-Wales approach, to the recruitment, retention and
funding of healthcare is important. We’re increasingly
recognising that the inter-professional nature of healthcare
delivery, and trying to co-ordinate that centrally, is something
that I think is important. The difficulty, I guess, when it comes
down to the funding, is healthcare is getting more expensive.
It’s getting more expensive to train individuals. We have to
recognise that we have to train people locally and to try to
balance all of those aspects is going to be a difficult job for
that funding body, I think.
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[5]
Professor Weeks: Certainly, I think the inter-professional
side of things is very important. I think it does give the
opportunity to have much greater overlap between the disciplines
and I think one can certainly applaud that, to improve efficiency
and efficacy, for sure.
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[6]
Professor Lloyd: If I may, I think one of the criticisms you
could level at the current arrangements is that there’s
something of a disconnect between training and service provision.
By its nature, training is not the same as service provision, but
if we’re going to plan for the services we need in the
future, we need to think, as my colleagues have said,
multi-professionally, but also what the service needs are in
particular areas. So, for example, if you have trouble providing
doctors in west Wales, say, which is an example that’s
pertinent to us, then if you would move the training slots from
there you perpetuate the problem and you make it worse, rather than
realising the opportunities that the area might have, which is
something that we might be able to realise through Health Education
Wales.
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[7]
Dawn Bowden: Which is all to do with, presumably, the kind
of forward workforce planning type of programme that they need to
go through. How does that work now, then? Presumably, you identify
the number of training places that you need and it either is
approved or it’s not. Do you see this new body operating
differently to that?
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[8]
Professor Lloyd: As medical schools, we’re not
primarily involved in the delivery in that aspect of the thing.
It’s the deanery that currently does that at the moment. I
think there’s a real opportunity for the universities to be
more involved in that with the health boards, which is something
that we’re doing through ARCH, for example, and to actually
be intimately involved in helping provide the solutions to the
workforce needs of the future.
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[9]
Dr Riley: Wales is pretty much unique in the UK in having a
single postgraduate deanery, you know, joined-up undergraduate
education and a defined area. I think we can be world leading if we
can get that structure right in terms of that delivery.
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[10]
Dai Lloyd: Can I just quickly ask Professor Lloyd to follow
up on—. You mentioned the ARCH project. Maybe you could just
tell us a little bit about that and whether that offers a model
that others might follow.
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[11]
Professor Lloyd: Okay. ARCH stands for ‘A Regional
Collaboration for Health’. It’s a collaboration between
Abertawe Bro Morgannwg health board, Hywel Dda and Swansea
University. It’s got several strands to it and it’s
linked to the city deal bid as well, which has been in the news
recently. The idea is that it will allow the university to work
with the two health boards around improving the health and
well-being of the population, driving economic growth and providing
and promoting innovation and research. So, an example would be: the
Cabinet Secretary for health was in Swansea this week and he was
opening something called the Health and Wellbeing Academy in the
school of human and health sciences, and that’s about looking
at providing a range of services in a much more social model of
medicine, outside of general practice, allowing people to go and
see an audiologist or a physiotherapist, or something like that,
without having to enter the healthcare system. So, one of the
things that we’re working up at the moment is looking at
improving primary and urgent care so that people don’t end up
in A&E. What this does is enable us to plan that on a regional
level. To relate back to the previous question, in order to make
that really work, we need to be thinking about the workforce that
we need to deliver it, which is why we’ve started also
training physician associates as well and advanced paramedics,
because they’ll be part of the workforce solution for that.
So, that’s essentially what ARCH does. It’s potentially
a model that could be very generalisable.
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[12]
Dai Lloyd: Ocê, symud ymlaen—Rhun.
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Dai Lloyd: Okay, moving
on—Rhun.
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[13]
Rhun ap
Iorwerth: Bore da i chi i gyd. Siawns mai un o brif ddibenion, os nad
prif ddiben, addysg feddygol yng Nghymru ydy darparu gweithlu ar
gyfer yr NHS yng Nghymru. A oes yna beryg bod hynny wedi cael ei
esgeuluso?
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Rhun ap
Iorwerth: Good morning to you all. Surely one of the
main purposes, if not the main purpose, of medical education in
Wales is to provide a workforce for the NHS in Wales. Is there a
danger that that has been neglected?
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[14]
Angela Burns: Sorry—
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[15]
Rhun ap Iorwerth:
Do you have a problem?
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[16]
Angela Burns: Sorry, the translation has stopped.
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[17]
Rhun ap Iorwerth:
We’ll sort that out. I’ll
carry on while we sort that out.
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[18]
Surely one of the main purposes of
medical education and training in Wales is to provide a workforce
for the NHS in Wales. Is there, on reflection, a danger that that
has somehow been neglected, driven perhaps by the nature of
competitiveness within higher education?
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[19]
Professor Lloyd:
I think both medical schools would
say—I’m speaking for my colleagues here, but both
medical schools would say that they’re doing things to
address that. For example, Craig here is on our rural and remote
health track, which is aimed at providing—. Well, I’ll
let you speak.
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[20]
Mr Hathaway: It’s an optional sort of course element where,
for the course of the four years of the degree, you opt to attend
lectures once a month or go and visit rural places where you get
lectures from rural GPs, pre-hospital emergency medicine doctors,
mountain rescue and things like that. It’s to encourage
people to experience working in rural areas. Another part of that
is that you also get to go away on clinical placement around Wales
much more than you would if you’re not on the track. So, we
make an actual decision to go away. I’ve been on placement in
Ysbyty Gwynedd in Bangor, I’ve been to Aberystwyth
twice—once in the hospital, once in a GP surgery—and
with a GP in the Port Talbot valley as well. I liked Bangor so much
I’m going there next year as well. I’ve already planned
that. The good thing about RRHIME is that, even though it’s
relatively new in the last few years, numbers have been increasing
year on year. So, in the current intake there’s about 15 or
16 students on that track, which accounts for just over 20 per cent
of the year.
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[21]
Rhun ap Iorwerth:
You’re clearly the exact kind of
medical student that we want. I’m sensing from you that you
see a career working in medicine in Wales.
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[22]
Mr Hathaway: Yes, but I was living in England. I did my undergrad
degree in England and I was living in Bristol for three and a half
years. If I hadn’t come back to do this medicine degree,
I’d still be in Bristol. So, there’s a
positive.
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[23]
Rhun ap Iorwerth:
We know from figures that we’ve
seen that two thirds of medical graduates in Wales work in Wales
afterwards. Do you think that’s a good figure?
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[24]
Professor Lloyd:
It could be higher.
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[25]
Dr Riley: I think what we’re doing is striving for
excellence. That proportion of graduates that stay in Wales has
been relatively static over a few years. It drops further when you
go further into training. When you get to higher postgraduate
training, you get to about 46 per cent of the trainees who are
graduates of a Welsh university. I think that there’s been
this perception that the number of Welsh-domiciled students has
dropped, particularly in Cardiff. I’ve got figures here that
show that’s not the case. I’ve heard that 10 per cent
of students are Welsh-domiciled in Cardiff. That’s not right.
There are 22 per cent to 25 per cent, depending on how you cut the
figures, across the years. That’s been relatively static as
well.
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[26]
Rhun ap Iorwerth:
As opposed to about 80 per cent in
England and 50-something per cent in Scotland.
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[27]
Dr Riley: The funding model in Scotland is different. The
funding model in Scotland allows that increase in Scottish
numbers.
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[28]
Rhun ap Iorwerth:
Okay, this is good. We’re getting
to a position where we’re able to identify that there is
another model in place that could help. Is it something that we
should aim for? Because we have very, very strong evidence. The RCP
says:
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[29]
‘It is crucial that Wales makes a
more concerted effort to attract its own students to medical school
in Cardiff and Swansea.’
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[30]
Martin Jones of Betsi Cadwaladr
says:
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[31]
‘if you’re starting with a
greater number of people who are predisposed to the idea of working
within their local communities, then the likelihood of people
coming forward’
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[32]
to study is higher. There seems to me to
be a real drive towards trying to increase the number of
Welsh-domiciled students in our medical schools. You are those
medical schools. If it means looking to a different model in
Scotland, so be it. What can be done to increase that
number?
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09:30
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[33]
Professor Weeks:
I certainly think that when we look at
our figures—and I’m sure Steve will confirm
this—for this year, as against last year, I think we’re
up to 61 per cent, from 52 per cent last year, of applicants now
who actually come into the school. So, we’ve got the right
trajectory.
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[34]
Rhun ap Iorwerth:
Fifty-one per cent of
applicants—
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[35]
Dr Riley: Around 50 per cent of Welsh students will apply to
Cardiff for an undergraduate place in medicine. For this year, it
was 288 students out of about 570. Those figures have been
relatively static over the last five years.
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[36]
Rhun ap Iorwerth:
That’s all Welsh
students—sixth-formers making applications to study medicine
anywhere.
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[37]
Dr Riley: Yes. This year, we’ve interviewed 213 of that
288. So, by contextualising the Welsh students and those students
who are from underprivileged areas, we’ve managed to increase
the ability to offer interviews to students. So, we’re up to
nearly 70 per cent of those who apply to us being interviewed. This
year, we’ve been able to offer 130 places, of those 213. So,
around 61 per cent of Welsh students who applied to Cardiff have
been offered a place this year.
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[38]
Rhun ap Iorwerth:
So, 83 of those students don’t get
into Cardiff. Do you track those?
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[39]
Dr Riley: We haven’t yet. So, there is a plan in place to
try and do that. It’s sometimes difficult to get those data.
We do follow-up surveys with students, but not all students reply
to us as to what’s happened subsequently. We know that around
10 per cent of Welsh-domiciled students turn down our offer and go
elsewhere, which is their own choice and we know that around 20 per
cent of students don’t achieve the grades to be able to get
into med school, when it comes to A-level day. That’s pretty
consistent, whether you look at England, Scotland and
Wales.
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[40]
So, those figures are starting to stack
up. I’d absolutely agree with you that we need to get more
Welsh-domiciled students in. If you look at the Scottish model and
if you look at the models that I’ve visited in Washington
state and in Maine, and I’ve talked to the people in
Australia and northern Ontario, these models do allow a pipeline of
doctors to come through into the NHS.
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[41]
Dai Lloyd: Julie first and then Angela.
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[42]
Julie Morgan: I had wanted to come in earlier on when Craig was
speaking, but perhaps I could just continue on this theme for a
moment because it’s obviously very important. I just wanted
to confirm on this: 61 per cent of Welsh students who applied to
the medical school were interviewed, is it?
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[43]
Dr Riley: No; 71 to 72 per cent are interviewed and 61 per cent
of the total who applied have got an offer.
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[44]
Julie Morgan: Have got an offer, right. That’s
fine.
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[45]
Dr Riley: So, 130 this year, which is significantly higher,
compared to normally 80 to 85. So, we’ve increased that
significantly this year, and that’s through the use of the
MMI—the multiple mini interview. So, fairness, openness and
transparency and the use of contextualised approaches to being able
to give the Welsh students that boost that they need, considering
the schools and education system that we face in Wales.
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[46]
Dai Lloyd: Okay. Keith, from the Swansea perspective.
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[47]
Angela Burns: [Inaudible.]
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[48]
Dai Lloyd: Go on then, briefly, and then Keith.
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[49]
Angela Burns: Just very briefly, following Rhun’s questions,
because what you say sounds lovely, but on the ground, it
doesn’t transpire. Just two examples: I’ve got two
students who didn’t even get a look-in at Cardiff. They were
told, ‘Don’t bother’, and they’re both now
at Cambridge. They’ll never come back to Wales and
they’re going to be bright, bright doctors. When they went to
these roadshows that try to attract students, they were literally
told by the people there, ‘You’re never going to get
the grades’ or—. I don’t even know what the
problem was because their grades predictions were absolutely top
class—A*s all across the board—and now both of them are
at Cambridge. So, now I’ve got angry parents, writing to me,
saying, ‘Don’t Welsh universities want Welsh students?
What’s going on?’
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[50]
Dr Riley: The trouble is, without knowing the
specifics—
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[51]
Angela Burns: I’ve written to your university on both of
them.
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[52]
Dr Riley: Because that’s certainly not the way that we
operate now—
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[53]
Angela Burns: This is this year.
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[54]
Dr Riley: In which case I don’t understand that. If
they apply to us and they did have those grades, they would have
been offered an interview. There’s no doubt about it, because
we were offering interviews for Welsh-domiciled students at lower
grades than we did for everybody else because of this
contextualised approach. So, I don’t understand, and
I’m more than happy to look at it with you and work out
exactly why, because that’s the sort of case we need to
address.
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[55]
All I can say is that I want to take Welsh-domiciled students into
the course, for all of the reasons I’ve articulated. I want
to work with you to be able to achieve that with different funding
models if we need to. We need to aspire to excellence, because
that’s what we want to have—an excellent health
service. So, those are the messages that I would give, and
I’d be more than happy to look at those.
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[56]
Dai Lloyd: Great. Well, perhaps a note to the committee to
that effect would be good. Sorry, Keith—the floor is
yours.
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[57]
Professor Lloyd: Thank you, Chair. I suppose the first point
I’d make is that Swansea is a graduate-entry medical school,
so it’s slightly different. We have 1,000 applications a year
of which we interview 300 for 72 places. If we had more places we
could take more students.
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[58]
The second point I’d make is that contextual admission, as my
colleague has described, is important, but there are other measures
that can be taken, and we’re describing something that
we’re calling a pipeline for encouraging people through,
because the problem starts sooner. There will always be very bright
Welsh students who don’t get into medical schools, but there
are a lot of Welsh students who don’t actually fulfil their
potential in schools, and we need to do a range of things to make
it easier for them to get into medical schools subsequently. We
have a number of feeder courses into our graduate-entry medicine
course, and the proportion of Welsh-domiciled students on that is
over 50 per cent. And we’re introducing a system whereby
people who get onto that course, if they do certain modules, will
be guaranteed an interview for graduate-entry medicine. So,
there’s a range of initiatives that need to be focused on,
not just at the point of entry, but the stuff that happens
before.
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[59]
Dai Lloyd: Craig.
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[60]
Mr Hathaway: I just wanted to say that, all the time,
especially now Swansea has shot up the UK medicine school league
tables to No. 6, it’s only going to get more appeal to the
outside—the English domiciled and elsewhere in the EU, at the
moment. So, it’s really important that we do get an increase
in these Welsh-domiciled students because there are only going to
be more people from outside as the uni gains appeal. I’ve
helped with this Reaching Wider programme; we had some Welsh-medium
schools come to the university, and we were trying to encourage not
only medicine, but also allied health professions as degrees.
Really, it could be a bit altruistic, that, because hopefully, I
suppose, they would apply for medicine and get in, but also, if
they didn’t, as a backup, they could take a route that so
many of us do now, through the graduate-entry course.
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[61]
Dai Lloyd: Good. If we move on to Caroline—your
questions are on applications and admissions, and Angela can come
back in on the back of those. So, Caroline—
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[62]
Caroline Jones: Yes, diolch, Chair.
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[63]
Dai Lloyd: —some issues have already been covered, so
there’s no need to go over old ground.
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[64]
Caroline Jones: Yes. I was just wondering, can you tell me
what the key factors are in determining which applicants get
interviewed and admitted? Are the academic factors—do they
play a key role in determining this, or non-academic elements?
What’s the proportion? How do you apportion the non-academic
and the academic and take everything into consideration regarding
an application?
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[65]
Professor Lloyd: For graduate-entry medicine, applicants
have to undergo a test called GAMSAT, which is Australian in
origin. Most UK medical schools use such a test. We use one called
GAMSAT. And that’s used as part of the interview selection
process because demand so outstrips supply at the moment. There are
1,000 applicants for 72 places, so we have to do something.
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[66]
Then, people apply in the usual way and they write a personal
statement, they fill out a CV, a standard form, and we sift all of
those, and then we interview about 300, and they have a series of
interviews. I think Craig is going back to help with that process
this morning. So, we have student ambassadors taking part in that
to make people feel at ease. Then we have a moderation exercise
after that where everybody sits down and works out what is the best
way of dividing up the small number of places. We’re looking
for the people who we think will make the best doctors. So, in most
medical schools, academic criteria—previous exam results
count for a lot. What we’re trying to do with the process
we’re introducing through our feeder courses is to recognise
that people will come to our courses without, necessarily, the
right level of academic qualifications. So, Craig, for example, was
telling me yesterday about his route into medicine, which is a very
good illustration of that.
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[67]
Caroline Jones: Okay. And the collation of data regarding
these applicants—you said that it hasn’t been exactly
good in that context.
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[68]
Professor Lloyd: My colleague said that.
[Laughter.]
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[69]
Dr Riley: Follow-up data are difficult to get, by their very
nature. So, we’re slightly different. We have 3,000
applicants for 268 places, so an order of magnitude higher. We
operate a multiple hurdle model that allows us to sift through. We
know that previous academic performance does predict ability to get
through a course, and we don’t want to set students up to
fail. So, what we do is we use academic achievement at GCSE,
accepting the Welsh system, giving that leg up to get over into an
interview, then we assess the non-academic skillsets that we
require to make good doctors within the multiple mini interview and
take those two things together to then offer the place. Now, many
medical schools in the UK will use something similar to GAMSAT
called UKCAT. We don’t use that, because we know that that
would disadvantage our Wales population, so we positively ensure
that we give Welsh-domiciled students the best possible chance to
get in.
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[70]
Dai Lloyd: Rhun next, then Julie.
|
|
[71]
Rhun ap Iorwerth:
Making a point, more than anything:
again, it revolves around this business of giving Welsh-domiciled
students the best chance, Chair, when I’m told about the
student who was one grade too short on English at GCSE to be
offered an interview, but had that grade in Welsh, but it was
deemed that that wasn’t good enough.
|
|
[72]
Dr Riley: That comes back to, I guess, the written senate
regulations of a particular course. Now, it may be that we have to
look at those senate regulations and say, ‘Hold on a minute,
should we be doing that exact approach?’ So, it’s about
the minimum requirements that the university set and, therefore,
can you influence that, can you change that? I would argue that we
should look at it and try and change it.
|
|
[73]
Rhun ap Iorwerth:
It’s about the Welsh
context—the rules by which you’re governed
and—
|
|
[74]
Dr Riley: Absolutely, yes. And I think we, perhaps, have lost
sight of that, but we are, with the changes that we’ve made
to C21, the focus on excellence, the focus on patient centredness,
the focus on community-based learning—then all of that can
come back into play.
|
|
[75]
Dai Lloyd: Craig, you had a point.
|
|
[76]
Mr Hathaway: Yes, the point I was just going to make is to enter
into graduate medicine at Swansea University—it is based on
degree. So, even though I didn’t apply for medicine, I chose
to do pharmacy before—I probably wouldn’t have got into
medicine the first time around. But there are a lot of people who
didn’t choose science qualifications before A-levels et
cetera, and the beauty of the graduate medicine course in Swansea
is that we accept students who, maybe, at 18 didn’t know
their career path and didn’t choose the right one.
|
|
[77]
Dai Lloyd: Julie.
|
|
[78]
Julie Morgan: You want me to go back now.
|
|
[79]
Dai Lloyd: Yes. No. [Laughter.] It’s all the same
situation, we never go back, we always go forward, Julie. The
floor’s yours.
|
|
[80]
Julie Morgan: I had wanted to ask about what you said about the
rural placements and all that sort of thing, when you raised that,
which I thought was very interesting and very encouraging, really.
But you did say it was extra to the curriculum and then you said
that some of the placements ended up being of that nature, so I
just really wanted to understand that a bit more.
|
|
[81]
Mr Hathaway: The evening talks that we get are optional, but
anyone who signs up to this theme throughout the four years is
expected to go to those.
|
|
[82]
Julie Morgan: That’s actually part of the course,
then.
|
|
[83]
Mr Hathaway: Yes, it’s part of the course, and you get a
formal recognition of you taking part in RRHIME at the end of the
degree as well.
|
|
[84]
Julie Morgan: Right, thank you. I only wanted to clear that up,
because it’s very positive, I thought.
|
|
[85]
Dai Lloyd: Excellent. Angela, did you want to come back in
here?
|
|
[86]
Angela Burns: Yes, I just wanted to ask—
|
|
[87]
Dai Lloyd: On this issue?
|
|
[88]
Angela Burns: No, I want to ask about undergraduate
training.
|
|
[89]
Dai Lloyd: You can, indeed.
|
|
[90]
Angela Burns: If I may.
|
|
[91]
Dai Lloyd: It’s still—[Inaudible.]
|
|
[92]
Angela Burns: I don’t know the details of what is contained
within undergraduate training, and I wondered if you could let me
know if there is enough exposure, in your view, to general
practice.
|
|
09:45
|
|
[93]
Dr Riley: If you look at all of the different courses in the
UK, they all have different exposure to general practice.
There’s a publication recently by Val Wass, which looks at
what you need to put in place to develop a focus on general
practice, if you like. It’s clear that it’s not
quantity; it seems to be quality that’s important.
|
|
[94]
So, taking on board those recommendations and looking at the way in
which we’re talking now, within C21, about trying to focus on
community-based learning and this idea of trying to embed students
within the community and in smaller groups, developing this
symbiotic relationship with the NHS to train these individuals
locally, so that the model that we’re looking at now is this
idea of a longitudinal integrated clerkship, where we embed
students within general practices and try and teach medicine within
those practices in a patient-centred way in the rural parts of
Wales, which should address some of those issues.
|
|
[95]
I think we’ve become much more product focused in our
approach to medical education, so this idea of, ‘What is it
we’re trying to deliver to the NHS?’ And that is this
idea that we have specialties that are short: psychiatry is another
example, so, we’re trying to address that by specifically
addressing psychiatric issues within the curriculum, and some
evidence is saying, from what we’ve done here, that those
students are becoming more attuned to potential careers in
psychiatry and general practice.
|
|
[96]
Cardiff has always been mid-to-high table in terms of the number of
its graduates that end up being GPs. That dropped down to about 20
to 22 per cent on the last figures that we’ve seen from the
General Medical Council. But so have many other of the schools in
the UK. So, it’s about trying to adopt best practice and
training people within the community in a patient-focused way.
|
|
[97]
Professor Lloyd: The answer to your question is that
probably not enough go into general practice. Our figures for
people who’ve done the four years at Swansea show that 30 per
cent go into general practice, which is high on the UK basis. We
also have one of the highest proportions of people going into
psychiatry, as it happens, in the UK.
|
|
[98]
Dai Lloyd: Including yourself.
|
|
[99]
Professor Lloyd: Yes, but they still go into psychiatry,
despite me being the dean, yes. [Laughter.] There’s a
second issue that is about the need for people who work in hospital
specialties to recognise and value the importance of community
specialties, and that’s going to become increasingly
important. As we have different models of care, as we move away
from hospital care towards more community and intermediate and
ambulatory care and a more social model of medicine, that’s
going to become increasingly important. So, we are going to need
more people in those kinds of roles, yes.
|
|
[100] Angela
Burns: So, could you clarify something for me? If you decide
that you want to be a GP and you have to go through all the
training at university, do you still do those rotations in
hospital?
|
|
[101] Professor
Lloyd: Yes, you do.
|
|
[102] Angela
Burns: And is that under your purview, or is that what the
royal colleges say?
|
|
[103] Professor
Lloyd: No, neither; it’s the deanery. There are two
points in what you said. The first is that we were thinking of
introducing a primary-care track, right from the beginning of our
course. The problem is that, very often, when people come into
medical school, they don’t know what sort of doctor they want
to be at the end. One of the wonderful things about medicine is
that there are so many different trajectories you can go on in it.
We can end up doing all sorts of different things. So, you actually
have to allow people a certain amount of flexibility, because they
may have an epiphany later on in their course and decide what it is
they want to do. You’re choosing between, I think, emergency
medicine, anaesthetics or general practice—
|
|
[104] Mr
Hathaway: Yes, sort of acute medicine or GP, I don’t
know.
|
|
[105] Professor
Lloyd: He doesn’t know yet.
|
|
[106] Mr
Hathaway: With regard to GP teaching on the Swansea curriculum,
we go into GP practices, I think it’s from the second or
third week of university in the first year. In the first and second
years, it’s every two to three weeks, and then we do block
placements in years three and four. So far, I’ve been to
Glyncorrwg, Port Talbot valley, a Swansea city GP, a placement in
Aberystwyth and next year, I’m either doing St David’s
or Brecon. So, they can be all over Wales. Some of my colleagues
have been up to north Wales, as well. So, it gives us an experience
of a city GP practice and a rural GP practice.
|
|
[107] Angela
Burns: So, sorry to beat this point to death, but I just want
to make sure I clearly understand it. When you are doing your
undergraduate medical training, do you have to, as part of the
course, do a placement with a GP?
|
|
[108] Professor
Lloyd: Lots of placements with GPs.
|
|
[109] Angela
Burns: You do. And, the rotations in hospital, who decides
those?
|
|
[110] Professor
Lloyd: The foundation placements that happen after
qualification are specified by the GMC and by deanery.
|
|
[111] Angela
Burns: Right. And some of those rotations are compulsory, but
not all of them. So, do you have to do, for example,
orthopaedics?
|
|
[112] Professor
Lloyd: No.
|
|
[113] Dr Riley:
No.
|
|
[114] Angela
Burns: Oh right, so they can just choose what they want to
do.
|
|
[115] Professor
Lloyd: Yes.
|
|
[116] Dr Riley:
Yes.
|
|
[117] Dai
Lloyd: But if you’re on a GP training scheme, you end up
doing a year of general practice and then six months of obstetrics,
six months of paediatrics, six months psychiatry, like it did.
|
|
[118] Angela
Burns: And so, if you’re doing your year of GP training,
who monitors the quality of that training? Because, one of the
complaints that I’ve heard from trainee GPs is, actually,
they then get dumped into a GP situation and it’s horrendous,
and then they leave general practice. We’re trying to drive
more people to have an interest in that particular branch of
medicine.
|
|
[119] Dr Riley:
Wales Deanery.
|
|
[120] Angela
Burns: Wales Deanery, thank you.
|
|
[121] Dr Riley:
And they do a good job of that, I think.
|
|
[122] Dai
Lloyd: Okay. Time is—it’s all very interesting
stuff, obviously, but time is marching on. Lee, some of your issues
have been covered, but you can drill down about Scotland if you
like. Or anything else, feel free—
|
|
[123] Lee
Waters: Thank you very much.
|
|
[124] Dai
Lloyd: But make it medical.
|
|
[125] Lee
Waters: Indeed, I will. I’m interested in the—.
Clearly there’s a consensus building from our side that you
are doing better than you were, and we would like to see you do
better still. I’m just interested in the counter pressures
that you might be under. Is there a resistance internally from some
academics who fear that having more Welsh-domiciled students may
impact on your broader reputation, may dilute standards? What are
the counter pressures that you face within the institutions against
going in this direction?
|
|
[126] Professor
Weeks: I think, speaking from a Cardiff perspective, and
I’m sure Swansea would say the same, there’s absolutely
no reason why shouldn’t want to encourage Welsh-domiciled
students, it’s counterintuitive. As Steve said earlier, what
it’s about at the end of the day is creating quality doctors,
and giving Welsh-domiciled students as much opportunity as we can
to maintain that quality and really drive up as many
Welsh-domiciled students coming through the system as we possibly
can. From our perspective, there is no rationale for doing anything
else.
|
|
[127] Lee
Waters: Okay.
|
|
[128] Professor
Lloyd: I would agree with what’s been said, and add that
we want to facilitate all underrepresented groups to have better
access to medical degrees, and Welsh-domiciled students can be one
of those groups. There can be separate issues there, but
there’s an overlapping set of issues there. So, we have the
issue of Welsh-domiciled students, our ambition is to be a medical
school for Wales with global reach, so we’re trying to do
that, but there are other groups that we need to consider who are
underrepresented for other reasons.
|
|
[129] Lee
Waters: I’m just trying to tease out whether
there’s any sort of cultural drag, if you like. I was struck
by the evidence of HEFCW in their submission, which says that,
|
|
[130]
‘Admissions to autonomous universities need to be
transparent, and cannot favour Welsh-domiciled students and this
needs to be taken into account in planning.’
|
|
[131]
So, there’s clearly some
mindset or some cultural resistance from a HEFCW point of view, so
I’m just wondering where that’s coming from and how
that reflects itself in your institutions.
|
|
[132] Professor
Weeks: In a sense, irrespective of wherever that’s coming
from, as Cardiff University we have a commitment to Wales.
I’m Cardiff born and bred and I wear that on my sleeve,
so—
|
|
[133] Lee
Waters: I’m not asking you to get your flags out
I’m just, you know—. To properly progress this agenda,
we need to understand the full context that you’re working
within, and whether there are some issues that need addressing
broader than your willingness.
|
|
[134] Professor
Weeks: Yes. I’m not aware of that.
|
|
[135] Dr Riley:
I don’t perceive that there is any block to promoting
Welsh-domiciled students into the course. I’m fully in favour
of that, we’re fully in favour of that. I think the fairness,
openness and transparency of the application process is something
that we hold very dear, and what we don’t want to risk is a
big press story, for instance, that, ‘Your process has a bias
towards x’ without having the legislative backing to say,
‘This is the way you need to go.’ Within the rules of
the game at the moment, we are doing all that we possibly can
within the contextualised approach to get the Welsh students in. If
we can raise the number of Welsh students that apply to us from 50
per cent to 75 per cent of those students, then clearly
that’s going to increase again, because we will have more
students to choose from. So, I think that’s what we’re
coming back to. We can talk about the Scottish model if you
wish.
|
|
[136] Dai
Lloyd: Not yet. Ian, then Keith.
|
|
[137] Professor
Weeks: I think one of the things that I would say is that
we’re talking very much about the admissions process, and I
think you’ve heard what Swansea and Cardiff are doing to
maximise the opportunities for, certainly, Welsh-domiciled
students, which is what Rhun is very much coming from here. But I
think it’s really about taking that step further back and
creating motivation, I think, for schoolchildren. I’m sure
Swansea will do the same, but we have a very active programme of
engaging with primary school children, for example, to talk about
STEM subjects generally and medicine in particular, obviously. I
think one of the big success stories that we’ve certainly had
going on to secondary education over the years is that we have an
event called Science in Health Live every year. We have coachloads
of secondary school children coming in. This has been so popular
that we’ve had to spread it over two days because the sheer
number of schoolchildren becoming involved in that is so high. So,
I think initiatives like that will help motivate the children of
that age to come into STEM subjects, and medicine on the back of
that.
|
|
[138] Dai
Lloyd: Great. Keith.
|
|
[139] Professor
Lloyd: Okay. I haven’t seen the particular piece of
evidence from HEFCW that you referred to, so I can’t comment
on that directly. What I would say is that the Medical Schools
Council, which is a representative body of the UK medical schools,
publishes each year a set of criteria for admission to each medical
school. The vast majority of medical schools use contextual
admission.
|
|
[140] Lee
Waters: Can you I just pick on something that Professor Riley
said, because you alluded to an alternative funding mechanism? You
also alluded to the limits of the statutory framework that you work
within. So, in terms of recommendations that this committee might
make, are there things that the Welsh Government could do
differently on a structural level that would help advance this
agenda?
|
|
[141] Dr Riley:
I think the way that the funding model works at the moment: for
instance, in Scotland they fund a set number of places, which
allows Scottish students to be drawn into Scottish universities
rather than applying preferentially to other universities in the
UK. So, changing that funding model would be one way in which you
could influence the way in which you could legitimately take more
students into the Cardiff course. I would say that there needs to
be a balance. I’m proud to be a graduate of Cardiff
University. I’m from Birmingham originally. I didn’t
get into Birmingham. I applied to Birmingham. Wales gave me a
place. I’ve never left. I hope that I’ve contributed
back to the economy of Wales. So, there has to be this—. We
have to drive more Welsh-domiciled students in, for certain, but we
have to also say that there are people that could potentially come
into Wales—as Keith, I think, has alluded to as
well—that will contribute positively to our health service
and our economy.
|
|
[142] Dai
Lloyd: Okay. Rhun, you’re agitating to say something.
|
|
[143] Rhun ap Iorwerth: Again, it was making a
point. It’s not about saying that we don’t want great
medical students from outside Wales to come here. It’s the
double, the triple or the quadruple lock, isn’t it?
We’re very fortunate that you came to study in Wales and that
you have not just made a contribution economically, but to the
health of the nation and so on. But if we can lock people in and
get people in who are from Wales and are therefore more likely to
want to stay in Wales, study in Wales and therefore be more likely
to stay in Wales. We had Betsi Cadwaladr even saying that we should
increase, specifically, Welsh speakers in order to serve the NHS in
Welsh-speaking parts of Wales. It’s looking for those locks,
isn’t it, and the role that medical schools in Wales can play
in promoting that? You talked about contextual admission. We need a
Welsh element of that context as well, and that is what we need to
be looking at, I think. There’s a different context to those
other medical schools in England that are part of the same
admissions policy. We have different needs.
|
|
[144] Dr Riley:
Our contextual approach is different to England, and it is Welsh
focused.
|
|
[145] Dai
Lloyd: Craig, and then Ian.
|
|
[146] Mr
Hathaway: Just quickly on your point about Welsh speaking,
there are a lot of English students who have come onto the course.
Some of them are Welsh domiciled, but they happen to have been born
in England. The course itself runs free Welsh lessons. It’s
only basic Welsh, but that’s a big advantage for patients who
want to—. You know, just as has been said,
‘Hello’ or ‘Thank you’ in Welsh is really
good for them. But the point that I put my hand up for was about
funding and incentives for bringing students into Wales, to study
in Wales and to stay in Wales. I couldn’t have applied to
Cardiff. I could have physically applied to Cardiff as a
postgraduate student, but I wouldn’t have received the same
amount of funding as I would have with the postgraduate GEM
courses. With regard to Wales compared to the rest of the UK, the
funding is largely similar, apart from Scotland.
|
|
10:00
|
|
[147] With regard to
keeping people in after, it may be worth—I don’t know
how feasible that is—exploring options of being different
from England. I know the junior doctor contract will help a little
bit, but the fact that if Wales was different with regard to, I
don’t know, incentives for staying in Wales, then definitely
a lot of my colleagues would stay in Wales.
|
|
[148] Dai
Lloyd: Okay. Ian, on this point.
|
|
[149] Professor
Weeks: I think it’s important on so many levels.
We’ve talked about the undergraduate level, the postgraduate
entry. We’ve talked about how much impact we have to make
with schoolchildren as well. And the other point is about the
postgraduate education as well. This point, I think, that
we’re looking at about creating education in rural
communities as a key part of the course—certainly
Cardiff’s initiative to try and do that—and we’re
putting that plan together at the moment. I think it’s very
much about being innovative in what we do in Wales. We are a very
innovative nation and I think this is an area where we should be
innovative. We shouldn’t follow the existing English system.
I think we have an opportunity to create something that will suit
us as one of the devolved nations, rather like Scotland has been
doing. So, I think it’s extremely valuable to have this kind
of exercise.
|
|
[150] Dai
Lloyd: The number of questions left roughly equates to the
number of minutes left in this session, so I would appeal, mostly
on this side, I have to say, for succinct contributions. Keith.
|
|
[151] Professor
Lloyd: I was simply going to say that there’s lots more
we can do and we can’t be complacent about retention. Our
latest figures are that 67 per cent of people who’ve trained
in Swansea have stayed in Wales after qualification. So,
we’re on track; we just need to do more of it.
|
|
[152] Dai
Lloyd: Great. Caroline, moving on.
|
|
[153] Caroline
Jones: Diolch, Chair. What kind of destination data is there
available for Welsh medical school graduates to help us understand
more about doctors’ choices in training?
|
|
[154] Professor
Lloyd: If I may, you’ve had evidence already from one of
my colleagues, Dr Heidi Phillips, who is admissions tutor in
Swansea. She’s done a project where she’s looked at the
trajectories of all our students. We know that people who graduate
from us are more likely to go into general practice than—.
They’re more likely to remain in Wales. They’re more
likely to go into general practice than other shortage specialties.
We don’t have that many years of data yet, so it’s
still working its way through the system. But, there’s good
evidence emerging that people, particularly from graduate-entry
medicine, tend to stay in the areas where they train and work, and
put down roots if they don’t have them there already.
|
|
[155] Caroline
Jones: That’s interesting. That’s good.
|
|
[156] Mr
Hathaway: Just really quickly, I’ve bought a house, but,
initially, I wasn’t planning to definitely stay in Wales, but
now I am. Also, with regard to postgraduate medicine, it’s
four years, so you get from student to doctor much quicker than
undergrads.
|
|
[157] Caroline
Jones: Thank you.
|
|
[158] Dai
Lloyd: Moving on. Julie, some of your issues have been
addressed, but feel free to address some more.
|
|
[159] Julie
Morgan: Yes, I wanted to ask about how you were reaching
deprived communities really. Obviously, we’ve had some
general comments already. Is there anything you could add about
those particular efforts where people have never thought to aspire
to be a medic in any way? Anything to add on what you’ve said
already?
|
|
[160] Dr Riley:
We’ve got some specific examples. So, with Tredegarville
primary school, our medical students go up and speak to the
schoolchildren. They’ve also been back down to Cardiff to
have a little look around the clinical skills lab. Our students are
allowed to special study components—SSCs—and we have a
number of our students now who are looking at ways in which you can
reach out into communities to increase the aspiration of the
schoolchildren. And we’ve got the links with the Seren hubs
that are starting to form now. So there’s a Seren conference
next week; we’re going there to try and talk to the A-level
students, again to give them information about the application
process and inspire them to apply to Wales to study medicine.
|
|
[161] Julie
Morgan: Would you say that students as they are at the moment
generally come from reasonably well-off backgrounds?
|
|
[162] Dr Riley:
I think there’s a real mix.
|
|
[163] Julie
Morgan: There is a mix, you think.
|
|
[164] Dr Riley:
There is very much a mix, and we’ve got students who are
first-generation medic applications, and we’ve got students
who are from a medical background. There is a real mix between the
two.
|
|
[165] Dai
Lloyd: Craig.
|
|
[166] Mr
Hathaway: I was the first person in my family to go to
university. I came from a village that you could class as
relatively deprived, and, with regard to ongoing work in these
areas that are deprived around Swansea, the admissions director,
Heidi Phillips, is doing work with some schools that, in the last
10, 20 years have never churned out a doctor at all. So,
she’s focusing on those schools as a priority to try and
encourage uptake of medicine and allied health professions.
|
|
[167] Julie
Morgan: So, you’ve all got this firmly on your
agenda.
|
|
[168] Dai
Lloyd: Moving on to question 10—Lynne, we’re
talking numbers of training places.
|
|
[169] Lynne
Neagle: Yes. We’ve had some evidence that people would
like to see more training places available in Wales. What is your
view specifically on that and whether we need a new training
facility in Wales?
|
|
[170] Professor
Lloyd: We have submitted other evidence suggesting that we
could expand our offering into west Wales, and, working closely
with Hywel Dda, they’re keen to take more of our students.
Many of the issues that apply to healthcare in west Wales also
apply in the north. Both of our medical schools have been in
discussion with Welsh Government about expanding, as you know, and
contributing to any expansion of the offering up there. I think
we’re all keen to do that. England have just announced 1,000
extra places for training medical students. Welsh students will
take up those places. Worcester, Chester—a number of
universities on our doorstep are looking at increasing their
offering. If we don’t up our game, those students will go to
England and may not come back.
|
|
[171] Lynne
Neagle: Okay. So, you think it’s more about working in
partnership then, rather than looking at developing something new.
Okay.
|
|
[172] Dai
Lloyd: Okay. Rhun.
|
|
[173] Rhun ap
Iorwerth: Specifically on the development of medical education
in the north-west of Wales, I’m talking here about people
applying to study medicine in Bangor, not just doing placements in
Bangor, which, of course, they currently do anyway. Do you think
that there is support for moving in that direction—even
possibly, medium term, a medical school in Bangor, but that’s
probably parked for the time being—and having medical
education based in Bangor as a means of addressing specifically,
perhaps, the rural medicine shortages that we have?
|
|
[174] Professor
Lloyd: We think that, for example, the rural and remote health
track that we offer would be ideal and have had discussions, as
have my colleagues in Cardiff, with north Wales about offering more
placements there in the short term, given the long lead time to
actually starting a medical school.
|
|
[175] Dr Riley:
I’d agree with that. I think we can work towards that with
you. I’ve been in contact with the Northern Ontario School of
Medicine, which has got a specific francophone programme that
allows students to go into those communities that are predominantly
French speaking to do their programmes. You have to get the—I
think as Dean Williams said to you, it’s about the science
faculty that needs to be there. Yes, we can deliver very
high-quality clinical placements up there; it’s the science
faculty and all the stuff that goes around developing a
well-rounded medical student that you need to have in place, and
that’s a programme.
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[176] Rhun ap
Iorwerth: And there’s no reason practically, even though
the medical school takes, you know, there’s a long run-in,
but there’s no reason why people shouldn’t be able to
apply to Bangor to study medicine, perhaps because of a
relationship between Bangor University and Cardiff University,
within a relatively short space of time.
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[177] Dr Riley:
We’d have to work through that with you.
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[178] Dai
Lloyd: Okay. Julie has got some issues about Europe.
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[179] Julie
Morgan: Yes, Brexit. I mean, it’s obviously something
that’s on everybody’s minds at the moment, and I
understand there has been a fall in the number of EU applicants to
medical schools. So, perhaps you could give us your views on how
this is going to develop.
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[180] Professor
Lloyd: The issue, I think, is more for the NHS workforce than
it is for medical school applications. We don’t take many EU
residents—non-UK EU residents—onto our course. I think
where Brexit will have an impact is downstream of that in terms of
the workforce that you have after qualification, would be my take
on that. And also, a particular local point, Michael Heseltine was
supposed to come and visit us yesterday in Swansea and he appears
to have got embroiled in some local difficulties.
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[181] Dai
Lloyd: Sad. Ian.
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|
[182] Professor
Weeks: I think the other thing to consider that’s very
important in that, because, of course, the other side of the
medical school—talking about creating good doctors, excellent
doctors for the future—is about the research side of things
as well, because that does attract a lot of people to an area. I
think Brexit is clearly going to impact on the research side of
things and our ability to attract quality research, and this is
causing a lot of issues for us at the moment. I think the
combination of the service, the combination of whether ex-UK
students want to come and train in the UK and Wales particularly,
and the research—we talk about the triple lock; I think this
is a bit of a triple whammy, which is potentially problematic for
us.
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[183]
Julie Morgan: In terms of undergraduates from the EU, do you have
many? Do you know the numbers?
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|
[184]
Professor Weeks:
I don’t know the numbers. Would you
be able to answer?
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[185]
Dr Riley: We didn’t have many at all until we started to
change our curriculum. Paradoxically, those numbers have increased
year on year over the last three or four years. We haven’t
seen that drop-off yet, although the numbers are down in the UK as
a whole.
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[186]
Professor Weeks:
Just to point out on that, in terms of
again going back to the research, as Cardiff, we’re fifth in
the UK in terms of research and second in terms of research impact.
I think we worry about how difficult it’s going to be to hang
on to that.
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[187]
Julie Morgan: Has there been any actual evidence yet? Sorry, Craig,
I know you want to come in.
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|
[188]
Professor Weeks:
Certainly, colleagues in the research
environment who are currently EU citizens have expressed the view
that they’re looking to move back out of Cardiff and back to
their homelands.
|
|
[189]
Julie Morgan: Yes, I’ve heard that anecdotally, but is that
actually happening?
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|
[190]
Professor Weeks:
People have told me—my colleagues
have told me this—that this is something that they’re
considering.
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|
[191]
Dai Lloyd: Okay, Craig.
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|
[192]
Mr Hathaway: To my knowledge, we’ve got two EU students in
my year of 72. I obviously wouldn’t know what would happen if
Brexit went ahead, and it depends on the outcome. But both of those
individuals—one was a feeder course via Swansea University,
so that person stayed in Wales and has chosen to study in Wales,
and the other person had been working in the NHS for a number of
years before and then decided to change career. So, even though
they are EU students, they’ve actually been in the UK for
some time. I think that’s good as well, because we want to
create doctors that will work in the UK. By showing that these
people have been living in the UK before, that’s got to be
positive.
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|
[193]
Professor Weeks:
I think the other thing that’s
important is the whole student satisfaction thing, certainly in
terms of making Wales a place where students want to come. So,
we’ve been working hard to drive up our national student
satisfaction scores. We’ve achieved 97 per cent in medicine
this year, which we’re very proud of. Again, the worry is
trying to maintain that position with all that’s going on
around. It really is a very worrying time.
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|
[194]
Julie Morgan: So, Brexit, you could say, has really increased your
anxieties for the future?
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|
[195]
Professor Weeks:
It has, yes. And we’re currently
joint third in the UK in terms of student satisfaction—I
think that’s something to be proud of and something that
we’d quite like to hang on to—of all the other UK
medical schools.
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|
[196]
Dai Lloyd: Okay, time’s marching on and Angela has got the
last question, for which you’ve got 13 microseconds to use up
asking it.
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|
[197]
Angela Burns: I was reading the minutes of a patient participation
meeting not very long ago, and in the minutes was a comment that
said that Swansea University’s medical school was considering
looking at or evaluating—I can’t remember the exact
wording; I don’t have it with me, I’m afraid, but
I’m happy to provide it to you—a Welsh qualification or
a Welsh necessity to the application process. Is that correct? And
also, if—. Well, is that correct?
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|
[198]
Professor Lloyd:
I’m not sure I fully understand the
question.
|
|
[199]
Angela Burns: The minutes said, and it was from a doctor, that
Swansea University was looking at making Welsh a pre-requisite
qualification for entry. I’m not sure—
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|
[200]
Professor Lloyd:
Okay. No, we’re not looking at
making Welsh a pre-requisite. We have increased the opportunities
for people to spend as much of the course as they wish to do
through the medium of Welsh, and you can do a number of clinical
placements in Welsh, but we’re not looking to make it an
entry requirement—that I’m aware of.
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|
[201]
Angela Burns: Okay. I assume—this is for both of you. I think
one of you—I think it might have been you, Stephen—said
earlier that you had to make sure that whatever you do with your
entry requirements was legally—that you weren’t going
to be under fire legally. I assume that setting your entry
requirements is entirely down to you. Therefore, if you were to set
an entry requirement that said it is preferable for a student to
have studied the Welsh baccalaureate, would that not help to
predispose the amount of Welsh students coming into the university
and being accepted?
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|
[202]
Dr Riley: I think it might have been that it was Cardiff who
was thinking about doing this exact thing. There is a possibility,
and we’re exploring it now with our quality standards
committee, of having a separate route of entry that would
require—. It might be a medicine degree with Welsh culture
alongside it and, to get into that degree, you might, for instance,
need a Welsh language qualification or a Welsh bac.
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|
10:15
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|
[203] So, it’s a
mechanism that’s aligned with what’s happening in
Scotland, but a slightly different focus to advantage that
approach. It’s complex, because you’re having to think
about what’s the content of the course and how you reflect
that when you accredit the course at the end of it, both from a GMC
professional practice perspective and from a university standards
perspective. So, we are actively looking at it, but I can’t
tell you whether that’s going to be something that we
can—. We can drive it forward, but whether it will come to
fruition is something that we need to work on in the next few
months.
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|
[204] Angela
Burns: So, you couldn’t just say, ‘You’ve got
to have English, Maths and Welsh bac, for example, in GCSE, as a
preferable. You have to then prove an outcome, do you, for that
request.
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|
[205] Dr Riley:
We’d have to go through the quality and standards committee
to be able to do that. But it’s on the cards.
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|
[206] Dai
Lloyd: Okay. Diolch yn fawr iawn. That is the end of the
session. Thank you very much indeed. A very high standard of
evidence this morning.
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|
[207]
Diolch yn fawr iawn i chi i gyd. A
gaf fi bellach ddweud y byddwch yn derbyn trawsgrifiad o’r
cyfarfod yma a’r trafodaethau i wneud yn siŵr bod popeth
yn wir ac rydych wedi cytuno efo beth yr oeddech wedi ei ddweud?
Gyda hynny, dyna ddiwedd y sesiwn. Bydd yna egwyl rŵan am
chwarter awr, achos mae popeth wedi’i amseru i’r funud,
fel sydd yn berthnasol i feddygaeth—popeth i’r eiliad.
Felly, diolch yn fawr i chi am eich presenoldeb ac fe welwn ni chi
eto, siŵr o fod.
|
Thank you very much to you all. Can I just let
you know that you will receive a transcript of this meeting and the
discussions we’ve had so that you can check that
everything’s correct and that you agree with what has been
noted? That’s the end of the session. There will be a break
now for 15 minutes, because everything is timed to the minute here,
as is relevant to medicine—everything to the second. So,
thank you for your attendance and I’m sure that we’ll
see you again.
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|
[208]
I’m cyd-Aelodau, mae yna doriad
nawr tan 10:30. Diolch yn fawr.
|
To my fellow Members, there is now a break
until 10:30. Thank you.
|
|
Gohiriwyd y cyfarfod rhwng 10:16 a
10:31.
The meeting adjourned between 10:16 and 10:31.
|
|
Ymchwiliad i
Strategaeth Genedlaethol Ddrafft Llywodraeth Cymru ar
Ddementia—Sesiwn Dystiolaeth 7—Pobl sy’n Byw
â Dementia
Inquiry into the Welsh
Government’s Draft National Dementia Strategy—Evidence
Session 7—People Living with Dementia
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|
[209]
Dai Lloyd: Croeso nôl, felly, i ail sesiwn
dystiolaeth y bore o’r Pwyllgor Iechyd, Gofal Cymdeithasol a
Chwaraeon yma yn y Cynulliad. Hwn yw eitem 3 y bore yma. Croeso
nôl i’m cyd-Aelodau. Eitem 3 yw’r ymchwiliad i
strategaeth genedlaethol ddrafft Llywodraeth Cymru ar ddementia.
Hon ydy’r sesiwn dystiolaeth olaf o’n hymchwiliad ni.
Bore yma, rydym yn mynd i glywed tystiolaeth gan bobl sydd yn byw
gyda dementia. Felly, rwy’n croesawu Nigel Hullah, Karen Kitch, Madeline Cook, Beti George, Michelle
Fowler, sydd yma gyda chyfieithydd, ac Emily Jones. Croeso i chi i
gyd. Mae gennym gwestiynau.
|
Dai Lloyd: Welcome back therefore to
the second evidence session of the morning of the Health, Social
Care and Sport Committee here at the Assembly. This is item 3 on
our agenda. Welcome back to my fellow Members. Item 3 is the
inquiry into the Welsh Government’s draft national dementia
strategy. This is the final evidence session in our inquiry. This
morning, we’re going to hear evidence from people who are
living with dementia. So, I welcome Nigel Hullah, Karen Kitch,
Madeline Cook, Beti George, Michelle Fowler, who is here with an
interpreter, and Emily Jones. Welcome to you all. We have some
questions.
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|
[210] We have
questions based on the evidence in all the evidence sessions thus
far, which will give you sufficient opportunity to, hopefully,
outline all that needs to be said from your point of view. Okay? If
somebody has opening remarks, we shall welcome those now. Anybody
want to go first? Nigel, go on. Crack on. That’s what we
want—a willing volunteer.
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|
[211] Mr
Hullah: I’ll go first. My name is Nigel Hullah. I’m
on the Welsh strategy task and finish group. I’m also a
member of the cross-party group, and I think I’ve met with a
couple of the AMs outside of the strategy. Can I first thank you
for giving us the opportunity to give evidence to this group? And
can I also say that I was in a meeting yesterday in London with the
UK dementia think tank, of which I’m a member? The general
feeling amongst the rest of the UK is that they’re looking at
Wales, scratching their head and wondering what we’re doing
and how well we’re doing it. There’s a great deal of
interest in the way the strategy has been put together, with, I
think, a commitment to the involvement of people living with
dementia. But saying that, Mr Chairman, there’s a long way to
go just yet. When the questions come up, I think we will all be in
a better position to answer that.
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|
[212] Dai
Lloyd: Great; thank you for that. We’re well aware of the
present situation, and we’re also well aware of the long way
that we need to go. Caroline Jones has got the first question.
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|
[213] Caroline
Jones: Diolch, Chair. Good morning, everyone. Could you tell me
please what experiences you’ve had when you’ve gone to
see, for example, your GP and primary care services? Are they
dementia friendly? And how we can improve upon the services that
are available, and that can better meet the needs of people with
dementia and, of course, their families and carers.
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|
[214] Dai
Lloyd: Who wants to kick off? Then you can all pitch in?
Michelle.
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|
[215] Ms
Fowler: Good morning, everyone. Thank you for inviting me.
It’s the first time I’ve been involved in anything like
this. I’m representing the deaf community. I work for the
British Deaf Association, and we represent people whose first
language is British Sign Language.
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|
[216] The first thing
I’d like to say is that there is absolutely no provision for
deaf people with dementia in Wales. The diagnosis is very difficult
because there are no specialists, and we would need to be diagnosed
in a different way. The memory tests are not suitable;
they’re not appropriate for deaf people. For example, if you
asked them maybe who the Prime Minister was a few years ago, they
would struggle to know the name, because they’ve had such a
poor education that they struggle with their literacy skills, so
they don’t read very well. Most of them left school with a
reading age of 8, so just basic news and general knowledge they
would really struggle with, and in a memory test they might never
have known that information, so it’s not that they’ve
forgotten it.
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|
[217] So, really, at
the moment, the provision is not appropriate for deaf people. There
is no specialist provision. They have to go to England to get any
specialist help. I’m not sure if you want me to go any
further about the experiences that I hear every day, when the deaf
community are feeding back to me and talking about awful
experiences that they’re having at the moment with GPs in
primary care.
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|
[218] Dai
Lloyd: In response to that, can I just say that there are
several questions? We will explore all of those avenues for all of
you, all right? So, we’ll go into every facet. So,
there’s plenty of time for you to come back and describe in
detail other facets. All right, Michelle?
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|
[219] Ms
Fowler: Thank you.
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|
[220] Dai
Lloyd: Karen.
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|
[221] Ms Kitch:
Three years ago I was diagnosed with early-onset Alzheimer’s.
I was 51. First of all, when I saw the GP, they said yes, there
were memory problems. Then I had to see a psychiatrist nurse who
thought maybe I was going through the change, but I’d had a
hysterectomy at the age of 42. Then I had to see a psychiatrist
because they thought I was depressed, which was a waste of time,
because they said to me, ‘You’re not depressed’.
I said, ‘I know’. Eventually, then, I got to the memory
clinic, and was told that I had Alzheimer’s. Because
I’m young, people automatically think that I’ve got
something else.
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|
[222] Caroline
Jones: So how long did the diagnosis take?
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|
[223] Ms Kitch:
I was very lucky. I was put on the sick in September, and by the
January I had the diagnosis. But maybe that was because of my age;
because I was so young, they wanted to—.
|
|
[224] Dai
Lloyd: Okay. Nigel.
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|
[225] Mr
Hullah: I think there’s a common element here. I’ve
taken part in all of the consultation events, and the common
element is the length of time from the time you first present to a
GP to diagnosis. In my case, I come from the free republic of
Townhill in Swansea and it took nearly four years for the hammer
finally to drop from the time I first presented. One understands
that you don’t want to misdiagnose at any stage. The
difficulty is that people lose their jobs, routinely; they get put
into a benefits system that is not good these days; they develop
huge financial issues and of course the other partner, if
they’re in a partnership, is wondering what’s going on.
It puts a terrific strain on socially.
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|
[226] The strategy is
committed to a clearer diagnostic pathway. We don’t think
that the diagnosis needs to be a medical one. We don’t think
there needs to be just doctors involved with this. To routinely
park dementia in mental health services we feel probably is the
wrong place for it to go. Most disability groups will tell you that
they shy away from the medical model of care. We’re hoping
that the Welsh Government recognises this and will develop it along
with the strategy—that we look for a more inclusive,
psychosocial approach. Because the early days are days of
confusion. You pinball from one agency to another. You don’t
know what’s going on. Things are happening to you. There is a
tendency, I think, for people to drop though the net, and the
tighter the net is, of course, the less likely it is that people
will drop through it. One of the innovations we’re hoping for
is more dementia support workers, and more peer support. Peer
support, we’ve found, is the best kind of support. It’s
other people who have been on the journey and are in a position to
help. In Swansea in particular, I’ve a meeting on Monday and
we’re hoping that every memory clinic will have a cup of tea,
a packet of biscuits and somebody like me in the room when the
diagnosis is given, as they do with any other disease. So,
we’re hoping that becomes a national standard.
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|
[227] Dai
Lloyd: Good. A very comprehensive answer. You’ve mopped
up a few of the questions there, I think. First of all, can I
apologise to Madeline for calling you Madeline Cook at the start? I
was misled, not for the first time in my life, but, anyway,
Madeline Phillips—welcome. Also, while I’m welcoming
people, can I welcome, in the public gallery, Dawn Cronin and Anita
Tomaszewski, who’ve also been very helpful in putting all the
information together for today and preparing the groundwork for
today—a very great thank you, indeed—so that this
session runs nicely? Having given you a bit of a warning there,
Madeline, would you like to add anything to the situation?
|
|
[228] Ms
Phillips: Hello, I’m Madeline Phillips. I was diagnosed
with Alzheimer’s last June. I’m a former headteacher
and I’m currently setting up a memory cafe in Cowbridge, the
first that there has been. I spoke to a group of trainee clinical
psychologists recently about life after my diagnosis and used these
key words: relief, in finally knowing what was wrong, a new
beginning, hope, challenge, humour about it all—very
necessary—and, above all, support and understanding. One
friend said, ‘It is what it is, but we’ll be there for
you.’
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|
[229] But where does
someone recently diagnosed go for support, information and medical
expertise? Who is there for us? I think that’s very patchy
and very bad from what I’ve heard. Individual professionals
have helped some people, but they’re thin on the ground, and
there’s no obvious pattern that ensures that we’ve easy
and clear access to the necessary help. But, most of all,
there’s a need for reassurance that we’re not alone on
our journey. Thank you for listening.
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|
[230] Dai
Lloyd: Great, thank you. Well done. Emily, would you like to
say something? And then we’ll move on i’m hen
ffrind, Beti George. Emily.
|
|
[231] Ms Jones:
My mother was diagnosed just under 10 years ago with early-onset
Alzheimer’s at a similar age to you, Karen—she was 54.
She was very lucky with her diagnosis in that she didn’t have
to go through a GP process. She was a senior OT at Ysbyty’r
Tri Chwm in Ebbw Vale, which is a dementia specialist hospital. So,
it was her colleagues who noticed that she was presenting with
signs of it and referred her to Dr Bayer at the memory clinic.
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|
[232] The problems
came during and after the diagnosis, because I felt very shut out
of the process. They would speak in a lot of jargon, which my
mother could understand, as she’d worked with it, but I
didn’t understand. I think maybe they thought—sorry.
Maybe they thought she was explaining things to me at home,
perhaps, but she never did, because she was in a state of denial.
It was just me and my mam at home, so we didn’t
have—you know, there was nobody at home to have an
understanding of it to explain to me. So, I had no knowledge of,
really, what to expect, of anything that was going to happen, and,
in keeping with that, there was no involvement from social services
or anything, really, until six years after her diagnosis. I really
feel that had people like that been involved a lot earlier, it
possibly wouldn’t be affecting me quite so
much—sorry.
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|
[233] Dai
Lloyd: No, that’s all right. So, have you got help and
support nowadays, Emily?
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|
[234] Ms Jones:
Since 2014, she’s been in a residential care home until the
start of this year, when she had to be sectioned and taken to
hospital, which is where she is now. She’s in a very advanced
stage of it, and I just feel that all of this could have
been—maybe not prevented, but helped and that both I and her
could have been prepared for it a lot better had there been that
involvement from not just Dr Bayer, who was great, I don’t
want to—. But I just feel, especially for carers, that they
shouldn’t feel ignored. Things should be explained to them. I
eventually had my own social worker—my mam had her
own—and that helped so much, but it was six years too late by
that point.
|
|
10:45
|
|
[235] Dai
Lloyd: Okay. There’ll be other questions on the carers
front.
|
|
[236] Beti, wyt ti
eisiau dweud rhywbeth? Wel, pawb—.
|
Beti, would you like to say something? Well,
everyone—.
|
|
[237] Ms
George: Yes, I mean, this is something that everybody should
listen to. Thank you, Emily.
|
|
[238] Ms Jones:
I’m sorry.
|
|
[239] Ms
George: No, no.
|
|
[240] I’m
speaking in English. I prefer to speak in Welsh, but my friends
here, if they find it easier, obviously, I’ll speak in
English. But it just highlights the problems that Welsh speakers
face. I don’t know—I don’t think two hours would
be long enough really, for me to share my thoughts with you.
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|
[241] As it happens,
it’s very timely, because David is in hospital. He went to
hospital last Friday with a chest infection and spent a day in a
trolley unit. The trolley was too short for him—he’s
tall, he’s got hip problems, his leg was stuck between the
frame, but there we are, that’s what the—. He was on a
trolley for a day. And then, on Saturday, he was moved into another
assessment ward, and on Saturday he was—. We got him up to
sit in the chair. Happy as a sandboy—his chest infection was
clearing; they’d given him an antibiotic drip. Then that was
the last time he was able to sit in a chair—he’s still
in hospital—because the physios and the occupational
therapists found it too difficult to get him out of bed to sit in a
chair. And, of course, as you probably would appreciate, the longer
he stays in bed, the trouble is that, probably, he will never get
out of bed. This is what I thought that the physios and the
OTs—. This is what I couldn’t understand. Why
didn’t they see that? They seemed to think that he was going
to be bed-bound anyway. So, the experience has been horrendous,
really. I was asked, ‘Oh, does he get out of bed at
home?’ Well, of course he does. And then I pleaded with the
physios and OTs to get him out of bed, but they said it was too
difficult. I’d done it for two years—helping him to get
out of bed and dressing him and doing everything for him.
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|
[242] A week later, of
course, he’s still there and the leg muscles are getting
weaker. Last night, I went in—it almost broke my heart.
They’d moved him again into another ward. He was
disorientated and I said, ‘I want to take him home
now’, but, of course, I cooled down—I do get a little
bit too emotional at times, I know. The social worker came and we,
at last, felt that there was somebody who was a support there. So,
they’re meeting this morning—the physios and the
community physio—to discuss various aids.
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|
[243] Now, the whole
experience has been distressing, not only for David, but for me,
also. Person-centred care it was not. There are not enough staff,
for goodness’ sake. I saw the staff working last night and my
admiration for them is unending. It really was an eye opener to see
them and I would like to see all of you going to this ward—E7
at Llandough hospital at sun down, or they call it—what do
they call it? Anyway, we call it ‘sun down’ in
dementia, it’s at about 6 p.m. or 7 p.m. I would recommend
you go there at that time to see what it’s like for the staff
to look after a whole ward—two wards, actually—of
people with dementia. Three looking after six—one nurse and
two healthcare supporters looking after six. Four of them were
wanting to get out of bed and they wouldn’t be stopped, so
they were wandering around—one had a broken hip, and the
other would fall because his legs were giving way under him. And
just three staff looking after these six. David was in bed, so he
was no trouble at all. Ideally, of course, he should have been
treated at home. There should have been an antibiotic drip for him
at home. Now the trauma of trying to get him back home is too much,
really. The medical people were totally satisfied, the chest
infection has gone, and they agree that he would have been far, far
better at home.
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|
[244] The whole system
is disjointed, there’s a lack of communication, there’s
a lack of understanding, it’s all a muddle, and there is not
a clear pathway at all. I think what is needed, and I agree with
Nigel, is a single named key supporter, link worker, whatever you
call them. There is such a system in Scotland—a link
worker—but it’s only for 12 months. I would argue that
this service should be there throughout the illness, and I also see
that we need—. This is my way of seeing things. I would like
to see a dementia designated unit attached to every health board so
that I, in the time of crisis—. By the way, your questions
about the GPs—the GP became involved when there was a crisis
last year in August and I happened to be away. Since then
they’ve been very supportive. They all say that they
don’t know enough about dementia. The one who’s taken
particular interest in David says that he hadn’t had any, any
inkling of what dementia means when he was trained, and he’s
young. I think, though, that has changed now. So, I would like to
see this unit with all professionals and disciplines, with specific
training for dementia, working together, with one telephone number,
a 24-hour service so that somebody like me, at a time of crisis in
the middle of the night, could ring this number and everything
would be sorted there and then. Because we now have got to ring
here for somebody, ring there for somebody, they come from all
corners—. I want it in one unit under one—well, not
under one roof literally, but—.
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[245] I think
there’s too much focus on dementia-friendly communities. I
think you seem to think that that will solve everything,
dementia-friendly communities. They haven’t helped us because
David is at an advanced stage—eight, nine years. I think
there’s an enormous emphasis on newly diagnosed, which is
tremendous, I’m glad that it is happening, but the vast
majority, like David, of course, have advanced dementia and they
seem to be neglected, and they seem to be forgotten. I must admit
that dementia is not as sexy as cancer. We all know if the same
amount of money was spent on dementia research as is spent on
cancer research, then there could be a breakthrough. It would be
much more likely so. In the long run it would save money.
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[246] The last point I
want to make is carers. They need to be respected. I’m not
talking about myself and unpaid carers here, but professional
carers. They need to be respected; they need to be paid a decent
wage. Ten years’ time, down the line, if there aren’t
any more carers, I don’t know, we’ll be in the middle
of a crisis that we’ve never seen the likes of before.
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[247]
Dai Lloyd: Ocê, diolch yn fawr, Beti.
|
Dai Lloyd: Okay, thank you very much, Beti.
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[248] Michelle, and
then Julie’s got a question.
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[249] Ms
Fowler: Thank you, and going onto a different topic,
personally, my father has dementia. When he was diagnosed, I found
out through the hospital. I was asking for information and they
didn’t provide an interpreter, they refused to provide an
interpreter for me, so I’d no idea what was going on for
quite a while with my father. He was going back and forth, and I
had no idea what was happening. Then they diagnosed
him—because he had a heart condition and he had a stroke, and
they diagnosed the dementia while he was in hospital. I had a text,
and I asked if they could only contact me by text, obviously,
because I can’t use the phone, but they contacted my brother,
but he’s deaf as well. We are, really, both next of kin, but
they found that difficult. The professionals didn’t want to
contact me. They were contacting my brother or my daughter, and it
was not appropriate. She’s a young woman. Why were they only
contacting my daughter because she is hearing? It was just easier
for them. They don’t realise the impact. My father’s
brother is elderly, and they were contacting him and his wife. They
weren’t the next of kin, but because they were
hearing—they were contacting anybody except me as the
daughter, as the next of kin. I was struggling to understand what
was going on. The information is not accessible because it’s
in written English. There’s no information in British Sign
Language. We need that translated so that we know what’s
going on. Welsh speakers ask for things translated into Welsh.
That’s fine, but what about translated into BSL? It’s
had a huge impact on all the family. It’s affected us as a
whole.
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[250] So, as part of
my work, I would really like to network with other people and see
what we can do. The complaints procedure is not accessible to the
deaf community because it either has to be in a written format or
maybe the telephone. They won’t provide interpreters. We need
to be able to make a complaint in BSL. The whole procedure needs to
be explained more clearly. Looking after my father has been so
difficult, trying to communicate with him. It affected him. He was
getting more stressed and aggressive. It wasn’t fair on him
because he was struggling to understand me. So, it’s really
had a huge impact on the whole family. Social services became
involved and they regularly booked an interpreter, which was really
good. So, I was able to understand then about the care and what was
available.
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[251] In the end, we
had to agree to put him into a care home so that he’d have
company and other people to talk to. I realised that company is so
important. Communication is vital, and that’s made me think
even more so of the deaf community, if they were put into a care
home where they couldn’t have company, because there would be
no-one to talk to. Imagine how isolating that would be. Imagine how
you would feel if you were put into a care home where everyone was
signing or where everyone was speaking Welsh and you were the only
person that couldn’t sign or couldn’t speak Welsh.
Imagine how you would feel. It’s so isolating. For people
that live far away, they might never see another deaf person. They
need their own language. The staff, the people that are looking
after them, they’re all hearing. They’ll be speaking.
In one situation, the deaf person is becoming aggressive and making
a lot of noise and she’s been locked into her room because
none of the hearing staff or the other residents can cope with her.
It’s a terrible situation, and that really needs to be looked
into. The experiences that I’m hearing from the deaf
community are appalling, to be honest. It’s really terrible.
They all hope that they don’t get dementia in Wales because
there is nothing for them. They would have to go to England to have
any sort of specialist support.
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[252] Dai
Lloyd: Okay. Point taken. We’ve got some specific
questions now. Julie next, and then Rhun.
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[253] Julie
Morgan: Yes, just listening to the last three contributions,
it’s obvious that communication and information is a huge
issue, and obviously, in particular, with the deaf community.
I’d wondered, when Beti told us about her recent experiences
in the hospital, whether you felt that you were getting the
information that you needed, whether the hospital staff were giving
you all the information about why they couldn’t do what they
said they couldn’t do. I just wondered if you could tell us
about that.
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[254] Ms
George: Yes. Simply put, they said that it was too difficult to
get him out of bed. These are experienced physios and OTs.
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11:00
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[255] When I was
there, they did manage to get him out of bed, and they watched me
helping them, and one thing that I noticed, because I’ve
always sort of helped him, under the arm: ‘Oh, you
mustn’t do that. You mustn’t do that.’ Well, you
know, I’ve done it for two years anyway. I think
they’re risk averse, really—too much so, at times. The
feeling I had is that they thought that he’d never get out of
bed again, and that is frightening. If he came home and he was
bedbound, it would be very difficult, wouldn’t it?
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[256] The information:
yes, the only thing is that they said it was difficult, and that he
would lash out, which he does, sometimes, but not with me. They
didn’t seem to visualise David at home, and that he was a
totally different person at home. They only see it in the hospital
environment. I think they must listen to the carer—somebody
like me—and have faith in me, that we can cope.
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[257] Julie
Morgan: I think that is a big issue that we’d like to
take on board there.
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[258] Dai
Lloyd: Yes, absolutely. Rhun, part of your question has already
been dealt with, really.
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[259]
Rhun ap
Iorwerth: A gaf i ddiolch?
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Rhun ap
Iorwerth: Can I thank you?
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[260]
Can I thank you all for your evidence
this morning? I don’t like calling it ‘evidence’,
really; thank you for sharing your stories and your experiences. On
the strategy’s aims to increase the numbers of people who
have a diagnosis, there is a target of 3 per cent, annually, as an
increase. Is that enough?
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[261]
Mr Hullah: Well, we have to support that because it’s
better than it is now. But, no, it’s not enough, and if you
look at the other national averages, it’s well below.
Diagnosis is one of the issues, I think, that we’ve brought
up time and time again, certainly at the cross-party group, and at
the task and finish groups. The importance of an early diagnosis
is—. It would take another hour for me to explain.
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[262]
Dai Lloyd: Which we haven’t got.
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[263]
Mr Hullah: Which we haven’t got. So, I’ll say it
very quickly. People can access very quickly the services, but the
early diagnosis is so important to the carers, because
they’re wondering what’s going on. They’re
sitting there looking at somebody who’s changing, and
they’re thinking ‘What’s happening?’ As has
been said earlier, it’s a relief when the diagnosis comes
along. It’s good that the Welsh Government wants to increase
its diagnostic level. I would remind you that it’s probably
still the worst in Great Britain, and it needs a lot more work. To
achieve this, you need to push extra resources into things like
memory clinics—maybe moving away from a medical model of
care. Does a doctor always need to deliver the diagnosis? Does a
consultant need to deliver the diagnosis? We don’t think so.
The consultants think they do, but we don’t think so, and
it’s best placed with what we could consider an appropriately
placed person. And, I mean, if you look at the latest releases from
the British Psychological Society, on person-centred care, a place
to start, it would seem that psychologists play a huge role in
this, as the tests leading up to diagnosis are usually all
psychological.
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[264]
Dai Lloyd: Dawn, you wanted to expand—. Nigel and Beti
have already alluded to this, but carry on.
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[265] Dawn
Bowden: Indeed. Yes. And thank you all for coming. You sharing
your experiences, it’s been very powerful to listen to what
you’ve been saying. I wanted to ask you specifically about
post-diagnosis support. I think Michelle’s evidence has been
very powerful, in particular the support for the deaf community.
We’ve got other groups that I think we’ve identified in
previous evidence as not having sufficient support, but, in
particular, I wanted to just explore with you a little bit more as
to what happened. Specifically, once you got your diagnosis, what
level of support did you find, both to yourselves, as those
diagnosed, and to carers? Emily, I know we heard you say that it
took a long time, and once it was in place, it was good. So, a
little bit more about that. And perhaps, a little bit of
information about direct experience or experience you know of
others where the experiences have been very good, so that we could
perhaps learn from those experiences and share the best practice.
Because, if you’re aware of where that has been good, that
might be something that we could be directed towards.
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[266] Ms
Phillips: You asked about support afterwards. I would say from
my experience, and I’ve listened—I’m on the
consultative group that meets in the Kymin in Penarth, and
it’s a multidisciplinary group, but there are five folk like
me with dementia of various kinds. They had just been diagnosed.
One, I felt, really was not coping at all. The others were
extremely upset. I knew what my experience had been, but I was,
because of my contacts, able to cope with it. They had nothing.
They were just left. In my case, actually, the diagnosis was
delivered in 10 minutes, I was with my husband and I was expecting
it. Thank you. We were out of the door, and then as we were going
through the door, we were told ‘Oh, and don’t forget to
put a’—and I’ve forgotten the name of
it—’health, um, in place.’
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[267] Mr
Hullah: Advance directive.
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[268] Ms
Phillips: Yeah, that kind of thing, ‘advance directive in
place’, [Correction: ‘power of attorney in
place’], as we went through the door. Now, actually, we knew
what that was, but I know that the two people who had gone in
before us would not have had any idea. But there really is nothing.
Some of us, as I say, like me, can—we’ve got colleagues
who are palliative care, who are whatever, and we can ask. But
there isn’t anything—even if you ask, you find that.
The family doctor, I have found, has been superb, and he has made
appointments every three weeks for my husband and myself. But
it’s bad, and that’s why I mention the pattern.
There’s no obvious pattern.
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[269] Dai
Lloyd: Karen, did you want to add to that?
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[270] Ms Kitch:
I’m fortunate that I have a social worker, but I didn’t
get the social worker because of dementia. I was diagnosed in the
January and in the May, my daughter was 16. We had a party and part
of my dementia is that I fall over. And, I fell over and broke my
foot. So, I ended up in hospital for two weeks. My husband had to
have a knee operation, so there was nobody at home for me. So, I
had to stay there because they wanted to get care in the house
first before I could go home, which was fine. The lady came out to
see me and the first thing she said to me was, ‘Right,
who’s your social worker?’ And I went ‘Excuse me?
Why would I have a social worker?’ ‘You have
dementia.’ ‘Uh, nobody’s ever told me anything
about this.’ So, I was fortunate, within two weeks, I had a
social worker. It has opened a lot of doors for me, I must say.
It’s helped a lot, it’s helped my family, because I
worked in pharmacy and they weren’t very helpful. You’d
think, being in the medical sector they would be good, but they
weren’t very good at all. My daughter, she struggles with my
dementia. Recently, I separated from my husband because he
can’t deal with my dementia. So, financially, I haven’t
got a career anymore. I haven’t got a husband, and my
daughter struggles.
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[271] Dawn
Bowden: Can I just ask, Chair, have any of you had access to
dementia support workers?
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[272] Ms Kitch:
I have a PA. That’s with the Dewis Centre for Independent
Living. She comes out for 12 hours a week with me; that’s the
maximum you can have. So, that gives my daughter a break, and used
to give my husband a break.
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[273] Dawn
Bowden: I’m just wondering at what point in the process
of the development of the condition that dementia support workers
are introduced.
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[274] Ms
George: With David, it was eight years before we had any
support at all. At the beginning, when he was first diagnosed, we
were lucky, he was put on a drug trial, so for about two years, we
would go back to the memory clinic every two months or so and we
felt very supported and very safe. But after that, when that drug
trial came to an end, we were left. And it was only last year when
the crisis point came and the GP contacted social
services—that was in August. They came out just before
Christmas—’Oh, there’s not much point in doing
anything now until after Christmas.’ Then we had an
eight-hour care package through direct payments—eight hours,
which wasn’t much—and then another crisis happened, and
then they’ve upped the care package to 36 hours a week, which
means a day and a half.
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[275] Dawn
Bowden: So, it appears to be more like responding to crisis as
opposed to a managed process.
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[276] Ms
George: Absolutely. There was nothing before.
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[277] Dai
Lloyd: Okay. Lee, more about—and also, as regards the
dementia plan, what would you like to see as regards support for
carers?
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[278] Lee
Waters: Absolutely. Can I echo the thanks for your testimony?
It’s very helpful in informing how the committee challenges
what the Government is intending to do. I wanted to ask,
specifically around carers and the strategy—the strategy is
planning to measure the help for carers. One of the ways it’s
doing it is by judging what percentage of carers are offered an
assessment in order to be given a support plan. I wondered if you
have any thoughts about—is a support plan helpful? Is this
the best way to judge how carers are supported?
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[279] Ms Kitch:
There isn’t a support plan for carers. My husband—he
had to research everything on the internet and it still
wasn’t enough. He had no support whatsoever, and in the end,
he couldn’t cope with it.
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[280] Lee
Waters: So, what would have helped him?
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[281] Ms Kitch:
It would have helped if we’d had somebody who he
could’ve talked to and he could have expressed how he was
feeling and perhaps somebody could turn around and say to him,
‘Look, we understand, but what if you try this way? Try that
way.’ I don’t know when my mood swings go. It upsets
him, it upsets my family, but I don’t know I’m doing
it.
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[282] Lee
Waters: No, of course. Are there more informal networks of chat
rooms, online communities that exist?
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[283] Ms Kitch:
I don’t know. He said there was nothing.
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[284] Mr
Hullah: Well, there are, but you have to be in the know. I
think, taking on your point, there’s so much research out
there—I mean, 75 per cent of care is delivered by unqualified
people at home. It’s estimated that 50 per cent of people who
are in a caring role will develop serious psychological problems
from the fact they’re caring. Eighty per cent of people in a
caring role will feel unsupported and isolated. These are not my
figures, these are figures that have been garnered from talking
with carers. Taking on everyone’s point, the best kind of
support for carers is peer support—it’s other carer
groups, it’s other people talking about the issues and the
dimensions of the demands in front of them. Not me, I’m
always introduced as Nigel, the man who lives alone in
Swansea—I don’t live alone with dementia, I’ve
got 10 people maintaining me. Somebody asked for a—I think it
was you who asked for an incident of good care. I was diagnosed, as
I said, in 2012 and I was left alone and I went up to 28 stone. I
must have had a psychological thing of drinking and eating myself
to death. And then all of a sudden, these three very annoying women
from the young onset team turned up at my door and just
wouldn’t let me lie—went through my fridge and put me
on a diet plan and on an exercise—. It really was annoying.
It really was.
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[285] Dai
Lloyd: [Inaudible.]—today now.
[Laughter.]
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[286] Mr
Hullah: That’s why I am like I am today.
[Laughter.] Because, as it takes a village to raise a child,
it takes a whole different mix of people to support people living
with dementia in the community.
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[287] Lee
Waters: Could I just ask Emily, reflecting back, what would
have been useful at the time the problem arose for you?
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11:15
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[288] Ms Jones:
Very similar to what other people have said, we kind of left the
hospital after diagnosis and there was nothing for six years. But
at that point, in 2013, I was given a care assessment, we had a
home assessment, but it was my auntie who saw that my mother and I
were at crisis point and she got in touch with them. So, the thing
that’s important to me, I think—the onus should be on
the health and care providers to tell people about this, because,
unless you know that something exists, you can’t ask for it.
We didn’t. We had no idea who to contact. I was 17 at the
time. You think you know everything at 17, and you don’t, you
know nothing. That was the problem. It took me having, as has been
mentioned, severe mental health problems before somebody noticed
that I wasn’t coping. And I hadn’t been coping for
those six years and I’m still not now. That’s very,
very difficult to look back on, at a distance of 10 years, and
think, ‘Okay, some of the challenges and the mistakes might
have been mine, but a lot of them weren’t.’ And
there’s nothing that I can do about that now for me, because
it’s far too late. My mother’s at a very advanced
stage. But if we can all change this for people who are going to
deal with this in the future, then we have to because—listen
to the effect that it has on people’s lives.
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[289] Lee
Waters: And the support plan, when you had it, was that a
useful thing?
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[290] Ms Jones:
In some ways. Personally, for me, they gave me my own mental health
occupational therapist and she was amazing. I honestly don’t
know if I’d be here without her. There were a lot of other
people—support workers—whom I had, and Pas who would
come in just to take my mam out for a couple of hours. But, at the
same time, the thing that I keep saying is that it came far too
late. Things that I’ve struggled with are now going to affect
me for the rest of my life. What was very hard was how mentally ill
I got, and having my mother see that, because my mother felt that
that was her fault, and in no way was it.
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[291] She was also
struggling with depression herself, which I didn’t realise.
So, I think it’s also very important, when somebody is
diagnosed with dementia or when they are continuing in the process
of it, for healthcare professionals to just keep an eye, at best,
that they might also be struggling with other illnesses. Dementia
is not the end of it. They can then develop all kinds of anxiety
and depression problems and, if that goes undiagnosed, that’s
very dangerous as well.
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[292] My mother, in
the hospital environment where she is now, she’s very
distressed. She’s lost so much weight, she’s stopped
eating, she won’t walk, and this is all—she’d
deteriorated very badly within the two months of her being in
hospital; she was as okay in herself as she could be beforehand.
And in no way do I want to blame anybody for that. The carers
she’s got in the hospital are amazing. Like you said, there
are three of them to sort of look after a ward of 12 people, and
you can’t do that. You can’t keep your eyes on
everybody all at the same time. She’s very stressed and
unsettled. She speaks but they’re not words and they’re
not sentences—it’s garbled. It’s very, very
difficult to not only have someone who can’t maybe remember
what they were going to say but now they can’t express it in
words. I think training for people, carers and for myself, maybe,
to learn how to better communicate—because at the moment all
I can do is sort of stroke her arm and smile and give her a kiss,
because there’s no other way I can communicate with her.
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[293] Dai
Lloyd: But that’s also the most valuable thing as well.
Lynne, do you want to take over? Then we’ll have one final
question from Angela as regards the staff training issue and
that’ll be it. Okay, Lynne.
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[294]
Lynne Neagle: Okay. We’ve had quite a few people tell us that
medication can be used in ways when it shouldn’t be used. One
of the things I’m really worried about is that medication is
being used for people living with dementia when other things should
be used instead, whether its support, psychologists, just generally
having help to cope with things. Instead, people are being given
medication, whether its antidepressants or worse things that can
have a really serious impact on people’s personality and the
way that they are. I just wanted to ask what your views were on
that, really, and whether that was something that you’re
aware of happening.
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[295]
Dai Lloyd:
Nigel, do you want to come
in?
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[296] Mr
Hullah: We believe that the pharmacological approach is the
wrong one and that it really should be the last one. We’ve
had conversations with the older persons’ commissioner on
this and she’s quite concerned, particularly about the use of
anti-psychotics in nursing homes in particular and whether or not
it’s always the appropriate response to somebody’s
behaviour. You know, how many other things have been tried before
they decide on medication? I understand why it’s done because
it’s an easy answer. If you’re in a situation where
you’ve got three or four people caring for 10 or 15, it may
be the swiftest answer. But they really need to look at
themselves—GPs need to look at themselves, not just people
with dementia, but generally. I think there’s an
over-prescription of medication, generally, to the population, I
feel. You go in there with a sore throat, you get antibiotics;
you’re not told to gargle with salt water.
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[297] I’m very
uncomfortable—I had a personal experience where I was
threatened with a section. I was threatened with it because I was
presented as being very aggressive. Well, yes, I’m an
ex-Royal Marine, so what do you expect? However, what I’m
saying, or what we’re saying is that as long as every other
avenue has been explored and there is good, clinical justification
for using anti-psychotics or, in some cases, worse, then fine, but
I think that our experiences are that, very often, that is not the
case.
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[298] Dai
Lloyd: Angela, just to wind up this session.
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[299] Angela
Burns: Yes, certainly. Thank you very much for your candour,
it’s really appreciated, and I know that, in different ways,
I think most of you have touched on the lack of training in some
ways. Beti, I think you made a comment about the fact—I think
it was you who said that young GPs are just coming out of medical
school and saying, ‘I don’t know anything about this
dementia.’ I think that, from you, it’s absolutely
horrifying to hear that because—
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[300] Ms
George: Things are changing now.
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[301] Angela
Burns: I’m glad to hear it, because it is a condition
that is very prevalent and is becoming more prevalent. I just
wanted to understand a little bit better what you think we could
recommend in terms of more awareness for staff. I think you made
the comment: there’s no such thing as a dementia-friendly
environment; we talk about it, but the reality is so far away. What
could we do to help make it more of a reality and not just in the
medical profession, but just throughout in terms of trying to train
carers and all sorts?
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[302] Dai
Lloyd: Michelle, you indicated.
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[303] Ms
Fowler: I was responding to what Nigel said about the
medication, sorry. Can I go back to that point?
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[304] Dai
Lloyd: Yes, go on.
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[305] Ms
Fowler: When deaf people sign, sometimes, they could think that
they’re being aggressive and being wild, but because
they’re moving their arms about, they’re trying to
communicate and trying to talk and they could be given
anti-psychotic medication or anything to calm them down when,
really, they don’t need to be calmed down, they just need
someone to understand sign language. When they assess deaf
people—you know, they respond in a different way to things.
Researchers found, in Manchester, in the mental health specialist
service there, a lot of research and the information is there,
comparing deaf and hearing people and their responses are
completely different and people need to understand that and need to
identify the good and bad practice and how to deal with
sign-language users.
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[306] Dai
Lloyd: That answers the question on staff training. Beti, did
you want to come back?
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[307] Ms
George: I think the Government have set some targets,
haven’t they, that they want—I think it was by April
last year; or, no, it couldn’t have been—75 per cent of
staff—? They talk about NHS staff in hospitals, but I think,
of course, it should also be other staff: the porters, the
caterers—everybody. In David’s case now, in Llandough,
the caterers come and say, ‘Would you like a cup of
tea?’—of course he can’t communicate. He’s
lost all his ability to communicate and, of course, I had to say,
‘Do you know he has
Alzheimer’s?’—’Oh. Oh, yes.’ And then
they put him on puréed meals and they came with a big plate
of sausage and mash and gravy and all the rest of it, and I said,
‘I think that he’s supposed to have a puréed
meal’, and then they looked—’Oh, yes. Yes,
sorry’, so they brought a puréed meal. No, I mean,
they should be, but how you go about it, I don’t know. The
Alzheimer’s Society have got training sessions—two
hours or something. I don’t know whether that’s enough
for people working in hospitals; I’m not sure. And what I
found was that, even if they have been trained—. Because I
did ask some of them—I don’t know what they were; they
were healthcare supporters, I think they call them these
days—and they said to me, ‘Oh yes, we studied
online’. Well, you know, studying something online is not the
same as actually dealing with people with dementia on the ward. So,
something needs to be done. How do you go about it? It’ll
cost, I suppose—it’ll cost a lot of money and, of
course, they haven’t got the time, because, as you know very
well, there aren’t enough nurses and other staff, and they
haven’t got the time to release them to go on these courses.
That’s another point. So, yes, I wish you luck.
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[308] Angela
Burns: But we could perhaps recommend that training is embedded
in the initial training of nurses and doctors and occupational
therapists and physios and all the rest of it. May I just add one
little extra to my question, then? If you take the medical side of
it away, in your day-to-day lives as either people affected with
the condition or people who care, are there any other groups of
people that you run up against consistently that you think would
benefit from having some kind of awareness training?
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[309] Ms Jones:
A lot of the time I think places like banks and things, because me
and my mam had a lot of problems, along with the lack of
information, with things that I was never told anything about, like
power of attorney or wills—things like that. Again, at 17,
that’s nothing to you. We found it very difficult trying to
sort that out at the point that my mother had lost capacity, so it
was something that I had to take on myself. It was very, very
difficult to get people to understand that she doesn’t know
this information any more, and I don’t know it. Like when we
had to switch the house insurance, because I now pay all the bills
for the house. They ask you things like, ‘What’s your
roof made out of?’ and ‘What year was your house
built?’ I’ve got no idea at 17—no idea. I
haven’t got any idea at 27, either, but, you know—
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[310] Dai
Lloyd: Neither has any of the rest of us.
[Laughter.]
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[311] Ms Jones:
As long as it’s not just me. But, you know, going into banks
when she’d left her bank card somewhere, or she’d
forgotten her PIN, and just having to go in and say, ‘She
doesn’t know it, I don’t know it either, what are we
going to do?’ and they don’t know. They don’t
know ways around it. They go, ‘What’s your security
question?’ and I think, ‘Well, if she doesn’t
know four numbers any more, she’s not going to know the
answer to anything else’. So, yes, maybe people who work in
places like banks and, you know, I guess—what do they call
them—like civil servants, people that might have to sort out
quite serious issues around things that she’s forgotten.
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[312] Ms
George: I think this is where the dementia supportive
communities—this is where they do very good work, and I would
not at any time think of demolishing dementia-friendly communities,
and this is where they really are useful.
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[313] Ms Jones:
Yes, but, in my town, which is only a very small town in the
Valleys, our local Wetherspoon’s is dementia-friendly, which
is great if I want to take my mam for a pint, but I don’t
tend to do that. But, in places that do really need
it—we’ve only got one bank left now, but, places like
that, they haven’t got that sort of training or that kind of
information.
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[314] Dai
Lloyd: Okay. A final comment, then, Rhun.
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[315]
Rhun ap Iorwerth:
Basically, I like communication; I used
to be in the communication business. If at that time of diagnosis
you are literally given a file and on the first page of that file
there is: ‘This is your contact; this is the information that
you need; this is where you need to turn for this; this is what you
need to know about links with the banks; this is what you need to
know about power of attorney’, and so on, would that kind of
really, really basic level of communication be a useful
start?
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11:30
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[316]
Ms Kitch: Probably, but when you have diagnosis you don’t
want to know that, because I went, for the first two or three
months, into meltdown anyway. I didn’t want to know anything.
So, I think it would be handy to have that information and take it
away with you, and then, when you’re ready, be able to use
it. Because my husband, he had to research everything. With my
employment, he got in touch with the Alzheimer’s Society and
they sent along somebody to go to the meetings with me, because
they wouldn’t allow him in the meetings. I was being fleeced
of all sorts of things, because I couldn’t remember things.
So, yes, I think it would be useful to have that, but, when you
have diagnosis, you don’t want to look at it straight
away.
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[317]
Dai Lloyd: Michelle.
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[318]
Ms Fowler: Yes, if you’re given a file like that—you
know, as a deaf person, we wouldn’t understand the
information anyway, if it was all in English. What tends to happen
is that people in the deaf community, they share stories and rely
on each other. So, that’s how they get their information. So,
the information would have to be accessible, possibly with a QR
code at the bottom of the leaflet, so that they could put their
smartphones on it and there would be somebody signing it into BSL.
That’s a suggestion.
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[319] Rhun ap Iorwerth: I apologise for
suggesting that it had to be a physical file. It is the information
contained within that file that’s what I had in mind.
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[320]
Dai Lloyd: I said Rhun has got the final word; I’m going
to say Lynne has got the final word.
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[321]
Lynne Neagle: Just to follow what Rhun said, if someone had said to
you, when you had your diagnosis, ‘Here is the number of
somebody that you can ring if you want to meet up and talk about
this’, would that have been better?
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[322]
Ms Kitch: Yes. You wouldn’t feel alone.
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[323]
Ms Jones: I think something like that would have been useful to
me, and I could have contacted somebody. I think my mam probably,
like you said, she wouldn’t want to know, and she would
probably be in denial about it. But, for me, to have that
information would be of value.
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[324]
Lynne Neagle: So, if they’d given you, then, a dementia
support worker, that would have helped.
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[325]
Ms Jones: If they’d given me the number of anybody that
would’ve helped.
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[326]
Dai Lloyd: Okay. Michelle.
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[327]
Ms Fowler: So, what about deaf people? They can’t phone.
How is that going to be accessible? They need to see people face to
face, and in many cases they refuse to provide an interpreter.
I’ve had the experience myself. I’ve had no
support.
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[328]
Dai Lloyd: That sounds like a recommendation.
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[329]
Ms Fowler: I’ve had to really, really fight to get
interpreter support.
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[330]
Dai Lloyd: Okay. The time is at an end. It’s been an
excellent session. It’s been very valuable to us as a
committee, who are looking to scrutinise and, if you like,
criticise the work of the Government as regards dementia care
planning. I realise that it’s been occasionally distressing
for yourselves, but it’s been extremely powerful testimony as
well, which will be forming a valuable part of our report on this.
Now, if there’s anything—. When you’re walking
out of here now and you’re thinking, ‘Oh, Duw, why
didn’t I say that?’—well, stick it in a letter or
an e-mail or any other form of communication to us, and it will
also be incorporated in what’s been said this morning.
Okay.
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[331]
So, with that, can I thank you
all—Nigel Hullah, Madeline Phillips, Karen Kitch, Emily
Jones, Beti George and Michelle Fowler? Not forgetting Dawn Cronin
and Anita Tomaszewski and everybody else in the public gallery.
It’s been a totally emotional experience, I realise, for all
of you. Thank you very much indeed for your commitment this morning
and for your presence. Thank you very much indeed. That’s the
end of that session.
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11:34
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Papurau i’w
Nodi
Papers to Note
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[332]
Dai Lloyd: We’ll move on to item 4, papers to
note.
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Cynnig o dan Reol Sefydlog 17.42 i Benderfynu Gwahardd y
Cyhoedd
Motion under Standing Order 17.42 to Resolve
to Exclude the Public
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Cynnig:
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Motion:
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bod y pwyllgor yn penderfynu gwahardd y cyhoedd o
weddill y cyfarfod yn unol â Rheol Sefydlog
17.42(vi).
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that the committee
resolves to exclude the public from the remainder of the meeting in
accordance with Standing Order 17.42(vi).
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Cynigiwyd y cynnig.
Motion
moved.
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[333] Dai
Lloyd: With that I will move on to the fifth item, which is to
move this committee meeting, under Standing Order 17.42, into
private session. Are Members happy with that? Yes.
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Derbyniwyd y cynnig.
Motion
agreed.
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Daeth rhan gyhoeddus y cyfarfod i ben am
11:34.
The public part of the meeting ended at 11:34.
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