The following amendment has been selected: amendment 1 in the name of Paul Davies.

We’ll now move on to agenda item 10, to debate the ‘Together for Mental Health’ delivery plan, and I call on the Cabinet Secretary for Health, Well-being and Sport to move the motion—Vaughan Gething.

Motion NDM6054 Jane Hutt

To propose that the National Assembly for Wales:

Notes the Welsh Government priorities for mental health as set out in the 'Together for Mental Health' Delivery Plan 2016-19.

Motion moved.

Thank you, Chair. I formally move the motion for debate, and I’m pleased to present the Welsh Government’s second delivery plan in support of our 10-year mental health strategy, ‘Together for Mental Health’.

Since the launch of the strategy in 2012, there’s been significant progress across a number of areas. Much of that progress can, of course, go largely unnoticed, but every day across Wales we see evidence that change is happening, making a difference to individuals whose lives are affected by mental health problems.

One significant area where this has happened is in the implementation of our groundbreaking legislation, the Mental Health (Wales) Measure 2010, and it’s fair to say that this was passed with cross-party support in the third Assembly. Implementing it has made real improvements to the care and support that individuals receive and in delivering a genuinely co-productive approach that places the needs of service users at the heart of service design and care and treatment planning, and that is something that we should be proud of.

Since April 2013, over 100,000 people have been assessed by local primary mental health support services that were established under the Measure, with over half of those having gone on to receive treatment in those services. Waiting times for assessment and treatment in primary care have continued to improve.

We’ve also seen the third sector taking a more active role in the way that mental health services are shaped and delivered through recent years. It is a good example of prudent health and care principles in practice. For instance, the Alzheimer’s Society’s dementia friends initiative is increasing the understanding of dementia and helping to tackle the stigma, and Bipolar UK offers a range of practical support to people affected by bipolar disorder.

We’ve continued to spend more on mental health services than on any other part of the Welsh NHS, and funding increased to over £600 million in the last year. In the past year alone, we announced over £22 million of new funding aligned to our priority areas for delivery over the next three years. That includes over £5.5 million for older people’s mental health care, which will support, amongst other things, the establishment of a multidisciplinary older adult psychiatric liaison service to help with quicker and more appropriate discharge from hospital and, hopefully, to reduce readmission rates. Also, £1.5 million is being invested in developing accessible community perinatal mental health services across Wales, which should help to improve mental health outcomes for women with perinatal illnesses, their babies and their families.

In child and adolescent mental health services, to support our together for children and young people programme, a further £7.6 million has been allocated to fund new community services for attention deficit hyperactivity disorder and autism, and better access to crisis services and psychological therapies. So, we’ve made real progress over the last year, including reducing out-of-area placements for Welsh children, and new services are starting to establish themselves well after a period of successful recruitment into those services.

The changes in CAMHS are the most significant for many years. By ensuring appropriate resources are available, we will help to achieve timely access to services and the right outcomes for children and young people. All of these commitments are built into the delivery plan to ensure there is a continuing focus on these key areas. Our new delivery plan also commits us to further improving access to talking therapies. Significant steps have been taken to improve the provision of psychological therapies in Wales, with an additional investment of nearly £2 million in adult services last year, and more than £1 million this year. More evidence-based psychological therapies are being provided locally than ever before.

The past three years have shown us that, while delivering our ‘Together for Mental Health’ strategy has been challenging, it has also been achievable, but, of course, there is much more to do. So, the draft delivery plan for 2016-19 that we’re debating today contains a number of ambitious new objectives, including resilience building and improved support for our young people, particularly those at risk of adverse childhood experiences; further addressing and preventing suicide and self-harm; and a new strategic action plan for dementia; implementation of the crisis care concordat to ensure appropriate support is provided to individuals in contact with criminal justice agencies; and a range of actions to ensure services are provided in a safe, timely and effective way that supports the dignity and respect of service users; and there is a continued emphasis on ensuring that service users and carers are able to influence the shape of mental health policy and services across Wales.

We know that stigma and discrimination continue to be major challenges. That’s why, in recent years, we’ve supported, together with Members across the Chamber, the Time to Change Wales campaign, increasing knowledge and understanding about mental health problems and getting people to start talking about mental health. Our new delivery plan places even greater emphasis on tackling stigma and discrimination.

Respondents to our consultation have welcomed the life-course approach that we’ve adopted in the plan, but have pointed out that some issues apply to people of all ages, for example loneliness and isolation. Respondents also made suggestions as to how the plan could be strengthened, including using the Social Services and Well-being (Wales) Act 2014 as a lever for cross-sector commitment and delivery, and building in the delivery role of the third sector and considering the physical health needs of people with mental health illnesses.

We’re giving careful consideration to all of the consultation responses, and the final version of the plan will incorporate many of the helpful suggestions that we have received, and, of course, I look forward to considering the comments made in this debate today. We also participate in an international benchmarking exercise on mental health services, and any relevant findings from that process will be incorporated into the final version of the delivery plan, which we intend to publish later this summer.

I trust that Members from all parties will recognise our shared achievements to date and appreciate that we haven’t taken soft options in setting our objectives for the three years ahead. Not all of the ambitions we’ve set out will be easy to achieve, but I’m confident that real progress can be made in the next phase of delivery.

The Presiding Officer took the Chair.

I’ll briefly deal with the amendment now. The Government has no problem with the amendment and will support it. I acknowledge that an integrated demand and capacity planning model to understand where services should be provided or modernised where resources are allocated is helpful, and I don’t see this approach as being in any way contradictory or an alternative to a ring fence that sets a minimum level and not a ceiling, as endorsed last year by an independent review. So, I’m happy for us to support that amendment. But I do look forward to hearing the views of Members from across the Chamber in today’s debate and, again, I can confirm that what gets said today will be taken into account as we finalise the delivery plan for the next three years.

Diolch. Rwyf wedi dethol y gwelliant i'r cynnig. Galwaf ar Angela Burns i gynnig gwelliant 1 a gyflwynwyd yn enw Paul Davies.

Gwelliant 1—Paul Davies

Add as new point at end of motion:

Calls on the Welsh Government to consider an Integrated Demand and Capacity model for financing mental health services as a more sustainable funding model than ring-fencing.

Amendment 1 moved.

Diolch, Lywydd. Minister, thank you very much for bringing forward this debate today. I have read the delivery plan with a great deal of interest and I concur with you on the Government’s overriding objectives—what you’re trying to achieve in terms of improving mental health delivery here in Wales. I don’t think anyone would quarrel with your objectives and much of your methodology.

You’ve touched, yourself, on how we are fighting this stigma at present, and that goes through all areas. It’s not just the stigma of one person against another person, but cultures can be inherent within organisations that can stigmatise people who have mental health issues. There’s no doubt that we definitely need more equality of entitlement to treatment between mental health and physical health, and this is one of the areas where I really would urge you to consider further how Welsh Government might be able to bring this forward.

I’m loath to mention the NHS in England, because I know that looking anywhere across the border tends to be a great anathema to many people here. However, within the NHS in England they have put forward a parity of esteem concept and it’s being introduced, in which equal rights for people with physical and mental health difficulties have been adopted, which has gone some way to acknowledging mental health needs, particularly of people with medical conditions. I wonder if it may be useful looking at that, and I’m sure other countries will also have very similar ideas, to see if we may be able to adopt any of those and move them forward in our own health service here.

I’ve got five sort of key areas I’d like to talk about, and I’m absolutely delighted that you are adopting our amendment. I did note what you said—ring-fencing isn’t about this as the maximum but rather the minimum—but sadly a lot of organisations will use at as, ‘Phew, as long as we’ve just spent what we have to, then no more’, and you do see it throughout Wales; you see it in a lot of organisations. They’re all hard-pressed for money; they’ve all got a lot of competing claims on a finite resource, and mental health does quite often come off as a cinderella spend in some of these organisations. So, we believe that an integrated demand and capacity planning model would be a much better way forward. It would also be a very good way of then being able to explore truly the demand, because mental health issues have a great many different shades of grey to them. And if you start to include, for example, young people with learning difficulties, which are very often as a result of some kind of mental health distress, then that also should fit into the bigger brief of mental health. So, delighted that you’ve agreed to accept that amendment, but I would like to be able to bring this debate back to the Chamber in six or eight months to find out how the Government are going to make that work and bring that forward.

I’d like to pick up on performance measures. In order for the strategy to be delivered effectively, we need to have an outcomes-based approach that is supported in parallel by a suite of these new financial indicators. We need to have greater public reporting by LHBs, local partnership boards and public service boards. I’d like to understand, Minister, what your report or your delivery plan doesn’t say, which is that in the many areas where you already have put targets in, how well you’ve achieved against them. So, for example, out-of-area placements for children and young people reduced below 2013-14 baseline by 10 per cent every year, so we need to have some kind of report that comes back out so we can measure where we are. And when we’re talking about how we do reporting, let me just pick another one, which is one where you virtually say it was just slightly woollier, where it’s saying that one of the measures of outcome would be to have feedback. How do you define ‘feedback’? Who collects it, who measures it, and who actually gets to see it? Is it going to stay within the organisations? Will it be sent forward to Welsh Government? There are so many indicators that have been nominated here; an awful lot of them don’t have hard cases attached to them in terms of where they get reported, who sees that reporting and who can take action. So, I’d urge you, Minister, to pick up on those.

I’m sorry; I’m galloping through this, because five minutes isn’t a lot to talk about such an important subject. CAMHS in-patients and waiting times; I think perhaps I will just say on this issue that I can see that the Chair of the new Children, Young People and Education Committee is present, and I’m absolutely sure that she will look forward to examining what is happening with CAMHS waiting times for young people and children, because although your report talks of it very successfully, we know that the Shillabeer review is not delivering everything that it should do, and we need to pick that up more.

And finally, Presiding Officer, I suspect I’ve run out of time completely to wind up, but I just wanted to say to you that the whole area of mental health delivery is so very important. If we just look at our young people, 23 per cent of all young people who attend at schools in Wales have some form of mental health impediment. It stops them from learning, it stops them from being successful, it stops them from having the lives that they should have, and when you start from that very level all the way through to people with autism, people with Asperger’s, people with syndromes that are recognised and have pathways, we have to help them because that is such a great percentage of our population who are not being the citizens they could be, and not having the help that they could be. So, anything that you want to do to improve mental health services in Wales, I’m absolutely prepared, and this party is prepared, to try and support you, but we do want credible outcomes, credible performance measures, and credible reporting back to the Assembly. Thank you.

Can I say at the outset that there has certainly been, I think, an improvement in mental health services since the mental health Measure was introduced, but, without a doubt, there are a number of areas where we need further improvement? I also welcome the update from the Government on their delivery plan; it seems to be a step forward from the last plan. There are definite actions here, and a timetable is noted as well, for implementation, and also—very importantly, I think—there’s specific reference in the plan to who is responsible for the different actions.

But, on the other hand, there are major questions remaining in terms of several aspects, including how progress is measured. For some indicators the target is very definitive. For example, a 100 per cent of girls who were identified as having serious mental health problems are offered appropriate support during pregnancy. That is good, but in other areas there are not so prominent improvement targets.

There are specific points, I think, that arise from the availability of talking therapies. A report by Gofal, the mental health charity, notes that far too many people are still being offered treatment by medication rather than other types of treatment and support. And even though they welcome the work that has been done by health boards to expand the provision, they believe that much more needs to be done to expand the range of treatments available. Specifically, they feel that people fail to be offered talking therapies because provision is not available in some areas, or because waiting lists are too long—that is, it’s not for clinical reasons.

I’ll also mention another area that Gofal thinks has inadequate attention, and that is eating disorders. They are very disappointed, they say, after working with the cross-party group on eating disorders to recommend a number of ways forward and specific actions that could be taken, as well as how to measure performance, that there was a big deficiency in the strategy in terms of tackling problems in that area.

If I can move on to an area that I know concerns many of us here in the Chamber—and we’ve just had a reference here to it—namely mental health services for children and young people specifically. We are very concerned here as Members because we do hear consistently from far too many constituents who share their concerns. I received a letter recently from the chair of governors of Cemaes Primary School in Ynys Môn. I’ll read from it: ‘The board of governors of Ysgol Cemaes has asked me to write to you to express our serious concerns about the child and adolescent mental health service. We have a number of children in primary school who need support and our understanding is that there is a waiting time of six months to access the service. We feel that this is quite unacceptable, and it does raise significant questions about the commitment of the national health service in Wales to the well-being and welfare of our children.’

It says it all; the people who are—

Angela Burns rose—

Ie wrth gwrs.

Thank you for taking the intervention. Would you also acknowledge that one of the issues with having such long waiting times for CAMHS services is that those young people are then thrown back onto local services provided by county councils, people like the disabilities team, the team around the family, and it puts them under immense pressure and takes them away from the people who should be their primary responsibility?

I think you’re absolutely right, and that there are further consequences as well to longer waiting times, as well as just passing the buck, if you like, to other parts of our public services.

Mae hi’n berffaith amlwg, rydw i’n meddwl, fod hyd amser aros yn gwneud gwahaniaeth i’r canlyniad yn y pen draw. Mae’r arolwg gan Gofal yn dangos perthynas glir iawn rhwng yr amser y mae rhywun yn aros am driniaeth a’r canlyniadau yn y pen draw. Yr hiraf y mae rhywun yn aros, yn ôl eu harolwg nhw, y lleiaf tebygol ydyw y byddan nhw yn dod i ganlyniad cadarnhaol o ran eu lles a’u hiechyd meddwl. Felly, nid mater o bobl yn gorfod aros yn amyneddgar am wasanaeth sydd yn mynd i fod cystal yn y pen draw ydy o; rydych chi’n aros am rywbeth a fydd, o bosib, yn methu â dod â chanlyniadau cystal yn y pen draw.

Cwpl o faterion eraill gwerth eu nodi cyn cloi: yr angen am therapi un i un i lawer o bobl sydd, ar hyn o bryd, yn cael cynnig therapi grŵp. Mae yna le i therapi grŵp, ond mae yna bobl ar hyn o bryd sydd yn cael cynnig therapi grŵp oherwydd nid yw’r adnoddau ar gael ar gyfer therapi un i un. Mae’r angen am apwyntiadau y tu allan i oriau gwaith yn bwysig iawn. Mae angen rhagor o apwyntiadau felly, yn enwedig lle mae llwyddo i gadw cyflogaeth yn un o’r allbynnau mae rhywun yn anelu amdano fo yn y pen draw. Hefyd, wrth gwrs, mae’n bwysig iawn i ehangu’r gofal a’r gefnogaeth sydd ar gael drwy gyfrwng y Gymraeg.

I gloi, mi fyddai Plaid Cymru—rydym wedi nodi droeon—wedi trio sicrhau ein bod yn cynyddu mewn termau real yr arian sy’n mynd i mewn i iechyd meddwl. Mi fyddem ni wedi sefydlu clinigau ‘residential’ ar gyfer anhwylderau bwyta ac wedi trio bod yn arweinydd byd-eang yn y maes hwnnw. Ydyn, mae adnoddau’n dynn—rydym ni’n sylweddoli bod adnoddau’n dynn—ond rydym yn sôn am faes yn y fan hon sydd, ers blynyddoedd lawer, wedi methu â chael yr adnoddau cywir i sicrhau ei fod yn cael ei iawn le o fewn ein gwasanaeth iechyd. Felly, oes, mae yna gamau positif ymlaen yn y strategaeth ddiweddaraf gan y Llywodraeth, ond mae yna ffordd bell i fynd.

I would like to thank the Welsh Government for tabling this important debate today. With one in eight people in Wales currently seeking medical help for mental illness and an estimated one in four of us experiencing mental health problems at some point during our lifetimes, it’s clear that we need to give mental health a far higher priority. We therefore welcome the fact that we are today debating the Government’s mental health strategy.

As the Welsh Government’s 10-year mental health strategy enters its second phase, it falls to us to ensure that delivery of the strategy matches its aims. Unfortunately, Gofal’s report, which was released this week, highlights the fact that delivery does not always match ambition. We must ensure that your new delivery plan actually delivers improved outcomes for the thousands of people in Wales suffering from mental health issues. The delivery plan for 2016-19 identifies children and young people’s mental health as a priority area, and we totally agree with you on that.

Young people referred to CAMHS have to wait much longer than adults have to wait. The target waiting time is a shocking 112 days and around half of all referrals exceeded that target. We therefore welcome the commitment in the delivery plan to reduce waiting times to 28 days for routine referrals and 48 hours for urgent referrals. When the former Health and Social Care Committee undertook post-legislative scrutiny of the mental health Measure, it found that children and young people were not benefiting from the Measure. Since the committee undertook its review, the Welsh Government announced it was reviewing the CAMHS service, and on this side of our party, we look forward to the review’s conclusions.

However, if we are to take the pressure off our acute services, we need to improve access to other psychological therapies. Early access to talking therapies, such as cognitive behavioural therapy, is proven to improve recovery and reduce the need for more acute services. Mind recommends that the maximum waiting time from referral to the first treatment should be 28 days, and when someone presents with a mental health emergency, the wait should be even shorter. However, waiting times across Wales are much longer; in some parts of Wales the average waits are around 11 months. This is unacceptable. People in distress should not be made to wait months for treatment. We wouldn’t leave someone in severe pain for that length of time. Why should mental health be any different to physical health? We must work with patients also to eradicate the stigma attached to mental health issues.

Of course, if we are to improve mental health services, we must ensure that the correct funding is in place. We welcome the Welsh Government’s commitment in the delivery plan to maintain the ring-fencing of funding for mental health. However, the level of funding appears insufficient. Mental health problems account for around a quarter of all health problems, yet we are spending just 11.4 per cent of the NHS Wales budget. In England, where the mental health budget is not ring-fenced, they are spending 11.9 per cent of the NHS budget on mental health.

One LHB, Aneurin Bevan, routinely spends over 17 per cent more than its ring-fenced allocation.

PricewaterhouseCoopers, in their review of the financial ring-fencing arrangements for mental health services in Wales, state that the ring-fenced allocation is not based on a robust assessment of healthcare needs. Cabinet Secretary, it is clear from all evidence that we need to spend more on mental health services in Wales. We understand that there is a pot—a small pot—and it has to be equalled in the services we provide, but we are asking that this is one priority that we do need to spend more on.

We welcome the fact that additional moneys have been targeted at priority areas in the delivery plan, but we would ask that you consider increasing the ring fence. I look forward to working with you to deliver your mental health strategy, but also to holding you to account to ensure that the strategy delivers real improvements to the mental health of the people of Wales. Diolch yn fawr iawn.

I’m pleased to have the opportunity to speak today. We know that one in four of us will be affected by a mental health problem in our lives, so it is vital that we give this delivery plan the attention and scrutiny that it deserves. I just wanted to make some brief remarks today on two parts of the plan. The first relate to my previous calls for a well-resourced, comprehensive and outcome-based dementia strategy for Wales, which is something that I’ve called for previously when I led a short debate on this in the Chamber, back in January. I’m delighted that the delivery plan includes the commitment to have a dementia strategy for Wales and I’m looking forward to hearing more detail from the Welsh Government on that, but I did just want to pick up on a few points related to that.

We know that there’s been fantastic progress in turning Wales into a dementia-friendly nation and I welcome what the Minister said about continuing to focus on that today. There are over 20 established dementia-friendly communities currently in Wales and I’m very proud that my constituency in Torfaen was the second in Wales to achieve dementia-friendly status. Whether it is businesses or local health services, right through to Big Pit National Mining Museum, I have seen this initiative make a huge difference to people’s lives. When you consider the numbers of people that are being diagnosed now with dementia, and the need to actually find a way through the challenges that that presents to us as a society, I think this is one of the most powerful things we can do to actually combat what can be a counsel of despair in the face of dementia. So, I’m delighted that the Welsh Government are continuing to focus on that.

The other area that I wanted to talk about was diagnosis rates, which are clearly absolutely vital, because it’s at that point when a patient gets the diagnosis, which is inevitably a devastating one for families, that they can start to come to terms with it and plan for what lies ahead. Of course, we know that dementia diagnosis rates in Wales are the lowest in the UK at present. I very much welcome the commitment in the delivery plan to look at a 50 per cent target for GP dementia registers and the stepping stone this provides for gradual yearly increases, but I do think that there is a lot more work to do. Fifty per cent would not be enough for illnesses like cancer and we should be, I think, aiming far higher than that with dementia. I’m aware that the Alzheimer’s Society has called for targets of around 75 per cent in each LHB by 2021. Even if you look at other parts of the UK, such as Northern Ireland, where the rates are 64 per cent, I think that we could be aiming higher. So, I know that the Minister is committed to increasing targets annually and I would be interested in further detail on how we plan to grow that target going forward.

Of course, diagnosis is meaningless without the right support in place afterwards. In fact, a diagnosis can make it harder to cope without the right support in place. The other area that I wanted to pick up on today was the need for named support workers. At the moment, only 39 per cent of patients in Wales get a support worker. I’m delighted that the delivery plan identifies the need to improve this, but I do believe that the suggested one support worker per two GP clusters needs urgently looking at again. This was a point that I made in my short debate. The Alzheimer’s Society have estimated that would be around 32 workers for the whole of Wales, but, at the current diagnosis rate, we would need around 370 to meet needs, and as many as 650 workers if we are to get diagnosis rates up to 75 per cent. So, I hope that that is something that the Welsh Government will be able to look at.

I very much welcome the commitment in the delivery plan to continue to drive improvements in adult mental health wards, based on the outcomes of the spot checks. But I also hope that the Welsh Government will continue to work hard to include the adult mental health wards in the Nurse Staffing Levels (Wales) Act 2016, which is a commitment that was given by the previous Minister to do as soon as is practicable. I think that’s vitally important.

Just finally, then, turning to children and young people, I very much recognise the points that have been made about the CAMHS service, and it’s something that I’ve raised many, many times in committee myself. I hope that the new committee will continue to have a focus on that. We’ve seen good progress by the Welsh Government, but we cannot afford to let up for one moment in that area. We’ve got to continue to have the resources, but also to drive it forward politically, and I hope that the Government and the committee, working together, can continue to drive improvements in that area. Thank you.

I consider it a privilege to participate in this important debate, and I thank the Cabinet Secretary for bringing the issue before us, dealing with ‘Together for Mental Health’. Of course, some of us are old enough to remember the mental health Measure brought forward by Jonathan Morgan, the former Member of this place, some years ago, which has brought much of this work forward, with a particular emphasis there on early treatment, and, as doctors, we are strong believers in that. It is crucially important that treatment is provided at an early stage, and this whole issue of waiting lists is entirely contrary to that fundamental principle.

Ultimately, we want to see more health professionals on the ground who can deal with these problems. As a GP, I would hope that I could refer a patient with mental health problems directly to talking therapies, but that isn’t the case at the moment, and it can take some months for my patients to see someone who can provide CBT and so on, and that situation must change. Even if we diagnose people at an early stage, if they then have to wait six months or longer until they get treatment—

Do you share my concern, the concern expressed to me by the charity Mind Cymru, that the Welsh Government action plan has been created on the back of insufficient evidence because mental health data such as waiting times for talking therapies are not being collected sufficiently?

There is a point there, yes, but, at the end of the day, we need more therapists, because we need more people to deal with the situation that currently exists, because waiting lists in this area are entirely unacceptable. And also, in dealing with drugs and alcohol and the abuse of those substances, we do need more professionals in this area, because there are also lengthy waiting lists in those areas, and that has major implications for mental health.

In speaking briefly about mental health problems among children, it’s very difficult in the Swansea area to refer a child to the CAMHS service. I’ve tried on a number of occasions, and, basically, they can’t be seen at all. This is crucially important point: in many areas, there is simply no service available, or that individual is just referred back into the education system, as we’ve already heard, and when they need to see someone who works in psychiatry that simply isn’t acceptable.

In terms of looking at this whole issue of mental health, there is a risk that we look at mental health in isolation. Well, it can’t be looked at in that way, and we’ve already heard that it’s a part of how we look at a person in a holistic manner: the psychological, physical and social aspects as well as the spiritual aspects. All of those things come together to actually make you healthy or otherwise, and every principle related to mental health must also be considered in physical terms as well as the social aspect of this.

In terms of co-ordination and collaboration across various services, we’ve heard a number of examples of this already, but I will just mention the police, because, in the context of some of the most serious problems we have in critical situations, when people have critical mental health problems where the police come into the process, it is very difficult on occasion to find a safe place for the treatment of these individuals. That, therefore, brings an overlap with the police and health services, and it would be far easier to deal with the whole situation across the board if the police service too were to be devolved to this place, because we are making policy here and discussing mental health services again this afternoon, but there are many aspects of mental health that are dealt with by our police forces, and they are currently not accountable to this place, and they should be. We should take every opportunity to ensure that the police service is also devolved to this place so that, when we deal with all of the health services available, the police should be part of that discussion.

But, fundamentally, what we want as doctors is early treatment for our patients, and that means more provision of health professionals, talking therapists and so on and so forth on the ground, so that we can refer our patients to them directly.

Thank you for giving way. I agree with you totally and I have no arguments, but do you also think there’s a need to train the doctors that are already in place because some of them have a lack of understanding sometimes on some of the issues people come to them with? So, it’s the training of those already in place, as well as more.

Yes, I would agree, because the whole system is under pressure. We could all do with far more time to deal with patients, and, once I’ve decided that I am going to refer a patient elsewhere, I want that patient to be seen, because what happens if you have to wait six months is that you go back to that GP, who’s already under enough pressure, and we can’t make any alternative provision. That’s why we have to tackle waiting times and employ more people in this area. Thank you.

It would be remiss of me not to start by welcoming the work that this Government has done and their commitment to improve mental health and mental health services, whether that be through increased funding for services, support for campaigns to end stigma, or the mental health Measure. But, as the Cabinet Secretary’s alluded to, and it should always the be the case in everything we do in politics and public life to achieve better outcomes and a better Wales, while much has been done, there are always ways in which we can build on this.

The draft delivery plan, and the outcome measures outlined in it, are a positive progress to be welcomed, but there remains scope for the Welsh Government to collect consistent outcome data across all mental health services, and serious consideration should be given to the performance measures put forward by the Wales Alliance for Mental Health—measures that capture patient experience, patient outcomes, clinical outcomes, and views from professionals.

Today, I wish to specifically focus on aspects of the ‘Together for Mental Health’ strategy that relate to the workplace in Wales. The recent recession and related threats to job security have not just placed financial pressures on workers in Wales, but have also been hard on people’s health and well-being too. Research by the mental health charity Mind reveals that one in 10 have resigned due to job stress, one in four have thought about it, and one in five people take a day off due to stress. In addition, Gofal highlights that trade union reps have reported that colleagues are approaching them on a much more regular basis to talk about mental health problems and to ask for information and support. Promoting mental well-being in the workplace and preventing and tackling mental health problems is made more prescient in the current economic climate, with low wages and job uncertainty—uncertainty that I feel could increase as a consequence of the unchartered waters we now find ourselves in post Brexit, and this can impact on mental health. Therefore, accessible support systems within the workplace and work environment are important. This can be done through Government and businesses measuring mental health problems in the workplace, and supporting trade unions, particularly equality works. I know that a lot of the right-wing press and politicians would have you believe the rhetoric of ‘these evil trade unions’, but the reps on the ground are amazing people who give their time voluntarily, and, in this instance, offer a link between worker and support services, as well as helping raise awareness and understanding of mental health in the workplace.

I’m sure that the Cabinet Secretary agrees with me that trade union reps play a vital role in promoting good mental health and well-being in the workplace, and may often be the first point of contact for workers who are experiencing mental health problems. The draft delivery plan sets out a number of actions relating to the workplace—actions that again could be built upon in order to better assess the impact of the strategy on workplace mental health and well-being in the public sector. Specifically, the recommendation of the mental health charity Gofal that surveying public sector staff regarding their mental health and well-being, and actively seeking out, understanding and responding accordingly, could see an overall improvement in staff mental health and well-being.

Finally, the importance of recognising and supporting mental health and well-being at work demonstrates all too clearly the need for mental health and well-being to cut right across the work of this Welsh Government. If we are really to deliver on the promise of ‘Together for Mental Health’ there needs to be exactly that—not solely a health strategy, but working together to place mental health as a priority for all Government departments from economy to education, housing and beyond.

I agree with the closing comments there of Hannah Blythyn that this is not just a question of looking at mental health issues; it’s a question of looking at it in terms of the broader physical health and, indeed, workplace well-being and health as well. I think you hit the nail on the head there, Hannah.

It’s over three years now since this strategy was published, and warmly welcomed at the time, as with many strategies before and since, but with the caveat that we see real outcomes and improvements beyond the words. I was looking through the Mind briefing that was e-mailed to Assembly Members and I noticed that there is concern that the strategy does not give enough of a role to the voluntary sector. The third sector can play a crucial role in giving a voice to people with lived experience and enable them to be heard. I would go further, actually, and say that the voluntary sector is probably the most suited to raising the profile of mental health issues and reaching out to those communities across Wales. I think it has a nimbleness and a localism to it that you can’t really create in the traditional mainstream channels. Those channels have their place, but the voluntary sector has its particular place.

Will the Member give way?

Of course, Lee.

Thank you very much. I just want to agree strongly with your comments and apply them particularly to the pressure facing CAMHS. The number of referrals to CAMHS has increased dramatically, but often CAMHS are unable to give the support that families need, and the resilience and tools they need. This is where the third sector in particular could come in with extra support for families.

Yes, I quite agree with you, Lee. In fact, I was listening to Dai Lloyd’s comments earlier, and Dai was talking about shortages across the board. You mentioned the shortage of therapists, and it struck me as you were speaking, Dai, that yes, there is a shortage of therapists, and I wonder whether this is an area that the Welsh Government could look at in terms of campaigning to recruit therapists, because a number of therapists that I’ve spoken to have said that they only found themselves going into that line of work accidentally after they were told, ‘You would be good at doing this’. They would never have thought of it before. So, I think that there’s an area—. This isn’t about money; this is about actually persuading people that they would be good at doing an area like that. So, I think this an area that the Welsh Government really could make some headway in. There are problems here across the rest of the UK as well, so if you really want to make a mark, Cabinet Secretary, then please look at recruitment of therapists and how you can campaign to get those into that job.

I was recently asked to host an event in my home village of Raglan on behalf of Time to Change Wales, the first national campaign to end the stigma and discrimination faced by people with mental health problems. I became aware of the existence of this group—going back to knowledge of these groups—purely through bumping into one of their champions, Bev Jones, who happened to live in my village. I bumped into her in the street, and through subsequent meetings we bonded, became friends, and she really raised the profile to me of the campaign Time to Change Wales, and indeed mental health issues in general, which I wouldn’t have been aware of before. It struck me how much we rely on people within this field, and often through accidental meetings, to increase our knowledge of what’s going on out there, which in our job as Assembly Members is vital to being able to help other people and to direct them on the right pathways.

As the Time to Change Wales website says, the campaign is needed because although mental health problems are very common, it can still be a taboo subject. Time to Change wants to improve knowledge and understanding about mental illness and, most importantly, to get people talking about mental health. This campaign, one of a number, is an example of how far we have come over the last few years, and how across Wales there are organisations and groups of volunteers who, through their hard work and dedication, are helping to deliver on the aims of ‘Together for Mental Health’.

A final few words on the development of Wales as a dementia-friendly nation. This topic was broadly covered in Lynne Neagle’s comments earlier. Again, I’m lucky; my home village of Raglan in Monmouthshire has helped lead the way in this field—don’t get the idea that everything is going on in my village, but a lot is—with the designation of, initially, the Raglan project a couple of years ago, and that’s morphed now into the wider Monmouthshire project, and that is reliant on local networks, local people. I know Mark Drakeford, in your previous role as Minister for health, in fact, visited that project in its early days. You would have seen how local volunteers are helping to deliver on the Government’s aims and are complementing the mainstream health channels to do that. Local people looking after each other in the first instance. It’s a great example of how community can work, with community looking out for community, people looking out for people.

There is a lot of good practice out there, in conclusion. Some of it is due to the actions of Government, some is in spite of the actions of Government, and that’s, of course, the UK not just here. Let’s keep the pressure up for some real change in mental health provision so that people across Wales are able to access the best services at the times in their lives that they need it most.

Can I thank the Cabinet Secretary for presenting the Welsh Government’s ‘Together for Mental Health’ delivery plan today? It’s most welcome. The last Labour administration introduced measures that saw a significant increase in funding for mental health services and stated that people who receive these services should have both care and treatment plans in place. Although we know that more needs to be done in this respect, I think we’d all agree it is the right way to be moving.

As we’ve heard, mental health problems affect at least one in four people in Wales, and it’s often linked to poverty, both as a cause and a symptom. Undoubtedly, poverty increases the stress and worry that can lead to poor mental health. For those suffering from mental health problems, securing and retaining employment and coping with day-to-day financial challenges can be a major hurdle.

The decision of the last administration to both increase and ring-fence spending on mental health funding provides the opportunity to increase access to support, enhance pathways and improve outcomes for service users.

The mental health delivery plan will be a vital component in achieving these outcomes, but I’d like to focus on one particular area, that of the mental health first aid programme, which is a key programme in the ‘Together for Mental Health’ strategy in raising awareness, particularly in the workplace.

Through their involvement in local partnership boards, it’s clear that public bodies have a role in this regard by co-ordinating strategies to ensure the implementation of the plan. They also have a role as employers in taking the lead on providing mental health awareness, both in respect of the day-to-day service delivery and amongst their own staff.

Local education authorities also have a crucial part to play in raising awareness around mental health issues amongst children in schools, including working to end the stigma that we’ve heard so much about surrounding mental illness and tackling any intolerance and bullying around that.

It’s true that most of our public service employers do provide counselling services for their staff, but, often, these don’t go as far as providing additional support to help them identify if their mental health is at risk or to provide further support services for those who do identify that they’re experiencing mental health problems.

However, it is to be welcomed that an increasing number of local authorities, health boards and other public services in Wales are starting to recognise the benefit of providing mental health awareness training, often in partnership with their trade unions. My own union, Unison, for example, has developed a comprehensive training package in this area for its members. There are also some excellent examples of major companies, like Admiral and Dŵr Cymru, who provide comprehensive mental health awareness training for their employees, not only to help them in their engagement with customers, but also to support colleagues in the workplace. These companies see raising awareness around mental health issues as a key part of their health and safety obligations.

I hope, therefore, that, in recognition of the importance of the delivery of this strategy, more public bodies will look to embrace mental health first aid programmes and provide awareness training, both for their workforce and for the delivery of their services.

Can I firstly commend the Government on its approach to the delivery plan, and in particular the extensive formal consultation and the engagement with stakeholders, carers and users of services?

As many people have mentioned today, one of the most significant contributions to the improvement of mental health services was the passage of the Mental Health (Wales) Measure 2010 and, in particular, I want to refer to the increasing ease of access to primary mental health assessments.

It goes without saying that timely access to assessments is crucial in terms of the prior diagnosis and ongoing treatment of mental ill health. Targets for those assessments have been challenging, but progress in meeting them has been very good in many parts of Wales. But there’s clearly been an increase in demand. No doubt, part of that has been caused by the availability of better access, and so that’s obviously to be welcomed, but it seems to me that an increase in people presenting with potential mental illness is also a result of the increasing pressures that people face in leading their lives—financial worries, relationship breakdowns, other health conditions and so on. So, the question of access to an assessment and the capacity to meet increasing demand, even if current performance is encouraging, is going to be vital.

One of the changes brought in by regulations under the Act was to change the eligibility for those entitled to undertake a primary assessment, in particular by withdrawing entitlement, for example, from psychotherapists. During consultation, under the regulations, concerns were raised in relation to that change, not least since some of those practitioners provide NHS services to patients at different points in their journey, as we’ve heard today. It’s obviously essential that those providing services are properly trained, that their expertise and experience is current, and that they operate within a recognised ethical framework. The Government has indicated it would look again at the issue of eligibility to provide assessments. So, in the interest of ensuring that we have the right levels and the right types of capacity to meet what is surely going to be an increasing need, I’d welcome an indication of whether the Government’s intention is still to bring forward proposals on the issue of eligibility, and if so, within what sort of timescale.

I call on the Cabinet Secretary for health to reply to the debate.

Thank you, Presiding Officer. I’d like to thank Members for the constructive manner in which everyone’s engaged in today’s debate, and also for this Chamber continuing to prioritise issues around mental health. I’ll try and deal with a range of the comments. I’m pleased that so many people spoke and made so many points, but I won’t have time to deal with all of them. As I said earlier, the calls that Members have made will be picked up and we’ll consider them as we take forward the final delivery plan.

Angela Burns started. I was very pleased to hear you acknowledge the issue about stigma, both in the workplace and wider society. This Chamber has a part, actually, in making sure that these continue to be addressed. I’m not somebody who’s going to pretend that it’s gone away because we’ve run a couple of events. In terms of the profile this has within the service, it’s an issue that regularly gets raised both with me and with my contact with other parts of the service. For example, last week, it was a specific issue that was raised in my own meeting with the vice-chairs of all the local health boards. So, it’s definitely something they understand is a ministerial objective and a priority for us. They also understand the point about the parity of esteem. I know it’s recently been talked about in a different way, but it’s something that we’ve been interested in and are keen to press on the service here for some time. So, that is very much part of what we expect to see delivered. In many respects I think we’re ahead of NHS England in the way that we deal with mental health provision and our waiting times stand as an expectation. The challenge for us is to not simply say, ‘We’re better than England’, but to look again, as we are doing now. What can we do better? What should we do better? And again, I’ll make this point, as I have done several times, about funding: we already spend more than the ring fence on mental health services. It is absolutely not to be seen as a minimum, but I’m happy to look at the work we committed to do earlier on.

It’s worth noting that, in terms of outcomes against objectives and indicators, of course we’ll publish information, but if I can just make this point at the outset: that over 90 per cent of service users in local primary and mental health services have been very positive about their experience. So, we do take their experience seriously and it’s not something that we take for granted.

A number of similar points were made by Rhun ap Iorwerth in his contribution, particularly the points—and a number of other Members made the same points—about a focus on talking therapies. Many members mentioned the same sorts of points, in particular on waiting times, where we have more stringent standards than in England. In fact, we’re seeing progress being made because we are recruiting to those services. Again, a point that Dai Lloyd made about the recruitment of people into the service: that’s why I mentioned in my earlier remarks that we spent £3 million last year on recruiting more people into the service for both adult and children’s services, and we’re spending an extra £1 million this year too. So, there’s no rowing back or a failure to recognise the need to have a different staff mix as well, but also to spend some of our resources on additional recruitment.

I’ll deal with the CAMHS point that a number of Members mentioned as well, because we do recognise the need to both improve access to the specialist CAMHS service and, at the same time, to ensure that we have a conversation with referrers and with families about referrals into that service, because children and young people themselves have recognised that a number are inappropriately referred in, and they’re actually in significant numbers. In this Chamber, you will have heard the previous Minister make this point on several occasions, and so part of what we have to do is to make sure there are other alternative referrals for people who don’t need the specialist support. That is, to look at the different range of alternative interventions and support available. For example, a school counselling-based service, what Families First do—all the different interventions that are needed there to support people who need some form of help and support, even if it isn’t at the specialist CAMHS end.

Will you take an intervention?

I’ll just finish this point. That was taken forward in the recent Together for Children and Young People programme, and the conference that I spoke to remotely—I couldn’t attend there on the day. This is something we have to work through at both ends is the point that I’m trying to make. I don’t mind who intervenes first. [Interruption.] Well, Angela Burns I heard first, and then I’ll deal with Rhun, to see if he wants to say the same thing or different.

Thank you, and I do take the point that Rhun made and that you’ve answered, however, where it falls down is in a place like this: for example, an urgent referral for CAMHS if a child is presenting with self-harm and has said they’re going to kill themselves. If that child is autistic, then they don’t get that help, because CAMHS say that that is not one of the disorders that they deal with. I’ve got this as an ongoing case in my constituency, and it’s absolutely a ridiculous situation, where a child fulfils one set of criteria, but, because they happen to have a particular disorder, they’re excluded from the CAMHS process, and so they’re then pushed back into social services. That’s the kind of clarity that needs to be brought to the situation.

I think there’s a point about seeing the whole person, rather than one particular condition, but if you write to me on that particular issue, I can offer something more helpful on it.

I’ll try and make some progress. Again, the UKIP spokesperson made a number of constructive points. The only thing that I would say in particular is, on the call for more money, I have indicated we’re investing more money. We’re investing more money than ever before, and we’ve continued to invest. The challenge isn’t the call for more money; the challenge always is where we find it and where we choose not to spend it as well.

On that point specifically—and it’s a general point on funding—funding for CAMHS does seem, on the face of it, to have gone down over the past few years. Could you give clarity on whether that is a coding issue of where exactly funding for treating 16-year-olds plus lies within the health service, or whether there has been a deterioration in funding for young people?

As I said, we announced significant additional investment last year of £7.65 million, and I indicated that in my opening remarks as well. So, I don’t accept that there has been a reduction in funding for CAMHS; that isn’t the challenge that we face. In fact, we wouldn’t have been able to recruit new people into the service to do something about addressing long waiting times—certainly not finished yet—without that additional investment in staff.

I’d better make some progress. In particular, I wanted to recognise the points made by Lynne Neagle in, again, a very well-constructed contribution about dementia in particular, and highlighting us being a dementia-friendly nation and having dementia-friendly communities, and the impact that has on individuals across that community, both in understanding, but also a better life experience as well, and also in particular for highlighting the scale of the challenge. I can say that we expect to have the new dementia strategic action plan by the end of this calendar year. But, on diagnosis, we’ve seen rates improve, and I expect us to reach 50 per cent by the end of this year as well, and then set our new level of expectation.

I’ll just deal with a number of the points that Dai Lloyd mentioned. On policing our practical relationships, it is something we work hard at, and we recognise we need to continue to do so, as well as your point about training for staff and the broader point about the mix of staff that we have.

Nick Ramsay, apart from mentioning Raglan at several points and opportunities, I’m delighted that you also recognise the challenges across the UK, but also the way that we take advantage of the life experience of people and the impact of volunteering as part of maintaining a good level of mental health and well-being.

I do, finally, want to mention the points raised by both Dawn Bowden and Hannah Blythyn, in particular looking at indicators and mental health issues in the workplace. Not just from my previous life as a lawyer, but my previous life as a shop steward for a trade union, I recognise the role that trade union representatives do have to play in helping to create a more positive workplace and actually take up action where that doesn’t happen. It is an important role that is sometimes not highlighted. But I went, myself, on mental health first aid awareness training and I’ve made sure that my own staff have undertaken that training for the particualrly stressful and difficult roles they do from time to time as well. That may be a point that individual Members may wish to consider for themselves.

Finally, I just want to deal with, not all of the points Jeremy Miles made, but to finish on this point, and it’s about engagement, because your recognise the points about the responses that people have made and how we deal with the demand profile at a time of economic uncertainty and not wanting to sit back. We had 137 responses to the consultation, and the responses and the way we engage are genuine. I can say that because those responses will have changed what we end up doing in the final plan. So, we will take account of what people say and what we need to do to deal with the demand that we have now and what we expect in the future, and to make sure that we come back not just to say that we’ve coped, but that we’ve improved the situation so that outcomes have continued to improve across Wales. I look forward to speaking more in this Chamber at another time about mental health action here in Wales.

The proposal is to agree amendment 1. Does any Member object? [Objection.] As there is objection, I will defer voting on this item until voting time.

Voting deferred until voting time.