6. 5. Statement: ‘Together for Mental Health’

– in the Senedd at 3:54 pm on 11 October 2016.

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Photo of Ann Jones Ann Jones Labour 3:54, 11 October 2016

We move on to item 5, which is a statement by the Cabinet Secretary for Health, Well-being and Sport, entitled ‘Together for Mental Health’. I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Photo of Vaughan Gething Vaughan Gething Labour

Thank you, Deputy Presiding Officer. In July, Members will recall that I presented the Welsh Government’s draft of the second delivery plan in support of our 10-year cross-government strategy, ‘Together for Mental Health’. I launched the finalised delivery plan yesterday to coincide with World Mental Health Day.

The 2016-19 delivery plan sets out 10 priority areas for service improvement, including examples of cross–working with areas such as housing and education, which demonstrates how we should be joined up in our delivery. It also demonstrates how we will continue to drive the implementation of the strategy. It sets out clear actions and performance measures to ensure delivery, and the detail has been informed by both the Plenary debate we held in July and the extensive consultation with service users and voluntary sector agencies, as well as a wide range of partners, agencies and stakeholders.

Since the launch of ‘Together for Mental Health’ in 2012, there has been significant progress across a range of key areas, including the implementation of the Mental Health (Wales) Measure 2010. However, more can and needs to be done so we can make a sustained difference to people whose lives are affected by mental health problems.

Our debate in July emphasised areas that are important to all of us: building resilience in individuals and communities to tackle poor mental health when it occurs; improved support for our young people, particularly those at risk of adverse childhood experiences; and ensuring that services are provided in a safe, timely and effective way, with dignity and respect for service users.

This new plan will also contribute to the delivery of some key objectives laid down in the healthy and active section of the programme for government, including sustained work on tackling stigma and discrimination, introducing a new well-being bond in Wales, aimed at improving both physical and mental health, and the piloting of a social prescription scheme to improve the availability of sources of support within the community.

We’ve continued to spend more on mental health services than on any other part of NHS Wales and funding increased to over £600 million in this year. Over the last two financial years, we’ve announced over £22 million of new funding for a range of new provision across all ages. We expect that to further improve accessibility to services and outcomes for service users.

Since the implementation of the groundbreaking legislation, the mental health Measure, there have been real improvements to the care and support that people receive. Central to the delivery of the Measure has been a co-productive approach, because we place the needs and the voice of service users at the heart of both service design and care and treatment planning.

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

Significant steps have been taken to improve the provision of psychological therapies in Wales, with an additional investment of £3 million in adult and children’s services last year and another £1.15 million this year focusing on in-patient services. We expect further improvement in talking therapies through this delivery plan period, and again that commitment is reinforced in ‘Taking Wales Forward’.

In relation to the workplace, as a Government we support businesses and organisations to recognise that mental ill health is not necessarily a barrier to effective working. Providing employment and maintaining people in good jobs is a positive way of supporting individuals who are recovering from mental health problems. Improving the mental health and well-being of staff is a key element of the Welsh Government’s Healthy Working Wales awards. Our corporate health standard and small workplace health awards aim to improve the health and well-being of the working-age population and reduce the mental, physical and financial burdens associated with sickness absence.

This delivery plan also identifies a priority area that aims to ensure children and young people with mental health problems get better sooner. We’re working and supporting the NHS ‘Together for Children and Young People’ programme, which is working with partners across agencies, not just health, to consider how best to meet the emotional and mental health needs of our young people. When young people need more specialist mental health services, we’re investing almost £8 million annually in specialist child and adolescent mental health services to help improve timely access.

The delivery plan also includes goals to help ensure groups at a higher risk of mental health issues receive the care that they need. We recognise that pregnancy and early parenthood are particularly challenging times, and we are offering additional support to families. So, we’ll ensure that parents have access to the information and support they need, alongside the £1.5 million we are investing in community perinatal mental health services across Wales.

This Welsh Government remains committed to providing support to people in Wales with dementia and their families. Last year, we announced a number of areas of priority work and the steps we would take to support each of these. This includes work on dementia risk reduction, increasing public awareness, improving diagnosis rates and ensuring that support is available to those affected by the illness. Investment made over the last two years is already showing some progress in this important area. In the delivery plan, we recommit to developing a dementia strategic plan to ensure the necessary drive and focus needed on this agenda. Engagement with experts in the field, with carers, with people living with dementia themselves, is under way. I expect that work to be completed so we can formally consult on the dementia plan in December this year.

The delivery plan sets out what the Welsh Government, the broader public sector, voluntary organisations and business can do to achieve our shared aims over the next three years. We’ve seen the third sector taking an ever more active role in the way mental health services are shaped and delivered in recent years, and help to ensure the ethos of co-production in service planning and delivery.

The past three years have shown that while ‘Together for Mental Health’ is a challenging agenda, real progress is achievable. I trust that Members from all parties will recognise the achievements to date. This new delivery plan is ambitious, but by working in partnership, I believe we can continue to make progress over the next phase of delivery.

Photo of Ann Jones Ann Jones Labour 4:01, 11 October 2016

Thank you very much. There are a number of speakers who want to speak. This is a 30-minute debate, so can I ask for some brief contributions and some brief answers as well? Rhun ap Iorwerth.

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru

(Translated)

Thank you very much, Deputy Presiding Officer. May I thank you for the statement and for the strategic plan that was published yesterday? I do recognise, certainly, the steps forward that have taken place since the launch of the plan in 2012, but the Cabinet Secretary himself has acknowledged just how much remains to be done, and I do look forward to the debate tomorrow afternoon in the Chamber, where we will have an opportunity to discuss some of the weaknesses—some fundamental weaknesses, indeed—in some areas of provision.

I have three questions, first of all on carers. The statement doesn’t mention carers of those who have mental health issues, apart from saying that they will be included in the dementia strategy. Looking after a member of the family who has a mental health problem can also affect the mental health of the carer. So, what kind of support structures are going to be put in place, particularly taking into account that caring for someone with mental health problems does pose a very different set of challenges to caring for someone with a physical problem?

Secondly, the statement doesn’t mention the staff needed in order to deliver improvements in services, namely the need for an increase in the number of therapists and also ensuring that there is adequate time available for continuous professional development. We know, for example, that many therapists work in the private sector, so what plans does the Welsh Government have to actually draw those people into the NHS, even if that’s only on a part-time basis, in order to enhance capacity?

And thirdly, one of the very real problems, very often in terms of those who need emergency care to prevent self-harm or suicide is either that they are not known to the service or that they have somehow slipped through the net—that there haven’t been follow-up calls in order to ask why they didn’t they turn up for their appointments and so on. An audit of cases among teenagers recently showed that many of those who had committed suicide weren’t known to CAMHS or hadn’t been monitored, so it’s the exact problem I was mentioning earlier. Would the Cabinet Secretary except that the nature of the problems that some of these individuals face means that they don’t have the motivation to turn up for their appointments, particularly, possibly, appointments early in the morning if one of the side effects of the condition is a failure to actually motivate themselves to get up in the morning and so on? In that context, would the Cabinet Secretary accept that, very often, we need to be far more proactive in assisting these individuals who need our support?

Photo of Vaughan Gething Vaughan Gething Labour 4:04, 11 October 2016

Thank you for the three questions. I’ll be happy to respond. I’ll take first your question about carers. In fact, of course, we talk about carers throughout the range of our different strategies and not just in this one too. They’re specifically mentioned in part of priority area 4, but that isn’t the only one of the 10 priority areas where carers are relevant. I would reference back to the fact that carers now have a statutory right to have their care and support needs assessed and met under the Social Services and Well-being (Wales) Act 2014. So, it isn’t just about seeing the strategy on its own and saying that carers aren’t mentioned enough, because we recognise that, throughout this, to treat the individual service user with dignity and respect, you also need to understand the context in which that care is being provided. The family and friends who are providing that informal or formalised care around them are part of that. So, their care and support needs are also part of what we need to take into account. So, I think that’s part of where we see this. It isn’t that carers have been forgotten—far from it.

I’ll deal with the point you make about suicide, because, of course, we launched the second phase of ‘Talk to me 2: Suicide and Self Harm Prevention Strategy for Wales 2015-2020’ in July 2015, and it’s taking a more targeted approach than the previous strategy. So, in particular, we’re looking to identify particular groups of vulnerable people. So, for someone who isn’t attending appointments, there are risk points there that are actually raised. The challenge is someone who really isn’t known to the services—it’s really difficult. That’s really difficult to prevent. The challenge here is understanding those people who really are potentially vulnerable, who should be a higher priority and how to help to support those. That is explicitly part of the ‘Talk to me 2’ strategy. I was very pleased, yesterday, to have an opportunity to discuss that with Samaritans Wales, when I spoke at the launch of their impact report in Wales. There’s a really positive flow of work and we’re actually seeing suicides reducing in Wales, which is not a trend we’re seeing in every other part of the UK. But there’s no complacency about where we are and it’s why we’ve got a specific strategy in this area to be more proactive in understanding who is at risk.

Finally, on your point about staff, there’s a fair point here about recognising who we need for the workforce of the future to actually achieve the objectives that we have, and a vision that I think people around this Chamber would buy into. It’s then about how we deliver it. But while I have discussed and set out the range of cash that we spend and the additional investment that we’ve made, the greatest call on that resource is actually wages. It’s money—and it’s staff that that money is procuring. So, when you see the step forward made in the NHS Wales veteran service, that’s because we’ve actually got more staff to provide the service and that’s why waiting times are significantly better than other parts of the UK that have a similar service. When we talk about CAMHS, almost all of that is going into staff, and that’s where we’re finally seeing waiting times reduced, because we’ve got the staff resource in place who are actually addressing the challenges within the service.

(Translated)

The Presiding Officer took the Chair.

Photo of Vaughan Gething Vaughan Gething Labour 4:04, 11 October 2016

So, a lot is about having the right staff in place. We recognise that there are still gaps in terms of where we want to be. It’s one of the few challenged areas, for example, in public services, as we have them now, where money is tighter, but there’s still a call for more staff in the NHS in different specialities. Our challenge will always be how we match up what we need and what we want with the staff who are available and make sure that they’re working in the right model of care and seeing the right people at the right time.

Photo of Angela Burns Angela Burns Conservative 4:08, 11 October 2016

Minister, thank you for the statement today and for publishing the delivery plan yesterday on World Mental Health Day. I have a number of questions I just want to ask you about this. Going back to a question I asked the First Minister, in your statement, in the area where you have your three bullet points, you talk about emphasising the areas that are important to us and you particularly talk about building resilience in individuals and communities to tackle poor mental health and well-being when it occurs. You also go on to talk about the piloting of a social prescription scheme. I raised concerns this morning with the First Minister, so I’d like to ask you directly: can you tell us how much read-across there was between this mental health delivery plan and other Welsh Government Acts, particularly the Social Services and Well-being (Wales) Act? I think there are some tensions between this implementation plan and that Act, in terms of one consolidating and encouraging individuals to very much do things and be responsible for themselves, and yet the social prescription and the comment about individuals and communities talks very much about actually relying on your community and getting involved in your community. I cited one particular area, but it’s about where you get organisations or community groups that are being closed down under the social services Act, because people are being told to be empowered and to take charge themselves, and yet this mental health delivery plan is all about how we integrate people with mental health, how we build them into communities and how we sustain and support them. So, I would just like to understand the read-across between different Government objectives.

Moving swiftly on, a very brief question: I think the Welsh Government’s Healthy Working Wales awards are an absolutely excellent idea. I just wanted to understand if you were able to offer guidance and mentoring funds to the small workplaces to ensure that the mental health stigma really is removed, because it sounds like a great idea, but we need to bring small organisations as well as large corporates with us.

I finally want to turn to the area of child and adolescent mental health services. I really welcome the fact that you say here,

‘When young people need more specialist mental health services, we are investing almost £8 million annually in specialist CAMHS’.

You also talk about the fact that you are putting together a plan that’s working with partners across agencies to best consider how to meet the emotional and mental health requirements of young people. CAMHS is a great service. I’m glad that you’re putting more money into it, but the problem is that there’s such a gap between the services that can be offered by local government, by partner organisations and by health boards and the kinds of services or conditions that a young person needs to have in order to access CAMHS. First Minister—. I keep calling you ‘First Minister’. I must have a prescience about this. [Interruption.] It is. [Laughter.] Cabinet Secretary, can you confirm or give an opinion as to whether or not you think that this is enough to try to close that gap, because young people need to have an incredibly wide range of conditions in order to be able to access CAMHS? What is happening is that a great many young people with suicidal tendencies, who are self-harming or have multiple conditions or multiple disabilities with conditions are being denied access to CAMHS because they don’t fit those strict criteria. I cannot see in the mental health implementation plan that you’ll be able to actually close that gap that well.

Finally, Presiding Officer, because I know I did just say ‘finally’. [Interruption.] I did. This is my last ‘final’. In the plan you talk an awful lot about measuring outcomes, which is something that is very dear to a Conservative’s heart. What is less clear is how you’re going to measure those outcomes. You talk about asking for people’s views. There’s not much clarity over whether it’s quantitative research or qualitative research. On an awful lot of the outcomes, where you’re going to do the measurements, you don’t identify what people are going to be measured against and what their baselines are. So, I’d like your view on how well we think we can really monitor this plan to ensure that it does deliver for the people of Wales.

Photo of Vaughan Gething Vaughan Gething Labour 4:12, 11 October 2016

Thank you for the series of questions. I’ll try and run through them briefly and quickly, bearing in mind the directive we had earlier on. On the point about building resilience and social prescribing, I don’t think there is any conflict between this delivery plan and the terms of the Social Services and Well-being (Wales) Act. I think there may be a challenge about the way people are choosing to implement that and the priorities that they’re actually drawing up, but there’s nothing in this delivery plan and the terms of the Social Services and Well-being (Wales) Act that cuts across and should prevent effective working between agencies to try and improve the voice for the service user. I’d be really interested, perhaps, if you’d write to me or speak to me about the particular example you’ve raised, both with the First Minister and me, about the community facilities that you say have been closed because of the Social Services and Well-being (Wales) Act, because I’d be very, very surprised if there was a real statutory imperative to close the service that you referred to.

There’s always the challenge about money, and you know that we’re living in straitened times. There is less money available to some services, which we would all value in all parties, but they are unlikely to receive that money to keep on moving forward. There’s always a choice about people who are able to provide those services, whether they’re volunteers or employees. Equally, there’s the perspective we made about the people commissioning those services, whether it’s the NHS or local government, about the purpose of that service, about the purpose of people providing it in the third sector or otherwise, and the quality that it is then providing as well. I’d be interested to hear more from you so that I can give, perhaps, a more helpful or specific response to the specific issue that you raised.

On the Healthy Working Wales awards, I presented a number of these awards in the past, and it’s been really interesting to see the way that businesses—small, medium and large businesses—have actually responded. Mental health and well-being has been a really important part of the criteria that are used. In each of the storyboards we understand the journey that a business has gone on. They’ve learnt an awful lot themselves about looking after the well-being of their employees and supporting people to come back into the workplace. So, I’m content that, in the process that we have in looking at how small workplaces are involved and engaged, any small workplace that wants to engage in this award will find proactive support from the Government and our agencies and our partners in Public Health Wales to try and get engaged and to understand the real value of supporting their employees before they have mental health problems, during that time, and, hopefully, to help them back into the workplace as well.

On CAMHS, the £8 million that we are investing in our ‘Together for Children and Young People’ programme, we have the NHS; it’s being led by the NHS. We have the third sector. We have a range of children and young people themselves involved as stakeholders. I think it’s actually a really positive way of people working together and recognising that, sharing together, actually they’re able to understand the challenges and the range of the problems and the answers as well. So, I recognise the point that you make about the difference between the specialist service, where people really do have very, very high-level needs, and people who understandably have a need that is not being currently resolved in a way that matches the needs of that individual young person and their family context in which it’s being seen. That’s part of the challenge of the work that we need to do with partners—it’s also why the mental health Measure has been important—about local services being made available. So, it’s seeing the whole spectrum from health and well-being—say, for a child at a young age, what happens within their education setting and other parts of their life, and then what happens if they do need additional support as well. So, I recognise that it’s not a complete picture as we are now, and I wouldn’t try to say that it is. But it features very heavily in the priorities that we have in this delivery plan.

Finally, on outcomes, we’ve worked to look at and to borrow heavily from the public health outcomes to have an approach about how we understand whether outcomes are improving. Equally, it’s been part of what the third sector alliance was very, very interested in, about how this work has improved. Some of that work is in place, and there is more that’s being developed with the third sector to understand outcomes of real value, so they can really buy into them and they can understand themselves what that looks like. I’ll be more than happy to have a conversation with you and other spokespeople and colleagues in the Chamber about how we’re developing that work and how we’ll then be able to actually assess each year, second and third year, the outcomes that we are achieving for people across Wales.

Photo of Caroline Jones Caroline Jones UKIP 4:07, 11 October 2016

Thank you for providing us with this update today, Cabinet Secretary, and for providing us with the final delivery plan yesterday. When we discussed the draft plan in July, I raised the issue of access to psychological therapies. Early access to talking therapies, such as CBT, are proven to improve recovery and reduce the need for more acute services. I therefore welcome the commitment to improve access to psychological therapies and details of the funding. I would be grateful if the Cabinet Secretary could outline how the Welsh Government will reduce waiting times for CBT in Wales. I also thank the Cabinet Secretary for the commitment to improving the CAMHS service. It will be welcome news that young people will not wait more than 48 hours for an urgent referral or more than 28 days for a routine appointment. However, I remain concerned about the out-of-area placement of children and young people. I welcome the commitment to reduce the number of out-of-area placements and the length of such placements. Can the Cabinet Secretary please explain why the reduction will only be by 10 per cent of the 2013-14 baseline? Surely, we can be more ambitious than that. Should we not aim to eradicate the majority of out-of-area placements, given the obvious impact this has on the mental health of those young people and their families?

I look forward to learning more about how the new well-being bond will work in practice and for details of the social prescription scheme pilot. It is important that we ensure that everyone in Wales has access to community support schemes such as the excellent Sandfields centre or Tŷ Elis counselling service within my region. Will the social prescription scheme fund referrals to community support schemes such as these? They currently receive no funding from the NHS, despite offering valuable services to them. We welcome the commitment to developing a dementia strategic plan. Dementia care and elderly mental health care is sadly lagging behind the level of care that we expect. Also, to state something similar to Rhun, actually, the well-being of our carers, whether they are paid or unpaid, is of paramount importance, in ensuring that they take their breaks when they should, and also their holidays, as we need them to be fully fit for the delivery of these services. Finally, Cabinet Secretary, we welcome the recognition that the role of the third sector has to play in the delivery of this plan. The voluntary sector and all of us have a very important role to play not only in improving mental health care, but also in tackling the stigma of mental health, and how does the Cabinet Secretary propose to support the very important work undertaken by Time to Change Cymru? Thank you again for your statement; I look forward to working with you to deliver improvements to the mental health of the people in Wales. Diolch yn fawr.

Photo of Vaughan Gething Vaughan Gething Labour 4:20, 11 October 2016

Thank you for the series of comments and questions. I'll just stick to dealing with the questions. Your question about psychological therapies—I indicated in my statement and partially in answer to Rhun ap Iorwerth and his series of questions, of course, that the money we’re talking about is going to be largely invested in staff to provide the therapies, and that's the point about how we want to see improvement in the quality of care and in waiting times themselves as well. We know there’s a need for expanded capacity. And at the same time, though, not just by expanding the capacity we have, we need to look—and this is part of the question in CAMHS as well—and also make sure that the right pathway exists so that people who don't need that specialist care have an appropriate form of care in another part of the system, so that means that people who really do need access to specialist therapeutic support can and will receive it. It's also why we've changed our waiting time standards. Our waiting times standards are now tougher than in other parts of the UK. We’ve halved the time it takes to get to actually see someone to have an assessment, and then the time it takes to actually start a therapeutic intervention as well. So, we're actually moving to have a more demanding system, recognising that access to therapy when somebody needs it is often more important and, actually, you often get a better result the earlier that access is provided, which is why we are making the significant investment that I've already outlined.

On out-of-area placements for children, we're very clear we've got an ambition to see the number of placements—not just for children, but also for adults, too, but you asked specifically about children—improve, so we need to make less use of these residential placements for children. We want to see more and more of that care provided in a local setting, in a community setting, and, often, the outcomes will be better. It's really if someone has very particular high-level needs that they would need an out-of-area placement, and that’ll be part of the work we need to do, to understand who really needs to have that placement and then to make sure an appropriate place is available for them. And sometimes that may not be in Wales—that may be the right thing for that person to do, but that is not the preferred option that we've set out or that services recognise they would want to have.

On your points about the well-being bond and social prescribing, the Minister for public health and I will provide Members with more details as we’ve more data to provide you, and in particular, on the well-being bond, what that could look like, what it will mean for communities, and, on social prescribing, too, it goes across both of our responsibilities, because there is a lot to this that is about public health and how we get people active and engaged and recognising that a lot of this is about a person's general sense of well-being, and social prescribing can help that and really help physical health outcomes, too.

There is real interest in this from the GP community right across Wales, and Dr Richard Lewis, once of the BMA, who is now the national clinical lead for primary care, is leading a piece of work on this, and I'm really optimistic about not just people buying into the idea, but then buying into a, hopefully, more simplified way to understand what social prescribing is and how to make that real for individual citizens and GPs themselves.

And, finally, on Time to Change Wales, it enjoys cross-party support. We’ve continued to fund it. We'll review the delivery of Time to Change Wales, what we've achieved, and we’ll then look at what we do next, because the campaign to end stigma and discrimination against people with mental health—we've made real strides on a cross-basis in Wales that we can be proud of, but no-one should pretend that this is completed. There’s still more for us to do, so we'll continue to need to engage with both the third sector and the wider public about what we still need to do to change the narrative on mental health that is a normal part of everyday life.

Photo of Lynne Neagle Lynne Neagle Labour 4:23, 11 October 2016

Can I thank you, Cabinet Secretary, for your statement? If I could just start with CAMHS, I very much welcome the extra investment that the Welsh Government has put into CAMHS, and I'm really pleased that we're starting to see some progress, but, as you know yourself, waiting lists still remain unacceptably high. It was something that the children's commissioner highlighted before the children’s committee last week, and we also know that there are areas of regional variation that are problematic. Can I just ask—we’re part way through the programme now—how exactly the Welsh Government is monitoring this and also monitoring any regional variations?

At the Samaritans’ impact launch yesterday, we learnt about their pilot schools programme, DEAL, delivering emotional awareness and listening in schools, which is a way of trying to improve the support that's available to young people in a school setting, and I welcome the commitment in the plan to looking at initiatives like that. Is that the kind of initiative that you would look to roll out across Wales, and will you be able to discuss this with the Cabinet Secretary for Education to see whether that might be possible?

If I can just move on to dementia, as you know, I have been a champion of the need for a fully resourced dementia strategy for Wales. Dementia is, I believe, the biggest challenge that health and social care now faces in Wales, and I believe it should be on a par with conditions like cancer. I’m really pleased that the commitment to a dementia strategic plan remains in the plan that you published yesterday.

I do just have a couple of questions, though. One of the areas of concern that I’ve identified previously is that the support workers, welcome though they are, will be done on the basis of GP clusters—a minimum of one dementia support worker per two GP clusters in Wales. That would allow a total of just 32 across Wales. Even on the basis of our current diagnosis rates, for everybody to have a dementia support worker we’d need around 370. So, I’d like to ask if that’s something you’re willing to keep under review, and whether that is something you will look at further when this plan goes out to consultation.

Similarly with diagnosis rates, they’re currently at 43 per cent in Wales, which is the lowest rate in the UK at the moment. The 2016 target is 50 per cent. The Alzheimer’s Society thinks the figure should be more like 75 per cent. It would be unthinkable if 50 per cent of people with cancer in Wales didn’t get a diagnosis. So, is that also something that you will continue to keep under review, and look to introduce more ambitious targets as time goes on?

Finally, any plan is only as good as its actual implementation on the ground. The cancer delivery plan has been driven forward by Welsh Government with some considerable success. Will you look at what mechanisms we can put in place to ensure that the dementia plan is driven forward at a senior Welsh Government level? Thank you.

Photo of Vaughan Gething Vaughan Gething Labour 4:27, 11 October 2016

Thank you for the series of questions. I’ll start with CAMHS. I recognise that we’ve had about a 21 per cent improvement in waiting times for people across Wales. However, the number’s still too high, and far too many people wait for too long. This still goes back to making sure that people who don’t need the specialist service have an alternative pathway for alternative support, because there almost certainly is a support need there, but CAMHS may not be the appropriate place for it. The investment that we’re making in staff should help with that, too. So, both things need to be done.

So, I recognise there’s more to do, and, indeed, on CAMHS it’s part of the issue that I’ll raise with vice chairs. In my regular meetings with vice chairs I’ve made it clear this will be something I’ll return to each time we sit down. They know they’ll have to tell me about where they are and whether they’ve improved from where they were previously. So, this will be part of the direct accountability they’ll have from me as a Cabinet Secretary, so it’s not going to fall off the agenda. Even when we reach a position where we can say that we’re comfortable, that will need to be sustained as well. So, I don’t think this will fall off my particular agenda, or theirs, for some time to come.

On the points you made, I’ll be happy to have further discussions with the Cabinet Secretary for Education about the role of support in and around schools, both primary and secondary. I’m sure that you and many others have visited schools in our constituencies and seen the school counselling service that exists, and recognise the value that teachers and headteachers in particular place on that service, and the difference they think it’s made both to behaviour and outcomes for the whole school community. So, it’s something we do want to see maintained, and there’s a clear strategic direction to support school counselling services. So, I’m more than happy to think about what we can do to understand what works best, and how people share practice, and what is an effective school counselling service for a particular school community or across a larger area.

On your final series of questions on the dementia strategy, the work leading up to consultation—the stakeholders have taken part, they represent different parts of the community, so it isn’t just that Welsh Government are sitting down on their own, and that’s important. It’s also important that the chief medical officer is part of that group as well, so there is some senior leadership from Welsh Government reiterating the importance of this particular strategy to the Government. I hope that when you see the consultation come in you’ll see that it’s real and meaningful.

Of course I‘ll review the points you made about the number of support workers, their role and function. I’ll review the points about diagnosis rates. I want us to achieve our current target of 50 per cent, and it should then be about, ‘And what do we then do next?’ I expect that, in the consultation, we’ll hear plenty from people about both of those points, and I would expect that to be the case, and encourage people to have a view on what is in the consultation and what people think is important, including if it isn’t there.

That goes to your final point about delivery. Yes, we will think seriously about delivery and how we make sure there is both senior oversight and a clear rationale about how that reporting is then made on the progress that we’re making, and whether we’re making the sort of progress that we really want to and that we set out to.

Photo of Elin Jones Elin Jones Plaid Cymru 4:30, 11 October 2016

We are way over time in this statement, but I have several Members not yet called. If I can get very short questions from each Member and short answers from the Minister, then I’ll call a few more speakers and extend the time. So, one question each, please. Joyce Watson.

Photo of Joyce Watson Joyce Watson Labour

I thought you were looking at me. Yes, I’ll be very brief and I thank you for extending it. First Minister—sorry, I’ve done it now. I’ve promoted you now. [Laughter.] Cabinet Secretary, can I ask you—it will be a brief question—whether you agree that the importance of tackling mental health head on really starts in the workplace? Will you welcome the fact that the Assembly yesterday—the Commission—signed an understanding called the Time to Change pledge, which clearly sets out our vision that we will support anybody, whoever they are, if they have a need to access support in the workplace because of their own mental health well-being, and that we will always be there for them?

Photo of Vaughan Gething Vaughan Gething Labour 4:31, 11 October 2016

Yes, I completely agree. I think it’s important that the Assembly and the Commission are showing leadership in this area too, not only in signing up to the Time to Change Wales pledge, but in recognising that being able to go back to work, and being able to remain in work, is really important for maintaining people’s sense of self-worth and well-being. I think most of us here get some enjoyment from actually being in the workplace. For lots of people, it can be a really important part of staying well and then recovering too. So, I’m really pleased to hear that the Commission is showing leadership in this area.

Photo of Darren Millar Darren Millar Conservative

Thank you, Cabinet Secretary, for your statement today. One of the things that I noted in the report and very much welcome is an increased focus on prevention and general health, mental health and well-being. I wonder to what extent you’ve considered the opportunities to introduce mindfulness into our schools across Wales. You’ll be aware that there’s been a fantastic project, which is being led by Pen y Bryn school in my own constituency in the town of Colwyn Bay, where they’ve been using mindfulness in that school. It’s built up tremendous resilience amongst the pupils there to be able to cope with the day-to-day pressures of school life and, indeed, gives them that resilience, which they can then take on into their high school education and even further. I note that there is a reference to mindfulness in the plan. I’m very pleased to see that. It’s the first time that it’s appeared. But, I wonder to what extent that’s going to be delivered and how it’s going to be delivered to people of all ages. We’ve heard about the pressures on CAMHS in particular. This, I believe, is an opportunity for us to seize the moment and do something in particular around mindfulness in our schools.

Photo of Vaughan Gething Vaughan Gething Labour 4:33, 11 October 2016

Thank you for the comments. I met Chris Ruane some time ago around the work that he had done in the cross-party group in Westminster. There was a consensus there for a broader approach, and the politicians themselves have found the usefulness of a mindfulness approach. I’m pleased you recognise that it’s formally mentioned in the delivery plan as well. The challenge will always be: what is the most effective route to support people to have that prevention and that resilience? I’d be very happy for you to write to me with details of the project that you mentioned in your constituency and how the school thinks that they have seen an improvement. That can then help to inform our approach as well. It’s something that we’re open-minded to, if you like.

Photo of Huw Irranca-Davies Huw Irranca-Davies Labour

Thank you for the statement, Cabinet Secretary, and for the launch of the strategy yesterday. It was a busy day for you on World Mental Health Day 2016 with events at Hafal, the Samaritans and others. You will have heard, as well, the inspirational speech by Nigel Owens, talking about removing the stigma and talking openly about mental health issues, which we all need to do. Could I ask him, in terms of community resilience, what role he thinks initiatives such as Maesteg becoming a dementia-friendly town, the parish of Kenfig Hill and some of the churches joining together to become dementia-friendly parishes, the men’s shed movement—the first one in the UK was in Tondu in my constituency, but now is in Maesteg and is spreading throughout the country—and the work of champions in mental health, such as Mark Williams in Ogmore Vale, championing perinatal mental health, which is touched upon in this strategy, and also men’s mental health as well—? Isn’t it right that these people and these organisations will underpin the success of this strategy?

Photo of Vaughan Gething Vaughan Gething Labour 4:34, 11 October 2016

Yes. I’m very happy to recognise the series of references you made to your constituency, where real work is taking place. You’ll recognise that we’ve got an ambition for Wales to be a generally dementia-friendly nation, and that means more dementia-friendly communities and a broader approach that we need to take as a society. Some of that is about recognising that a number of the problems that men face are about their inability or unwillingness to talk or to be open about challenges, which are internalised and then end up being a bigger problem than they otherwise might need to. I’m really pleased to recognise the volunteer movements that are taking place, encouraging men in particular to find the space to have that conversation, to be more open and to actually have a better way of dealing with the challenges that many of us will face at different points in our life.

I’m really pleased to deal with the point you raised about stigma, and not just Nigel Owens—there’s a broader point here about the world of sport, where actually there’s an opportunity to reach out, not just to men, and to recognise people who achieve at a high level and the challenges that they face, and for them to be open to talking about their own experiences, and about how that can feed into community-based sport for men and women, too. So, there’s lots for us to be excited about, and to harness the advantages we can gain for all those different parts of our community and the different reach that different people have, because sometimes the message isn’t most effectively delivered by a politician.

Photo of Nathan Gill Nathan Gill Independent

Thank you, Llywydd. Cabinet Secretary—for now—Nigel Owens OBE yesterday talked about the need to talk about mental health issues, and he also talked about how suicide is the biggest killer of men under the age of 45. I would like to see counselling services in every school in Wales, which I think would go a long way towards preventative medicine, which is something that you’ve hit on quite a lot in this report. It would also encourage people, especially men, to talk about their feelings from a younger age. Do you agree with that, and do you think it is possible for us as a nation to be able to have counsellors in every school in Wales?

Photo of Vaughan Gething Vaughan Gething Labour

Yes, I do. We’ve made significant progress on school counselling, in fact, and I’m pleased to see that there’s some recognition both of the importance of it and support for the difficult choices that local authorities and headteachers will have to make about their budget lines, as we face significant challenge over public expenditure generally. But, you make an important point about middle-aged men in particular and suicide risk, and there is this point again about different actors being prepared to stand up and say that they face challenges themselves and to describe how they got through it. What’s been really interesting, actually, is not just veterans talking about it, but often serving emergency services personnel as well, who’ve talked about the challenges they’ve had and how they got through them. So, there’s a wide range of different people who recognise that they’ve got a role in improvement across the country. We have a responsibility as the Government, and the NHS does as well, but actually a greater number of actors taking part in challenging stigma and discrimination will also help, I think, to improve the outcomes of people who really do reach out for support when they most need it.

Photo of Elin Jones Elin Jones Plaid Cymru 4:37, 11 October 2016

(Translated)

Thank you to the Cabinet Secretary.