Questions now from party spokespeople. The Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Presiding Officer. There will be a debate held in the Chamber this afternoon on obesity, and that underlines the threat that this poses to public health in Wales. How much does the Government spend and what resources is it investing in trying to tackle and prevent obesity in Wales?

Well, it’s very difficult to give a particular answer in terms of pounds and pence as to what we spend on this agenda, because it is so wide ranging. Our approach to it takes in active travel, for example, so there’s all the work that we’re doing through the department that Ken Skates leads, but also work that we’re doing in terms of our support for public health more generally—our work through the healthy network of schools, for example. So, it’s very hard to put a particular figure on this, given the fact that the work we are doing ranges from schools, through local authorities, and through the NHS, and aspects of the NHS such as our exercise programmes, and so on. So, in terms of putting pounds and pence on it, it’s very difficult to say.

Thank you very much, Minister, rather than Cabinet Secretary. Considering the cost of tackling and treating people because of conditions caused by obesity, considering the cost to the health service, however much is spent by the Government isn’t enough, and I hope that the Minister would agree with that. If somebody wants to give up smoking, there is a wide range of support available: nicotine-related products, support groups, there is also heavy taxation, of course, on produce, and the prevention of advertising and so on. As we can see that such steps have worked—have taken time, but have worked—and that’s reflected in the numbers that smoke now, does the Minister agree with me that we need to take a similar approach as we try to tackle this huge challenge in terms of public health, namely obesity?

Well, I’m pleased that you have recognised the success that we have made in terms of driving down smoking levels, which are at their lowest level since records began. And we’re making really good progress towards our target of 16 per cent by 2020.

You’re absolutely correct that tackling obesity is a very complex issue, and it does involve things such as taxation and advertising. We’re very pleased that the UK Government is committed to the sugar levy, for example. However, we are concerned that there doesn’t seem to be any demonstrable progress in that area. So, this is something we continue to push on, as we do with pushing for further and stronger action in terms of advertising as well. And, again, this is something that we make regular representations to the UK Government on. There is work here for Government to do, both at Welsh Government level and UK Government level. There are also things that the industry itself can do; for example, the work that the industry has done on a voluntary basis in terms of reducing salt levels in food is actually held up as a global example of good practice. So, there’s a role there for the industry to see what more it can do in terms of sugar and fat content too.

With respect, even though I acknowledge the work that is being done in Wales to tackle smoking, when I’m talking about the successes that have happened over the past decades, I’m talking about successes that have happened on a worldwide basis as this problem has been recognised. It’s clear to me that we need to take a long-term approach, starting now, with regard to obesity too.

I hope that the debate this afternoon will be a way to bring a number of ideas to the table with regard to further steps that could be taken here. But the parallel with smoking, I think, does give us one other warning, I believe. A huge amount of money has been invested over the years in preventing action by governments on smoking. Can you and the Welsh Government give an assurance that you will be restricting the influence of the corporate world on public health policy in Wales with regard to obesity too, so that we won’t have to wait for decades for action as we had to with smoking and also with preventing climate change?

I thank you for that question and I’m very pleased that Members have chosen to have a debate on public health with regard to the individual Members’ debate this afternoon. I’m really looking forward to hearing the ideas that Members from all parties will come forward with, because we are interested in what works and we’re interested in innovative ideas, so I look forward to the debate this afternoon. In terms of learning lessons from what has happened in terms of tackling smoking, obviously we’re keen to see what has worked in that area and what we can read across to tackling other public health challenges, not least physical activity and smoking, but also issues around substance misuse more widely, such as the over-consumption of alcohol, for example.

The Welsh Conservatives’ spokesperson, Angela Burns.

Thank you, Presiding Officer. Cabinet Secretary, the Royal College of Paediatrics and Child Health have highlighted that bronchiolitis in babies is a major winter pressure on the Welsh NHS. I’m sure you’re aware that the Joint Committee on Vaccination and Immunisation recommends palivizumab and Synagis as vaccinations that should be offered to high-risk groups to help protect against the effects of bronchiolitis. What advice has been provided to the health boards to ensure that a consistent approach to this matter is employed?

We expect all health boards and the wider NHS Wales system to follow consistently the advice of the Joint Committee on Vaccination and Immunisation. That’s a stance this Government takes on each of these issues.

I’m very pleased to hear you say that Cabinet Secretary because, in fact, in England, the NHS uses a centralised route of funding to pay for these injections, which ensures that at least the minimum guidelines are met. I’m sure you’re aware, but evidence is demonstrating that by considering small cohorts of at-risk babies, there’s a clear economic case for using Synagis due to the subsequent reduction in hospital admissions. However, there is widespread variation on the decision making in Wales with regard to babies being able to access medicine, with health boards taking different approaches and it’s slipping between the gaps in specialities. So, will you consider looking at a change in either the way the vaccine is funded or looking at changes in how you might be able to issue more guidance on this matter?

Yes, and if the Member wants to write to me with the information that she believes she has, I will be happy to look at that and take it seriously and consider what we can do next to improve the position in Wales.

I’m even more delighted to hear you say that. I just want to run past you one particular family, whose 12-month-old twin girls were 28 weeks premature. They’ve both suffered from bronchiolitis on four occasions this season alone, resulting in nine hospital admission days and six separate visits to A&E. These babies have been denied the vaccine as they do not fall within the strict vaccination criteria. However, the constant admission to hospital and having to persistently fight the virus has put a huge strain on the family as well as stunting the babies’ development, particularly one who has got cerebral palsy due to her being so prem. Is it possible for us not just to look at the health boards obeying the guidance issued by the JCVI, but also enable them to be a little bit more lateral in their thinking in such circumstances so that they would look at the overall picture and demonstrate the flexibility allowed to help alleviate the pressure on their hospitals, on NHS finances and on that family, families like them, and those babies? It is £600 per injection compared to nine hospital stays and six visits to A&E. I would have thought that it’s patently obvious.

Thank you for the follow-up question and the example. As I regularly say, we take an evidence-based approach and we look at the evidence and the expert guidance that the JCVI provides. I think it’s important to understand whether or not the vaccine would be effective in avoiding the admissions and the course of treatment that you outlined in the individual case. It’s also important to understand whether there is an alternative route to treatment, whether it’s the vaccine or another form. And of course this goes back to the treating clinicians understanding and advising on what is the best course of treatment. We know that there are individual patient funding request routes for treatment that falls outside the normal routes. But I think the most helpful thing is for us to receive the correspondence from you outlining the current position, so that I can look at that properly and seriously and I’d be happy to have a follow-up conversation with you.

Thank you.

UKIP spokesperson, Caroline Jones.

Diolch, Lywydd. Cabinet Secretary, it was extremely distressing to read in the papers of a family’s torment of an 86-year-old man who killed his dementia-suffering wife, aged 85, and then, himself unable to cope, stepped in front of a train. He was his wife’s devoted carer and they leave six children who feel let down and claim social services provision was inadequate. This is unacceptable and we need to improve collaboration as well as communication between departments to prevent people, like this couple from Cardiff, from slipping through the cracks in our system. Whilst our condolences go out to the family, what lessons can we learn and how can we prevent this tragic situation from happening again?

I recognise the particular example that the Member highlights. It is a truly tragic case that I understand the family will be incredibly upset about. The challenge in learning lessons not just from this individual matter, but the broader societal challenge we face, is where is the division of responsibility between individuals and their families, between social care and the healthcare service as well. What can we each expect from each other and how do we then make sure that we become a generally dementia-friendly nation?

You will know that I’ve given a commitment in this Chamber to a range of Members who have taken an interest in this particular area that the dementia action plan that we are consulting on will have a draft for consultation issued before the end of this calendar year. That will set out the position of the Government, having worked with and listened to stakeholders, the third sector and individuals themselves living with dementia, to try and understand what we have now but also what we could do in the future. I expect to make a statement to the Chamber at some point in the new year as well.

Thank you for your answer, Cabinet Secretary. In 2014, a review of residential care, ‘A Place to Call Home?’, was completed. It concluded that too many older people living in care homes had an unacceptable quality of life. Although a series of requirements for action on care homes has been implemented by Sarah Rochira, our older people’s commissioner, who is dedicated and has a team of dedicated staff, it is clear that her resources will be much overstretched to cover the whole of Wales. Now, more than ever, there is a need for the voluntary sector to become engaged. However, how can we ensure that our most vulnerable in society are treated with the dignity and respect that they deserve?

I thank the Member for the second question. In terms of resources, we’ve just had a debate about the budget and we have to allocate budgets to each of our areas, recognising the reality of the restricted finance we have available to us. The challenge is not always about money, but I think the points that you finished on are really about the culture in the care that we provide and the way that that is commissioned, largely by local authorities, but in terms of the commissioning of healthcare as well, and what we would all expect for ourselves and our own loved ones too.

That point about the dignity with which people are treated, that really is about listening to and properly engaging with the individual and their carers. That goes in to the direction of travel of this Government’s policy over a long period of time. It was started off previously by Gwenda Thomas in bringing a range of matters together about the citizen’s voice within social care. And actually, for the health service too, there is something about catching up some of the ground that social care has made. It’s not on an even basis—it’s uneven within social care; we recognise that—but it’s about generally having a greater engagement with and listening to the individual and their family and working with someone to deliver healthcare, rather than simply providing healthcare to or at a person.

So, there are real challenges here, but I think we should all take some comfort in the fact that, the overwhelming majority of the time, health and social care deliver great dignity and compassion in the care that’s provided. But there shouldn’t be any reason or expectation that we’ll become complacent about the quality of care that is delivered.

Finally, Cabinet Secretary, there is much publicity and concern at present regarding top-up fees in care homes and what these fees are being used for. How can we assure relatives and, indeed, residents in care homes that their fees are being used appropriately?

Well, where individuals pay top-up fees, it’s because they’re assessed, and either they want to pay a contribution on top or they’re assessed as being able to make a contribution. This is something about the commissioning of care, and it’s about who commissions that care and what standards are provided. There is something for the public sector in the way that care is commissioned, and you will be aware that the Minister is leading the implementation of the Social Services and Well-being (Wales) Act 2014 and the joint commissioning of a range of services between health and local government partners in the future as the Act is progressively implemented. You’ll also be aware of the role of individual families, too, because there’s something about the quality of care and how we get to that point.

So, the public sector definitely have a role, but equally individual families have a role as well in the sort of care they wish to provide with and for their loved ones, but equally people going into care—it isn’t as if people are always in a position where somebody else is making those decisions for them. Where people are paying their own fees, those fees are paid by individuals who often do have capacity to make choices, and it’s about how we equip people to make those choices. That’s why the information and guidance provisions in the social services and well-being Act are so important. I remember, with a range of other people in the Chamber, going through the scrutiny and having exactly these sorts of issues highlighted when the Bill was going through its scrutiny and became an Act. So, we’re well aware of the challenges, there’s no pretence that we’ll resolve them simply by a certain point in time, but it is an issue we recognise exists and one we’re determined to see improve.