Thank you. I now call the party spokespersons to question the Cabinet Secretary for Health, Well-being and Sport, and first this week is Caroline Jones.

Diolch, Ddirprwy Lywydd. Cabinet Secretary, South Wales Police dealt with more mental health incidents last year than any other UK police force. Police officers in south Wales dealt with nearly 39,000 mental health issues during 2016. Cabinet Secretary, do you agree with me that people facing mental health issues should be cared for by specialist mental health services, rather than the criminal justice system? Can you outline the actions you are taking to reduce the number of mental health incidents being dealt with by police officers?

I thank the Member for the comments. I think we need to be clear about what we’re talking about, because there’s a challenge of whether people continue to see a police cell as a place of safety, and that is not the view this Government takes, or the police force, or the health service. There’s actually much improved work that’s been undertaken between NHS Wales and police forces across the country, and I’m pleased to see there’s been a significant reduction in people inappropriately placed. We’re now down into very, very small figures. There’s still further improvement to go, but it really does depend on the categorisation that the Member uses, and whether or not these are people who are partly in the criminal justice system appropriately or are people with mental health problems who are being misplaced and not in the appropriate care for their actual care needs themselves.

Thank you, Cabinet Secretary. The Mind workplace well-being index shows that mental health problems are the leading cause of workplace absence. Even the NHS is not immune, and we lost a third of a million days to mental health issues amongst health staff last year. One of the biggest barriers to tackling this issue is the lack of access to psychological and talking therapies. What is your Government doing to improve access to psychological therapies and reduce waiting times for mental health treatment in Wales?

It’s no surprise to me that mental health reasons are a significant cause of workplace absence. From my previous time outside this place, as well as within it, I would be surprised if that were not the case. Our challenge is: how do we recognise it and the issues about stress within the workplace? We have specific programmes of activity, working with employers, and the awards we give about encouraging employers to take better and more anticipatory care of their workforce—recognising the significant gains to them as a business from doing so—as well as how we support people if they are out of the workplace. There’s something there about investing in occupational services in both the private and the public sectors to take care of our workers, and then, if people do need to access specialist mental health services and talking therapies, we, of course, have invested in those services successfully and progressively. This institution, as an Assembly, and, indeed, the Government, has recognised for a number of years the need to treat mental and physical health with a parity of esteem, and that has led to further investment in mental health services. We’re the first part of the UK to have meaningful working-time standards, and, actually, our performance against those is relatively good. However, there is more ground to achieve and more to be done. So, we can take some comfort in what we have done already and the priority for this area of action, but there’s much more to do before any of us can say that we’re satisfied.

Thank you, Cabinet Secretary. While we welcome steps to improve the numbers working in mental health care, such as the introduction of new courses at Glyndŵr university focusing on mental health and well-being, we are still short of both staff and funding for mental health services in Wales. How do you respond to the director of Mind Cymru, who states that the mental health arena is still ‘significantly underfunded’? What plans does your Government have to increase resources allocated to tackling mental health issues, faced by one in four of us?

Well, you’ll know from the budget that this place passed that we’ve seen a significant additional resource go into mental health. It’s the largest area of spend within the health service budget, and that came from the sensible and mature conversation that took place between this Government and Plaid Cymru and others. Now, that’s meant that we are continuing to prioritise mental health as an area of action, and that is not the position that the third sector recognises takes place across our borders. I don’t complain about the third sector in this, or any other area, calling for more resources. It’s their job to campaign; it’s their job to champion issues. It’s our job, though, to manage a finite group of resources. So, I don’t think it’s good enough for the Government simply to say, ‘Someone has called for more, therefore we’ll provide it’. We have to balance that against other priorities. I’m clear that this is a priority area of action, and we’re seeing that in deed and not simply in words with the extra investment we are making in mental health services.

Thank you very much. Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch, Ddirprwy Lywydd. Cabinet Secretary, we have discussed winter pressures on accident and emergency departments on many occasions. We now have the figures for January, which show that, in major A&E units, just 74.1 per cent of patients were seen within four hours. Now, when those figures were released, I think the BBC report stated that:

‘Undoubtedly there will be sighs of relief in the Welsh Government’.

Did you breathe a sigh of relief when you saw those figures?

I think that’s a very odd way to try and pose a question about a serious issue for the health service and for everyone who works within it. This is a real and serious issue for people who require care, in particular during the winter period, when we know that more older people are more likely to need admission into a hospital for care, and more older people need support in their own home. It’s not about breathing a sigh of relief; it’s looking at where we are as a whole system. Where we recognise there’s a need for further improvement—and not just in A&E, but the points we’ve made previously about anticipatory care that you’ll be familiar with in your own constituency, with the advance care work that is taking place in Ynys Môn, but also about the delayed transfers of care as well. As we’ve seen from the last figures, we’ve made improvement and there’s room for further improvement, as the whole system needs to work together, health and social care. It’s not about a sigh of relief; it’s about saying, ‘Where are we now? What more can we do, and is that system resilient?’ The system is coping, but it is a very real struggle. We see it in the staff, we see it in the people needing care, and I expect and I want to see further improvement made over the course of the year, and to get ready for next winter as well.

It’s not an odd way of asking at all. It’s asking for your assessment of where we are. I would have liked to hear a much stronger message in terms of ‘there must be much more improvement’. Those figures for Wales—74.1 per cent seen within four hours—I’ll remind you that, in England, the figure was 82 per cent, the worst performance in 13 years, seen as a scandal and a crisis in England. Of course there’s room for improvement in Wales.

We’ve discussed, of course, the importance of primary care and social care in helping relieve pressure on A&E on many occasions before. I’d like to focus on the role of general practitioners in providing urgent appointments. I’d like, on the record here, to send my sympathies to the family of Ellie-May Clark, whose case was reported over the weekend. Without getting into the specifics of this case, it’s clear that such a case is not going to help the perception that we’ve all heard, at times, that it’s difficult to get appointments with GPs. Now, yesterday, the older people’s commissioner released a report highlighting the barriers many people face in accessing the GP, with those perceptions about the difficulty of being seen very prominent in that report. Of course, lack of real data means that we don’t really know if perception matches reality, but one result certainly is that, if the perception is there, more people are going to go to A&E; we know the pressures on A&E. One way to address that perception, of course, would be to collect and publish more data on waiting times for the GP. Do you accept that we need performance data on availability of appointments and waiting times for a GP in order to tackle those perceptions?

I don’t think it would actually be helpful to try and say that we’ll start to collect data for GP waiting times and appointments. You’d need to construct a significant system to do so, and I’m not at all persuaded that that would be the right thing to do to improve patient access. We have a range of different ways of trying to look at improving patient access, including, actually, peer-to-peer conversations between primary care operators who understand what best practice looks like, and the impact that that has had both for the staff within the service as well as for the citizens that they serve. I’m happy to look at alternative ways to improve practice, whether the ideas come from other parties or, indeed, the conversations that we continue to have with the British Medical Association and the Royal College of General Practitioners about the reality of the position that they face in caring for our patients up and down the country. The tragic case you mentioned is an individual instance that I do not think it would be reasonable to try and posit as an illustrative example of the reality of care that is provided up and down our country. It is a tragic case, and I look forward to seeing the outcome of the coroner’s inquest into what took place.

It is about tackling perceptions, though, and I’m slightly disappointed again. Data are very, very important. Quite often, the Minister claims an achievement and there are no data to back it up, when often there are data to back up where the problems are occurring within the NHS. There is an underlying problem, of course, throughout the emergency care system. We know there are people of all ages with chronic conditions that need to be managed in the community, including being able to have same-day consultations and so on where necessary.

Now, the older people’s commissioner’s report also highlighted the barriers many people face in discussing issues with a GP they might not know, with time limits on how long they have to describe the symptoms, and so on. The report even notes that one person said there was a notice in reception at one surgery saying that there was a one-issue rule—clearly not appropriate in an age in which more and more people have multiple conditions that the NHS has to deal with. Do you accept, then, that, if patients feel rushed by a GP, or turned away from an appointment, patient safety is compromised, ultimately? Will you agree that neither practice is acceptable and needs to be stopped?

Well, I think it’s a pretty cheap shot to say that I claim achievement for the health service without there being data or evidence to support it. I recognise what you say about perception, but I don’t think championing perception over evidence is a particularly helpful thing for the opposition spokesperson to do. I take seriously the older person’s commissioner’s report, and I’ve already undertaken to write to health boards highlighting the messages from that report and reminding them about the guidance that the older person’s commissioner will be issuing.

I want to see a genuine conversation between the Government, the health service, practitioners within the service, and the public, on what would make a difference to them. We see good examples across the country of changes in practice that are improving access for people and making it easier for them to have a consultation with the right healthcare professional at the right time for them. That is the approach we’ll continue to take as we do recognise that we think there is a need to improve access across every part of our healthcare system, to have a more involved and engaged patient, and that does mean that both people who access and use our service will need to behave in a different way and understand different ways of accessing that service, and to be supported in doing so and have the changes that are being made explained—for example, a more remote consultation process as a first point, for example, in the Neath pacesetter that I saw with both Jeremy Miles and David Rees; that’s been well explained there and broadly well supported and received by the public—but also about supporting our staff to work in different ways as well.

Thank you very much. The Welsh Conservative spokesperson, Suzy Davies. I think your questions are to be directed to the Minister for Social Services and Public Health.

Yes, thank you very much, Dirprwy Lywydd. Good afternoon, Minister. Thank you for your announcement yesterday on the appointment of the inaugural board for Social Care Wales. As we know, its duties will extend well beyond those of registration, as fulfilled by the care council, and its chairman made plan to me yesterday that they’re looking forward to using their combined expertise to be a critical friend to Government as well as influencing direction and priorities in policy for social care and social services. This, hopefully, may redress the imbalance of the solitary expert voice for social care on the parliamentary review panel. How do you as Minister plan to capitalise on this body of expertise in order to avoid the integration agenda resulting in a sort of medical model for social care, and how have you evaluated how much more resource it’ll need than the care council in order to carry out its roles in professional development and policy influence?

I thank you for the question. I understand that you had a very useful meeting with members of the board yesterday, and I think that the advent of Social Care Wales is a really exciting time for the provision of social services and social care more widely in Wales. When I was putting together the membership of the board—and I should say we had unprecedented interest in it, which, again, is really exciting—I was keen to ensure that the board did have a strong balance of people. So, we have service users on the board, we have people from all kinds of sectors that work within social care, to try and ensure that there is a strong and wide expertise and voices on that board as well. So, I’ll be working closely with the board, especially in the early terms, to work on their programme for the future in terms of their programme of work and so on, and to ensure that they are properly resourced to undertake the work that I’ll be asking them to do.

With regard to the parliamentary review, though, I do think it’s unfair to suggest that there isn’t enough expertise in social care on that panel. The members of that panel were chosen because they have such expertise that they can take a whole-system look at health and social care, and the terms of reference have been clear that it is a whole-system approach that we are looking for. Of course, we did set up a specific sub-group as well, which is specifically looking at social care as well, so I do think that social care will be well represented and well considered by the parliamentary review.

You’re well blessed, Minister, in having this support in helping you make sure that the voice of social care is well represented in what’s likely to be happening over the next period of this Assembly, anyway. One of the things that you won’t find any opposition from anybody on, I suspect, in this Chamber, is the focus on the integration of health and social care, really focusing on primary and intermediate care levels. These, themselves, are NHS terms. They’re medical structures, and I think an explicit statement of intent to adopt a more social-focused model of integration would actually be pretty welcome in this Chamber. Medical intervention is, when you come to it, just part of social care. Emotional support and the place of human contact can be just as important, not least to carers, who themselves may not have any medical needs, of course. They’re at the heart of any future look at care—as, indeed, will be the nature of housing and the cross-pollination of skills in an integrated workforce. It’s going to need considerable and ongoing research to support good practice and policy development, so is this a job that you foresee, at some point, Social Care Wales taking over? Obviously it would complement their work in career design and development. And if not, why not?

I thank you for that question, and I agree that carers play an absolutely central role in the whole system of social care in Wales, and you’ll be aware that we’re refreshing our carers strategy at the moment. Part of that is looking at young carers, older carers, carers of older people—but also looking to ensure that carers can actually have a life outside caring as well, because we know how important that is. And our carers strategy will be led by the key things that carers are telling us are important to them. When talking about the intermediate care fund, I prefer to talk about it and think about it as an integrated care fund, which is handy because it doesn’t require any changing of the ICF letters, but it is very much integrated in the sense that it is working, in many places, closely with housing, for example, to ensure that we have step-up, step-down facilities available within the extra-care setting: so, places where people can find a residential placement that will change with their needs over time. So, people with early dementia might be able to go to an extra-care setting, where they won’t have to move over time, but the support available to them in that place can change with them, and I think that that’s an important way in terms of improving the care that people receive.

I recently was at the launch of the Health and Care Research Wales project, which took place in Cardiff, and that’s about bringing universities together with the social care sector itself, because we have such expertise within the social care sector in terms of the practitioners and the social workers and so on, but I don’t think that, so far, we’ve been making the most of that expertise and of those experiences and the potential for research there. So, again, this a new and exciting innovation in terms of being able to understand very well what’s happening in social care, looking at barriers and opportunities and so on, and listening to people who actually do the work on the front line.

Thank you very much for that answer, actually. I still want to develop that a little bit further because the future of social care—we’re not talking about it because it’s fashionable. It’s because it matters to so many people and we all recognise that it needs change. And even though I, personally, have no fixed view on whether this should be evolutionary or revolutionary, what I’m really looking for is an indication from you about quite how brave you’re going to be when it comes to innovation. So, for example—this is just an example, as well—there’s a nursing home in the Netherlands that allows university students to live rent free alongside elderly residents in that nursing home, in a 30-hour per month ‘acting as a good neighbour’ contract, as part of a project aimed at warding off negative effects, and there are similar intergenerational programmes in Lyon and in Cleveland in Ohio. One programme, which began in Barcelona in the 1990s, has been replicated in more than 20 cities. We really have to lift our eyes at what’s going on in the rest of the world, I think. So, I’d be very interested to know whether you’re discussing similar ideas with private providers, housing associations and colleges and universities. And I’m glad that you hinted at that earlier on, because if we’re going to make this really work, it has got to be about more than just local authorities and the NHS.

I agree that we do have to think very innovatively about it, because of the scale of the challenge—there’s no doubt about that. Innovation really does need to be central to our approach to meeting those challenges. Some of the models that you described I am familiar with, and I’ve asked officials to provide me with some more advice, because I do think that learning from best practice from other countries is something that we should absolutely be keen to do—as I would hope other countries can look to us in areas where we are performing well, as well.

Thank you very much. We now turn to the questions on the order paper again. Question 3—Dawn Bowden.