The following amendments have been selected: amendments 1, 2 and 4 in the name of Rhun ap Iorwerth, and amendment 4 in the name of Jane Hutt.

Item 6 on our agenda this afternoon is the Welsh Conservative debate on child health and I call on Angela Burns to move the motion.

Motion NDM6251 Paul Davies

To propose that the National Assembly for Wales:

1. Recognises that secure housing, healthcare, education, and being safe at home, safe at school and in the community builds the foundation for a child’s healthy development;

2. Notes the importance of a long term vision for Child Health, which promotes health and well-being from birth.

3. Calls on the Welsh Government to improve data collection and the understanding of child health in Wales by:

a) extending cancer experience surveys to collect data for under 16s;

b) conducting research into peer bullying; and

c) re-evaluating perinatal mental health support to ensure consistency across Wales for vulnerable families.

Motion moved.

Diolch, Deputy Presiding Officer. I am pleased to bring this debate to the Assembly today on behalf of the Welsh Conservative group. I have given much thought to the discussion I am hoping we can develop today. As a mother of two young children, the issue of child health and well-being is obviously extremely close to my heart and something I feel passionately about. I am so very aware that too many of our children really struggle to reach a good equilibrium in terms of their health and well-being. And because the factors that influence child and adolescent health and well-being cut across a number of portfolios, I appreciate that the Cabinet Secretary may feel that some of this debate strays away from his portfolio, but I make no apologies for cleaving to the premise that all children deserve the best start in life.

We would all wish for the best for the children and youngsters of Wales, however I’m keen that we recognise the importance of clarifying and setting a long-term vision for child health that promotes health and wellbeing from birth, because a healthy and emotionally resilient child is more likely to navigate better the turbulent waters of adolescence; will be more ready to learn and maximise their life chances; more likely to have developed healthy lifestyle habits; be better able to weather the slings and arrows of outrageous fortune; and cope with not just the joys of life but the turmoil of disappointment and sadness. I want to work with other parties and the Cabinet Secretary to achieve this. I trust that the tone we set today is not seen as confrontational but as a mature debate bringing ideas and suggestions forward to achieve an aim that every one of us in this Chamber would want to support.

So, let us start by looking at some facts. In Wales only 4 per cent of the NHS budget is targeted solely on women and children’s health needs. With International Women’s Day being celebrated around the world, surely this needs to change and we need to see a greater percentage of the NHS budget focused on women and children, because inequalities in health do not happen by chance—they are determined by where we live, the health of our parents, our income and education. And although children cannot effect these circumstances their development can be seriously affected by these circumstances.

According to the Chief Medical Officer for Wales’s report published in November 2016, the gap in health inequalities between the richest and poorest is widening. A perfect example of this is seen in young people’s tooth decay. While percentages of children with tooth decay in Wales has fallen from 48 per cent in 2008 to 35 per cent in 2015, which is very welcome news, Merthyr has seen figures rise to a startling 57 per cent. In other words, over half the children in that area are suffering from tooth decay. And according to the British Dental Association, in Wales as a whole, almost two thirds of teenagers suffer from decay, making them 60 per cent more likely to be affected by the disease than their English peers. I’m sure that the Cabinet Secretary will agree with me that these figures are concerning. So, why do I raise such an issue? Because we should bear in mind the importance that oral health has to general well-being. Poor oral health not only affects physical health, but also a child’s confidence, mental health and development.

We also need to gain a greater understanding of the causes of child ill health, and this is where I believe that effective monitoring and research is so important. We often view health inequalities through the prism of social economic deprivation, and sometimes ignore other aspects of a patient’s life that can have an impact, such as their gender, ethnicity, disability, or their mental health or parental responsibilities. I remain concerned that we do not have a good enough understanding of the individual to be able to address their needs effectively and adequately. To do that, we need more detailed research to be conducted across all age groups, and we need to expand that research in order to analyse the impacts on child health and well-being of relatively modern pressures, such as social media, and the impacts of pornography, of media objectification of young women in particular, and a rampant peer bullying. In fact, I’ve just had an e-mail that I’m going to read out—or a bit of—from a young woman who said,

The pressure to be perfect, to look perfect, to act perfect, have the perfect body, have the perfect group of friends, the perfect amount of likes on Instagram—and if you don’t meet those ridiculously high standards, then the self-loathing and the bullying begins.’

This is why it’s so important for us to really understand the impacts that these have on young people.

In Wales, as many as one in three of our children live below the poverty line, but, again, there’s a distinct lack of data on the depth of this poverty. We also need to consider, when undertaking studies to address this, to correlate research at levels that details gender, disability and ethnicity, because it will ultimately provide better and more accurate information for policy makers to base their decisions around. We must move away from the one-size-fits-all approach and ensure that a far better understanding is gained. This chimes with the calls that were made in the Royal College of Paediatrics and Child Health’s ‘State of Child Health Report 2017. It calls on the Welsh Government to fund a longitudinal study to track outcomes of infants, children and young people growing up in Wales to create data that will directly inform policies and services. Additionally, it states that the HealthWise population survey needs to take responses from under 16s as well. Now, both of these recommendations are important and also work alongside CLIC Sargent’s campaign for the Welsh Government to start collecting cancer patient experience data for the under 16s, which they don’t currently do. NHS England has committed to a methodology to do this, and I would like to ask you, Cabinet Secretary, to consider this for Wales.

All these recommendations will help us to better target resources, but at a minimal cost. As these studies are already taking part, all it would require is either a further expansion of those studies or minor improvements and changes to the research methodology.

The report also suggests that the Welsh Government should work with its counterparts in other parts of the UK to identify gaps in data collection and to ensure existing sources are comparable with other UK nations. Now, we’re not trying to play one part of the UK off against another here. But I do feel that by pooling knowledge, by pooling resources and pooling best practice, then we have a better chance of improving outcomes for all.

The CLIC Sargent report also highlighted another very worrying finding, which has a very serious impact for young cancer sufferers. They found that young people felt they were not listened to or taken seriously when first presenting symptoms to GPs. This is concerning, as we all know that in many cancers, it’s vital to catch them early. Additionally, GPs rank the lack of training opportunities as one of their top-three barriers to identifying cancer in young people. I would urge the Cabinet Secretary to look into this matter as a priority, to ensure that young people have the voice they deserve.

Finally, before I close, I’d like to focus on the well-being aspect of children’s health. Subjective measurements of child health and well-being can help us better understand the different types of mental health issues faced by children and young people. Research by the Children’s Society has attempted to explore the gender patterns in the well-being of children in the UK, and their recent ‘Good Childhood Report 2016’ found that objective indicators, such as family structure and household income, have a much weaker link to children’s well-being than indicators that are subjective or closer to them, such as the quality of their family relationships and other child-centred measures of deprivation. The report went on to find that the number of 10 to 15-year-old girls who defined themselves as unhappy has risen from 11 to 14 per cent over a five-year period, whereas figures for the number of boys in the same age group over the same period has remained stable at 11 per cent.

The Girl Guide movement also undertook work around this issue in their girls’ attitudes survey 2016. This found that 33 per cent of girls aged 11 to 21 would not seek help, because girls are just expected to cope, which is, in my view, a collective indictment of how we are bringing them up. And I make no apologies for emphasising the Girlguiding report and the other reports that focus on young women, today of all days—International Women’s Day—because that report also stated that girls aged between 11 and 21 say that mental health and well-being are the most important issues for them, to improve girls’ and women’s lives. And when asked what action they wanted to see, 34 per cent of respondents said they wanted to see greater support for younger people with their mental health. Worryingly, over a fifth claimed that they didn’t know who to ask for help, with these figures rising closer to a third in that very vulnerable, older, 17 to 21 age group. I accept that this survey was a UK-wide one, taking in opinions from Welsh Guides, but it did take in opinions from Welsh Guides and I would urge a similar study to be undertaken in Wales to help inform policy. However, I don’t imagine that the findings will be that much different. I think that the findings highlight that isolation and fear are not simply the purview of the elderly, but also surround many young people and affect their well-being. That is why some 7 per cent—or is it why some 7 per cent of 15-year-old boys and 9 per cent of 15-year-old girls are regular smokers? Numbers have dropped in recent years, but not to the level of other EU countries. This is a ticking time bomb, which if not adequately addressed, will have a serious long-term impact on the individual’s health. Is this why alcohol abuse in the young is increasing, as are self-harming and eating disorders?

As girls get older, they are more likely than boys to experience emotional problems such as anxiety and depression. These emotional problems sometimes emerge as conditions such as anorexia, which can be treated, but often have long-term health effects once the condition itself has been dealt with. Anorexics will often suffer from brittle bone disease later in life, or have problems reproducing due to a condition that may have been treatable if caught and identified earlier.

Young cancer survivors may also have longer term mental health needs. CLIC Sargent highlights that when cancer hits, it can affect every part of a young person’s life, including schooling, emotional health, relationships and confidence. Cabinet Secretary, what we need to ensure is that we are producing resilient and well-adjusted children who will grow into resilient and well-adjusted adults. We need to focus our efforts on ensuring that children have access to effective mental health support. We need to ensure that children are taught the value of adopting healthy lifestyle behaviours and making good relationships. We need to give them an opportunity to grow up in supported environments, in which parents and carers are able and enabled to support their kids. We need a clear and unambiguous vision for the health and well-being of our children, and the Welsh Conservatives would like to come along on that journey with you in order to give that vision for the children of Wales.

Thank you. I have selected the four amendments to the motion, and I call on Rhun ap Iorwerth to move amendments 1, 2 and 4, tabled in his name. Rhun.

Amendment 1—Rhun ap Iorwerth

Add at end of point 1:

and regrets the effects of cuts to housing benefit on the ability of social housing to provide secure housing for children.’

Amendment 2—Rhun ap Iorwerth

Add at end of point 2:

and continues with suitable support for physical and mental health as a child grows up.’

Amendment 4—Rhun ap Iorwerth

At the end of point 3, insert as new sub-points:

considering how schools can help to create environments to tackle obesity;

ensuring all schools are able to offer excellent facilities for sports.’

Amendments 1, 2 and 4 moved.

Thank you very much, Deputy Presiding Officer, and may I welcome this motion, tabled by the Welsh Conservatives? I will move amendments that we believe strengthen this motion further. We are, of course, aware of the impact that securing quality housing, healthcare, education and being safe in the home, and so on, have on a child’s development. I’m sure that some of you will recall some previous Plaid Cymru debates in this Chamber on preventing the eviction of families with children from their homes, where we’ve listed the numerous and negative impacts of homelessness, overly full and poor housing on children, but it’s always worth reminding ourselves that children living in houses that aren’t adequately heated and in a poor condition are more than twice as likely to suffer chest and breathing problems and conditions such as asthma and bronchitis. There’s a strong relationship between overfilled housing and the helicobacter pylori, which is one of the main causes of stomach cancer and other diseases in the digestive system. They are twice as likely to develop such diseases when they reach 65 to 75 years old. Homeless children have four times as many respiratory diseases; they are five times as likely to suffer diarrhoea or stomach complaints; they are twice as likely to have to have an emergency admission to hospital; they are six times as likely to have speech defects and a stutter; and four times as likely to have asthma as children who are not homeless. This list of the impacts of a poor start in life is a lengthy one, but it’s worth rehearsing it time and time again, and until the wider political culture in Westminster recognises, for example, that it’s never acceptable to balance a budget by making children ill through cuts to welfare and so on, we will repeat these points time and time again. And I think that issue of housing is reflected in our first amendment.

I will move to our next amendment. I think it is quite clear that the evidence that we’ve received from neurological scientists shows that brain development does continue swiftly through the teenage years and into one’s early adulthood, and therefore it is crucial, I think, that the health and well-being of children, both physically and mentally, are supported as they grow up through those years. The Government, of course, does have a child health strategy for children up to seven years of age, but we are of the view that we need appropriate support beyond that age and throughout the adolescent years. The strategy needs to deal with physical health. I think it is fair to say that we need far more support for preventing and treating mental health problems too, before they become lifelong conditions, which can be very grave indeed. We often talk about the importance of identifying and treating cancer at an early stage, for example, but the same is true with mental health issues too. We need to recognise that and take strategic action.

Our final amendment reflects the need for a continuous focus on tackling obesity. Schools have a crucial role to play here. I would like to see sport and other physical activities, because not all children enjoy or benefit from competitive sport, but all of this needs to play a far more prominent part in the new curriculum. Clearly, this will require improved facilities for sport. But, in addition to that, I do think that schools should consider how they can create an environment that tackles obesity: to consider what’s on the school menu more than they currently do—there have been some developments, of course; and controlling access to junk food through vending machines, or managing whether pupils can get takeaways at lunchtime and so on. I also think that science teachers could have a role in ensuring that pupils do get some health literacy, so that they can differentiate between healthy eating advice based on evidence and the scare stories and dietary fads and so on.

So, those are our amendments. We will be voting against the Government amendment. We are not convinced that the current support is sufficient. We would have preferred to see the wording emphasising the need for a revaluation of the situation, as it currently stands. But this is a very important motion and, in being amended in the ways that I have proposed, I do think that this can be a clear statement of our ambition to give children the best starts possible in life.

Thank you. I call on the Cabinet Secretary for Health, Well-being and Sport to move formally amendment 3, tabled in the name of Jane Hutt.

Amendment 3—Jane Hutt

Delete point 3(c) and replace with:

monitoring the progress of the new perinatal mental health support to ensure consistency across Wales for vulnerable families.’

Amendment 3 moved.

Formally.

Thank you very much. Suzy Davies.

Diolch, Ddirprwy Lywydd. Well, Members, you can tell from the tone of the motion that we are looking today for an open and discursive debate, which will help inform three things, I think: firstly, how to improve the well-being of individual children, which is obviously the most important, but also how to help them grow up with a sense of resilience and confidence to be good citizens, and then, of course, how to help our Governments, regardless of their politics, to agree that without an effective long-term vision for child health, other aspirations for our young people are going to be a bit of a stretch.

Raising our children, regardless of their circumstances, their start in life, their challenges, which of course may be lifelong in some cases, to be able to cope and to really believe that tomorrow is another day is the most valuable of gifts, not just for an individual child, but for a strong social fabric. And yes, of course, as part of healthy maturing, young people in Wales, as anywhere else, need to come to terms with the usual youthful crises of confidence: things not going their way and a range of petty injustices. But something seems to be happening that is making this healthy maturing more difficult.

We heard earlier from Angela Burns about the growth in unhappiness for girls and their sense of being stranded with their anxieties. It’s younger boys who admit to being unhappy, often associated with schoolwork, conduct and inattention. Left alone, these unhappinesses that children experience can grow into something far more serious than youthful unhappiness. These findings, while they might be exacerbated by what we recognise as the effects of poverty, are found across the socioeconomic board, and we miss them if we rely too heavily on indicators, as Angela said, such as family income and structure. You can find the happiest, most resilient, most emotionally supported children in the poorest communities in Wales and the loneliest, most directionless, most emotionally abandoned children living in mansions. Who is the more deprived on those indicators?

Of course, I’m not gainsaying any of the evidence about the connection between poor child and maternal health and deprivation. Everything I’m sure we will hear today about overcoming social inequalities and building the data to approach it in a more granular way is something I’m sure that the Cabinet Secretary will see the sense in. It’s the kind of data we collect that will inform change. My point is that every child’s mental health is important and if one in four of us is likely to experience poor mental health, then it’s pretty clearly no respecter of objective socioeconomic boundaries. Building up this different granular data is essential not just to judge the scale and depth of poor mental health, but for designing effective mental health support for all children. We know that the child and adolescent mental health service is struggling. I’m sure poor old Lynne Neagle is fed up of saying it. And, yes, young people may be being wrongly directed towards CAMHS and, yes, in all fairness, Welsh Government is investing more in talking therapies, which is good news, but we are in difficulties in meeting the specific mental health needs of individuals before adulthood, and we are in difficulties preventing poor mental health in the first place.

So, in looking at a long-term vision for child health, let’s not ignore preventable poor mental health. Compulsory teaching about healthy relationships, different sexualities and gender equality is part of that, I would say— so I hope that your colleagues, Cabinet Secretary, will have their working party report on that sooner rather than later—but so is understanding that you are part of something bigger than yourself or even bigger than your own family. It’s easy enough to blame social media for this, so I will, but when you’re getting 500 likes for a picture of your new eyebrows well beyond your teens, and when that becomes more important than saying hello to your next-door neighbour, standing up for someone else on a bus, or carrying someone else’s bag for them when they’re trying to control a buggy and three kids, do you have to ask, ‘Why are people more unhappy?’

Of course, we can’t go back. I see tremendous examples of individuals coming together via social media to stand up as a community and fight for something or, even better, take responsibility for it themselves. Individuals who, in the analogue age, would never have gone to a public meeting or got involved in working as a group to solve a problem in their area, because they were too shy, had no self-belief or, worst of all, thought it was somebody else’s problem, someone else’s responsibility. If you just take the example of social care in years to come, we are not going to be able to deal with that if we are a disconnected society. We need our children to grow up healthy in body and mind, strong and confident enough to contribute to healthy communities. Thank you.

I’d like to thank the Welsh Conservatives for proposing this debate today. Securing better health outcomes for children and young people is one of the most important tasks facing us in this Assembly. Previous Assemblies and the Welsh Government have taken steps to improve child health, but it isn’t enough according to the Royal College of Paediatrics and Child Health in their annual ‘State of Child Health Report’. They highlight the fact that child health outcomes lag well behind our counterparts in western Europe, particularly in mental health outcomes and child deaths. This debate is particularly opportune as we had the news yesterday that air pollution is an urgent public health crisis. The British Lung Foundation, in a recent study, found that nearly half of Welsh councils did not have any air quality monitors outside schools. The British Lung Foundation also found that, in the five areas identified as having unsafe levels of particle pollution—Cardiff, Chepstow, Newport, Swansea and Port Talbot—only six schools had nearby monitors.

Air pollutants have been documented to be associated with a wide variety of adverse health impacts in children. Because of the rapid changes a child’s body undergoes, children are especially vulnerable to the effect of air pollutants. A recent Royal College of Paediatrics and Child Health report showed that air pollution can produce detrimental effects on growth, intelligence, and neurological development. Babies and toddlers can often struggle with wheezing and frequent coughs as a result of air pollution, and there is emerging evidence that it can also affect mental and physical development.

Research from Sweden has found that relatively small increases in air pollution were associated with a significant increase in treated psychiatric problems in children. But perhaps the most significant finding of the RCPCH report was the overwhelming evidence that air pollution is associated with reduced lung growth during childhood and increased risk of developing asthma. Every 20 minutes a child is admitted to hospital because of an asthma attack, and one in three children in every classroom suffers from the disease.

Yesterday’s warning by Public Health Wales that air pollution is more of a concern than obesity and alcohol should shock us all—not just because of the 2,000 people who needlessly lose their lives each year, but because of the impact air pollution has on child health. The Welsh Government must ensure that air pollution monitors are installed outside every school in Wales, and work with local authorities and the UK Government to reduce the levels of air pollutants around schools and places where children play.

As well as taking action to reduce air pollution, the Welsh Government must also ensure that children and young people affected by air pollutants have early access to pulmonary rehabilitation. Governments at all levels have a responsibility to protect our nation’s children from the scourge of air pollution, and, now that Public Health Wales have identified this as public health crisis, I hope that urgent action will be taken. Thank you.

It’s a pleasure to take part in this important debate on child health, and I just want to take a few moments, if I can, just to highlight how important it is to get health messages home to children and to parents, and indeed to teaching professionals in our schools. One of the tools that, traditionally, has been used to deliver those important messages has been our school nursing workforce, and I had the pleasure of visiting an excellent school nursing service in Bryntirion Comprehensive in Bridgend recently with Suzy Davies, my colleague, where we heard first hand from the school nurse there, who’s actually employed by the school rather than the health board, about the sorts of services that she is delivering, and the way in which she is able to engage with the school population as a result of the way that she is employed by that particular school.

Now, we know that the school nursing framework in Wales is currently under review, and I know that the Government are hoping to refresh that within the next few months, and I very much welcome that, but I wonder whether the arrangements within that new school nursing framework will be sufficient to take advantage of the opportunities that school nursing really affords. We’ve got around 220 or so school nurses in Wales—every secondary school has a named school nurse available to it—but those individual school nurses are not full-time dedicated to an individual secondary school. As a result of that, the sort of trust and confidence that young people very often need in order to establish a relationship with the school nurse allocated to their school simply isn’t there.

That’s in stark contrast to the model that I saw at Ysgol Bryntirion, where the nurse there, Judith, was available every single day of the week for the pupils and the staff, and she was there, engaging, giving sort of occupational health advice, giving safeguarding advice to members of the professional staff team and, in addition to that, giving very important public health messages to those children in that school, and supporting them through what have often been very difficult times in their lives. I think the one big thing that struck me was that she’s been able to establish a relationship not just with the school, but with the wider community that that school actually serves—the wider school family. As a result of those relationships, they’ve seen staff absence rates massively fall, they’ve seen school attendance rates amongst the learners rapidly increase, they’ve seen pupils not going home when they’re unwell, but actually being able to manage their conditions within the school day in a way that would not have been possible had she not been available there.

I appreciate that the wider school nursing service that is available across Wales in each individual health board area has a number of other important functions to undertake: things like immunisations, and oral and dental healthcare programmes, which are a core part of their work. But the one thing that our current school nursing service doesn’t have very often is sufficient time to be able to invest in individual school sites so that they can develop the sorts of relationships that I saw, which had been cultivated over the years by Judith with Ysgol Bryntirion.

Of course, it’s not just our secondary schools that need access to school nurses. We also need to ensure that our primary schools have access to trusted school nurses as well, and, indeed, I’d like to see them be more widely available in our FE colleges and our universities, because, of course, we all know that they are also places where young people and staff need support from health professionals who can be available and on hand when they need them.

In terms of public health, why not get the school nurses involved in delivering lessons on nutrition, on physical activity, on substance misuse? We’re facing an epidemic, at the moment, of mental health and well-being-related problems, as Suzy Davies quite rightly said a few moments ago. Nipping these things in the bud could be something that our school nurses might be able to do, if they were properly equipped and properly trained to be able to do so. So, I want to extol the virtues of school nursing and encourage the Government, in its response today, to perhaps lift the lid a little bit more on what is being done to refresh that school nursing framework and perhaps tell us a little bit more about where things are currently at in terms of the time frame for delivering on the promise to refresh it. Thank you.

I welcome the opportunity to speak in this afternoon’s debate and to take on board some of the very many points that have been brought forward. I very much hope that the Cabinet Secretary, in addressing the debate, will talk about the streams that the Government are pulling together, because, as Angela Burns, in her opening remarks, made quite clear, most of this actually transcends the health portfolio and goes into many portfolios across the whole of Government. Very often, there can be examples of excellent practice going on, but, very often, they’re done in isolation, and, actually, if we are going to see an overall improvement in the health of young people and children here in Wales, it does need a co-ordinated approach and some clear targets about where we want to be in five and 10 years’ time.

I can appreciate that targets, very often, can be very prescriptive and limit some of the more imaginative thinking that might need to be developed, especially in some of our rural areas, where delivery of service can be more challenging, but, ultimately, if the Government has a strategy and a goal, at least the whole muscle of Government, and the supporting bodies underneath that, can work in that direction and that common goal that we all want to see, which is an overall lifting of the chances of young people here in Wales.

I recently undertook a visit to ACT, the training provider just down in Cardiff South and Penarth, which I’m sure the Cabinet Secretary is aware of; it’s in his constituency. Darren Millar, my education spokesman, came along with me there, and they were highlighting that the safe space initiative that they’ve created there for young people who found problems in their school life and haven’t settled into the normal school day—through that safe space culture, through that safe space initiative, they have offered those young people the opportunity to really regain their confidence, regain the appetite for education, and, ultimately, gain a purpose. I’d commend that initiative to the Cabinet Secretary. I appreciate it sits in the education field, but surely, also, if you have children who feel fulfilled and feel content, that has a direct impact on their health as well, then, it does. I see the Cabinet Secretary acknowledging that he’s familiar with it. It’s not just here in Cardiff we need to see that ability, it’s across Wales, and I do commend ACT for developing a satellite hub in Caerphilly to offer the same sort of initiatives and opportunities.

I’d also like to develop the theme about air pollution that has been brought forward by Caroline Jones, and I raised it in First Minister’s questions yesterday. Again, this is an area that the Government can make significant progress on. They do have the levers, via the planning system, via the transport system, via the public health system that is here in Wales, to make significant improvements and gains in this area. It cannot be right that we tolerate 2,000 people dying prematurely here in Wales—five people a day—and actually we are not making the progress that we should be in these areas when we have the solutions at our disposal. I accept you will never get to zero, but we can make some real, deep-seated changes to the way people work, the way people go about their everyday lives, that would have a huge impact. I would suggest that any other field that would be seeing 2,000 people a year dying prematurely would be commanding greater attention from the Government in using some of the levers they have. Again, I do hope that the Minister, maybe, will be able to engage in what measures he has set specifically to Public Health Wales to make improvements in this particular area.

Another area I’d also like to touch on in particular is the event that Angela hosted at lunchtime, where many women who have suffered the tragedy of abuse—physical and mental abuse—in their lives have managed to rebuild, and get the confidence back to actually bring up their families and actually put themselves on the road to being valuable members of our community after being so demoralised—and humiliated, I think, was the examples that were given to us, and their self-confidence so destroyed by the abuse that they’d gone through. There were many good examples there, again, of where good practice could be brought forward, and my colleague Angela Burns did bring forward that in earlier questioning about some of the experiences in Germany. Why should the victim be the person who is hounded out of the community that they have lived and been brought up in, when the perpetrator very often stays within that community? Again, we can look around and find good examples of good practice that the Government can use, with the resources they have, to develop the process of supporting people in the community to rebuild their lives, rebuild their confidence, and become valuable members of our society again and not feel alienated and pushed to the margins. To see the work that that group has done is admirable to say the least.

In closing, I would just like to touch on the additional learning needs Bill that is currently going through the Assembly. I’ve taken some representations, in particular from Diabetes Cymru, that have touched on health needs that, at the moment, in the way the Bill is drafted, don’t sit within the Bill—they sit within the regulations, I understand. I can see the Deputy Minister indicating that—the Minister indicating that. I’ll give him sudden promotion again. But, again, I’d like to see if the health Minister does support the calls for health needs, and the underlying health needs of young people, to be included in the Bill, because, obviously, that is an important category that that legislation does need to capture, and, again, it would have a massive impact on improving life chances for young people here in Wales.

So, with those couple of comments, I look forward to hearing the Cabinet Secretary’s responses, because, working joined up and collectively, we can make a big difference to the outlook of young people here in Wales.

As human beings, we have basic needs: food, water, warmth and rest, security and comfort. These very basic needs have to be met before we can even start to aim to fulfil our potential. My children are lucky enough to come home every night to a familiar place—a place that they know, a place that they call home. It’s a place where they feel safe, where they feel that they belong. It’s where they have their favourite belongings: a cuddly toy, their books, their toys, their beds. It’s a place that is their own.

I’m astounded to find that, last Christmas, over 1,100 children were homeless here in Wales. No home means no roots. It means children have anxiety, stress and worries that no child should expect in twenty-first century Britain. This figure includes children who are homeless and living in temporary accommodation. It does not include 16 to 17-year-old independent children who have left home or care through choice or not.

One thousand one hundred children—that cannot be right. This represents twice the headcount of St Joseph’s in Wrexham. What chance have those children got to get back onto any sort of level playing field, considering the experiences that they must have had while spiralling into homelessness and the experiences they may have while striving to get out of it?

We really need to focus on the root causes of the ills that plague our society. It’s tragic that the very basic and fundamental needs of Welsh children are not being met. They deserve better.

Thank you very much. I call on the Cabinet Secretary for Health, Well-being and Sport. Vaughan Gething.

Thank you, Deputy Presiding Officer. I’d like to thank Members for tabling a debate on this important and wide-ranging topic. I’m happy to confirm the Government supports all of the amendments.

We launched the Healthy Child Wales programme in October last year, for all children and their families, to improve health, social and educational development and long-term physical, mental and social outcomes. The programme will safeguard the health of children through screening and surveillance services from birth to seven years of age. The programme promotes resilience and is aimed to empower families to make informed choices to provide safe and nurturing environments.

I just want to deal gently with one of the points that Angela Burns made at the start, and that was the percentage spend within health services on women and children. I don’t think that’s actually a helpful approach, simply because I think we’re trying to have a whole-service approach to see that whole person in their context. There are actually many other areas of spend and activities that won’t be captured in the figures you represent that are of course hugely important to what health and care services can do as their contribution in partnership with others too. Much of the rest of your contribution recognised and reflected on the fact that we need to see children in that whole context and where they have those interactions and what those could and should do to improve.

I welcome the tone of contributions in the debate, including the way that Angela Burns set off. I’m happy to continue to discuss what we could and should do from a Welsh Government perspective to improve outcomes for children and their families. But, we should not try to get away from the unavoidable reality of what else is happening outside this place too.

For example, support for families renting houses is not devolved. Since 2011, in this area and others, there have been continual cuts from the UK Government to that support. That is a deliberate choice and it means less support for families in need, the majority of whom are actually in work. It’s only one example of the choices the UK Government have made that have had a very real impact upon outcomes and prospects for children. Sadly, it is going to get worse.

Poverty is the biggest limiting factor for the health, well-being and future prospects of our children. The Institute for Fiscal Studies forecasts that the number of children across the UK who will grow up in poverty will expand by more than 1 million so that over 5 million children in the UK will live in poverty. They will be driven into poverty by the direct and deliberate choices of the UK Government. That will affect all that we can do and what we are able to achieve with and for children and their families.

Here in Wales, I’m pleased to say we take a different approach. We invest over £124 million annually in the Supporting People programme to support vulnerable families and help prevent problems early. Local authority homelessness services have a statutory duty to refer households with children to social services where they’re at risk of becoming intentionally homeless.

And of course, in education, we recognise that development sets the basis for a child’s health development. That’s why the Donaldson review of the curriculum in Wales, ‘Successful Futures’, recognises that children and young people need to experience social, emotional and physical well-being to engage successfully with their education—seeing that child in their whole context. As Members will know, Welsh Ministers have accepted all of the recommendations set out in that report for education across the six areas of learning and experience. One of those areas is, of course, health and well-being, to draw in themes including mental, physical and emotional well-being. We’ll continue to work with pioneer schools to develop the health and well-being guidance to support the curriculum framework.

The Welsh Government is also transforming the additional learning needs system. It is vital that all children and young people in Wales are able to access education that meets their needs and enables them to participate in the learning experience. The Additional Learning Needs and Education Tribunal (Wales) Bill will drive us towards this and provide a fair and equitable system for all learners with additional learning needs. I’m happy to confirm again that the health needs that are not learning needs will be subject to statutory guidance that the Minister will publish before the end of this month.

I recognise the importance of providing a long-term vision for child health. One of the points that Angela Burns made was certainly in the Royal College of Paediatrics and Child Health’s recent report, and that’s why I’m happy to confirm today that this Government will develop a new children’s health plan to directly respond to that central recommendation.

I’ve listened to stakeholders, and I recognise the need to describe the national priority areas that health services should be addressing to improve outcomes for children and young people. I also recognise the role of improved data collection in the understanding of child health in Wales—in general terms, but also to support this plan.

In respect of the direct points made about the cancer delivery plan, we have a further renewed focus on delivering person-centred care. The most recent cancer patient experience survey showed how well services are delivered to the adult population. We recognise the need to develop patient-reported experience measures for children affected by cancer to ensure that we are meeting their needs. We will consider extending the age range for those taking part in this survey in future commissioning.

For the first time, in 2016, the Welsh Government published data on local authority counselling services that operate in secondary schools and year six of primary schools. Over 5 per cent of children who went to the school counselling service in 2014-15 did so for reasons that relate to bullying. Evidence shows that a counselling service within an overall schools strategy can be highly effective in preventing the escalation of mental health problems. We expect schools to make it clear that peer bullying will not be tolerated and that the anti-bullying message is put into practice.

The Cabinet Secretary for Education is currently reviewing anti-bullying policy to ensure that it remains fit for purpose. We’re determined to have clear and consistent support for people being bullied, and we want to reinforce our aim to create space for people to report and be supported through bullying.

In 2015-16, I announced over £1.5 million for new recurrent funding to develop community-based perinatal mental health services to improve outcomes for women with perinatal illness. The NHS reports that more than 1,500 women have been referred to community perinatal services since April 2016. I, of course, recently announced an increase in spending on mental health generally by a further £20 million within the Welsh Government’s budget that this place has passed. We continue to spend more on mental health services than on any other part of NHS Wales. We will, of course, monitor the effectiveness and impact of this new perinatal mental health support to ensure consistency across Wales for vulnerable families.

Through our network of Welsh healthy schools schemes, we’re supporting schools to create an environment to help tackle obesity. Over 99 per cent of maintained schools in Wales are actively involved in these schemes.

Of course, I recognise the points made in the motion and the amendments about sport. We don’t want to forget the importance of physical education within the curriculum, but of course PE is much more than simply sport. We do, of course, want schools to offer excellent sporting facilities. That’s why our twenty-first century schools and education programme will see an additional £1.4 billion of investment in schools and colleges to provide learners with the state-of-the-art facilities that will inspire them to fulfil their potential. I’m happy to briefly confirm, in response to Darren Millar, that the school nursing framework is being developed with and by the workforce itself, and it will be launched in the near future.

In finishing, Deputy Presiding Officer, I’m happy to confirm that I look forward to working with people across different parties in this Chamber and outside this place. I look forward to doing that to help to deliver the very best possible outcomes for children and their families here in Wales.

Thank you very much. I call on Angela Burns to reply to the debate.

Thank you, Deputy Presiding Officer. Cabinet Secretary, the Welsh Conservatives are delighted to hear about the children’s health plan that you are proposing, because this is at the heart of this debate. The reason we brought this is because, whilst you highlighted a great number of initiatives within health, within education—all of which are welcome—it’s about driving a theme, it’s about weaving a golden thread through the various fabrics of the Government. We want to see—and I hate this word ‘overarching’, but it does actually encompass it—an overarching vision, because these children are our future of tomorrow and if we can make them healthy, resilient, content and robust internally today, then they will be able to cope so much better with what happens in their futures.

We talk about the great strains on the Welsh NHS in terms of financial constraints. We talk about the obesity crisis, the smoking epidemic and the air pollution problems. All of it has to be pulled together in a way that we can start today with the youngest of our young and move them forward and look at it in a holistic way. I’d like to work with you. We would like to work with you to ensure that this child health plan actually looks at it in that collaborative way. It’s rather like the National Assembly for Wales, which has sustainability and equality as driving principles that underpin this place. I would like to see child health and the well-being of children as the driving principle that underpins all Government policies. It’s something that over the years various committees—. I think the Deputy Presiding Officer and I were both members of the Children and Young People committee when we looked at budgeting and how budgets can impact on child health and child educational outcomes.

I thought that Rhun ap Iorwerth made some very, very valid points on the amendments. Tackling obesity: there’s an example of where, if we had a vision where we understand that obesity is a problem in terms of health, then we would actually be driving that change at school level. You’re right, Cabinet Secretary; it’s not just about elite sport or sport. Actually, it’s about fun. It’s about going outside and bopping around in a gym or in a playground, getting active and getting moving. If we have that overarching vision, that golden thread, then we’d be looking, right from cradle to grave, at how we make ourselves healthy. To be frank, for someone of my age it’s probably a done deal, but my goodness me, the two-year-olds, the three-year-olds, the four-year-olds, the seven-year-olds, my girls—12 and 14—all our children—

The trampoline awaits.

I’m not sure trampolining would sustain me, actually, David Melding. [Laughter.] I don’t want to break any other bones. But it’s about catching the young and changing their lifestyles and changing their expectations. The other thing we haven’t touched upon is this: a healthy, emotionally resilient individual who at 18, 19 or 20 goes into a job or goes into higher education will actually be somebody who will succeed much better in their life. They will actually have better outcomes and, in turn, will bring up happier, healthier and more resilient children. I’m very pleased to hear that you’re going to take this forward and try to build a vision. We will work with you. I’d like to thank everyone—I haven’t had a chance to say thank you to everyone—for taking part in the debate.

The proposal is to agree the motion without amendment. Does any Member object? [Object.] Therefore, we’ll defer voting under this item until voting time.

Voting deferred until voting time.