4. Will the Cabinet Secretary provide an update on the provision of mental health services and support in north Wales? OAQ(5)0169(HWS)

We recognise that the health board are working hard to make the necessary improvements to mental health services across north Wales. A new mental health strategy for north Wales was agreed by the board on 20 April and has been endorsed by their six local authority partners.

Thank you. Thanks for your response, Cabinet Secretary. I’d like to acknowledge the work that the Welsh Government is doing and the commitment to raising awareness and tackling the stigma around mental health. The challenges facing us in north Wales have been and are well documented. I welcome the health board’s new multi-agency approach to developing the new mental health strategy, which you’ve just mentioned, and the commitment to work with service users as well as staff to improve our services. However, it’s clear, and I know that the health board also acknowledges, that there is so much more we can do to improve mental health services in our area. Hopefully, the new strategy and the health board’s engagement with service users are a step in the right direction, but, clearly, there is much more that needs to be done, and it’s something that I will be paying close attention to, holding them to account on behalf of my constituents in Delyn. Cabinet Secretary, can I ask that you continue to strongly monitor and make sure that improving mental health services and support is a priority in, and for the people of, north Wales?

Yes, I am happy to give that assurance. It’s been a real step forward, though, to actually get to the point where there is a proper mental health strategy to consult upon—not just to consult upon, but it’s been drawn up following work that the health board has done with local government, as I mentioned, but also with the third sector and with staff in the service, and with users of the service as well. To be fair, that wasn’t the case and wasn’t the position prior to special measures. It wasn’t an acceptable position, and this was a significant factor in the health board going into special measures. The reality is not just the provision of the service, but actually the forward strategy not being where it could and should be. So, there’s a real step forward, and the new leadership brought by Andy Roach, and also the significant progress made by both the interim chief executive and the current chief executive, should give us more confidence for the future.

But it’s certainly not an area to let go of or to be complacent and say everything is fixed because there is a new strategy. There are real challenges to overcome and this is a significant part of interest to the regulators when they meet to advise the Welsh Government on the progress that Betsi Cadwaladr has made and that progress that is still required to come. So, Healthcare Inspectorate Wales continue to take an active interest in the provision of mental health services, I continue to be concerned about the progress being made and I’ll maintain that concern and that interest until we are in a position not just where we can see the health board leaving special measures when the regulators advise us it is appropriate to do so, but even after that there needs to be a continued focus on the provision and improvement of mental health services right across north Wales.

Continuing gaps in north Wales in dual diagnostic treatment for people with mental health problems and substance misuse mean that the revolving door is tragically still alive and well. It’s a decade since a Welsh Government-commissioned report into tier 4 inpatient detoxification and rehabilitation services was leaked to me, having being buried, identifying people deliberately reoffending because of these gaps and the hospital admissions because of the absence of this treatment. The Welsh Government did come forward with a proposed model working with three third sector providers in north, central and south Wales. A decade later, where are we up to with that, so that those people desperately needing that dual diagnostic treatment can receive it in the region they live?

You ask about provision across a range of different areas and substance misuse, obviously, is a matter that the Minister leads on. I’m happy for us to write to you to give you an update on where we are with tier 4 services in north Wales and, more generally, for Members across the country as well.

You’re entirely right, of course, to say that we shouldn’t mislead ourselves in thinking that the situation has been resolved, because I had quite a shocking meeting with professionals in the sector in north Wales a week or two ago, and they mentioned that it was a lack of capacity, a shortage of beds and a shortage of staff that was one of the central problems, which creates a vicious circle where people are released from units too soon because the capacity isn’t there to take new patients into a community regime that doesn’t have the capacity to deal with the numbers, which, at the other end, is going to push more people into those units in order to deal with the burden. What they told me was that the situation is now worse than it has ever been before.

Now, I accept what you say in terms of a long-term strategy and looking to the future, but the reality is, of course, that there have been two years now since the Betsi Cadwaladr health board was put into special measures, and, as you said, one of the reasons for that was the deficiencies in mental health services. So, I’m sure you will acknowledge that the situation as it currently exists is not acceptable. But what people want to know is: what is the plan to deal with these difficulties now, today, whilst, of course, moving forward to longer term plans in the future?

I thank you for the question and I recognise that the challenges that are faced by the service in north Wales are about a proper understanding of capacity and demand and need, but also how the service is organised—that really does make a difference—and making sure that the resources available to it are properly used and organised. There is something about having a proper, clear strategy to understand what we’re trying to achieve and why, as well, and there’s a really significant step forward that has been made. But objectively, the provision of mental health services in the round is in a better place in north Wales than it was a couple of years ago.

But as in every other service, if you’re at the front line and you’re in a busy and a difficult and demanding job, you may not be able to take a step back and think ‘This is better than where we were a year ago, 24 months and 36 months ago.’ That’s part of the reason why we have an objective process with the regulators. They don’t take my word for it about the progress made. The regulators come up with a rounded assessment independent of Government and they then give us advice about the progress through special measures. Whatever happens with special measures, there will be a need to continue to look at, as I said in answer to Hannah Blythyn, the provision of mental health services, the quality and the outcomes delivered with and for people in north Wales. I am under no illusion whatsoever that the progress we describe must be honest, but it must also recognise there is more still to be done, both in the here and now, in the immediate period, as well as for the medium and longer term future. So, I certainly don’t try to deny the challenges and I’m sure I’ll get many more questions in this Chamber about where we really are.