I call on the Cabinet Secretary for Health, Well-being and Sport to move that motion. Vaughan Gething.

Motion NDM6314 Jane Hutt

To propose that the National Assembly for Wales:

1. Notes that social prescribing is an important form of intervention that is already used across Wales;

2. Considers priorities for the further promotion of social prescribing across Wales; and

3. Notes Welsh Government commitments to trial a national approach to social prescribing linked to mental health.

Motion moved.

Thank you, Deputy Presiding Officer. I’m happy to move the motion on the paper before us today. As all of us recognise, our health and well-being depend on many factors: family, relationships, work, play, housing, education and money, to name but a few. The ways in which we manage when our health is affected are numerous. We know that we often feel better after a walk in the park, or socialising with friends, yet often our first port of call when we feel unwell is to see a doctor.

A report from Citizens Advice estimates that a fifth of GP time is spent on primarily social problems. It is not always possible for GPs to fully explore the personal circumstances or social determinants that may have triggered the attendance, resulting, on some occasions, in an over-reliance on medical intervention. In Wales we have a vast array of non-clinical community services that offer real health and well-being benefits, and these services and activities are, of course, diverse in their nature. They range from rambling groups and befriending support, to debt counselling and parenting classes. These types of activity all support and work alongside clinical care, or even act as an alternative to medication, and the benefits of community-based support and activities can be numerous. For example, they can lead to improvement in physical health; reductions in the symptoms of anxiety or depression; the acquisition of learning, new interests and skills; a reduction in social isolation and loneliness; and, of course, increased sociability and community skills. And all of these things can lead to increased self-esteem, confidence and empowerment.

People who benefit from these services often go on to act as volunteers themselves, increasing community capacity and resilience. People and professionals may not be aware, though, of the potential health and well-being benefits of these services, or how to access them in the first place. I should indicate at this point that I’m happy and the Government will support the Conservative Party’s amendment, noting the King’s Fund definition of social prescribing as

‘a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.’

But, that said, I don’t think we should overly worry about definitions at this point, especially ones that look through the lens of the national health service rather than the person who needs care and support, including, of course, the care and support they can access for themselves. Social prescribing really is simply a term for a mechanism that links people with their community services and opportunities that should help them to improve their general health and well-being, but usually recognised social prescribing schemes enable the referral of an individual to a link worker to work together with them to agree a non-clinical social prescription to improve their health and well-being.

A survey carried out on behalf of Nesta found that four in five GPs think social prescriptions alongside medical prescriptions should be available from GP surgeries. They say it would allow them to concentrate on the patient’s medical problems and treatment rather than the social issues that, often, they can do little about. As the start of our motion notes, a variety of social prescribing or community referral schemes already exist or are in development across Wales. They’re an important intervention in their own right and can help support people to take responsibility for their own health by accessing that community-based support, and reduce reliance on statutory services.

Of course, the national exercise referral scheme is one of the best known of such schemes. It’s a Welsh Government-funded scheme delivered by Public Health Wales, and it’s been developed to standardise exercise referral opportunities across all local authorities and health boards here in Wales. The scheme will successfully support clients with a chronic condition or who are at risk of developing chronic disease.

Locally, through primary care clusters, there is evidence of an investment in social prescribing models based on roles that help people to assess their well-being needs and agree with them what local care and support will help to meet those needs. In Torfaen, for example, social prescribers are located in GP surgeries and receive referrals from anyone experiencing a social issue that is impacting on their physical or mental health. The patient has the opportunity to tell their whole story, sometimes for the first time, and to work with a social prescriber to decide how best to resolve those issues. After the recognised success of the north Torfaen social prescriber, the scheme was extended to south Torfaen in January this year.

Another example is local area co-ordination in Swansea that seeks to reduce the pressure on statutory services by fostering local relationships and assistance. The programme works with individuals, families, and carers of any age, and enables them to achieve their idea of a good life. That, of course, will differ for different people and communities. The programme provides information and advice to anyone who accesses it. It also provides more in depth, one-to-one, input to people who might be older, disabled, or have mental health problems or be excluded in some way. There are, of course, other examples across Wales of programmes that link people to the local, non-clinical services they need.

As the motion indicates, we’ll continue to consider the priorities for the further promotion of social prescribing across Wales, because access to these services needs to be more systematic and seen as a normal part of our approach to health and well-being—

Would the Cabinet Secretary give way?

Yes, of course.

I thank the Cabinet Secretary for his recent visits to the Bridgend area and the ABMU area, but also to the social prescribing that he’s seen working within the clusters in the lower Llynfi valley and the gateway to the Valleys. But also, in the Llynfi valley, he was seeing other networks within the community, along with the Spirit of Llynfi Woodland, along with local schools, along with the six local GPs—but it’s integrated into the local community, and it’s great to see, I think he’d agree, the innovative way in which all partners locally, not just the GPs, but every other partner, have taken on this idea of social prescribing for the well-being of their communities.

Yes, it’s a good example of the range of services that exist right across the country—local opportunities and how people are linked to those opportunities to improve their general health and well-being, and not a reliance on medication and medical intervention. It’s also a good example of the way we de-medicalise the service and, in particular, the way that healthcare support workers and other community-based workers have been really important in getting people to actually get active and get involved in their community, to take more ownership of their own choices in a way that is enjoyable for them and appropriate and local.

Trying to make this work more systematically is something that Dr Richard Lewis has undertaken in his role as the national professional lead for primary care in the Welsh Government. People in the Chamber will know him from his former role with the BMA, and he’s continuing to champion the role of well-being services and the need for more systematic access and referral. The future generations commissioner has also facilitated a round-table discussion with stakeholders on behalf of Dr Lewis last autumn and that’s generated a lot of enthusiasm and discussion.

The challenge now, over this next year, is how we roll out what we hope will be a more consistent and effective approach. But, within this Welsh Government, we’re committed to supporting stakeholders to share learning and good practice. So, in March, the Welsh Government sponsored a Mid Wales Health Collaborative conference. That event brought outdoor sector colleagues together with healthcare professionals to discuss the positive health and well-being benefits of outdoor activity, and increase awareness of the benefits of using green spaces. So, it is important to continue to develop the evidence base of what exists, and also what works. And the Welsh Government has, therefore, commissioned a review of the principles of sustainable community-based volunteering to tackle loneliness and social isolation among older people. And that will focus on models of best practice and the impact that they have had. The research findings will be published in September and used by health boards, local authorities, the third and community sectors to inform the development of further community-led volunteer models.

To help people find the right care at the right time and in the right place—often with the right person and the right service—the Welsh Government is continuing to work to co-ordinate the development of a single virtual directory of services for health and social care in the third and independent sectors. The directory will be used by both the public and professionals. It will underpin the new local authority information, advice and assistance services, and the 111 telephone and website service, and it will include the wide range of services available in local communities and explain how people can access that care and support.

In ‘Taking Wales Forward’, the Welsh Government committed to launching a Wales well-being bond to drive forward healthier lifestyles. The social prescribing agenda aligns closely to the aims of the well-being bond, which will look to take forward innovative health and well-being projects. We’re currently working closely with our stakeholders on the best way to achieve this. And, so, I say this generally, because I would welcome the views of Assembly Members on what further action is needed at national level to promote well-being services, and I welcome your views and ideas on what you think the priorities should be. And a number of Members will have their own local experience. For example, I know there may be Members who want to talk about Valleys Steps, which is engaging in Cwm Taf, a year into a relatively successful approach. So, the views of Members and wider stakeholders will lead into the Welsh Government’s commitment to trial a national approach to social prescribing in mental health. That should help us to take this work forward.

In accordance with our ‘Taking Wales Forward’ commitment, I’ll begin a pilot on social prescribing this December—or by this December. It will be aimed specifically at improving the mental health offer and the support for people with low to moderate mental health issues. The evidence base around social prescribing is limited, but growing. By funding a pilot, we think we’ll contribute to the evaluation of the role of social prescribing in Wales, and investigate the factors that make it most effective. The pilot will add to the excellent work already taking place in Wales, and we’re now engaging with stakeholders to work up proposals for the pilot scheme. I’ll make further announcements about the development of the pilot scheme and the well-being bond after the summer, but I look forward to hearing Members’ contributions to today’s debate.

Thank you very much. I have selected the amendment to the motion, and I call on Angela Burns to move the amendment tabled in the name of Paul Davies. Angela.

Amendment 1—Paul Davies

Add as a new point at end of motion:

Notes the Kings Fund definition of Social Prescribing.

Amendment 1 moved.

Diolch, Deputy Presiding Officer. I’m very grateful to the Government for bringing forward this incredibly interesting topic, and I formally move the amendment tabled in the name of Paul Davies. We on this side of the Chamber support the general principles of this debate, and we’ve brought forward our amendment because we believe that social prescribing has no firm definition, a point brought forward by the NHS Confederation, for one, and, of course, they represent the health boards, so it’s very important that they should feel very comfortable with this going forward. And we feel that the King’s Fund have come up with a clear way of setting out in very simple terms what it means, and they refer to it as:

‘a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.’

And, of course, the King’s Fund definition very much follows the direction of travel that we have here in Wales about asking people to start to take control of their own health, to participate, to be participants in their health agenda, and to be participants in their lives going forward. The King’s Fund very much identify that there is a range of social and economic factors that will allow patients, and need patients, to be treated in a holistic way. We definitely are not saying that the King’s Fund definition should be ‘the’ definition. We just want to see it as a benchmark—it’s what the English NHS have looked at; it’s what the Scottish NHS have looked at—because we need to have somewhere where we can start developing our own version of social prescribing, and I’m delighted that you’re going to be funding a trial to go forward on how social prescribing works.

You’ve already said about the positive impacts. I’m not going to rehearse all those arguments, but I know, as a committee, the Health and Social Care Committee are looking at loneliness and isolation in older people, and this is something that social prescribing might really be able to help. I know that my colleague Mark Isherwood will be talking in a while about co-production and about the need to bring on board third parties in order to deliver social prescribing. But I just particularly wanted to cleave to one of the points of your original motion where you say ‘considers’; you would like us to consider priorities for further promotion of social prescribing, and I would like to make two suggestions to you. How can the Welsh Government encourage a greater roll-out of social prescribing to young people? Throughout Wales, we have a significant number of young people who are in a very dark place: they’ve got eating disorders, they are self-harming. Some end up in a place so dark that their only alternative is to take their own lives. I represent a constituency that has seen a fair number of suicides from young people in the last couple of years. We know from evidence that, if you can engage people in areas like drama, exercise, art therapy, music therapy—very, very important ways of being able to perhaps bring someone back as they start that walk toward the cliff—if we can identify those people and get them before they’ve gone too far down that path, I would be really interested to see if we can start bringing this whole social prescribing agenda much closer to younger people as well, and not merely see it as reserved for either the elderly or for those in highly deprived areas.

I’d also wonder, as my second point, taking this forward: will the Welsh Government consider other professionals to be part of the social prescribing team—not just health professionals, but people such as school counsellors, or additional leaning needs co-ordinators? Because, as we all know, we’ve got enormous pressures on our mental health services. Children and adolescent mental health services are stuffed to the gunnels, they can’t turn around, and, if you have a school counsellor in a secondary school who’s talking to a young person who may be struggling with, for example, grief, because somebody they love desperately has died, that person should be able to socially prescribe a route for that young person to perhaps get to somewhere like Cruse or some other bereavement organisation. If they identify a child who’s starting to self-harm at about 12 years old, 13 years old, and those first tell-tale slashes across the tops of the arms appear, can they then pick up that child and refer them straightaway to some kind of therapy group, a counselling session, one of the third-sector providers that we need to engage with to make social prescribing a success? I just think that if we can perhaps broaden it out to other trained professionals, but in other fields, we might be able to alleviate some of the backlog or bottleneck that happens when you go into a doctor’s surgery, because they are already under immense pressure, and we can bring more people in in a truly productive way to actually start to produce the solution for people who are desperately in need. I’d be very grateful, Cabinet Secretary, if you would think about those two ideas and perhaps consider them as part of your motion here today. But we absolutely support this motion.

I’m pleased to take part in this very important debate on social prescribing.

Now, as young doctors over the decades, we’re all taught that there are four aspects to the health of a patient: yes, physical, psychological, but also not forgetting social and spiritual aspects. Remembering all of those influences on the health of people directs us to think about what makes people ill in the first place and makes us think about the barriers that work against their recovery.

I remember complaining to the local authority, many years ago now, as a conscientious GP, about the condition of housing of my patients, which was affecting their health, and those complaints were completely ignored. This is one of the reasons why I stood for the council in the first place. As a county councillor then, not as a doctor, I got answers to my complaints about the condition of housing and a plan to improve the situation. That’s what my understanding is, basically, of social prescribing—that GPs and nurses in the community can refer people to projects that tackle their illness, looking at the bigger picture of their health in its entirety, referring people, therefore, to the voluntary sector, most often, such as arts activities, volunteering, gardening, cooking, healthy eating advice and a wide range of sporting activities, such as walking. One of the easiest things to do is to just walk more. I always preach in this place about the 10,000 steps that we need to walk every day—walking. Keeping fit is just as good as antidepressant medication when the depression is not so severe.

The aim of social prescribing is to fill a vacuum in many aspects of society, with isolation and loneliness increasing—that’s why we are holding this inquiry as a health committee—despite all of our computers and the internet, because we recognise there is more to the recovery of our patients than simply physical issues.

Many years ago, our chapels and churches were very active here in Wales, with hundreds of people attending every Sunday, and some meetings being held every night of the week too, with a full and broad range of activities. Such close-knit communities were naturally an assistance to many people who were suffering depression and loneliness, but things changed and we need solutions to the same spiritual requirements today.

Very often, as a GP, I feel a little like a minister or a vicar in advising my patients, but forgetting the social and spiritual aspects, and focusing only on the physical, the tablets and the surgery is also real neglect, which can undermine the recovery of our patients.

We look forward to enhancing social prescribing—and we support the Government in this regard—and tackling or getting to grips with evidence of its effectiveness despite how difficult it is to get hold of that evidence. Thank you very much.

It’s good to hear from a GP who is reflective on their behaviour, because far too often, I’m afraid, some GPs have reached for the script, rather than other solutions to people’s mental distress.

Last night, I spent quite a lot of time running around trying to contact people who were yet to register to vote in order to beat the midnight deadline. Many were delighted to be reminded that they needed to get registered and I was successful in that regard. But I also met other people who disturbed me quite a lot. I’ve met them before. These are people who say, ‘No, I’m not interested in registering to vote; I’m absolutely not interested in voting because they’re all the same, whatever happens, there’ll be no difference to my life’.

These are people who are so far away from engaging with society and making any sort of positive contribution that it’s really quite disturbing. That is potentially quite dangerous as well. These are not people who are busy working hard to make ends meet for their family; they’re generally people who have completely fallen out of the workforce and, in some cases, will have no more than a cursory acquaintance with the workforce throughout their lifetime. I’m not a liberal on this matter. I do not think we should tolerate people living off the state and not being required to contribute anything back. It’s bad for them and it’s bad for the whole of society.

We, of course, have to support people who fall out of the workplace because of some personal crisis. One in four of us will undergo a significant mental illness in our lifetime and employers are not always adept or, indeed, sympathetic to the situation. Losing your job or having a baby can mean you’re out of the workforce for a considerable time and, not surprisingly, people lose their self-confidence, in some cases become agoraphobic, unable to tolerate being outside in open spaces or in unpredictable situations.

In other scenarios, as the Cabinet Secretary has described, people end up using out-of-hours services as a prop for their pain, which is neither appropriate for actually helping them feel better about themselves—but is also clogging up emergency services for those who do need them. So, I was very interested to attend the frequent attenders multidisciplinary team that’s operating across Cardiff and the Vale. They look at the top 20 attenders in accident and emergency, out-of-hours and the GP surgeries for that month, and they get prescribed tailored services to meet their particular needs. It is really very, very impressive what the outcomes are: 80 per cent of these people get back on their feet and resume their normal existence and are no longer an inappropriate burden on emergency services.

It’s Communities First that often takes the lead on getting people referred to them. They lay on well-being courses, confidence building, living life to the full, social support networks—whether it’s gardening or cookery clubs. Generally, under the King’s Fund definition, there’s often a link worker involved, and I suppose one of the key questions for the Government is really: what will happen once Communities First fades away, and who are going to be the link workers who need to be there to guide the individual through social situations that they find difficult, and to support the rest of the people involved in that social group to know that there will be support available if things become difficult? I think Angela Burns has made some interesting comments about the role of the third sector in this regard, but there does need to, clearly, be statutory services having some oversight over this as well.

I just wanted, lastly, to state my concern about the challenges facing young people at the moment. The statistics I received yesterday from some of the employment link workers working in Communities First areas are really quite frightening. In Cardiff north and east there are 166 year 11 young people who are 16 and are about to do whatever exams they’re going to do—they have no destination next year. They do not yet know where they’re going to be next year, and we need to ensure that they’re not NEETs. And a further word of warning is that there are 86 people from the last cohort who would be year 12s if they were still in education who are completely unaccounted for. We do not know what is happening to these people. Hopefully, some of them are gainfully employment, but others are completely missing. So, we need to roll out social prescribing to ensure that everybody is given the opportunity to make a contribution and is gradually being moved towards enabling them to stand on their own two feet.

Social prescribing is a core element of the co-production revolution, and the fact that the Welsh Government has tabled this debate shows that we’ve come a long way since I first led an Assembly debate on co-production to a lukewarm response. This is about moving from the medical model, which sees illness or disability as the problem, to the social model of disability and the right to independent living, emphasising that people are disabled by society, not themselves; that we must work together to tackle the barriers to access and inclusion for all; and that everyone must be allowed independence, choice and control in their lives. This is about doing things differently, moving from a needs-based approach to strength-based development—to helping people in communities, young and old, identify the strengths they already have in order to tackle the root problems preventing them from reaching their potential.

As the Welsh NHS Confederation states, engaging the public and patients in co-production means developing and implementing a national programme with an agreed timescale across Government, which identifies actions for all public services to take to engage the public and patients in living healthier lives. The King’s Fund definition referred to says that social prescribing or community referral is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services. As they say, this is designed to support people with a wide range of social, emotional or practical needs and many schemes are focused on improving mental health and physical well-being. This can involve a variety of activities, which are typically provided by voluntary and community sector organisations, including volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports and physical activity, involving a link worker, as Jenny indicated, who works with people to access local sources of support.

A study into a social prescribing project in Bristol found improvements in anxiety levels and in feelings about general health and quality of life. A study of a scheme in Rotherham found reductions in NHS use in terms of accident and emergency attendance, outpatient appointments and inpatient admissions. Cartrefi Conwy runs several projects empowering and enabling older tenants to take control of their lives, not letting their age or anything else affect them, their independence or quality of life. In Lancashire, the Green Dreams social enterprise, set up by a local GP, provides community based solutions to unemployment, isolation and reduced quality of life. Independent evaluation by Lancaster University found mental and physical health improvements, reduced GP appointments and many patients returning to work. Around 40 GPs are now referring into that scheme.

The Co-production Network for Wales highlights time credits social prescribing as a powerful tool for encouraging the hard to engage or socially isolated in activity that might have a health, well-being or family reconnection impact and earns them time credits. Co-production Wales has highlighted the upcoming 8 June presentation by the chief executive of Interlink RCT—Rhondda Cynon Taf—connecting individuals, communities and organisations at a strength-based practice study group. As he says, patients are being referred from GP surgeries through social prescribing and through social care settings, often called community co-ordination or local area co-ordination. He adds, however, that many of the resources available are not directed at what matters most to people, where they need it, to improve their own health and well-being, but that this is particularly a problem in the most deprived areas, and that models that work in isolation that are not collaborative and are not connected or able to restore community provision will fail to tackle gaps and will be limited in scope and effectiveness.

Five years ago, I heard Western Australia’s inspirational mental health commissioner speaking at a Co-production Wales conference in Cardiff. It was he who first launched local area co-ordination over a quarter of a century ago, making a real difference to both local people and professionals, who started to act and think differently. This shifted focus from people as passive recipients of social care to people who have gifts, assets and contributions in inclusive communities. Volunteer-run walking schemes supported by Let’s Walk Cymru, such as Troedio Clwyd Walks, improve physical and mental well-being and tackle loneliness, saving NHS Wales money, but Welsh Government funding ends on 30 September, providing no assurance for the volunteers. The Welsh Government must provide continuity. After all, as the Chief Medical Officer for Wales states, the social prescribing approach can help the management of chronic conditions and decrease demand for health services—let’s make it happen.

Diolch, Dirprwy Lywydd. I would like to thank the Cabinet Secretary for bringing forward this debate today, and I’m delighted to take part. I’m firmly of the opinion that social prescribing, particularly when it comes to mental health, can deliver real health benefits for Welsh patients, and UKIP will, therefore, be supporting the motion.

As results from studies in Bristol and Rotherham have shown, social prescribing schemes can lead to a reduction in the use of NHS services, but, more importantly, lead to improvements in mental health and general well-being, improvements to quality of life and reduced levels of depression and anxiety.

It’s the last point that I find the most encouraging. Rather than condemning patients will mental ill health to a life on antidepressants, which have been shown to have terrible side effects, social prescribing can be used to better effect.

Social prescribing can also deliver cost savings to our NHS. Preliminary economic analysis of the Rotherham study found that the scheme could pay for itself within two years due to reducing reliance on NHS services. My only concern is that, for this to be truly effective, we need to pump significant investment into primary care. To be able to effectively deliver social prescribing, GPs need to be effectively resourced, giving them the time to be able to consider the whole person more consistently, and they need access to fully resourced community services to which to refer patients when appropriate. According to the Royal College of General Practitioners, the promotion of social prescribing ultimately needs to be managed carefully as it generates expectations of general practice to carry out non-health functions, which it has limited capacity to do. They also state that social prescribing schemes can certainly be beneficial to a patient’s overall health and well-being, as some pilots have shown. To be effective, there needs to be better integration between health and community services, so that GPs and our teams can signpost our patients most appropriately.

As I’ve highlighted many times, our NHS is most effective when we have a true partnership between the public, private and third sectors. Social prescribing is such a partnership approach. If we consider and mitigate the additional burden that social prescribing places upon our GPs, I do firmly believe that it has the potential to deliver enormous benefit to Welsh patients. I therefore look forward to seeing further details of the social prescribing trials and hope the Cabinet Secretary can assure us that resulting social prescribing schemes will be properly resourced and not place additional burdens upon our already over-stretched GPs.

It is clear that the traditional approach to mental health care is not working, particularly for our younger population who are facing new and varied challenges to their mental health. We need new ways of working, as the taking of a pill method appears to do more harm than good. So, social prescribing has a role to play in meeting this challenge and I look forward to working with the Welsh Government to deliver a Wales-wide approach that benefits patients and our GPs alike. Thank you.

I think we could all do with a bit of social prescribing today. I think it’s been a very difficult day for us all and a very sad day and anything to lift our spirits would help. But I would like to thank the health Secretary for bringing forward this proposal because I think it shows that there is an understanding that there’s more to health than just looking after the physical well-being of a patient. Jenny Rathbone has underlined the fact that one in four of us is likely to suffer some kind of mental health problems during our lifetime—. I think it’s very much the point about asking patients what matters rather than, ‘What is the matter?’ I’m very much of the view that I think we have to respect and treat the individual and the patient and not just the illness.

My husband’s a GP and he’s been social prescribing for almost two decades, mostly referrals to sport centres. But I think it’s important that we develop this further, and I’d like to focus just a few words on the opportunities to use social prescribing in relation to the arts. Now, as the health Secretary is aware, we’ve established a cross-party arts and health group within the Assembly and I’m very keen on this. I was chair of the Live Music Now charity and it was incredible to watch the transformation that came in care homes when we sent expert musicians in to play and to really have an impact and to raise the spirits of the people in those care homes. I think the Welsh Government actually has a very good record in relation to how arts impact on health: 50 per cent of the revenue funded organisations subsidised by the Arts Council of Wales are related to health in some way.

I look forward to welcoming the Cabinet Secretary to the next meeting of that cross-party group where we’ll be making a presentation to him and asking him to support the efforts to build a more robust evidence base to support arts and health in Wales. There is a huge amount of work, as I said, being undertaken already. The Welsh arts council is already in the process of collating the work that is already being done in Wales, and there needs to be, I think—

Will you take an intervention?

Sure.

Thank you. I was just rather hoping that in your role as chair of that cross-party group, you might also perhaps look at the role of art and music therapy for younger people, because at the stage of their life where they are, they need a course correction very often. A lot of them are starting to walk down a poor mental health route for all sorts of reasons, and there is a lot of evidence out there that if you can catch them young enough, in their teens and in secondary school when they’re going through those kinds of issues, then actually it can help to bring them back before it becomes really hard to start rescuing people. And I’d be really grateful, and I’d like to join your cross-party group if your cross-party group would actually have a look at that as well, because it’s that whole principle of, ‘If we can catch them young and save them earlier, it helps them and it helps us.’

I think that’s a really good point, and I’d like to invite you, perhaps, to come and address one of our meetings. I think that would be very, very useful because you’re quite right—if we catch them young, if we catch them early, the arts can be a great mechanism for turning people around.

I think it’s also important to focus on older people. I think if we’ve got a lot of people now—you think about the massive increase that we’re going to see in people requiring residential care, that’s projected to rise by 82 per cent by 2035. So, we need to think about how we’re going to deal with that, but let’s think about how we’re going to give them the quality of life; it’s not just about parking these people—it’s about making sure that they have a good life.

But I would like to finish by asking the Cabinet Secretary just one thing, and that is really about the budget. Now, I know that there’s £180,000 being earmarked for volunteer-led networks in relation to how we use this, but, actually, in the context of a £6 billion fund, how far do you think we can take this? This is quite innovative stuff. We do need to, I think, make sure it’s evidence based. But I just wonder if you could tell us: what are your ambitions here? It’s clearly early days on this, but I just wonder: could we really be a pioneer country, really setting out a marker for the world to follow?

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

Thank you, Deputy Presiding Officer. I’d like to start by thanking all Members who have contributed for their considered and constructive contributions. This isn’t an area where the Government has a hard-and-fast view on what work and must work. As I indicated, we’re looking at developing an evidence base based on examples of what already takes place in Wales, and the evidence of what works best.

I think we’re really talking about appropriate prescribing. Sometimes, it may be that social prescribing is something to replace poor prescribing decisions by clinicians and, of course, we should always constructively review what clinicians do, but there are, of course, entirely appropriate reasons why people’s health will be treated by a form of medication prescription. This is about how we add to and potentially replace some of that in a way that is appropriate for the individual. If you like, picking up on what Eluned Morgan said, ‘What matters to you, not what is the matter with you’, and see how we empower people to take more ownership of their own choices, and then to give them those choice and how easy those choices often are, if only they’re pointed in the right direction and helped in that way. There was much in Eluned Morgan and Angela Burns’s contribution, even without the intervention that Angela made, where there was actually a lot of commonality: book prescriptions, art, music and sport, and the role that they have. There are a number of things we’re already doing with young people, both myself and the Cabinet Secretary for Education, where we have a number of things we’re doing in schools to help to try and support people and their resilience in the most general terms, and understanding what we can do to promote that general well-being for the child and their whole family, and to think about how that works. But I would not pretend that we have perfect answers. As you know in Government, there is rarely a day when there is a perfect answer, and if there is one I have yet to come across it myself. But we are thinking seriously about what we’re doing and, as I said, the pilot that we’re going to develop to start this year will be about building their own space. To go back to Eluned’s point about where the budget is, that very much depends on what the evidence tells us about both the cost of providing the service, but then of the impact of that service, and our broader challenge, if we’re speaking honestly and in a mature way, about how we shift the way in which we provide services with citizens, not to citizens, and actually how we make those choices different ones as well. So, the challenge is about how we gear this up to make that system-wide shift and change.

Just going back to Angela Burns’s contribution, I’m happy to recognise your point about how you refer people into a service, and what that service is, because there will, of course, be occasions when that service comes from a medical professional. There may also be times when what we call social prescribing doesn’t necessarily get routed through a GP or a healthcare professional. But if it is about how you provide someone with a route to actually access support, resilience and advice to improve their general health and well-being—that’s why I don’t want to get too tied up on a definition, but I do recognise the King’s Fund definition is a useful place to start from—.

Again, thinking about Dai Lloyd’s challenge about walking—those of us who have iPhones—other smartphones are available, of course—if we walk around with them, they have this handy thing on them that tells you how many steps they think you’re doing, how many flights of stairs you’ve had. I don’t always think it’s entirely reliable and I tell myself there are occasions where I’ve done more walking when my phone’s been sat on a desk—but this job is difficult and politicians are often very poor examples of doing what we say others should do. At election time, we almost all get our 10,000 steps in, but in a normal day otherwise, it’s actually really quite difficult—but it’s something for us about how we take time to do things for ourselves as well.

Then we had Jenny’s contribution and, in particular, I’m pleased to hear you mention the frequent attenders work that’s often there about not saying that frequent attenders don’t have health and well-being needs, but their needs are being met or dealt with inappropriately in going to the wrong place for the wrong care at the wrong time. That point is about how you provide people with a route to understand what their needs are and how they’re then met appropriately. Often, that is about directing them to other services or towards what they can do for themselves.

I’m particularly pleased that you highlighted the cross-Government challenge that we have. Good health and well-being is not just an issue for the health service, it is absolutely an issue that goes into education, that goes into housing, it goes into the economy—virtually every area covered in ministerial portfolios. Also, thinking back to my previous life, when I was an employment lawyer, and about the links between health, well-being and work—.

Finally, in terms of some of the other points made by Mark Isherwood and Caroline, we recognise, as I said earlier, the broader benefits of this approach and in particular the importance of the third and independent sectors in helping us to get this right. So, I’m really pleased about the constructive debate that we’ve had. I look forward to developing our approach to social prescribing in Wales and to further raise awareness of the health and social benefits that it can bring. I ask Members to support the motion and the amendments and I look forward to reporting back to Members in due course on the work that we will undertake in the pilot and developing the approach here in Wales.

Thank you very much. The proposal is to agree amendment 1. Does any Member object? Therefore, amendment 1 is agreed in accordance with Standing Order 12.36.

Amendment agreed in accordance with Standing Order 12.36.

And so the proposal is to agree the motion as amended.

Motion NDM6314 as amended:

To propose that the National Assembly for Wales:

1. Notes that social prescribing is an important form of intervention that is already used across Wales;

2. Considers priorities for the further promotion of social prescribing across Wales; and

3. Notes Welsh Government commitments to trial a national approach to social prescribing linked to mental health.

4. Notes the Kings Fund definition of social prescribing.

Does any Member object? Therefore, that motion, as amended, is agreed.

Motion NDM6314 as amended agreed in accordance with Standing Order 12.36.

That brings today’s proceedings to a close. Thank you.

The meeting ended at 16:37.