The following amendments have been selected: amendment 1 in the name of Rebecca Evans, and amendments 2 and 3 in the name of Rhun ap Iorwerth.

We now move on to item 8 on the agenda this afternoon, which is the Welsh Conservative debate on community mental health teams. I call on Darren Millar to move the motion. 

Motion NDM7028 Darren Millar

To propose that the National Assembly for Wales:

1. Notes the Health Inspectorate Wales and Care Inspectorate Wales Joint Thematic Review of Community Mental Health Teams.

2. Further notes the increasing number of referrals to community mental health teams across Wales.

3. Regrets the lack of parity between physical health and mental health services.

4. Calls on the Welsh Government to improve the support provided by and access to community mental health teams, including:

a) increasing spending on mental health services in real terms each and every year until the end of the Assembly term;

b) ensuring that crisis teams are available 24/7 in all major emergency departments;

c) urgently working with health boards to improve community mental health facilities for service users and staff; and

d) raising awareness over access to community mental health teams so service users can get the best advice possible.

Motion moved.

Thank you, Deputy Presiding Officer. I'm very pleased to move the motion today in my name on the order paper. I think that some of the debates that we've had on mental health issues here in the National Assembly have seen the Assembly at its very best, coming together in order to highlight some of the challenges that we face collectively and bringing together people from different political persuasions to try to have and agree a consensus in terms of the approach that we can have on some of these issues. Indeed, there has been a lot of common ground in recent years. We were, of course, very fortunate to  have the Mental Health (Wales) Measure 2010, which was put forward by my colleague and former Assembly Member Jonathan Morgan some years ago, which was supported by all political parties in the Senedd at that time. And, of course, we've had a number of debates on mental health, including those where we've had Assembly Members talk about some of their own struggles and challenges with mental health problems. And I think they've been some of the most powerful debates, frankly, that I certainly as an Assembly Member have experienced. 

We've also come together, of course, to try to support the aims and objectives of the Time to Change campaign, to tackle the stigma around mental health. And so it's in that spirit that we bring forward this debate this afternoon, and we're very grateful to acknowledge the support that we've had from Mind Cymru and from the British Association for Counselling and Psychotherapy, which have indicated to us that they fully support the motion that's before us. 

Now, we've had debates on many aspects of secondary and primary mental health care, but I don't recall ever having a specific debate focusing on the issue that we want to talk about today, and that is community mental health teams. And I think it's important that we look at this issue, and very timely that we look at this issue, because, of course, we have seen the identification of a number of problems with community mental health teams as a result of the Healthcare Inspectorate Wales and Care Inspectorate Wales joint report, which was published in February. But I just wanted to take the opportunity to remind people what community mental health teams are about. 

Now, from their name, you might think that they're part of the primary care system, because they're based in the community, but that of course is not the case—they are firmly part of the secondary care approach to mental health. They are multidisciplinary teams that very often involve psychiatric nurses, psychologists, therapists, counsellors, support workers and social workers, who come together in order to support people with quite acute and difficult mental health problems—complex and severe mental health problems.

The Llywydd took the Chair.

I mentioned a few moments ago that there had been this joint report, which the healthcare inspectorate and the care inspectorate had produced. Some of the findings in that report were very, very concerning. The report found that there was a disparity and a variation in the consistency and the availability of services provided by community mental health teams across Wales, and it's some of those issues that I want to just focus on for a few moments, if I can.

One of the problems that was identified was that there was a difficulty in the referral system—that it was pretty inconsistent, and that not everybody was able to access services in a timely fashion when they needed to be able to access them. It was clear from the report that general practitioners were not always clear on how to refer directly into their community mental health teams and very often were referring to hospital teams instead.

The report said that there was a need for a single point of access, from a referral point of view, so that people knew exactly where to present their patients when they were in need of care and support. Of course, this chimes very well with some of the findings and recommendations that we've seen from Assembly committees that have looked into our mental health services as well. We remember that it wasn't that long ago that we debated the Health, Social Care and Sport Committee's report on suicide prevention, which also highlighted this issue of needing to have some clear pathways and some timely access to support when it was required.

The report found also that many people find difficulties in accessing community mental health teams, particularly during a crisis. While there were some parts of Wales where people were getting immediate support, in other parts of Wales there were people who were struggling to access services, particularly GP out-of-hours services. Of course, a number of people were reporting that they had to make a number of separate presentations in an emergency department before they were getting access to the sort of crisis support that they needed.

I think it was just two fifths of those who were surveyed as part of that work who said that when they contacted their mental health teams—their community mental health teams—during a crisis, only two thirds were actually getting the help that they needed. That's why we have made one of our calls in this debate the need for crisis teams to be available 24/7—around the clock—in all our major emergency departments across Wales, so that the support is there when it's needed in a crisis. We need that uniform access and pathway to that crisis support.

It's very difficult to understand precisely what the level of demand is for community mental health teams, because, of course, there's no data currently published by the Welsh Government in relation to them. Fortunately, Mind Cymru have done some work on this, through freedom of information requests. It suggests that between 2014-15 and 2017-18, referrals into community mental health teams have grown by around 18 per cent, and that is over 4,000 additional referrals going into those teams, currently standing—or in 2017-18—at 26,711 referrals in a year. Now, that is less than the actual number of referrals across Wales, because, unfortunately, there's one health board that was unable to give any information about the number of referrals that were going into their community mental health teams, and, unfortunately, that's the only health board that was in special measures—the Betsi Cadwaladr University Health Board.

We know that Betsi is in special measures because of concerns around its delivery of mental health services, so I think it's particularly troubling that that is the one health board that doesn't seem to be able to have a grasp on the total number of referrals, because, of course, you need to know what the referrals are in order that you can plan to meet the demand that's presenting itself to those teams, so that you can manage people's care—remember, these are very vulnerable people—in an effective and safe way. So, I think it is concerning that there is a serious lack of data, and that's one of the reasons we will be supporting the Plaid Cymru amendments that have come forward, one of which refers, of course, to the need to publish data on a regular basis. 

Now, we talk a lot in this Chamber about the need for parity between mental and physical health services, and I think it's absolutely right that we should have equality between those two services, to make sure that we are measuring performance against similar suites of targets. But it's clear that here in Wales there are too many people at the moment waiting for far too long for access to talking therapies. I know it's a matter of concern to people in all political parties here, including members of the Government. And those waits have been highlighted in the HIW and care inspectorate report, and it can be anything up to two years. Now, when people are referred to secondary care services for support, they need that support in a timely manner, and waiting, frankly, for two years before they get access to the treatment that they need is clearly not good enough. 

Now, there are targets that the Welsh Government has for both local primary mental health support services and, indeed, for community mental health teams and secondary services to meet, but what is strange is that, usually, if you're in a level of more severe need, you would expect that you would need a quicker intervention, so the target should effectively be shorter. That's not the case in terms of the targets that the NHS in Wales is currently operating to in respect of mental health services, which I think is something that we need to work to address. 

For example, local primary mental health support services, which are there to support those with mild to moderate or very stable, severe enduring mental health needs have a target of 28 days from presenting themselves to a primary care team to the date on which they are assessed. That is the target period—they've got to be assessed within 28 days. And then there's another target that there is 28 days from the date of that assessment until they must receive treatment. Truncated—56 days being the maximum that someone should have to wait from the time that they are referred to the time that they receive treatment. 

But for secondary care services, including access to community mental health teams—and these are people with more severe and more complex mental health needs—the target is 26 weeks from assessment to treatment—not from referral to treatment, but from assessment to treatment. Now, that, to me, clearly suggests that there's a problem in the system somewhere in terms of what the level of priority ought to be. Now, I appreciate there are going to be challenges in being able to bring that target time down, but it is concerning that we're not there at the moment.  

And, of course, performance against these targets is not published routinely. I'm assuming it's measured somewhere by the Government, but we don't have the data to be able to demonstrate whether the NHS in Wales is meeting these targets, and I think that we need to do something about that. There was a clear commitment in the 'Together for Mental Health' delivery plan, published for 2012-16, that said that we would have a mental health core data set by December 2014. We don't have that yet, and, in fact, I think it's being kicked down the road to 2022, which is clearly not ambitious enough. Neither have we seen annual reports for quite some time, in terms of the delivery of the Together for Mental Health programme. That was a commitment that was made—that we would have annual reports—but we haven't had them. 

So, clearly, things need to change. We very much hope that the Assembly will support the motion before us, and we will accept those amendments that I referred to earlier. Thank you. 

I've selected the three amendments to the motion, and I call on the Minister for Health and Social Services to formally move amendment 1 tabled in the name of Rebecca Evans.  

Amendment 1—Rebecca Evans

Delete points 3 and 4 and replace with:

Recognises the need to ensure parity between physical and mental health services;

Calls on the Welsh Government to improve the support provided by and access to community mental health teams, including:

a) continuing to increase spending on mental health services in real terms each and every year until the end of the Assembly term, subject to the outcome of the 2019 spending review;

b) ensuring arrangements are in place to respond to mental health crisis 24/7 in all major emergency departments;

c) urgently working with health boards to improve community mental health facilities for service users and staff; and

d) raising awareness over access to community mental health teams so service users can get the best advice possible.

Amendment 1 moved.

Formally. 

I call on Helen Mary Jones to move amendments 2 and 3 tabled in the name of Rhun ap Iorwerth. 

Amendment 2—Rhun ap Iorwerth

In point 4, add as new sub-point at end of point 4:

publishing meaningful performance data on waiting times, including by age groups and diagnosis, so that claims of improvement can be independently verified.

Amendment 3—Rhun ap Iorwerth

In point 4, add as new sub-point at end of point 4:

ensuring that community mental health teams liaise with welfare rights services to protect vulnerable people against DWP assessments and decision making processes that can often exacerbate mental health conditions.

Amendments 2 and 3 moved.

Diolch yn fawr, Llywydd. Can I thank the Conservatives for bringing forward this important motion? I welcome the opportunity to take part in this debate, and I'd like to associate myself with much of what Darren Millar has said. I think it was a very thoughtful portrayal of what is a very complex problem. I think, particularly, we can all agree that there is something really wrong with the waiting time targets. When somebody is seriously mentally ill, they need help immediately, and there is a real risk that, if somebody presents asking for help and they don't get it immediately, their condition will worsen. If it's got a comorbidity with drug and alcohol, as often is the case, you will have people whose self-medication may get out of control—that is one of the reasons I believe that we end up seeing such a high proportion of our prison population being people with mental health issues, because sometimes those mental health issues are not addressed in a timely way. And I say that in the co-operative spirit in which Darren Millar has put forward this debate. I think we would all aspire here for better and we have to look to the Minister to deliver that.

I won't repeat the comments that Darren has made. I just want to speak very briefly, Llywydd, to our two amendments and to begin by saying we won't support the Government amendment, because we think Darren Millar has made a very strong case for the need to have co-located emergency crisis teams in A&E departments. I have myself seen some very distressing situations, very busy A&E doctors trying to deal with young people, particularly, presenting with very serious mental health issues. They haven't got the capacity or the skills to do it and they need somebody to be able to come in straight away, somewhere where they can refer straight away. I can think of one particular case where I had to sit in A&E with a very, very highly distressed young person who was suicidal, and there was nowhere for her to be taken, except at that stage—and this was some years ago, thank goodness—potentially a police cell. You can imagine how awful that was for her but also for the medical staff that were dealing with her. So, we believe the case for co-located teams is made.

If I can turn to our own amendments and amendment 3, there is no doubt that successive changes in the social security system, which, of course, were begun by Lord Freud under Tony Blair—the work capacity assessments—have hit people with mental health issues very hard. It is easy to see if somebody has, say, a physical disability that means they need to use a wheelchair. It is much harder to see how debilitating a mental health problem can be. I have to say that, as an elected Member in this place, I have never failed to win an appeal, when I have supported a person with a mental health problem, from their original Atos test—where, of course, the tests are undertaken by people who are not qualified and they don't know, frankly, very often, what they're doing—and I'm sure there are many of us in the room who've been able to support successful appeals. But I am left with the question about people who do not know, who don't have somebody with them who can seek that kind of advocacy.

These tests were clearly designed by people who do not understand the experience of invisible disability; they don't understand fluctuating conditions. And the very process of forcing people with an ongoing mental health issue to repeatedly be reassessed is actually—and I can think again, and I'm sure others in this room—exacerbating mental ill health. We need to challenge this and one practical way in which we could do that here is to ensure that community mental health teams across Wales have really strong relationships with local benefits advice, so that those people who have to go through those assessments—much as we might like to see them gone—have some proper professional support. it isn't always possible for them—

Will you take an intervention? 

I'd be very happy to take an intervention. 

Do you think that—? I think you make a very strong case that mental health problems can be linked to welfare reform. Do you think that devolution of the administration of welfare could help, if we could shape some of those assessments and procedures ourselves? 

I think, absolutely, it could. I think we might bring a very different set of values to those assessments and I'm very glad that the Welsh Government has finally agreed to keep that under review.

I'll turn very briefly, with the Llywydd's indulgence, to our amendment 2, which looks at the case for data. If I can just give one example very briefly, we've been raising for a long time the waiting times in CAMHS. The then First Minister rightly said that there were probably too many young people on the CAMHS pathway who didn't need to be there. A decision was made in 2017 to remove some 1,700 children from the pathway—around 74 per cent of them were on waiting lists at the time. Now, that may have been absolutely the right thing to do for those individual young people, but my point is that we don't really know—we don't really know where they went, we don't really know what their outcomes were, and we don't know if they actually got more appropriate interventions.

Darren Millar has already referred to some of the issues around the lack of information, the lack of data—I am absolutely shocked, though sadly not surprised, that there is a local health board that simply can't tell people about the number of referrals to their community mental health teams. I'm sure the Minister would agree with all of us that this isn't acceptable and I would urge him again today to accelerate that 2022 deadline for effective collection of data. We cannot solve the problem if we don't know how big it is and we don't know what it looks like. Even with the best will in the world even the most gifted Minister in the world cannot do that.

So, I'll end my remarks, Llywydd, by thanking again the Conservatives, thanking them for accepting our amendments, and commending this motion and our amendments to the Chamber.

I am grateful for the opportunity to speak this afternoon on the findings of this report, produced jointly by Healthcare Inspectorate Wales and Care Inspectorate Wales. The findings make grim reading. The report found disparity and variability in the consistency and availability of treatment, care and support provided by community mental health teams across Wales. It makes 23 recommendations over 40 areas to address the current failings in the system.

I would like to address my remarks today to problems facing patients in accessing the services they need. I am concerned that patients are often unable to access the care they need in a timely manner or close to their home. The most recent figures show that just over half of patients were seen within the 28-day referral-to-treatment time target for mental health services. Nearly 6 per cent of patients had to wait longer than six months for treatment. Waiting times for talking therapies also cause concern, with 16 per cent of patients being forced to wait over 28 days for this vital service. One of the significant inequalities and inconsistencies highlighted in the report relates to 24/7 crisis care across the different health authorities. Some health boards, such as Cwm Taf, operate a telephone helpline for anyone experiencing a mental health crisis. This service is available 24 hours a day. However, other health boards operate this service for just 12 hours a day, and some of these helplines exist only to support people already known to the service.

There are inconsistencies even within the health boards. Abertawe Bro Morgannwg health board provides a 24-hour service for people in Swansea but only a 12-hour service for residents of Bridgend or Neath Port Talbot. This postcode lottery crisis care cannot continue. It is unfair and unacceptable.

Crisis care for children and young people are equally impacted by significant inequalities. Only three health boards in Wales provide crisis teams for 12 hours a day, seven days a week. In Powys, no services are available on weekends or after 5 p.m. on weekdays. On the subject of services for young people, I have to raise the issue of the lack of beds for young people with high-risk mental health problems. There are only three specialist in-patient units in Wales, with 51 places. Since December, Welsh patients have been removed from Regis Healthcare in Ebbw Vale because of concerns about their safety. As a result, this leaves only 27 beds elsewhere. Healthcare Inspectorate Wales have described the shortage as 'unacceptable'.

Issues also exist at the other two units. Tŷ Llidiard in Bridgend is under restricted criteria for referrals until improvement work is carried out, and the unit in Abergele has recruitment issues. As a result of these shortages, young people are not always able to receive timely care close to where they live and are having to be placed out of the area. Concerns about capacity were first raised by the Welsh Government in 2013, six years ago. It is clear that Welsh Government must, as a matter of urgency, review the demand for these services against the ability and capacity at CAMHS units to ensure that young people can receive the treatment they need. Early diagnosis is very important in mental health, Presiding Officer. If it is diagnosed, either by family practitioners or others, it can be cured early rather than leaving it too late, and, if the treatment comes later, it takes much longer to treat the person for the rest of their life.

Presiding Officer, I hope the Minister will accept the recommendations in this report and act to ensure that people with mental illness receive fair and equitable treatment irrespective of which part of this nation they live in. Thank you.

Llywydd, I'd like to officially thank the Tories for bringing this motion forward. I agree with Darren Millar's view, and I acknowledge it. It's in the spirit of working to ensure we get the right services for some of the most vulnerable people that this debate has been put forward, and that's crucial.

Last month, I chaired the cross-party group on mental health in which the report was discussed. The following day, actually, following that meeting, I raised it in the business statement with the Trefnydd, where I sought a statement from the health Minister as to how he would respond to the report, and I was informed that perhaps by the end of the week I would get a response, and I welcome the opportunity to ask the same question again today and see if we can now actually get a response from the Welsh Government to that report, because we haven't had it yet.

Now, it's essential that people with mental health needs as well as their carers and their families—we haven't mentioned their carers and their families yet—get the best care and support possible, and it's concerning that the report by HIW and CIW that was published actually shows there are inconsistencies in care across Wales, and stresses that there's a need for vast improvement in the community health teams in order to ensure people experiencing mental health needs and their families receive the best care and support.

We are increasingly moving to a world where care back in the community is the main aim, and, if we are to achieve that, we must ensure that people do feel safe and in control when they go back into their own environment. We cannot afford to not address the key findings in this report. And the foreword says it all, really. The Member for South Wales East, Oscar, actually stated the issues about inconsistency, availability of treatment, care provided in the community—said it all, and, in fact, if you read the report, we hear the words 'variable' and 'inconsistent' so many times, and it is important that Welsh Government, health boards and local authorities need to carefully consider and examine all areas highlighted in the report and act on the recommendations so that people living with mental health illness will receive equitable care wherever they live in Wales. 

People described the service as cumbersome and difficult to navigate. They referred to a lack of understanding of different referral criteria, which meant that referrals, especially from GPs, were submitting the wrong information, leading to delays in accessing assessments and support, and, more worryingly, there were concerns expressed over access to services for people experiencing mental health crises, which Darren Millar highlighted in his opening points and in his motion. Half the people didn't actually know who to contact out of hours, and that's frightening—to think that, if someone has a mental health illness, families and carers don't know who to access to help that person. We have to address that. 

There were several questions raised in the report over the delivery of safe and effective care. Please read those words: safe and effective care for these vulnerable people. And it's already been highlighted about the lack of data, but also the involvement of family members or carers in producing the actual care plans for those individuals. The report highlighted that almost half of family members or carers weren’t involved in the discussions leading to the decisions for the community health team support to be discontinued. So, they were being discharged with over half of the family members not actually being involved in those discussions. A third said that they weren't provided with information—. Sorry. Less than a third said that they were provided with information of who to contact. That is not acceptable. If you're caring for a person with a mental health illness and you're putting them back in the community, because you're discharging them, without support, the least you can do is to ensure their family members and their carers are informed as to what action to take if a crisis arises. We need to address that if we really respect the individuals who are facing those challenges. We often in this Chamber—. Darren said—you're quite right—we often in the Chamber highlight the vulnerability of these individuals and the actions we as an Assembly should be taking to protect them, and this report is saying we're not doing that. We should, therefore, request that our Government ensure that they respond to all the recommendations in this report to ensure that those people are able to depend upon the services available via the community mental health teams and all other teams to provide the care they would expect—the care I would expect if it was me or my family.

In concluding their findings, the CIW and HIW noted:

'There is still significant improvement required across Community Mental Health services to be in a position to meet the vision set out in Together for Mental Health'.

I look forward to that coming to fruition. Minister, I do know that one of the big issues is about resource. We've been talking about talking therapies—it's about resource. Sometimes, we haven't got the resources to do that. I accept that, but we need to start developing those resources. We haven't got enough, so let's get them in place, let's do the training, let's get people to be able to deliver those services. We have to be in a position, as a nation, to support people with mental health illness to ensure that, as a community, they're not left vulnerable in their own homes.

I think it's fairly evident that, here today, many of our Members, cross party, recognise the urgency for continued improvement in our provision for mental healthcare support. We are all too aware that mental health problems do not discriminate; they effect mothers, children, fathers, expectant mothers, young people, adults, the middle age, the elderly generation and those with other ailments and diagnosed conditions compounding the problem. While attending to mental health requires a considerable degree of self-care and the implementation of healthy lifestyle habits, for victims of adverse and traumatic experiences and severe mental health crises, proper mental health intervention and care is essential. Yet, our mental health services and the current organisation and management of our health boards are currently, in some instances, too ill-equipped to deal with this demand. The quality of care that is required to prevent a further increase of suicide rates—among young people and male adults in particular—substance abuse and debilitating mental health illness is profound.

As an Assembly Member—a constituency Member with an office in the town of Llandudno—sadly, I see too much anecdotal evidence of people who simply cannot access mental health support or any form of counselling or anything, at a time when they present at a time of major crisis. Indeed, Presiding Officer, the training and retention of qualified medical staff and professionals is one of my chief concerns. According to Mind, as part of the GP training curriculum, currently, just one of 21 clinical modules are focused on mental health, and the number of rotations that trainee doctors complete in a mental health environment has been decreasing in the last five years. It's going backwards. Yet, these trends are not reflecting that mental health issues are now the modern-day epidemic and the fact that a third of GP appointments now relate to mental health issues.

So, I ask the Minister, in all honesty and in all sincerity, how can the Welsh Government ensure that trainee medical professionals and doctors are receiving the training—the relevant training—that is really needed for our current generational needs, whilst—

Will you take an intervention?

Yes, sure.

Do you agree with what my colleague Helen Mary Jones said—that many people's problems with mental health could well be linked to welfare reform? And if you do accept that, do you accept that if we had control over some aspects of welfare reform here, we could mitigate some of those worse aspects of it?

What I would say, with respect, to the Member is that there is a plethora of reasons why mental health issues—

But is welfare reform one of them?

And, to be honest, let's—. We are talking about mental health problems and how we, across this Chamber, can work towards—

Causes?

Welfare reform—let's have that debate another day. But I'm more concerned about my constituents who cannot access treatment and support when they need it, Leanne.

Furthermore, turning to the delivery of healthcare, I wish to draw particular attention to the disparate and unequal provision of crisis care and out-of-hours services. This regional discrepancy is epitomised by Swansea, which offers a 24/7 emergency telephone point, compared to Bridgend and Neath Port Talbot, which only run this service from 9 a.m. until 9 p.m. And, I'll be honest, I don't have any provision in Aberconwy that I know of, or my constituents know of, after 5 o'clock. People, when they present, when they feel at their lowest ebb—it can be at 2 o'clock in the morning, it can be at 4 o'clock in the afternoon, it can be at 7.15 of an evening, and we do not have those services in place. We do need a 365 24/7 support system somehow in Wales.

The crisis relief situation is even more alarming for children and young people. In Cwm Taf and Cardiff and Vale, CAMHS crisis teams are available from 10 a.m. to 10 p.m. seven days a week, yet in Powys no services are available on the weekends or after 5 p.m.. 'What justifies this variation?' I ask the Minister. Surely, equality to access to services should be an endemic thread running through any service that he provides as a health Minister.

Indeed, regarding management, the Chamber should also be aware of the accommodation issues for high-risk young people. My colleague Mohammad Asghar really elaborated well on the problems that are being highlighted in the lack of recruitment of people in the Abergele unit, which sees people—and it also sees local authorities and health boards spending hundreds of thousands of pounds when we're perfectly well-equipped, in terms of equipment and the buildings in Abergele, but we don't have the trained, qualified staff.

In Aberconwy, the cancellation of mental health appointments at very short notice due to a shortage of consultant psychiatrists and other specialist advocates has adversely affected patients at Nant y Glyn and Roslin. And when you do present with a mental health issue, to suddenly have your appointment cancelled is the most debilitating issue in the world, it really is. When raised as a matter of concern, little heed is taken.

Now, I look forward to the forthcoming 2019-22 'Together for Mental Health' delivery plan, but let this not be another delivery plan with ambitious targets and lots of words with very few actions. I would ask the Minister: please, concentrate on the needs of those with mental health issues across Wales, and let's be pioneers and champions for them, because they are a very integral part of our society.

I welcome the opportunity to contribute to this debate. If I shut my eyes, it could almost be groundhog day, because when I first came to this Chamber, I sat in this very chair and my colleague Jonathan Morgan sat where Nick Ramsay sits, and in the ballot for Measures at that time, he was lucky enough to win the ballot for the mental health Measure that came out. The Government took that mental health Measure on themselves, and it was subsequently introduced. One of the things, obviously, that the Measure was trying to achieve was an end to the postcode lottery that many people felt existed at the time. Some 10 years later, sadly, that postcode lottery, according to Healthcare Inspectorate Wales's report, clearly does still exist in many mental health services.

This isn't about scoring political points in any shape or form. I don't believe mental health is a political point, to be honest with you. I would find it remarkable if anyone from any political party was trying to do down mental health services or the provision of mental health services. It is a challenging environment to work in, especially when you look at the increased demand for those services. But it is vital that there is a coherent plan put in place to actually live up to the sentiments that were expressed in this Chamber some 10 years ago about cancelling out that postcode lottery, about understanding the significance of the demands on the services, whether that be in the community setting or in the acute setting. I do hope that the Minister, when he engages with the rounding up of the debate this afternoon, will give us confidence that, as a Minister and as a department—and across Government, in fact, because this isn't just about the health department, this is across Government—there is a collegial plan in place to actually lift those delivery targets so that people can, ultimately, get those waiting times down and achieve the response that they require when an emergency does happen and family members look for that support to support that loved one who finds themselves at that crisis point.

One of the things when the Youth Parliament was announced recently and when I met members of the Youth Parliament from my own elected area—each and every one of the members highlighted as their priority area mental health services for young people, and the delivery of mental health support in the school setting, in particular. One thing that the mental health Measure obviously didn't confer was that right on anyone under the age of 18. It was a point that we tried to look into at the time, and it is a growing and troubling area of concern that you look at the wait times for young people to access help and support, you look at the wait times for the families to get that support, and it's just not happening, Minister. I do hope, again, that in your response to his, you can give us some insight into what developments you are putting in place to support people in education who do struggle with their mental health, because, obviously, we do know that is a growing area of concern. As I said, when I met members who were elected from my own electoral area to the Youth Parliament, they were deeply, deeply concerned about this area and listed it as one of their top three priorities.

Also, I do believe that, looking at the report and in particular looking at some of the language that comes out, there is provision, obviously, and rightly so, for the provision of mental health services in English and Welsh, but as a representative for South Wales Central—and the Minister himself represents one of the most diverse communities in Wales, Cardiff South and Penarth—it is important to make sure that languages are covered in the provision and people aren't excluded by the language they speak. I appreciate this is a very difficult area to work with, because sometimes you're talking very few people, but there does need to be better delivery of translation and translation services in the mental health field, so that people don't get excluded by the lack of an adequate translator to be there at the point of need and in the community.

And if I could end on the final point as well, I do think that one of the things that would help GPs in particular deliver a better service is especially around talking therapies, because this is another area that I have a personal interest in. I do regret that very often people get treated medically through a drug or some other form, when talking therapies can be so helpful to people and actually keep them away from the acute sector, if they access the talking therapy in a timely manner. And there is no national register available for professionals—therapists or counsellors—to be on. There are many recognised bodies that give accreditation, but if you're a GP, for example, there is no national register there that you can access and signpost someone to, to access that support via talking therapies. I do think that's an anomaly in the system that—and I might stand to be corrected—could be rectified relatively simply by putting that in place. So, I do hope that the Minister might engage in that point as well in his address back to the Assembly today. But I do welcome the opportunity to contribute to this debate, and in particular the spirit the debate has been taken in, because when one in four of us will have an episode of mental ill health through our lifetime, it is incumbent on us as legislators that when we pass legislation it delivers, and when a problem presents itself we address it.

I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Llywydd. I'm pleased to have an opportunity today to restate this Government's recognition of the importance of continuing to improve mental health services. I do want to say that I welcome the general tone of the debate today, with lots of thoughtful contributions, including those that I agree with and those where I don't agree with every single part. I think it is helpful to have a genuinely healthy debate where there are differences of view and, overall, I think, a shared ambition to see improvements in experience and outcomes through our mental health services, and, importantly, the point that this isn't just a matter for the health service. The improvements and the things that give people resilience around their mental health are often not about the health service itself.

Now, one of the major parts to today's motion and debate is the thematic report by Healthcare Inspectorate Wales and the Care Inspectorate Wales. It highlights key themes and issues arising from their joint inspections of community mental health teams. The joint inspections reflect the integrated nature of these services between local health boards and local authorities, but the thematic report focuses on adult services. We have, of course, discussed in-patient CAMHS earlier today in the topical question, and we have a large amount of work in train to try and improve mental health services at an earlier, more preventative stage in the joint ministerial task and finish group in response to the 'Mind over matter' report. The thematic report recognises that progress is being made, including increasing collaboration between health and social care and in providing a responsive service during a period where we are experiencing increased scrutiny and demand for mental health services. The report makes 23 recommendations for improvement, and I can confirm the Government will respond to each of those recommendations.

Now, in an initial response to the report, the chief exec of NHS Wales wrote to Healthcare Inspectorate Wales on 20 March. That set out the Welsh Government's expectations that health boards will engage with local authority partners to provide robust improvement plans as their response to the recommendations in the report, and I can confirm that supporting community mental health teams will be a priority area in our 'Together for Mental Health' delivery plan. We will consult on the delivery plan within the next few months, and the delivery plan will also take forward the recommendations from the recent review of care and treatment planning by the NHS delivery unit. To support these improvements,  we'll target additional investment over the next financial year. That will include funding to increase the range of and access to psychological therapies, and that will build on the additional £5.5 million made available in the year just ended.

The joint review also makes recommendations in relation to the Welsh community care information system. We've committed significant funds to support the implementation of this ICT system across our 22 local authorities and seven health boards. It addresses that information-sharing interface within health boards and between health boards and local authorities, including our community mental health team. I do want to respond to some of the points about the mental health core data set, which we are committed to finalising. It will include identifying appropriate and meaningful targets and developing a more outcome-focused approach to this work. These data items are being developed by a multi-agency national project steering board, and are currently being taken through the Welsh innovation standards board to ensure they're collected in a consistent way. I don't want to be explaining how the statistics we eventually produce are actually different in different parts of the country. The work is currently phased but is due to conclude by the end of this calendar year, and the data set will be captured within the Welsh community care informatics system. From a mental health perspective, we've employed staff to support work directly with teams across Wales throughout 2019 to pilot forms and data collection using our existing IT systems in preparation for the implementation within the Welsh community care information system. [Interruption.] I will.

This will include work to inform outcome-focused practice, capture service user experience and improve consistency in using outcome measures and to measure progress and recovery. That work we'll look to extend across all teams in 2020-21, so mental health data will be published on a regular basis when that system is properly and fully operational.

I'm grateful to receive an update on that, but obviously it's eight years after a clear commitment to introduce this core data set, and many people will feel that that is not sufficient regard or priority, frankly, in terms of doing this. Surely there are pieces of information that can be published in the interim—an interim suite, if you like, of targets—with some clear performance data attached to them before that core data set is published. Will you accept the ability to be able to produce something in the interim that is meaningful, perhaps against the performance of the targets that you've already got? I think it is a concern that there isn't sufficient information from health boards like Betsi—a board in special measures for its performance on mental health—and I'd be grateful if you could tell us: can you provide something in the interim, and particularly, can we get some information from Betsi?

I think there are a number of additional questions there, Llywydd. I can say, though, that we do already make performance data available. That's published, and I'm more than happy to consider again if there are things we could do in the interim. But my aim is to have a regular publication of data about mental health services that is genuinely useful, and, to do that, it has to take in engagement with a range of different people. I would much rather have something that is useful than something that is convenient or quick.

Now, the joint thematic review focused on community mental health teams. It's important to understand the overall demand for mental health services that has regularly been referred to in today's debate. Management data shows that crisis resolution and home treatment teams have seen an increase in both referral and assessment in the last two years. In the last year alone, community mental health services received around 20,000 referrals for crisis assessments, and there are, on average, an additional thousand referrals each month to local primary mental health support services when compared to 2013. In terms of activity, over 200,000 people have been seen by local primary mental health services since their introduction, with 100,000 people receiving therapeutic interventions. That increasing demand in part reflects a better understanding of mental health in our society, in part additional factors that are driving people to seek greater help for a potentially greater prevalence of mental health challenges, and a willingness to seek help that is actually a positive. This is also a result of our approach to provide more support in the community. We've seen an increase in the need for community-based services and we've seen a reduction in the number of people who need to be admitted to hospital.

In recognition of the increasing demand, we continue to spend more on mental health than any other part of our national health service. We continue to ring-fence mental health funding. In reality, we know that health boards spend more than the mental health ring fence, and since 2016-17, the increase in the ring fence has been 12.5 per cent. In the next financial year, the ring fence will be set at £679 million—a real and meaningful and sustained increase in funding. And that includes an additional £14.3 million of targeted investment to improve key priority areas, including child and adolescent mental health services, perinatal, psychological therapies, crisis and out-of-hours. And on crisis and out-of-hours services, this is a top priority for NHS Wales in the year ahead. It builds upon our previous work in establishing CAMHS crisis teams and adult psychiatric liaison services working at weekends and out-of-hours.

Now, I do understand and want to recognise and reiterate the comments about a parity of esteem between physical and mental health, and to restate our Government's commitment to achieving that—an equitable level of care, whether that be physical or mental health.

So, I welcome the continued focus upon mental health. I look forward to Members engaging in the next stage of 'Together for Mental Health' and the consultation it will have. We are committed to delivering real and sustainable improvements in services, experience and outcome. And we'll do so as rapidly as possible, in maintaining the quality of care that each of us would expect.

I call on David Melding to reply to the debate.

Diolch yn fawr, Llywydd. Can I say that Darren Millar started this debate by saying that mental health debates are amongst the best debates we have in the Assembly? And the Minister generously acknowledged the constructive tone of this debate, and I think we would all agree that it's been very meaningful and apposite. Darren also went on to talk about the personal stories that several AMs over the years have given in terms of their own mental health issues—myself included—and I think this is very important in terms of public figures, and particularly celebrities, when they do speak out. It does allow this whole issue to be demystified, and it's very, very important. Darren then went on to talk about the 'Time to Change' campaign, which, of course, has that type of objective at its heart. Then he talked about this debate being important because we often overlook the importance of community mental health teams and, in particular, he highlighted the need for 24-hour, seven-day crisis teams, which other Members, and also the Minister, referred to.

Helen Mary said that waiting times are a real problem, and I think it is appropriate that we focus on that. That data needs to be improved and we need to bring forward the deadline for the new scheme of data as soon as possible. And the Minister spent some time talking about that in this response. 

Mohammad Asghar talked about the variability and inconsistency across Wales, which is a real challenge, I think—that we need to drive up standards in general and ensure that people get a really first-class service wherever they are in Wales. 

David Rees talked about the need for a timely response to the HIW/CIW joint report, and he invited the Minister to say when the Government would respond. I'm afraid you'll have to be disappointed on this occasion, because you weren't quite told when that would be. Although, in fairness to the Minister, he did give some detail on the Government's approach. And then David talked about the place of family and carers in this, and often they don't even know how to contact the out-of-hours and crisis teams. That's a key failing.

Janet talked about the fact that all sorts of people present with mental health difficulties. We're all vulnerable. Most of us, subjected to certain factors, would probably suffer some form of mental distress or ill health. And that's really important. And then I thought she talked very appositely about the need for more mental health models in medical training, and I think all Members have been impressed with the points you made there. 

Andrew R.T. said it's a bit like groundhog day: 2007, Jonathan Morgan wins the ballot. I've always been slightly suspicious of the phrase 'you win a ballot', but, anyway, his name was drawn, and he chose a mental health Measure. And I had the honour to chair the legislative oversight committee that looked at that. And it was really an important milestone, I think, in our work. And Andrew also talked about the value in political consensus on this.

Can I commend in general the Minister's response? I think he did try to tackle the main questions that were brought up—not to our full satisfaction necessarily in every case, but I don't think anything was avoided. The thematic report recognises that progress is being made, but the Government will be replying to each of the recommendations and then will develop a delivery plan. I think that's important. The work on the data set is continuing and must be robust. Clearly, the deadline has to reflect that, but we do need it as soon as possible.

He also acknowledged the need for out-of-hours and crisis teams to be a top priority and then made, I thought, a very important point. I will end on this, and I thank you for your indulgence, Presiding Officer. As demand is increasing, in large part because we now talk more about mental health and we are seeking to get more people to come forward, we are improving in primary and, in this case, community care teams the sort of help they can get. So, the fact that we are seeing an increase in demand really does, to some great degree, reflect that we are improving, at least in terms of general perception of the importance of coming forward and seeking help. With that, I conclude the debate.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting until voting time.

Voting deferred until voting time.