The next item, therefore, is the statement by the Minister for Health and Social Services, an update on the dimension action plan. And I call on the Minister to make the statement—Vaughan Gething.

Diolch, Llywydd. Next week is Dementia Awareness Week. In February last year, I launched the dementia action plan for Wales. The plan sets out our vision for Wales to be a dementia-friendly nation that recognises the rights of people with dementia to feel valued and to live as independently as possible in their communities. The plan drew heavily upon the experience of people living with dementia and those caring for people with a dementia diagnosis. I'm determined that the lived experience of people living with dementia will continue to guide the delivery of our plan as we take it forward with key stakeholders in health, local government and the third sector.

At the outset, I recognise the pressure on front-line services and the need to make the ambition set out in the action plan a reality. That’s why I announced £10 million a year from the last financial year to support the delivery of the key actions in our plan. I’m clear that the investment of additional resources must lead to a step change in dementia services. That must mean that people most affected feel that improvement as part of their everyday lives. I’m also clear that, in line with our commitment in the Well-being of Future Generations Act 2015, the additional resources will be focused upon prevention.

To ensure the improvements are driven locally and in a joined-up way, £9 million of the additional funding was distributed to regional partnership boards through the integrated care fund. As a result of this funding and our integrated approach, we're now seeing positive and tangible change. For example, there is now additional support available for GP-led clinics to increase diagnosis rates, which, as Members will know, was a key priority and concern within the plan. We’ve also seen an increase in the number of dedicated support workers who play a key role in ensuring person-centred care is delivered.

Since publication of the plan, the number of dementia friends and dementia-friendly communities has also increased. We now have an extra 19 dementia-friendly communities, making up 72 dementia-friendly communities here in Wales, and an additional 38,000 dementia friends trained over the last year as part of the Alzheimer’s Society initiative. And the Welsh Government, of course, continues to provide funding to help support that Dementia Friends initiative. That plays a key role in tackling stigma, improving support in the community and raising awareness and our understanding of dementia.

During the last year, we've seen our first acute hospital in Wales receive dementia-friendly status from the Alzheimer’s Society. Ysbyty Gwynedd is only the second hospital in the UK to receive this status. It recognises the positive action taken by our staff to respond to the needs of the local community.

Another key action in the plan was to develop teams around the individual who provide integrated, person-centred care and support. The plan makes it clear that a one-size-fits-all will not work, and areas need to consider what change is necessary to be able to create services that adapt to what is required as a person’s needs change. Each area is now demonstrating how this is becoming a reality, for instance, through the development of multi-disciplinary teams, with an emphasis on the involvement of allied health professionals to provide a re-ablement approach. Crucially, these teams are able to provide more integrated care through activity that is driven by both the statutory and the voluntary sectors. 

Joyce Watson took the Chair.

As part of this work we are seeing examples of flexible and enabling respite support, such as flexible outreach, and offering respite options beyond the traditional respite admission to a care home. At the same time, we see an increase in support for those who are in care homes or a hospital setting so that people affected by dementia receive personalised care and support no matter where they are. We have examples of work ongoing in care homes, which further strengthen that person-centred approach, and projects that support planned discharge from hospitals. 

In addition to the funding routed through the integrated care fund, Welsh Government support has been provided to the Welsh ambulance services trust. This includes establishment of a dementia team, training and awareness for champions, and the delivery of training for emergency service call takers. WAST has also been involved in establishing an all-Wales blue-light dementia working group, which will work together to share best practice. The aim is to ensure that all of WAST's staff who come into contact with people affected by dementia are trained to understand their needs and how to provide support. 

One of the ways in which the plan has helped move the dementia debate forward has been the recognition of the diverse needs of particular groups, for instance people with protected characteristics who may be living with dementia and people who may be able to understand only their first language as their condition progresses. The Welsh Language Commissioner and Alzheimer’s Society Cymru's recent report into Welsh language and dementia has made a number of recommendations and established a task and finish group to oversee these improvements. Welsh Government officials will sit on that group so we can consider any further work that is needed in this area. 

Public Health Wales’s 1000 Lives programme is also working with memory assessment services to agree standards and principles that each service will work towards as part of the dementia pathway. That includes pre-diagnosis, assessment period and post diagnosis support and intervention.

Driving the range of improvements we want to see as a result of the dementia action plan and associated additional investment is key. To that end, we've established a dementia oversight of implementation and impact group, which informs, oversees and monitors progress against the action laid out in the plan. I really am grateful to all members of this group, which includes service users and carers, people with the lived experience of living with and working with dementia, for their ongoing commitment and challenge. 

Having the right type of workforce is, of course, crucial in this area and we've established a learning and development sub-group, led by Social Care Wales, to establish an enabling workforce approach to dementia care here in Wales. This approach to learning and development will be centred on the principles of the 'Good Work' framework that I had the pleasure of launching in Ysbyty Ystrad Fawr. It puts individuals at the heart of learning and development and focuses upon compassionate practice. All of this is designed to improve care for people living with dementia, their families and their carers.

The dementia action plan signalled that we would create an all-Wales dementia allied health practitioner consultant post to help drive further improvement and to ensure that support and advice is available to health boards and local authorities on their improvement journeys. We've now completed all of the necessary preparatory work, and I'm pleased to confirm that we'll shortly begin the recruitment process for the post, and I expect the successful applicant to be in post by the end of this summer.

Finally, I’m pleased that the Welsh Government has committed to become a dementia-friendly organisation. Over 200 of our staff are already receiving training. It is important that Government helps to lead by example, in recognising our role as a major employer and the positive impact that can have on supporting colleagues, friends and our local communities who are living with dementia.

Given the strong partnership arrangements that we have in Wales I believe we're well placed to continue to create a society that positively supports those faced with a diagnosis of dementia. An ageing society means that the challenges in this area will increase but the first year of the dementia action plan has put in place many of the things that we think that we will need to respond effectively to those recognised challenges. Only by working together can we realise the shared vision for Wales to truly become a dementia-friendly nation.

I'd like to call Janet Finch-Saunders.

Thank you. Thank you, Minister, for your statement. The dementia action plan, of course, promises to improve person-centred dementia services and is based on a number of principles in dementia statements, including the right to an early and accurate diagnosis. Diagnosis, of course, forms an important part of your plan, especially as you even recognise that only around 53 per cent of individuals in Wales with dementia have had a diagnosis. Indeed, it was found that almost 19,000 with dementia remained undiagnosed in 2017-18.

So, in terms of realistic achievements in this area, could you confirm that your commitment in the plan to set targets for health boards to increase diagnosis rates by at least 3 per cent a year has been carried out and is being dealt with? And, once diagnosed, it is essential that there is a flexible support system. As such, the Welsh Government committed to the development of the multidisciplinary teams around the individual.

So, if that's the case, and that has been achieved, could you confirm to the Chamber today that every individual living with dementia that has been highlighted and identified has in fact been provided with a fundamental care plan? Thank you.

Thank you for the questions. I set out in my statement and reiterated the importance of diagnosis. It was a particular issue of concern, both from the wider community living with dementia, as well as Assembly Members, in the run-up to the plan. The commitments in the plan remain, about our expectation to see year-on-year increases through the plan. We also have a mid-point review to understand how successful we've been. We'll next have figures available on the increases in diagnosis rates in September of this year. But, as I set out in my statement, we're taking a range of practical measures to try and assist that. In terms of flexible support, again, I set out in my statement a range of the steps that we are taking to provide that flexible support and actually the point about having teams around the individual to understand the needs of that person, what matters to that person, and how that may change over time as the condition progresses.

And, in terms of a guarantee that everything is in place now, I think it would be foolish for me to try and suggest that is in place. This is a continuing journey. And on that journey of improvement we should all recognise that not every single intervention will be delivered successfully. There will be more for us to learn about what we don't get right as well as what we have got right. So, I want to be realistic and honest with people about where we are. It's a journey of improvement. There's huge commitment from our staff across local authorities and the health service in particular, and the third sector. But key to all of that is a commitment of people living with dementia to help inform the work we're undertaking and to be honest partners in both challenging and supporting us on the improvement that we all recognise is required.

I'm pleased to respond to this statement from the Minister, which gave an update on the dementia action plan. May I say, first of all, that I have been vice president of the Alzheimer's Society for many years, and I have also been vice president of Forget Me Not dementia clubs recently in Swansea? I also have personal experience of dementia over the past two years, following the death of my father recently, after months of suffering with dementia.

So, in responding to this statement, I want to emphasise the change that's required in services in our communities, having set out my association with the Forget Me Not clubs and the Alzheimer's Society and a number of others who work voluntarily in our communities. And, of course, most of the care for people with dementia is also done on a voluntary basis by families, and their contribution is crucial in this regard. If it were all to fall on social care and the health service, then we couldn't cope with this appalling situation in any way whatsoever, so it's important that we recognise and pay tribute to the contribution and commitment of voluntary carers the length and breadth of Wales in this regard.

And, of course, as the Minister has already said, there is still stigma. People fear discussing dementia. They fear being in contact with people with dementia. That's part of the importance of having that training to become dementia friendly, as the Minister has already mentioned. It's the need for patience. When you are in the queue, paying for something, or waiting to pay for something, behind someone who has dementia, we need patience. We shouldn't be putting pressure on people and hastening them. We need patience and we need to give people time. Because, at the end of the day, much of this is about dealing with the prejudice against dementia and dementia care, because people don't see it as being a physical problem and they see it as a mental health issue. But, of course, dementia is a physical ailment because the brain shrinks. So, that is a physical illness, and dementia deserves equal treatment with other physical illnesses and conditions, and that's what doesn't happen at the moment. If it were dealt with in that way, then we would have the same respect for those suffering with dementia as those with cancer or heart disease.

So, there's a great deal of work to be done in terms of preventing that stigma in our society against those who have dementia, and I would like to hear what the Minister is doing in moving forward with his action plan in order to deal with those issues. Ultimately we are talking about care on the ground and the need for more specific services on the ground.

Social care: the Minister will know my ideas about having a national care service, because the quality of care now is often deficient, can be dangerous or not available at all, and everything then falls on the families. We need more respite care when families are under huge pressure. We need more respite care for them. So, does the Minister have plans specifically to increase the respite care available?

I do welcome what he said about people here in Wales who are first-language Welsh speakers. Of course, as dementia develops, then you lose the ability to speak your second language relatively early. So, we need provision, and we need services in the Welsh language in order to deal with people who are suffering dementia and who are first-language Welsh speakers. They lose their second language, and that happens in all countries where there is more than one language spoken. But, we need a strategy as a matter of urgency to tackle that, because it's our aging population who tend to get dementia. It's not always linked to old age, of course, but there is a substantial percentage of those people who are Welsh speakers, and that's the only language that they have when dementia takes hold, as my own father's experience proved.

So, at the end of the day, I welcome the statement and I welcome the work that's ongoing. But, at the end of the day, as you've mentioned, you need a step change and we need to transform the scale and the quality of the services available on the ground in order to tackle this issue and to provide fairness to our people who have dementia and their families. Thank you.

I thank the Member for his comments and questions. I will deal with a range of the specifics that you've provided. But on your last point about the Welsh language provision, in the statement, I've set out the work that has been done jointly, first with the Welsh Language Commissioner and the Alzheimer's Society, and that task and finish group will help to inform us more about what we need to do. And as there is Welsh Government participation in the task and finish group, we will learn through the course of that and not just when we get the final report. Obviously, we'll then expect to respond to that and to understand how we will reform services—not just a central directive from the Government, but, actually, how each of those regional partnership groups will need to think again about how they provide services. This is not a care preference, but a care need, and we do need to reflect that. 

On your broader points about recognising the contribution of the voluntary sector, the organisations themselves are involved in organising activities, support and services, as well as advocacy, championing and challenging us, again, to recognise the role of individual carers—often, members of families who go out of their way and give up lots of their life to care for loved ones. And without that, we wouldn't provide not just a service, but the sort of compassion and dignity that we want to see. Which leads into the point you make about the challenges of stigma. So, for all that we have a responsibility to do within the Government, within the health service, within local authorities, much of what we discuss is about our part to play as members of society and the country we live in, and that's why we aim to be a dementia-friendly nation. It's about how we behave with and towards other people, not just those that we know, but in particular, how we behave towards those people that we don't know, and that point about a greater level of tolerance and understanding that would not just make a difference here in the field of dementia, but more generally. I'm thinking of the way that we're prepared to treat other people, and expect to be treated ourselves.

That's why I'm particularly pleased to see such a large number of people, over just one year, who have got engaged and become dementia friends—38,000 extra people in one year, now 158,000 dementia friends across Wales. That's a really positive step forward. And I can say that from my own point of view, my constituency office and I, we are dementia friends—I am a dementia friend—having undertaken the training. Because I recognise it wasn't just about the job I do in this place, but actually, as a constituency Member, we already work with people living with dementia, and we will be contacted by people living with dementia now and in the future as well. It's a big part of our constituency already, and for other constituency and regional Members here too. And I know that Jayne Bryant and others are looking to encourage people so that this place could become the first dementia-friendly Parliament as well, if every Member has undertaken that training, together with their staff, and I'd encourage people to do so.

And on your broader points about how that helps, actually, we're seeing more and more people getting involved across the retail sector, for example, not just the support in terms of the charitable funds that people are providing, but actually, again, encouraging their staff to become dementia friends. And Boots is a good example; other community pharmacy and multiples are available. But in this particular one, it was the Wales part of that company that led the charge within that company, by having, in every single Boots outlet, dementia friends. There was a large programme of activity and engagement, and I was very proud to recognise that when they came here, and they're actually challenging the rest of the Boots group within the UK to do likewise. So, again, a movement that is gathering pace here in Wales, with that initiative, is going to make a difference here and beyond.

I just want to finish on your point about personal experience that many Members in this place will have. We recognise that a change is required. And not just because we can often talk about our own experiences, but the needs of our population are changing. It's not just about age—there is more than that—but actually our ageing profile means it will be a larger reality of the country that we are and will be in the future. And if we didn't recognise that a change was required to deliver the dignity and compassion that you talk about, then we wouldn't have a plan, we wouldn't have measures, and we wouldn't be taken so seriously as we are. The challenge will be to meet the ambition we've set in the plan, to make a real, practical difference.

Thank you for your statement, Minister. It's good to have an update today, and I welcome much of the positive report that there is in your statement, particularly about the increase in the number of dementia friends. I've got a few specific questions on the action plan. I was grateful for your replies to myself as Chair of the cross-party group on dementia around the transparency of funding for the plan, which is largely going out through the integrated care fund, and concerns about that have also been raised in the health committee. I was pleased to receive your answer and the assurances that you gave. But can I ask whether there are any plans for there to be any kind of independent evaluation of the impact of the plan, in recognition of some of the concerns that have continued to be expressed about transparency?

Linked to that, you've mentioned the work of the DOIIG, but I know that some third sector organisations are very keen to have a different leadership structure, one that involves somebody particularly championing this cause at Government level. Have you given any consideration to how this work is going to be driven forward by particular leaders within Welsh Government? You mentioned in your statement the input of those living with dementia, and that is a very positive feature of the work of Welsh Government in this area. And, in particular, I'd like to recognise the ongoing impact of DEEP in this area. But there was a phenomenal amount of involvement by those living with dementia in the formation of the plan. So, can I ask you for further detail? There was some 1,000 people who inputted into the action plan, so can I ask for some further detail on how you will continue to ensure that those living with dementia will be fully involved going forward?

And, just finally, I was pleased to see the reference to the Welsh Language Commissioner and Alzheimer's Society Cymru report in your statement. It is a really important report, and one that I was really pleased to attend the launch of. I don't think that we can overestimate the importance of the ability to communicate in your first language for someone with dementia, given the huge challenges of communication that exist. I'm pleased that Welsh Government are going to be involved in the group that the commissioner and the society have set up, but can you take this opportunity to restate your commitment politically to ensuring that the excellent recommendations in that report are driven forward?

Yes, I'm happy to give the commitment that you asked for at the end about making sure that we do continue to take forward the commitments that have been made, and in particular the point about first language provision, because as I said in answer to Dai Lloyd, this is not a preference, it's a care need, because actually you can't access the care that you need if you don't have the ability to communicate in what sometimes is the only language available to you. So, I'm more than happy to restate that commitment.

On your point about DEEP, they were definitely involved and a really important part of us getting to having a dementia action plan in the first place, and actually getting one signed off where there was an agreement that it was the right thing to do to move forward. We listened about making sure that there were people involved on the oversight, implementation and impact group. And it's important that we don't just say that means everything is sorted. People living with dementia are represented by a handful of people in one group. That comes back to the point about generally having teams around the individuals so that our services are genuinely responding to the needs of people and proactively seeking the views of those people as we develop and deliver services. That is central to our ambitions in the plan.

And that's partly why—and I'll come back to your first point now about evaluations, to understand is that really is happening. So, yes, I can confirm there will be independent evaluation, it will be commencing throughout this year and it will continue until the end of the plan. There will be an initial assessment of evidence and data availability to highlight any key gaps we may have and a final draft report on central elements will be delivered by the end of 2021, with a final evaluation report that is currently due to be provided in Spring 2022. So, we are definitely making sure that the independent evaluation understands the impact of the steps that we're taking. 

On your second point that you made about leadership within and outside the Government, I have an open mind about whether there should be an identified dementia champion or not. Because actually this is a big service challenge that is in more than one area. I recognise the argument about having a champion and I recognise how actually that may not deliver all we'd want to do. So, I have a genuine open mind. I don't think it would be fair to say that the allied health professionals consultant is effectively going to be the champion. They'll have a role, obviously, in championing the needs of the service and understanding and listening to people, but I do have an open mind about whether an identified champion or champions could help us to make more progress. That will come from listening to people and services on that oversight and impact group as to whether that would be the right thing to do to help drive forward this agenda. So, an open mind—certainly not closed to it—but I'm interested genuinely in what will make the biggest difference in the most rapid period of time. 

Thank you, Minister, for your statement here today. As the number of people living with dementia in Wales increases, it's so important that we get this provision right. I notice firstly in your statement the reference to the increased number of dementia friends and dementia friendly communities. My office, along with the offices of many other Assembly Members, have undergone that training and I think it's really important in terms of the support that we offer to our communities. What can be done to encourage other such community support services to engage with the training that the Alzheimer's Society offers?

For my other questions, I want to focus on some interesting things that I have seen out and about on constituency visits. Firstly, I recently met with the occupational therapy team at Ysbyty Cwm Cynon to discuss their work supporting people who have recently been diagnosed with dementia and how they enable them to regain their confidence and to live independently. I joined one of those OTs on a house visit in Penywaun, and had such really positive feedback from the person being helped about how the intervention had really changed his life. So, what can be done to ensure that other areas, both within Cwm Taf and further afield, learn from this kind of approach?

I also recently visited the award-winning virtual ward at St John's medical practice in Aberdare, which is a shining example of a multidisciplinary approach. And this kind of approach is so useful to supporting those living with dementia, as well as many other conditions. So, what can the Welsh Government do to help enable and incentivise such partnership working in GP clusters to assist those living with dementia to receive the very best multidisciplinary care?

And finally, I also visited Ysguborwen Care Home in Llwydcoed to see a fantastic project that was being delivered by the Wales Co-operative Centre, which allowed residents to utilise modern technology, such as iPads, screens and interactive tables, in order to engage with hobbies that they'd held all their lives or to look at old photographs that really re-jigged those deep parts of the memory and brought such happiness to them. What more can Welsh Government do to encourage care homes to utilise the very powerful benefits of modern technology in order to help those who live with dementia to maintain those pre-existing hobbies and interests that can add so much to their quality of life?

Thank you for the questions and comments. I think, turning to your point about GP clusters first, I think that, when we consider the action that's been taken through the regional partnership boards that we're looking to promote, lots of that activity is taking place within primary care. So, having more GP-led memory clinics and the focus on diagnosis needs to be accompanied by an improvement in the quality of care that is then provided, rather than simply improving the diagnosis rate and then not providing the service wrapped around that person and how they live their life. So there's an awful lot of focus on that. And this is standard business for our health service. It's not an additional add-on or a niche area of specialist activity. The numbers of people living with dementia will only increase in years to come, so better management of the condition and better identification is central to that, and without an active GP community, we're unlikely to realise a number of the ambitions within the plan.

I'm really pleased to hear that you and your office are dementia friends, and that's part of the awareness raising, the leadership and people recognising and saying out loud, 'I'm a dementia friend, I think you should be too.' And asking that question as we go about our business is part of doing so. But, to get from where we were, where we had 120,000 dementia friends in Wales, and then in the last year to get to 158,000 does show there is a developing and increasing level of awareness. And, as I said, I think that we all have an individual stake in needing to do that, and I think it'd be a really proud moment for Wales if we were able to be the first dementia-friendly parliament within the UK and beyond.

On your point about technology and activity, and lots of it is what I've seen within care homes and beyond, technology is being used really positively to help people exactly as you say, with hobbies and activities. There's lots of activity around music, but actually just on storing and reminding people of memories and the understanding of how we can make it easier for people to access those memories are things that actually continue to bring great joy to people's lives, not just the person themselves, but actually their family and friends around them as well. So, I'm interested not in just seeing the whole range of different activities but actually how we can try and understand which ones we think can help to make the biggest difference and, at the same time, how we can make sure that who that person is is reflected in those memories, rather than saying you're only allowed to have a photo book or to go and sing, because for lots of people like me—I love singing. Others may not like listening to it, but I love singing. And on a recent visit to west Wales, I looked again at how they had a range of singing activities for individuals that was making a big difference to people, but there are others who may not find that appealing at all, so we've got to think again about what matters to that person. 

And I want to end on your point about the occupational therapy team in Ysbyty Cwm Cynon. I, too, had the pleasure of visiting them to meet the team and some of the people who are living with dementia who came into Ysbyty Cwm Cynon for the afternoon to explain how their work had made a difference to them. And there's a point there about the earlier we understand someone's needs, the earlier we can intervene and support them to retain more of what matters and is important to them. There is learning to be taken from across Cwm Taf Morgannwg, a real example of good practice that others should learn from across the service. And I'm happy to say that they've built in evaluation and research into the work that they're doing. So they won't just be able to say, 'We think we're doing the right thing', they'll have an evidence base to talk to the rest of the health board and, indeed, the rest of the NHS and wider family on how to make a real difference for people living with dementia. 

Thank you.