Item 7 on the agenda is a debate on the Equality, Local Government and Communities Committee report 'Rough sleeping follow up: Mental health and substance misuse services.' I call on the Chair of the committee to move the motion—John Griffiths.

Motion NDM7267 John Griffiths

To propose that the National Assembly for Wales:

Notes the report of the Equality, Local Government and Communities Committee, 'Rough sleeping follow up—Mental health and substance misuse services', which was laid in the Table Office on 19 December 2019.

Motion moved.

Diolch, Dirprwy Lywydd. I'm pleased to open today's debate on the Equality, Local Government and Communities Committee report on the level of support for rough-sleepers with substance misuse and mental health issues, or co-occurring disorders as they are regularly referred to.

As a committee, we have been looking at rough-sleeping since the winter of 2017. Since we began this work, I think it's fair to say we've seen a real change in the sense of pace and urgency from Welsh Government in tackling these crucial matters. This is most evident in the establishment of the homelessness action group, and the Welsh Government's acceptance of the group's first set of recommendations. These looked at the very short-term actions that could be taken to alleviate levels of rough-sleeping over the winter. We look forward to the final set of recommendations from the group, and the Government’s response.

We are hopeful that some of the short-term actions, in particular around assertive outreach, will have started to help get some people off the streets. This is even more pressing when we consider the recent publication of the annual rough-sleeping count. As we stated in our original report, this count can only ever provide a snapshot, and cannot be seen as a definitive figure. However, it does provide us with some sense of the numbers sleeping rough. It is therefore worrying that the 2019 count showed a 17 per cent increase in the numbers compared to 2018.

Moving on to this particular piece of committee work, this is a case of the committee being very much led by the lived experience of those who slept rough. As part of our follow-up work on our original report, we spoke to rough-sleepers across all areas of Wales and those who provide them with support. Time and time again, we kept hearing about the barriers faced by those with co-occurring disorders. We heard that the right support is simply not there for people to get the help they need when they need it. We are incredibly grateful to all those who were willing and able to share their often difficult memories and experiences. 

There has been a worrying increase in the number of homeless people dying on the streets. Of these deaths, two in five are caused by drug poisoning. This is unacceptable, and provided further impetus to look in more detail at the issue.

I would like to thank the stakeholders who gave evidence to us. They were open and frank in their assessment of where the system was going wrong. They also had lots of ideas as to what could be done better. There were two things that they said to us that I would highlight. One was that this is an issue where the solutions are known, and that we just need to get on with implementing them. Secondly, we were told that being open and honest with us could have ramifications. This was not the first time that we had heard such concerns during our consideration of these issues. So, I would welcome the Minister today making a clear statement of support that organisations should be able to voice concerns about services or support without the risk of jeopardising their own funding.

As we highlight in our report, there are a lot of policies, strategic documents and action plans covering this area. This is to be expected when it cuts across so many different policy fields. However, it does mean that co-occurring disorders can fall between the gaps, as there is no one person or organisation to ensure that it is all brought together. But we are seeing positive change on this front, with actions in both the substance misuse delivery plan and the mental health delivery plan that seek to address some of the barriers to getting the right support to some of the most vulnerable people.

In the Welsh Government response, they state that the current deep dive project on co-occurring disorders will be looking at how issues can be unblocked to ensure full implementation of the service framework for co-occurring disorders. So, it would be useful if the Minister could outline what some of these particular issues are and whether they chime with the committee’s findings, in particular on commissioning, culture and leadership.

We have heard of pockets of good practice delivering life-changing support to people, but we are concerned that there is not the ability for this good practice to be replicated across Wales. We heard from the witnesses that often, the competitive nature of commissioning means that this does not happen. Organisations cannot then learn from others either what works well or what doesn't. I am therefore pleased that the Government has accepted recommendation 2. I would welcome some more detail today on the research and evaluation work being undertaken by Government to support dissemination of best practice.

Closely linked to the sharing of good practice is that of culture and leadership. Dr Sankey from the Community Care Collaborative told us about the silos she has tried to break down in bringing all the support services under one roof. But this has been challenging and difficult. Yet, Dr Sankey’s work and the Housing First models show us that services can work together to deliver integrated and cohesive support. And it is that sort of support that helps deliver the life-changing help that sticks, brings people off the streets and enables them to manage their substance misuse and mental health conditions.

The Welsh Government accepted in principle our recommendation 4, which called for them to take a lead role in bringing forward the necessary culture change. In their response, they emphasise the importance of local authorities stepping up to deliver this strategic leadership. We are slightly concerned that this could mean a continuation of fragmented delivery, with integration varying from one local authority to another. So, how will the Welsh Government endeavour to ensure that this does not happen?

We also note the emphasis that Welsh Government place on the housing support grant in their response, and we will continue to make our calls for the budget for this important funding to be increased in the 2020-21 budget.

Dirprwy Lywydd, in closing, we hope that we will start to see the necessary changes that mean that we see far fewer people on our streets, and those who are there get support in a quick and timely manner. I very much look forward to hearing the views of other Members and, of course, the Minister’s response. Diolch yn fawr.

Well, as our report states:

'An issue that kept being raised was the difficulty for rough sleepers to access integrated substance misuse and mental health services' and

'we have concerns on the level of integrated support for rough sleepers with co-occurring disorders.'

Although we noted that:

'There may be some small pockets of integrated services such as the work of the Community Care Collaborative in Wrexham', referred to by the Chair,

'these appear to be the exception and not the norm.' 

Briefing us on her research into priority need and rough-sleeping, Dr Helen Taylor from Cardiff Metropolitan University, told us that just making someone a priority would not address the issues that they were experiencing. She said that it won't solve the problems—giving them somewhere to live and giving them help; they have to want to do it. You have to give them that chance. Dr Taylor also told us that many spoke of their experience in schools, which did not know how to deal with their conditions and behaviours.

In accepting our first recommendation, the Welsh Government stated that it has

'established a Welsh Government Co-occurring Substance Misuse/Mental Health Deep Dive to consider progress in the development of co-occurring mental health and substance misuse and the challenges that remain.'

Perhaps it could tell us in plain language what that means, how and when this will report, when things will be done differently, and how performance will be monitored. 

The Welsh Government only accepts in principle our recommendation 4 calling on it to take

'a lead role in working with organisations across sectors to drive forward the necessary cultural change', and dodges our statement that it should

'update the Committee on the actions it has taken and timescales for future actions to deliver this recommendation at six, nine and twelve months.'

And we thought long and hard about that, and that was an important recommendation for us. It instead states that:

'Implementing the Housing Support Grant will be the key mechanism through which we will achieve this objective.'

Despite this, as we've heard, the Welsh Government played fast and loose with this grant in its draft budget by giving it a cash-flat settlement—a cut in real terms—with Cymorth Cymru, Community Housing Cymru and Welsh Women's Aid warning that services preventing homelessness and supporting independent living have now reached tipping point. As a supported-living service provider in north Wales told me, and I'll say it again, the consequences will be increased pressures on the NHS, A&E and blue-light services, adding that this, combined with the Welsh Government's planned redistribution of housing support grant, will be 'devastating to north Wales'.

The Welsh Government accepts our recommendation 7, and says that it is currently undertaking further work to understand the barriers faced by rough-sleepers with co-occurring disorders and neurodiverse conditions, and that this,

'will form part of developing future services which better meet the needs of vulnerable individuals.'

Several witnesses with experience of rough-sleeping referred to their own Asperger’s or autism or that of loved ones. What has the Welsh Government been doing all these years, despite being told repeatedly that, too often, autistic people are being treated as the problem by public sector officials at senior levels, who have failed to establish and meet their communication and sensory processing needs?

In accepting our recommendation 9, the Welsh Government states that it remains committed to ensuring that residential rehabilitation and in-patient detoxification services are available and that it allocates £1 million ring-fenced annual funding to area planning boards for the provision of these tier 4 services and that it is currently tendering for a contract for an all-Wales substance misuse residential rehabilitation framework, which will provide a list of approved residential rehabilitation and detoxification service providers. What they don't say is that it’s still unclear whether the £1 million is ring-fenced; that their previous framework, which resulted in referrals to non-framework units outside Wales, has expired; that, following damning reports, a previous Welsh Government stated that it was taking forward work on three units in Wales, but two of these have since closed; or that the latest ONS figures show that Wales saw an 84 per cent increase in drug-related deaths over the previous decade and that, across England and Wales, Wales comes second only to the north-east of England for the highest mortality rate for drug-related deaths.

As the Wallich's chief executive told us,

'we definitely need to improve access to tier 4, but, at the moment, my services can't get people through the assessment.'

As the chief executive of Kaleidoscope told us, tier 4 is chronically underfunded and there's very little funding for anyone with a drugs issue to get into a tier 4 service.

I wasn't a member of the committee during the course of this inquiry, but having read the report subsequently, I'd like to thank my new colleagues for this comprehensive and detailed piece of work. So I'd like to start off by thanking the committee for doing a sterling job and to say that I look forward to playing an active role in future inquiries. 

I'd also like to thank all the organisations and individuals who gave evidence during this inquiry. I know that dedicated staff pour their life and souls into trying to help people who have very complex needs; it can be a very difficult job, and I'd like to pay tribute to all those workers and volunteers for their efforts. 

The scale of the challenge facing vulnerable people who are at risk of homelessness or who are already homeless is truly daunting. Homelessness is increasing year on year. Wales faces a rough-sleeping emergency, according to the the homelessness action group. The ONS estimates that 34 people died in Wales in 2018 as a result of homelessness. Let's just pause a moment on that point: 34 people died because of homelessness in Wales, our civilised society, in 2018. Who can disagree with the committee's assertion that these are shocking statistics and, in one of the richest economies of the world, unacceptable? Let's remember that homelessness is not inevitable, it's a political choice, given that governments have the power to prevent it. So what's going wrong in Wales, given that there are no fewer than six separate Welsh Government programmes to try to reduce this problem?

Let me quote from the report: rough-sleepers have difficulty accessing substance misuse and mental health services and 

'there are currently very limited, if any integrated services for rough sleepers with co-occurring disorders.'

The report goes on to highlight specific systemic problems and offers solutions. 

Its first recommendation is that the Welsh Government provides a report on the implementation of the rough-sleeping action plan so that faults within provision can be rectified. The Welsh Government's response: this isn't necessary. 

We learn that there is a lack of sharing of good practice where we have pockets of success—the Community Care Collaborative in Wrexham and Housing First programmes in Gwent are given as examples of excellent practice that should be replicated elsewhere. 

The Welsh Government does accept the committee's recommendation to improve shared practice and remove the barriers that exist within commissioning systems that can act as a disincentive for people to be able to be honest about initiatives that haven't worked. Yet, what are they actually going to change? Nothing. There's a general consensus that establishing consumption rooms has the potential to protect vulnerable people from dangerous situations. The north Wales police and crime commissioner, Arfon Jones, has been campaigning to be allowed a consumption room pilot scheme in order to see whether positive results that have been seen in other countries can be replicated in Wales. Here is an example of an elected representative seeking to improve people's lives proactively, but he was denied the right by the UK Government that is ideologically opposed to this.

The committee report urges the Welsh Government to look at clarifying whether the devolution settlement enables safe injecting rooms to be set up in Wales, and if it isn't, to demand the power be devolved. Their response was 'no'.

The other recurring theme is a lack of time and resource for staff to be able to adequately deal with the issues they face every day, so let's see an increase in the housing support grant, as has already been said. I have no doubt that the Minister has a real desire to solve these problems, and that she would love to be able to tell this Senedd in a year's time that real progress has been made, but I'm afraid I am sceptical whether she'll be able to do so. As one witness told the inquiry:

'I really hope we're not sat here again in three years having the same conversation, because I suspect we will be.'

So, I would urge her to treat this report with utmost seriousness—I'm sure she does—and to think again about using the considerable levers of Government power that the Government has in order to drive through change with passion and vigour, rather than keeping faith with what witnesses to the committee described as a broken system. Minister, you have the power to effect change, please use it.

Can I begin my contribution by thanking members of the committee, and our new member as well, for their contributions today, but also John and his chairing for taking us back to look at this issue, which predecessors on this committee, under his stewardship, have looked at—both this and also wider issues related to it as well? I think it was well worth doing, because it's probably one of the most rewarding experiences that I've had as a committee member in my time to actually be sitting down with people with lived experience of rough-sleeping, of homelessness, and them talking us through it. It was very difficult, very challenging—both for them but also for us to hear what they are telling us, frankly, where they've been through the mill time and time again. It's like a game of snakes and ladders, but where the snakes are immeasurably longer and the fall much deeper than the ladders—the slow step up, bit by bit.

We did hear of good practice, but in pockets, and this difficulty of not only leadership locally on the ground within individual organisations, within individual areas, but also how to disseminate that wider, because one of the themes that was consistently said to us is that, actually, we can see what works. When you have all of the services properly co-ordinated, when, as was said to us, there should be a no-wrong-door approach—when you present with an issue of rough-sleeping or homelessness, the services there should pick you up and then wrap around you, one way or the other.

Of course, one of the examples of this that we heard that there was good success, in Wrexham and in other places, was, of course, the Housing First approach there, but it's not, we were told as well, by many people, including those representing organisations involved directly in providing the Housing First approach, the magic bullet. It's a very good approach, and credit to those who are taking it forward and the Welsh Government for supporting it, but it's not a one-size-fits-all model on it.

But it's worth reflecting not just on some of the challenges but the way forward, because we were told by people—by witnesses in front of us—that we have the right framework in Wales that should be able to fix this, so that we can get to the point where the best practice we see is as normal. We were told this by people who came in front of us, and the frustration over, as Delyth has just said, people saying to us, 'We don't want to be back here in three years' time under John or somebody else's stewardship saying, "Let's have a look at this again" and point out the same things, and how we're still failing on culture, on leadership, on sharing best practice and on that no-wrong-door approach there.'

So, let me just pick up on a couple of things here that came directly out of the report that Ministers have looked at. We were told by many witnesses that one problem was the commissioning process. We were told, and it's there in the report, as one witness told us—. So, if you've got a sector driven by competition, and we did pick that up a lot—even though many organisations out there were trying to do the right thing, many of them also felt a little bit guarded, because they felt they were also in competition with other organisations that are overlapping but not quite with the same objectives, which is quite interesting.

So, if you've got a sector driven by competition, we were told, it means, first of all, nobody can be vulnerable, nobody can say, 'These are the lessons we've learnt, look at what a cock-up we made over here, we need to change it.' Nobody can be vulnerable, everybody has to be brilliant all of the time, especially so Ministers can see they're being brilliant to keep their contracts, to keep doing their work. Well, if you can't have a system that's vulnerable, you don't have learning cultures that are swift and agile and can flex, unless you completely step outside the system and are prepared to do something else. In fact, we did speak to some people who had stepped outside of the system entirely, and had chosen, then, to do things outside of the system without support. And to commend them, they were achieving amazing things but they couldn't fit it into the boxes that they were told to do it within.

And we also heard about this big dilemma where people were choosing not to access services sometimes because they felt it was better for them to be on the streets. That was quite remarkable. Members of the public out there, my constituents would say, 'Surely that cannot be right', but we heard about this. We heard from one witness, 'The real thing that's stopping people coming in is that the offer we have in services is less than what the streets offer.' If you're in the throes of addiction, you've got all these complex mental health issues and other things—you can turn that pain off with spice or heroin quite easily. We can't offer that. You can be nobody in a flat or you can be somebody on the streets. There are cultural implications as well for people who've been out there for a long time.

This is getting beyond the tabloid headlines with this stuff—the complexity of this. I was immensely proud to be part of this. I think the homelessness action group will pick up on some of the acceptance in principle positions of the Minister, and bring forward, I think, some of the solutions, because this is still a work-in-progress. Lots of good work is going on, Minister, but getting a grip on this I think will be day after day, week after week, month after month, until we don't have to come back in three years and say, 'Look at what we're pointing to again.'

I would like to thank all those who took part in our inquiry and our excellent committee clerks for facilitating this follow-up inquiry into rough-sleeping, notwithstanding the passion for this subject shown by our Chair, John Griffiths, who has taken us to meet people with lived experience, which is very humbling.

We all know that we have a homelessness crisis and that the official figures greatly underestimate the number of people forced to sleep rough. We should feel ashamed that even one person is forced to sleep rough on our streets. It is morally reprehensible in the twenty-first century. Of course, the reasons for homelessness are varied and complicated, and are often far more complex than we can imagine. Not having a roof over your head and our follow-up focused upon rough-sleepers with co-occurring mental health and substance misuse issues. We must ensure that homeless people are treated when they go to seek help with the respect and the understanding that they deserve, so that they don't feel that it's an us and them approach. So, culture towards homeless people when they go to services seeking help must change.

It’s a shocking statistic that two thirds of deaths among the homeless are as a result of drug poisoning. When we look at the time an outreach worker has to talk to a person to build up a rapport and gain their trust, it equates to 2.5 minutes, and this is by far inadequate. This is why I was surprised that the Welsh Government did not unreservedly accept all of our recommendations, particularly recommendation 3. And while I am grateful that the Minister has accepted the principle of the recommendation, Welsh Government must do more to work with the UK Government to mitigate the harms from substance misuse.

I'm also disappointed that the Welsh Government is prepared to step back and hand the reins over to local government when it comes to driving cultural change. Our fourth recommendation was made because evidence was given to the committee that the main barrier to delivering truly integrated services was a lack of leadership and a silo approach. Although the Minister has said that she accepts the principle of our recommendation that Welsh Government takes a lead role in driving cultural change, in the same breath they indicate that Welsh local authorities are to step into that space occupied by Welsh Government direction in the past. This is not leadership, it's abdication. The last thing we need is 22 different approaches to integrated services. Part of the reason we have such a rough-sleeping crisis is because of different organisations taking different approaches. Co-occurring mental health and substance misuse get overlooked in the scramble to tackle the housing need. Public Health Wales told the committee that barriers exist within the health departments also. It is therefore vital that Welsh Government provide the leadership, direction and the funding in order tackle the complex issues surrounding rough-sleeping.

Unless there is clear direction from the top, we are not going to get anywhere and the successor to our committee will be discussing this issue once more in a few years' time. Welsh Government are very good at coming up with plans, but it's the delivery that counts. I really hope that this time is different because some of the most vulnerable people in our society are really depending upon us. Thank you.

I'm very pleased to take part in this debate and I commend the work of the committee under John’s leadership. To me, reading this, and I have to say, Caroline’s just sat down and warned us that if we don't act, in 20 years’ time we'll be going around the same racecourse, well, I kind of feel that 20 years ago we were discussing a lot of these issues, perhaps not focused on homelessness and rough-sleeping particularly, but the whole issue, really, of what this report goes to, and that’s a plea for leadership and more integrated, imaginative services, particularly for the most vulnerable in society. So, I do hope that we can move forward very, very quickly.

As you see in the report, presently, key stakeholders feel that there are barriers against achieving integration, and when you're tackling rough-sleeping, one thing you do need is a very integrated approach because of the complexity of the issue. One witness even went so far as to claim that innovation was not welcomed in many of the public services in Wales, and I do find that disturbing. Another witness from Public Health Wales told the committee that, and I now quote:

'there's a different culture within substance misuse and within formal mental health services…there is a paucity…of joined-up leadership at the very senior level'.

That is exactly what we must see an end of and we must move to opening up our services to the ideas that will lead to the very highest outcomes. I think at the heart of these frustrations is what is sometimes a rather weak commissioning process, and poor practices, lack of training, and I particularly welcome the committee’s call for an urgent review of commissioning by the Welsh Government. I do think that that has much merit.

I suppose one way to progress at the moment is to ask ourselves, 'What would effective commissioning for services to tackle rough-sleeping look like?' Well, as I hinted earlier, it would look like effective commissioning in some other areas, but perhaps it’s not as common as we expect; pooled budgets between various services; long-term commissioning so that we know that there is that service we need with the security that it’s going to be there for the long term and that people can then be referred into; integrated services; and the encouragement of innovation. These things need to be at the heart of an effective commissioning process.

This is, of course, challenging. It’s easier to do this piecemeal and just look after your particular patch, but to tackle homelessness, a wide-ranging approach is absolutely vital. It does require courage and bold approaches, for instance—and I welcome the report meeting some of these subjects, which are very sensitive, and meeting them head on and talking about them—co-ordinated detox services, covering alcohol and drug misuse, and connected to mental health services; considering safe rooms for the use of drugs; assertive outreach, and that means, you know, when our outreach workers are there making contact with rough-sleepers that there is a real grip and sense of purpose about where they need to move these vulnerable people on into a more structured lifestyle and how to get that going. 

Housing First models: again, this concept that you need to be in a home first before you can have greater stability, and that we basically will not evict highly vulnerable people ever. We may move them on or put more support in, but we won't evict. Integrated homelessness action plans: we talked a bit about this in yesterday's statement on the housing support grant, and I welcome this. I think this is the Welsh Government recognising what needs to be co-ordinated at the local and regional level, but we've really got to see implementation, and see it very, very quickly. Then suitable housing options into which these most vulnerable people can be referred, and there'll be a range of models that are necessary there, some of them perhaps catering to very specific needs, such as former veterans or people who have more recently left the armed services and found it very difficult to connect back into civil life. 

So, I'm pleased that we're discussing this this afternoon. I think it's a really good piece of work, and I do hope the Welsh Government will be taking it forward and responding to the excellent recommendations with real force and commitment. Thank you, Deputy Presiding Officer. 

Thank you. Can I now call the Minister for Housing and Local Government, Julie James?

Thank you, Deputy Presiding Officer. Firstly, I'd like to thank the committee for all of the very hard work and for giving me the opportunity to respond to this important debate in the Chamber today. I'd also like to place on record my thanks, and those of the Minister for Health and Social Services, to all of those who contributed to the work of the committee, but very particularly those with lived experience who took the time to engage with the committee and those who support rough-sleepers on a daily basis for sharing their views and their experiences with the committee. It's been so very valuable, I think, in coming to the very important recommendations the committee has made.

As we've discussed on numerous occasions, both in this Chamber and in committee sessions, rough-sleeping continues to be an endemic issue across Wales. Members are, of course, aware that the national rough-sleeper count for 2019 was published last week and that many local authorities reported an increase across a two-week period as well as an increase on the night of the count. As I set out in my written statement last week, this is extremely disappointing but is not, unfortunately, surprising.

Whilst the data reported can only provide a very broad indication, we can see for ourselves on far too many streets in both rural and urban areas across Wales that rough-sleeping remains a persistent and growing issue. I set out to this Chamber in October last year my acknowledgement of the need to look afresh at how to achieve the goal of ending homelessness in all its forms, including ending any need at all for anyone to sleep on the streets. This is precisely why we published a new strategy for preventing and ending homelessness last year and established the expert homelessness action group to work at pace to advise on how best to achieve this goal. It is precisely why we have protected homelessness budgets, including the vital £126 million that goes into the housing support grant. Deputy Presiding Officer, only yesterday in the Chamber, I introduced the new guidance on the housing support grant, which addresses many of the commissioning priorities that Members have set out today about the way that services are commissioned, and I really very much hope will address some of the concerns that people have expressed in the Chamber today. 

I will just say one thing, though, on long-term commissioning: I completely agree with that—I think David and Mark Isherwood mentioned it—but they could do us a big favour in assisting us with the UK Government giving us more than a one-year budget, because obviously it's very hard for us to do commissioning over longer than one year when our own budget is on an annual basis. So, I do think some cross-party work in persuading the UK Government to help us with that would be very much appreciated, as we absolutely accept that longer term commissioning would be beneficial in this and many other sectors. 

The work of the committee in examining rough-sleeping and the complex relationship between substance misuse, mental health and housing need provides a useful evidence base to take this work forward. Rough-sleeping, as we all know, is the most acute form of homelessness, and, as well as supporting those at this crisis end off the streets and into suitable accommodation, we also recognise the importance of investing in early intervention and prevention to tackle the root causes of homelessness. This includes continuing to invest and improve health services. For example, we know that improving the mental health and well-being of young people has a direct impact on the numbers of young people falling into homelessness. It is worth noting that Welsh Government continues to spend more on mental health services than any other part of the NHS. Our recent announcement in the draft budget to commit a further £20 million to mental health services, raising the mental health ring fence to £712 million, demonstrates our continued commitment to improving these services. 

In response to those talking about the substance misuse tier 4 issues and other issues—just to point out that we are currently tendering for a contract on an all-Wales substance misuse residential rehabilitation framework, which will provide a new list of approved residential rehabilitation and detoxification service providers. In addition, we wrote to all directors of social services to remind them of their responsibilities for social care assessments and funding for that residential rehabilitation ahead of the introduction of the new framework, and to ensure that sufficient funding is provided not only from commissioned substance misuse services but from wider sources across the public service. 

The links between substance misuse, mental health and issues with accommodation are widely recognised, with both acknowledged as possible cause and consequence of the other. Our response has to be centred on the needs of the individual, and I fully agree with the committee on the need for an integrated service and multi-agency approach to most effectively supporting people. We have been working across Government for some time to jointly take forward this work. Both the published substance misuse delivery plan 2019-22 and the mental health delivery plan 2019-22 have specific actions to address many of the recommendations made by the committee regarding rough-sleeping and access to mental health and substance misuse services. Close working is under way across departments to ensure the actions within these plans support the strategy for preventing and ending homelessness. 

Co-occurring substance misuse and mental health is a priority in both of the delivery plans, and we have, I think, as Mark Isherwood mentioned, established the deep-dive group to examine the barriers to responding more effectively to co-occurring mental health and substance misuse issues, as I am acutely aware that many challenges remain. The group is made up of a range of experts, including policy experts, commissioners and practitioners, including both health and housing, to support that work. I'm very happy to report back to the committee once we've got that piece of work from that group. 

And, in addition, work is being taken forward as part of the partnership agreement for prison health, which includes a specific focus on substance misuse and mental health, and improving transfer of care on release. The partnership agreement is being supported by Welsh Government investing an additional £1 million into primary health services in the prisons. As referenced in both the mental health and substance misuse delivery plans, Welsh Government has also invested £1.3 million in new services for people with housing and complex needs, with a focus on supporting Housing First. This funding is specifically aimed at developing integrated services, working with the hardest to reach and improving access to support for both mental health and substance misuse support and treatment. 

The committee rightly highlighted the potential Housing First has, not just in relation to helping people into accommodation, but also in providing the stability that can make it far easier for someone to tackle their other issues, like substance misuse or mental ill health. I have previously set out that Housing First needs to be part of a wider rapid rehousing approach, as it is intended for those with the most complex needs—precisely the individuals this committee report most focuses on. It has worked around the world and it is working here in Wales. The first two people who entered the Salvation Army project in Cardiff are still in accommodation two years after joining the project in late 2017. Both individuals had a history of rough-sleeping over a number of years prior to their entry into that project. 

All our evidence shows that Housing First takes time. Support workers need time to develop a relationship with people who have often felt let down by the system and have disengaged from society, to earn enough trust with them to agree to even join the project. They need time to ensure that the correct decisions are made, such as the type of tenure, type and location of property, to work with housing associations and private landlords to find that property. And, crucially, time needs to be invested by the support worker after someone has entered accommodation to help them face life's challenges and ensure they receive the support they need to thrive in any accommodation.

The projects we are invested in are succeeding and we recognise health services are an absolutely integral element in ensuring they succeed. As at the end of December, 40 people were sustaining accommodation in one of the seven Housing First projects that we fund directly. Another 21 were in temporary accommodation awaiting a match to a suitable property, and that is 61 people, all of whom had a history of rough-sleeping and either mental health or substance misuse—or, more often, co-occurring issues—that would likely otherwise be sleeping rough tonight. 

As a Government, Deputy Presiding Officer, we will continue to take forward the complete public service response required to achieve the goal of ending homelessness and to recognise the key roles of health and housing in leading this important work. Diolch. 

Thank you. Can I now call on John Griffiths to reply to the debate? 

Diolch yn fawr, Dirprwy Lywydd. May I start by thanking everybody who took part? There is obviously a strong degree of consensus across the Chamber, I think, in terms of the importance of these issues and the need to try and make sufficient progress so that, in years to come, as a number of Members said, we're not having more or less the same debate in the same circumstances. We need to move on and to make substantial progress.

I very much agree with the point that Delyth Jewell made as well—if the UK is the fifth, sixth, whatever biggest economy in the world then it's totally immoral not to have a much better way of organising ourselves as a society in order to avoid these incredibly stark problems that so many people in the public are very shocked by. The number of people that have said to me that they just cannot understand why it's not possible to organise services and organise society in a way that avoids the extent of rough-sleeping that we currently see in our towns and cities—and, as the Minister pointed out, obviously, there are also issues in rural areas; it's not just an urban problem, although that's where the preponderance of the problem lies. So, we really need to find better ways forward.

I think what Mark Isherwood said about people needing to be given the chance to want to make the necessary change is really important, and that's why assertive outreach is very significant, because that word 'stickability' I think is very important. Services and those providing the services need to stick with those sleeping rough so that they are there when that opportunity comes along; when that person is ready to make the necessary change, there is somebody there to guide them and to make sure that they do take the opportunities available at that time. Obviously, if people aren't there with them around that time, then that window of opportunity may be lost, and the people may never make that change. As we heard earlier, it's absolutely shocking to think that 34 people died sleeping rough on the streets in Wales in 2018. Every life saved obviously is absolutely priceless, so we really do need to make assertive outreach an ever more important part of the service that we provide.

It is very wide-ranging and complex in terms of the issues involved, as Members stated. Mark Isherwood was talking about schools recognising issues and problems as young people go through the system. There are many conditions, such as Asperger's and autism, that are related. Young people with mental health issues need to have those problems recognised and addressed at the earliest possible opportunity.

I think much of what the Minister said was about that preventative approach that we need to make more of a feature in our services. So many Members on the committee spoke about the power of lived experience and actually hearing first hand from people sleeping rough, as well as those providing the services to them, what their experiences are and what they think will make the difference. As Huw Irranca-Davies said, there cannot be a wrong door. Wherever people sleeping rough may make contact with services, they have to be connected with whatever services they need to address their issues. They cannot simply be referred on to another agency, another person.

I think the drugs issues are significant, and the non-devolved aspects. I would urge Welsh Government to work very closely with the UK to bottom out, really, to what extent we could have safe rooms for injecting for drug use, whether that's possible within the devolved powers that we have, or whether we do need further devolution, further understanding, to make that happen. I do think it's quite instructive that the police forces in Wales are very interested in making that change and they see real advantages were that to come about.

I think David Melding—and it's always good to have people who are not on the committee at the moment making contributions on committee reports—made some very interesting points around commissioning. To what extent is it possible to be innovative, to truly integrate services, to have pooled budgets, to move on to a long-term approach within the current commissioning arrangements? It does seem to be weak at the moment, and, yes, we do need an urgent review. I heard what the Minister said about Housing First and the important progress made there, and also the housing support grant and how that might drive some aspects of necessary change, but I really do think we need to have a full review of all of those matters.

The Minister also mentioned prison services, and that's a significant part of building partnerships and making sure that no aspect of service delivery, devolved or non-devolved, is neglected in any way. The action group is a very significant development, as I mentioned in my opening speech, and we're very pleased as a committee about that. We'd be very interested to see how the Minister responds to the recommendation and takes the suggested work forward.

So, I think this is such an important set of issues, Dirprwy Lywydd, it's exactly why our committee has not just devoted quite an amount of time and work to these matters, but has returned to them. I think our commitment to the sector and to those sleeping rough is that, as a committee, we are not going to walk away from these matters; we are going to show that stickability that we urge on others. We will return to these matters, and we will continue to hold Welsh Government to account.

Thank you. The proposal is to note the committee's report. Does any Member object? No. Therefore, the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.