The following amendments have been selected: amendments 1 and 2 in the name of Darren Millar.

Item 7 on the agenda is the Plaid Cymru debate on eating disorders, and I call on Bethan Sayed to move the motion—Bethan.

Motion NDM7288 Siân Gwenllian

To propose that the National Assembly for Wales:

1. Notes that Eating Disorders Awareness Week 2020 takes place from 2 March to 8 March and that the focus this year will be on the importance of empowering and supporting families and friends.

2. Believes that:

a) eating disorders are serious mental illnesses with high mortality rates;

b) recovery is possible;

c) families and friends can play a crucial role in supporting recovery.

3. Commends those that worked on and participated in the Eating Disorder Service Review 2018 launched by the Welsh Government and its ambition to build a world-class eating disorder service for Wales which is accessible to all who need it.

4. Believes that empowering and supporting families, friends and other carers will be essential to realising this ambition.

5. Regrets the extended period of time it took for Welsh Government to respond to the outcome of the 2018 Service Review.

6. Calls on the Welsh Government and health boards, local authorities and all other stakeholders to ensure full implementation of the Eating Disorder Service Review 2018 recommendations.

Motion moved.

Diolch. Well, it seems timely to have this debate today, because I started my career in 2007 with starting the cross-party group on eating disorders, and I finish this part of my career before going on maternity leave today with a debate on eating disorders and the eating disorders framework. So, it's an emotional day, and bear with me if I get out of breath or get emotional. 

We've had an event today with Beat Cymru to mark Eating Disorders Awareness Week, which is why I wanted to have this debate as well today, because I think that it's an important week that we should be marking every year to ensure that we can try to raise awareness of eating disorder services here in this National Assembly, and also to ensure that we put into place strong Government policies to ensure that we don't continually have to debate it, but that we have strong services in place to ensure that this most pervasive disease is targeted.

It's often driven by a lack of awareness. People say many, many times that it's a diet gone wrong. Enormous pressures that people face in society, from childhood trauma to abuse, to the images that we see on social media every day—we all know it, and we all know that it affects not only women but everybody in society. A general lack of self-esteem or an association with other mental health conditions can obviously intensify that eating disorder.

There are a variety of reasons behind every single case of eating disorder. Not one person I've ever met has had the same instance of an eating disorder. But what I do know is that it has the highest mortality rate of any mental health issue in the UK, and yet we still need to recognise the fact that there is a strong lack of investment, not only here in Wales but in other parts of the UK, and we need to change that. 

There are 1.25 million people in the UK living with an eating disorder, but this could be an undercount, because some people simply don't recognise that they have an eating disorder, because, as with other mental health problems, we don't often recognise it in ourselves. And often, and particularly men, they ignore it entirely and they don't know how to then approach people for support.

Treatment is possible and support is possible. But I've had discussions with people who have eating disorders over the years about the word 'recovery' and some people say to me that they will never fully recover from an eating disorder, but what I would say is that the road to recovery is there for us all if we want to embrace it and that we can deal with that eating disorder even if it does stay with us for the rest of our lives.

I'd like to say that there are—[Interruption.] I'm sorry—Nick.

Joyce Watson took the Chair.

You just took me back to 2007, and I think your cross-party group on eating disorders was one of the first CPGs that I attended, and you brought a young man along with you to that meeting who had been suffering from an eating disorder. So, I think the point you made there, about, often, men don't want to own up to the fact that they've got an eating disorder or a wider mental health issue, is a particular problem. So, perhaps that's something that can be addressed moving forward, so that that big chunk of people who don't report do actually come forward and say—hold their hand and say, 'Hey, I've actually got a problem.'

Thank you for coming to that first meeting, Nick. I think you were talking about James Downs, actually, who has been an amazing campaigner. He's moved to England now and he's doing exactly the same type of campaigning that he did here there. So, he has a mountain to climb, but he is very much still involved, and I think it's very important that we do encourage those people to come forward.

The issue, I think, for many people is that the wait is often dangerously long and the provision of services is patchy in many areas. In some areas they're very good, but others almost non-existent—if we look at mid Wales, it's very hard to get access to those services. And what we do need is more consistent support—when they have access to those services in the community, many people say that they don't have those support groups to go to afterwards, where they can meet other people and they can share their experiences with other people. 

So, in 2018, Dr Jacinta Tan led the Welsh Government's eating disorders framework review. This was the review that we campaigned for back in 2007 and which Edwina Hart, as the current Minister, put in place at the time. And then we campaigned for the review to happen in November 2018. To be fair to Jacinta Tan, the review was very strong, very robust, and had involvement from carers, patients and their families, and they felt engaged and involved in the process. My only regret at the time was that the Welsh Government took quite a long time to come up with any ideas as to how they were going to put that review into place, and I think we would be urging the Welsh Government here today to tell us how they're going to implement the changes in the review to make this a reality.

Waiting times—many, many other conditions are an issue here. We know from the patient episode database for Wales that NHS wait times are on top of the often extensive time that it takes many people to come forward and seek help for their condition. So, this could be up to at least three years. So, in the service review, a maximum wait is recommended of four weeks for non-urgent referrals and one week for urgent referrals. Yet, this is far, far from the reality of what is happening at the moment. What's concerning is that the Welsh Government seem, as I said, far away from implementing it, so I'd like to know when they are going to do that. 

So, whilst waiting times are a problem, so too is access. And I've lost count of the amount of times people have told me that they are not able to access services at a speedy time, so that they can, then, treat their eating disorder. 

And then many of them—. I don't want to criticise health professionals overtly, but we do know that, if you do go to your general practitioner—they're not specialists, but they don't know, sometimes, who to refer a patient to, they don't know what the processes are. So, I think much more training in that regard is needed. And then the review talks about an all-age approach to service delivery, which would take out some of the challenges that transition between child and adolescent mental health services and adult services often pose. I don't want to take up all my time before I'm able to sum up; I realise I'm going slower than usual.

I did hear from the ambassador for Beat, Zoe John, here today who said that she was deemed to be not thin enough to get treatment, and I think that is absolutely criminal. We need to review the BMI, even if you don't want to scrap it. I think if I was in Government I'd scrap it, because, even if you don't go in with an eating disorder, you may come out with an eating disorder because you're told that you're overweight or that you need to do certain things with your lifestyle even though you may be doing those things already, and I think that's key to look at and wasn't actually addressed in this eating disorders review.

There are so many stories that people have told me, but it's been a privilege to lead on the eating disorders cross-party group and I hope that you'll take the mantle forward while I'm away and make sure that the Welsh Government does implement the changes to the review so that I can come back and I can be—well, I won't have much to do then. [Laughter.] So, I'm not going to have to time to react to you; you'll have to bring in someone else. But diolch yn fawr iawn.

I have selected the two amendments to the motion and I call on Angela Burns to move the amendments, 1 and 2, in the name of Darren Millar.

Amendment 1—Darren Millar

Add as new point after point 5 and renumber accordingly:

Further regrets the length of time to develop waiting times for adult and child services outlined in the Minister for Health and Social Service's response on 26 September 2019.

Amendment 2—Darren Millar

In point 6, after ‘stakeholders to’ insert ‘urgently’.

Amendments 1 and 2 moved.

Thank you very much indeed, acting Deputy Presiding Officer. And Bethan Sayed, I'd like to give you fair warning that, if you think that once your little bundle of joy has disappeared—been delivered—you're going to have less to do, you are sadly mistaken. [Laughter.] But it is going to be a great ride, and I wish you all the well. We on the Welsh Conservatives benches would like to thank you very much for all you have done here in the Assembly in driving forward this very, very important area, because important it is. It affects so many people, not just those who have a condition of eating disorders, but also the families and the friends. You have very neatly taken away an awful lot of the things I wanted to say. 

We support the motion absolutely, but we will oppose it in order to get our amendment heard. The reason we want to get our amendment heard is we actually believe that we're calling on Welsh Government to stop talking the talk—now the Deputy Minister needs to walk the walk and we need to see the movement and get the eating disorder service. It says it all in here; I don't need to repeat it. We just need to do what it says and we need to say it now. 

Time is vital. Early detection and intervention is an underlying principle of this review, and it is recognised by all the professionals that early intervention is so important. And yet I have constituents who wait literally years from the onset of their eating disorder through to beginning to get any kind of treatment. And, if they are lucky enough to access the treatment, then very often it's only for six weeks. Well, what on earth is six weeks going to do when you actually need mental health support and understanding to undertake a very, very long journey?

Waiting times are not just lengthy, but it's also about getting that day and that residential treatment. And I've had constituents—parents—come to me and say that their GP said to them, 'Your best bet is to nip up to the Priory in London, or go to Clouds'—or whatever it's called—'in Wiltshire.' Well, that's no answer, is it? Because your loved one needs to have residential support to get them through this, and we need to really have a look at this.

The one point I want to pick up is the whole area of GPs having more experience during their training of all mental health issues, including eating disorders. I speak from within the experience of my own personal canvas, within my family, when the message has been, 'Pull yourself together', and, 'It's a phase she's going through.' You know—yes, phases are what you go through when you grow from size 5ft 3 to 5ft 4. You can call that a phase, but eating disorders aren't a phase. I think that we really need to ensure that general practitioners, because they are the front line, understand that all mental health issues need to be treated well, and that eating disorders is a proper thing, it's a condition, it's a disease. And if you can help someone manage it and learn to live with it and control it and hopefully conquer it, then they will have such a better outcome in life. 

So, one of the things I really want to drive forward is that additional training of GPs, in rotation, in the community, in rotation, in mental health services and understanding the importance of it. Thank you once again for bringing this debate forward—and good luck, you're going to have a great time.

I now call on Rhun ap Iorwerth.

Thank you very much, Chair. I went to the event over lunch today in the Senedd, arranged to mark Eating Disorder Awareness Week, organised by Beat, and sponsored by Bethan Sayed. May I tell you how pleased I am that I went to that event, to be able to listen to young women explaining so eloquently how their lives were impacted by eating disorders: the pressure to conform in the first instance in terms of their body shape or their appearance; the lack of understanding and awareness that they had of the danger that they could fall into the trap of an eating disorder; how they hadn't realised that a problem was developing for them until that problem had turned into a serious one; and how the response to their cry for help, or for assistance from the health service, had been unacceptably poor? 

That convinces me certainly that we should be taking eating disorders far more seriously than we have been taking them in terms of the need for urgent action. That is the cry from Beat and the young women that I heard from today—namely, to take urgent action. And the guidance on what we have to do is already with us. What we are asking for, very simply, is to take action on what emanated from the eating disorder service review. 

Having high quality services that are required by young men and women who suffer from this mental illness; ensuring that there's consistency in services across Wales; ensuring that we develop ways of monitoring the care that is provided; ensuring that staffing levels are given adequate attention, and that funding is in place on a health board level to implement a system that is appropriate; and ensuring that we teach our young doctors with regard to eating disorders, and that there is more time given than the less than two hours that is provided in training for medics at the moment, and that that period is increased so that there is an awareness amongst the health workforce as a whole about the seriousness of this issue.

That pattern does follow the review. Let us, through this brief debate today, make the point as a Senedd that we expect these recommendations to be implemented, as a matter of urgency, for the sake of our young people.

I now call on the Deputy Minister for Health and Social Services, Julie Morgan.

Thank you. I'd like to thank Bethan for bringing this debate today, and also use the opportunity to thank her for all the work that she's done in this field, and how she's made it a really important area of work for the Assembly, and for all her work with the all-party group, and to wish you all the best for the future.

I'm really pleased to have an opportunity today to draw attention to Eating Disorder Awareness Week and to emphasise the work that's being done to improve the eating disorder service in Wales. I absolutely accept that eating disorders are serious conditions that affect not only those with the condition, but can have a huge impact on the lives of families and friends. And friends and families are often instrumental in the holistic care of those with eating disorders, and it's fitting that there is an emphasis this week on empowering and supporting these friends and families. 

I would like to join AMs in commending those who've worked and participated in the eating disorder service review. As Bethan said, in 2018, the Minister for Health and Social Services commissioned Dr Jacinta Tan of Swansea University to review eating disorder services in Wales and to determine what changes need to be made to improve services and outcomes.

I know—and I think Bethan did say this at the beginning—that the experience of those with eating disorders and their families was absolutely central to Dr Tan's conclusions, and I'm personally grateful for the investment that these people have made towards improving eating disorder services in Wales. I know it can be very difficult—Rhun very vividly described the young women who contributed to the event at lunch time. I think it's absolutely vital that the human struggles that are going on for people in Wales are absolutely central to policy decisions. I was also very stuck by what Bethan said about—I think it was Zoe John who said that she was not thin enough. The review is quite clear that patients who require treatment should never be told that they're not ill enough. I absolutely fully agree with that.

Dr Tan's review provides a wide-ranging analysis of current eating disorder services and made a number of significant recommendations that reflect what services could achieve in the longer term. The review talks about the role of friends and families in participating in treatment: being allies of therapists and motivating their loved ones. It also acknowledges the emotional, financial and occupational sacrifices that are made to support friends and family.

The review recommends that the needs and perspectives of families of those with eating disorders should be considered within the development of policy and the design of services, and involved in the treatment of their loved ones. I fully support this principle and expect this, along with other principles underpinning the review, to shape the development of eating disorder services in Wales.

The Minister for Health and Social Services wrote to health boards setting out the actions he expects to be taken in response to the review: reconfiguring services towards earlier intervention; working towards achieving NICE standards for eating disorders within two years; and developing plans to achieve a four-week waiting time within two years. Welsh Government have received submissions from all health boards setting out the suggested approach to achieving these targets while ensuring that longer term planning aligns with the ambition of the review.

It's clear that extra funding will be necessary in order to start to deliver the level of services needed in Wales, and officials are currently developing an approach to funding that will enable progress to be made. I know that many people would like to see this happen at a greater pace and I think that's been the theme of the contributions here today, but this has been a significant review, which does require detailed analysis. It has been necessary to engage with clinicians to test the recommendations and to ensure that we move forward in a way that takes account of the progress that's already been made in many areas. And to support this progress, the Minister for Health and Social Services announced that there will be a national resource to ensure that the progress seen in some parts of the country can be made across Wales, because the issue of the services being piecemeal across Wales was another very important point that was made.

While it is important for health boards to deliver services within their areas, we do need to ensure that people living in Wales can expect excellent treatment for eating disorders, wherever they live. The changes we are working towards are ambitious and do reflect the scale of the challenge we face, and these changes will not happen overnight. The work undertaken by professionals, those with eating disorders, and their families to develop the review has been instrumental in determining the steps being taken forward to improve services in Wales. So, there is a clear plan ahead.

I'd like to end, really, by thanking Bethan for contributing to the situation that we have got. We've got a clear plan that we're working towards, but it is complex and it will take time. But, as you heard in my speech, there are time limits given to reach the situation that we want to be in.

I now call on Bethan Sayed to reply to the debate.

Thank you, and thank you to those who have contributed; I appreciate the response we've had. What I will start with is: you said, Deputy Minister, that it won't happen overnight, and I appreciate that any service change will take time, but I think what I would urge you to do in that sense, therefore, is to ensure that the people who contributed to the review—be they patients, be they carers, be they loved ones—are fully engaged in the timelines that you do have.

Because what they told me was that, once they'd contributed to Jacinta Tan's review, there was a drop-off and they didn't find out from Welsh Government what was happening. They weren't kept in the loop. And they don't have anything more that they want to be able to do than to find out what's happening and to be involved. So, I would urge you, even if you're going to tell them, 'It's going to take a bit of time, please bear with us', do you know what, they're not going to criticise you for that, because they know you're giving them that information? So, please, be abreast of that.

You say that extra funding will be necessary and you are approaching civil servants to look at how that will happen. Obviously, you will have read in Jacinta Tan's review that she would be predicting around £9 million to be able to do that. So, I would like to understand what your civil servants are doing in terms of costing different models and how they are going to approach that in future budgetary requirements, therefore. Because of course, at the moment, it's still the £1 million recurrent that we campaigned for in 2007, and things have changed since then. Yes, pockets of money have gone into different services, like transition and such, and that's something I totally welcome, but fundamentally it's still quite small in relation to the budget of the NHS in its entirety. And as we've said, again, people die from this condition, and we want to stop that happening in the future.

So, I'll finish now, and I would just like to say that it's not something that should be—. Mental health in all of its forms, as we'll discuss in the next debate, is important, but specifically, eating disorders don't just come into health, they come into education as well. Many people have told me that they go into schools and they would like to have more information about what that means to them. Emily Hoskins, who was here earlier, said her father is a teacher and people were telling people in school—just because they knew that Emily had an eating disorder—if they had an eating disorder in that school that they could go and see him. Well, he was dealing with that as a carer, and then coming in and people referring him to help those with eating disorders. That wasn't really appropriate.

So, I think we need to look at all elements of society and how not only the education system can accommodate those who need it, but also how the health system then can be amended to ensure that those who need treatment get it in a timely fashion and get the treatment they need for their own demands, here in society.

Thank you very much to everyone who took part, and I hope that changes will be afoot to ensure that those changes do help those people at the front line, so that they don't become so poorly that they have to enter a treatment unit in England, and that they can remain in the community to receive that specific treatment.

The proposal is to agree the motion without amendment. Does anyone object? [Objection.] Then I'll defer voting under this item until voting time.

Voting deferred until voting time.