The next item on our agenda is the debate on the Health, Social Care and Sport report 'Inquiry into the impact of the Covid-19 outbreak, and its management, on health and social care in Wales: Report 2—Impact on mental health and wellbeing'. I call on the Chair of the committee to move the motion. Dai Lloyd.

Motion NDM7610 Dai Lloyd

To propose that the Senedd:

Notes the report of the Health, Social Care and Sport Committee: Inquiry into the impact of the Covid-19 outbreak, and its management, on health and social care in Wales: Report 2 – Impact on mental health and wellbeing, which was laid in the Table Office on 17 December 2020.

Motion moved.

Thank you very much, Deputy Presiding Officer. This is our second report on the impact of COVID-19 on health and social care in Wales. It focused specifically on mental health and well-being. In addition to detailed recommendations, we reached one overarching conclusion, namely that it's more important now than ever that the Welsh Government makes the necessary improvements identified in our report of 2018 on suicide prevention and in the Children, Young People and Education Committee's report, namely 'Mind over matter'.

COVID-19 has brought many challenges in terms of its physical effects, but also in its impact on people's mental and emotional well-being. Being cut off from your family, your friends and other support networks for long periods of time has had a profound effect. We know that more than half of adults and three quarters of young people feel that their mental health has worsened during the lockdown period. We are also extremely concerned about the well-being of care home residents, particularly those living with dementia. Significant harms are being caused by prolonged separation, with continued restrictions on care home visits. We understand the anxieties faced by care home managers, of course, but the risk of harm from coronavirus must be balanced against the risk to residents' health and well-being by prolonged separation from their loved ones.

The pandemic has also had a profound effect on the wider determinants of mental health and well-being, including economic, societal, environmental and educational factors. It has exposed and magnified the inequalities in society. It will be a long time before the full extent of the impact of the pandemic on the nation’s emotional and mental health is fully understood. However, it was clear that mental health services were under significant pressure prior to COVID-19, and demand for these services will only increase.

People's needs will differ. The pandemic has exacerbated known risk factors for self-harm and suicide, such as loneliness, isolation, lack of belonging and lack of meaningful occupation. Some people with ongoing mental health conditions may have been unable to access their routine services for some time, and they will be in greater need now than ever before. Some people will have experienced bereavement during the pandemic or as a result of it. Losing a loved one is never easy, but to go through this at a time when you can’t be with them at the end of their life and don’t have access to friends and family for support will no doubt affect people’s ability to come to terms with their loss.

Other people who have never experienced mental health problems before may be affected by the population-level trauma that has occurred. Feelings of anxiety, sadness and loss, these are natural responses to a frightening situation and it's important not to over-medicalise them. However, appropriate support must be in place for everyone that needs it. This must cover the range of mental health needs, from low level, early intervention through to more specialist services and crisis care. It should also include quality and accessible bereavement services.

The right services and support must also be in place for health, social care and other front-line staff, who have experienced increased workloads, staff shortages, workplace trauma and the loss of friends, colleagues and service users. Without support themselves, they risk becoming unwell due to stress or other mental health difficulties as a result of being physically and emotionally drained.

Now, as a committee, we've repeatedly called for the need for parity between mental and physical health. Before the pandemic we were concerned that insufficient progress was being made in this regard, and we fear that COVID-19 will only set it back further. If parity is to be achieved, then mental health must be a key consideration in the Welsh Government’s decision-making process and recovery planning. This will require a public health approach to mental health that promotes well-being, prevention and early intervention, and which spans Government departments and all sectors of society. We need to see improved joint working and a clear, shared understanding across Government and public services about the importance of public mental health, and a funding model that supports this.

We thank the Minister for her response to our report as a committee. We welcome the fact that all our recommendations were accepted, either in full or in principle. However, as is often the case with Welsh Government responses, the narrative tells us what the Welsh Government is already doing, rather than addressing our specific recommendations. In response to our call for a written update on the implementation of our recommendations and those of the children’s committee, the response says, and I quote:

'the Committee will understand that the implementation of the breadth of recommendations is a significant programme of work and needs to be balanced with the implementation of our responses to other related Committee reports and the commitments set out in the Together for Mental Health Delivery Plan. It should be recognised that the programme of work to deliver the improvements runs beyond this term.'

That's the end of the quote.

When it comes, the written update must address our specific recommendations. It must also provide detailed timescales so that we can get a clear sense of what’s been achieved and what else needs doing and by when. We would urge in particular for the work of the task and finish group on suicide prevention data surveillance to be developed as an urgent priority.

We recognise that these are difficult times and that implementing some of our recommendations is no small task, but we can’t afford not to do this. It's been clear for some time what we need to do to improve mental health and well-being in Wales. We really must now make changes to avoid further unnecessary suffering and preventable deaths. Thank you very much.

Can I start by commending the committee? I'm not a member of it, but I really think this is an excellent report, as was the previous one, and I also commend the committee members for the way they've sought to work across the sectors and have a very integrated approach, and I think that's clearly shown in the first recommendation, which makes a very powerful reference to the children's committee report, 'Mind over matter'. I'm not a member of the children's committee either, but in my view, the 'Mind over matter' report, of all the outstanding reports completed by committees in the fifth Senedd, I think that report has been the most influential and I think you are quite right to refer to it.

I think the short- and long-term impact of the pandemic on mental health will be very, very considerable, and I thank the committee for focusing on such issues as bereavement care. I think we now have a lot of children who did not see their grandparents in their last days, who would have found it very difficult even to process the event of those losses, and that will be with them for many years, and will affect them as they go into adulthood and in their attitudes to matters of life and its passing and death. I think it will take a lot of careful work to ensure that people are able to access the level of support they'll want, and this really does bring us on to a public health approach; I think that's entirely appropriate.

I also think it was right for the committee to emphasise the need for well-being support for front-line staff, particularly NHS staff, and I know many colleagues in the Senedd would have had their briefing updates from the various health boards. And when we were having—or certainly in my region, we were really pushing the health board to outline what it was doing to support staff, and I'm grateful for the work they've done, but I think this will be ongoing as COVID is with us for much of the coming decade, probably, and as we manage it, perhaps we can realistically hope for it to be less severe, but it's still going to be a factor and a real threat.

I think there are some wider things in terms of the public health approach as well, like other social factors, the importance of exercise, the availability or the access to open space that many communities lack; these have been really detrimental things for people's well-being and mental health. In our urban design and our regeneration work, we must ensure that these sorts of gaps are filled. Suicide prevention, I think, is the right approach in terms of emphasising that we can really prevent a lot of the suicides that take place. The victims of suicide really do deserve this type of approach, and until we do that, we will, I'm afraid, suffer a level of suicide that is a reflection on wider services, but also on that public health approach not being as full as we need it to be.

Can I just finish by thanking the Welsh Government for accepting all the recommendations? But I did rather agree with some of Dai Lloyd's comments at the end, in terms of what is the depth of the commitment, and I do point to recommendation 12, where the committee recommends the Welsh Government's budget for 2021-22, just published, demonstrates a strong commitment to improving public mental health in Wales. I'm pleased the Government accepted that recommendation, but then, under financial implications, the Welsh Government says, 'none additional'. With that comment, I conclude my remarks.

Thank you. Lynne Neagle.

Thank you, Deputy Presiding Officer, for the opportunity to make a brief contribution in this debate, and it is difficult, I think, to do justice to such a wide-ranging report in this debate. There were a few issues I wanted to pick up on; the first was the very clear link made in the report for the continued need to see action on both 'Everybody's Business', the health committee's suicide prevention report, and the Children, Young People and Education Committee's 'Mind over matter' report. I wanted to place on record again my thanks to Dr Dai Lloyd for the strong partnership that has been established between the Health, Social Care and Sport Committee and my committee. It is absolutely crucial that we do not take our foot off the pedal for a second on delivering on both those reports. They are both landmark reports. They are both reports that had widespread consultation, not just with people with lived experience, but expert stakeholders, and I believe both reports have a huge amount of buy-in. So, I would urge every possible action to continue to prioritise both those reports.

I wanted to focus on two specific recommendations, really, which are recommendation 6 and recommendation 7. These deal with the fact that the committee was really concerned that there was a disconnect between the assurances the committee was given about mental health services continuing during the pandemic and what we heard on the ground. We were being consistently told by Ministers and by the head of the NHS in Wales that mental health services were designated as essential services. But what we heard from stakeholders on the ground was that people had indeed had difficulty getting access to those mental health services that they need, so I entirely concur with the committee's findings that Welsh Government really needs to delve into this and to check that the methods being used to check that people are getting services are actually representative of people's lived experience on the ground. I pay tribute to organisations like Mind Cymru, who are doing lots of work in gathering lived experience, but I think it is also essential that Welsh Government listens to people with lived experience about what their experience has been in the pandemic.

As we have said then in recommendation 7, we have called for mental health services to be prioritised. It has been a consistent aim of both committees for there to be parity between mental and physical health. Yet what we saw in the pandemic, which is somewhat understandable in a physical health emergency, was an immediate change to mental health services, because everything moved online, and online does not work for everyone. Phone calls do not work for everyone, and I think it's crucial moving forward that we ensure that our mental health services are resilient enough to deliver that parity in the kind of crisis that we are facing.

I wanted to just say something about crisis care, because the Welsh Government's response refers to the urgent access review, which is a very interesting document, 'Beyond the call', and I'd encourage Members to take a look at it. It describes the 900-odd calls a day that are made to the police, accident and emergency, and other emergency services for people in need of mental health support. But what I would urge from the Government is urgent action on the other part of that jigsaw, because if people are calling the police and going to A&E in those kinds of numbers, then we have failed miserably in providing the services that we need for people earlier on. We cannot rely on—

The Member just needs to wind up now, please.

—those emergency services to pick up the pieces, so I'd like it if the Minister could say something in her response about when she expects the other part of that review, the NHS crisis and care services work, to be completed and implemented. Diolch yn fawr. 

I'm very pleased to have been able to play a role in this hugely important inquiry. The pandemic has caused wider damage than simply the direct physical damage caused by COVID-19 itself, and I think we can expect the impact of the pandemic on mental health to last possibly longer than the impact on physical health. We heard as part of this inquiry about the direct impact of the pandemic and the restrictions on people's mental health, of the loss of loved ones without being able to be with them in those crucial hours, those feelings of loneliness and isolation, and people not having a meaningful role during these times.

But also there’s been an impact on people’s access to mental health services, sometimes because of restrictions and additional pressures on the health service, and at other times because people were not sure where to turn during the pandemic—they weren’t comfortable, perhaps, talking to people on these new digital platforms about things that may be causing them anxiety. There was even uncertainty at the outset as to which services were to be provided. We had that shocking incident in north Wales when almost 1,700 people were told that they were to be taken off waiting lists for mental health care. Yes, an admission was made that that was a mistake, but it tells you something that somebody somewhere thought for just one second that it might be acceptable to tell people who were on waiting lists for mental health care that they would have to be taken off those waiting lists.

We did discuss during this inquiry the fact that we don’t need to overmedicalise things on all occasions, that we need to take account of our natural, emotional responses—bereavement, sadness, anxiety about the current situation, and so on and so forth—and we need to think of other ways of looking at the well-being of people. I’ve been pushing the Government to do everything possible to allow outdoor exercise and to ensure that people can get out in the outdoors. These are soft approaches, but equally important.

If we look at the impact on certain groups, I’m very grateful to Bethan Sayed for the work that she has done in emphasising the need to think about the well-being of new parents. That is very important. But I will conclude by just mentioning two of the groups that we looked at specifically. One is the front-line workforce. We need to keep those in the front of our minds, and the evidence that we heard very clearly that many will be feeling impacts similar to PTSD even for years to come because of this. I would like to hear the Minister’s comments on the steps that will be taken to ensure that sort of support in the long term for health and care workers who have been through so much and have been so selfless throughout this period.

The second is the impact on older people and what steps the Welsh Government will take to support them—yes, those in care homes, and those who will have loved ones in care homes. The loneliness that has been felt by so many is something that is going to require support for years to come. Yes, this has been a mental health crisis as well as a physical health crisis, and it’s always important that we bear that in mind.

I now call on the Minister for Mental Health, Well-being and the Welsh Language, Eluned Morgan. 

Thank you very much, Dirprwy Lywydd. First of all, may I thank the Chair and the committee for taking time to consider this very important issue? I welcome the report and its findings. I support and accept or accept in principle all of the committee's recommendations. There's a great deal contained within the report, and I don't think I'll have time to go through everything this afternoon, but I do want to take this opportunity not only to thank you, but also to thank all of the staff across the health and social care sector who have been working so exceptionally hard to treat and to care for not only those who have been suffering from COVID-19, but also those who care for other patients that had emergency needs and others in the health sector who were caring for the most vulnerable people in our communities. 

The past 11 months have been unrelenting, and the pandemic has clearly had a significant impact on our communities, our patients and our staff, and I fully recognise the physical and emotional demands that have arisen as a result of this. So, we understand the huge impact that there has been on the nation's mental health, but it's clear that we don't yet have a full picture of what the long-term impacts that could arise from the pandemic in the area of mental health. I fully understand that the mental health impacts emerging from the pandemic must be central to our response to recovery plans, and it's also clear that some have suffered much more than others in this scenario and we have to be sensitive to that too.

Since the onset of the pandemic, we've put arrangements in place to understand the changes in mental health demands in order to develop our planning in this area, and these arrangements include regular reviews of the available evidence, including population surveys, weekly meetings with health boards and regular meetings with the third sector. But I do acknowledge and accept the point that was made by Lynne Neagle about the potential disconnect that we have seen, and it's something I've been really concerned about—hearing one thing from people from the third sector, hearing something else in terms of the figures that you get in a kind of cold document.

It's really important for me that I get a better sense of what it's looking like on the ground. I've made a real effort to listen to the third sector, to listen to young people. I listened to a group of young people this week from Platfform. You'll be aware that I'm getting regular updates on the situation in relation to CAMHS—weekly updates on that—and it's obviously something that is a standing item on our agenda on the task and finish group. So, I'm trying to get a better sense of where we're at. It is important, I think, if people can keep giving me examples of where it's not working; I think it's really important that I get to hear about that so we can really address the systems issue if that's where things are falling down.

Of course, responding to mental health needs requires a multi-agency and a multifaceted approach, and it's not something that the NHS can do or should do alone. What we've done is we've strengthened our cross-Government action in the 'Together for Mental Health' delivery plan, with an emphasis more on the social aspects and those economic aspects that we have to bear in mind all the time—so, looking at things like health and debt and housing, education and employment. This game is far from over. We don't know what's going to happen when furlough ends. What is that going to look like? People are really concerned about what their economic circumstances will be, and we know there's direct correlation between unemployment and mental health issues, so we've got to be sensitive to what may come down the line. I have recently had the opportunity to discuss this with my Cabinet colleagues—that potential for the socioeconomic impact of the pandemic on mental health—and we all agreed that we have to have a concerted, cross-Government approach to stem what could be a potential surge in demand for mental health services.

One of the things I'm really keen to do is to put more emphasis and more support and more money into that tier 1 support, that tier 0 support, really supporting the third sector, demedicalising where we can the issues relating to mental health. We've been putting other measures in place, like online cognitive behavioural therapy, and it's great to see that over 9,000 people have already accessed this kind of support. Rhun was asking where people go for information. 

This was something I was very keen to do. I was very eager to see what I would do in that situation. What would you do if you don't understand the system? So, we've ensured that every health board has had to show clearly on their websites exactly what services are available in this area.

You've heard that there has been an additional commitment of £42 million. I'm sorry, David, that that wasn't recognised in the financial impact, but it was there, so the money is there and that takes us up to about £783 million that we spend annually now on mental health. That is really important for me. I'm testing out at the moment whether we're spending it in the right places. I'm slightly concerned that we need to look very seriously about whether we're spending that money in the right places. I certainly would want to see a clearer emphasis—in the knowledge that 80 per cent of mental health issues start when people are children and young people, I would like to see a rebalancing of funding going towards that end.

I'll be updating the committee shortly on progress in terms of delivering our response on perinatal mental health and suicide prevention, so I won't go into the detail of that here. But I have recognised the significant work that is going on already across the Welsh Government in terms of our 'Together for Mental Health' programme. One of the things I want to do is to keep an eye on delivery. Dai, you were asking about delivery—you know, what's our timetable. What I've done now is to pull together a ministerial delivery and oversight board for Wales, and we met for the first time last week. That's what I'm trying to do—just get a much better sense of what's going to be done at what point and whether we're on track. Because there's no point in developing a new programme unless we've delivered this programme. So—

The Minister needs to draw her comments to a close, please.

Thank you. I've got so much more that I could say, but I just want to finally say something about the workforce. We have put a lot of measures in place. I am very concerned—I've met with the Royal College of Nursing, the Royal College of Psychiatrists and with GPs, and I think it's really important that we stand by these people who've been on the front line. As Rhun suggested, people have been through trauma here and we need to stand by them and it may take a while for all that to come through. So, we need to be there for them. 

But just finally to say thank you very much to the committee for this work and to give you an assurance that we're doing all we can to deliver in these really, really difficult circumstances.

Thank you. I have no Member who has indicated that they want to make an intervention. Therefore, I'll ask Dai Lloyd to reply to the debate.

Thank you very much, Dirprwy Lywydd. We've had an excellent debate. I, like others have suggested, would've liked to have seen the debate scheduled for longer, but we are where we are, as they say. This is a very detailed report; a great deal of work went into it, as well as the other reports that we referred to—the previous reports of the health committee on suicide prevention and, of course, the excellent reports by the Children, Young People and Education Committee under the excellent chairing of Lynne Neagle. I would like to pay tribute to the work of Lynne Neagle, as the Chair of that committee. The collaboration has been excellent and I think both committees have been able to achieve so much more, in working together, than they could've done alone in the same areas, but with different age groups. Because it wasn't possible, on most occasions, for the health committee to undertake work related to children and young people, but it was important that that was done, and I'm hugely grateful to Lynne Neagle and her committee for that.

Of course, the mental health challenge as a result of this pandemic is a huge one—we understand that. But we need to emphasise it, because we haven't seen the half of it to date. In addition to that, there is a level of anxiety that occurs naturally in any society that emerges from some mass emergency. We have seen that occurring and it is still happening. Obviously, there would be a level of anxiety in any individual, which wouldn't necessarily have an impact on mental health, but it does need to be dealt with, and the natural way of doing that, as others have said—and thank you to David Melding for his mature and dignified contribution in terms of looking in broader terms at public health in terms of physical activity and so on—is to deal with that level of anxiety that doesn't fall within the definition of 'mental health problems'. Everyone feels that. I thank Rhun ap Iorwerth too for his wise words, as usual, and for his support as a member of the committee.

To conclude, I'm grateful to the Minister, Eluned Morgan, for her contribution and for her wisdom in responding in such a meaningful way to our recommendations. I also have to say that I welcome her appointment in the first instance, which is a reflection of the importance of this agenda. It's important that we tackle all of the challenges. May I conclude by thanking our clerks and researchers for their unstinting work on all occasions? The conclusions are there from our previous reports as a committee, as well as Lynne Neagle's committee's reports, and we must address them. Thank you very much. Support the motion.

Thank you. The proposal is to note the committee's report. Does any Member object? I don't see any objections. Therefore, in accordance with Standing Order 12.36, the motion is agreed.

Motion agreed in accordance with Standing Order 12.36.