The following amendments have been selected: amendment 1 in the name of Lesley Griffiths, and amendment 2 in the name of Darren Millar. If amendment 1 is agreed, amendment 2 will be deselected.

Item 7 is the Plaid Cymru debate on eating disorders. I call on Rhun ap Iorwerth to move the motion.

Motion NDM7934 Sian Gwenllian

To propose that the Senedd:

1. Notes that Eating Disorders Awareness Week 2022 takes place from 28 February to 6 March 2022.

2. Notes the 'Welsh Government Eating Disorder Service Review 2018' and Beat’s recent 'Welsh Eating Disorder Service Review—3 Years On' report.

3. Believes that improvements in eating disorder services in the last three years have been uneven, continuing the inequity documented by the review.

4. Regrets that treatment for those affected in Wales varies greatly depending on age, diagnosis and location.

5. Calls on the Welsh Government to:

a) commit to increasing the resources allocated to mental health year on year over the course of the next five years and holding health boards to account over their investment in eating disorders services;

b) publish a new framework for eating disorder services that contains timelines for the achievement of targets, focussing on:

i) early intervention and prevention;

ii) integrated care;

iii) support for families and other carers;

iv) investment in the workforce, including support for staff wellbeing;

c) re-establish and maintain clinical leadership over eating disorder service provision at a national level.

d) fund an eating disorders clinical audit to ensure that all health boards collect and report a standard and comprehensive set of high-quality data.

Motion moved.

Thank you very much, Deputy Llywydd, and I'm pleased to move this motion formally. It is something that is so very important to many people and families across Wales. At least 60,000 people in Wales suffer some sort of eating disorder. There are a number of different disorders—bulimia, anorexia binge-eating disorder, a number of others—and every one poses some grave challenges to those suffering. It costs lives. Anorexia has the highest mortality rate of any mental health problem. Disorders can lead to all sorts of complications and physical disorders too.

But there is treatment available, and people can recover, having suffered eating disorders. They do recover, and providing the right treatment and the right support at the right time is crucial. Delays in treatment can intensify suffering for the victims and those who care for them. It can lead to much higher costs for the NHS too. So, once again, we're talking about an area where early intervention and early treatment bring benefits on a number of different levels.

It's no coincidence that we've chosen today for this debate—it is Eating Disorders Awareness Week, and the theme of the week this year is increasing understanding of eating disorders within medical training. There are so many people who rely on contact with their GP or with primary care in order to identify the signs of eating disorders, and the beginning of that diagnostic process and leading to treatment. But, on average, there is less than two hours of training provided to medical students in Wales on issues related to eating disorders. There is no doubt that that weakness within the training process has led to delays in treatment for many individuals.

It is good to be able to report that the charity Beat think that they are making ground on this, and that the two medical schools have responded positively to their questions on extending the level of training for the future. And I'm sure that the third full medical school in Bangor will also want to support this initiative.

Back in the spring of 2018, Welsh Government commissioned an independent review of eating disorders services, as they were then, and that review, submitted to the Government in late 2018, found a system geared towards providing care for those who had already become severely ill rather than on early intervention. It found significant variation in the availability and quality of eating disorders treatment across Wales; gaps between services rather than care that was integrated; often families weren't being informed, weren't being supported or empowered through the process of treatment.

The review set out an ambitious vision of a world-class service focused on prevention and early intervention, identifying and providing quality treatment before people become severely ill in every part of Wales. So, where are we now? What did Beat find in its three-years-on review? Well, whilst some progress has been made in expanding and improving eating disorder services over that three-year period, Beat would argue that this has been uneven, continuing the inequity documented by that original eating disorders services review. I'll tell you about one young woman who saw her GP in my constituency, and found the GP to be very sympathetic and understanding and eager to help, but who told her, 'Please register where you're at university', because that GP had no faith in the likelihood that her young patient would be able to access support at her home address. And that is totally, totally unacceptable.

The eating disorders services review called for treatment to be accessible at an early stage, with the removal of referral or eligibility criteria. In some areas, new specialist teams based in child and adolescent mental health services had been established, some health boards had developed or expanded adult community eating disorders services. But, in some areas, access to specialist treatment is still restricted to those who have already become severely ill and isn't available for those with certain types of eating disorders, such as binge-eating disorder.

So, our motion today calls specifically for an end to that variation in service provision, another postcode lottery that is putting sufferers in some parts of Wales in particular at a disadvantage. Welsh Government's amendment deletes that, and instead points to a general commitment to continue the improvements of eating disorder services across Wales, and I haven't denied that there have been improvements.

There is reference in the Government's amendment to the need for increased investment. Again, our motion calls for that too, but where the Government's amendment is vague, the motion calls for specific actions to ensure that an increase in mental health funding happens year on year in a five-year drive, as we portray it, to push up the resources available for treatment of eating disorders among other mental health issues.

We call for more to be done to hold health boards to account for their investments in eating disorders, but, crucially, we dig down, we call for the publication of a new framework for eating disorder services, including timelines and targets, and we'll support the Conservative amendment, which addresses the issue of timescales and timely reporting too. We need a clear map, a clear map towards providing that early invention that I said is so important.

There are significant gaps in the data that health boards currently provide on waiting times. There doesn't appear to be a standardised system in place across Wales to consistently measure and report the full waiting time from initial referral, if that referral takes place at all early enough, to the start of specialist treatment.

We need to prioritise prevention too. There needs to be a focus on investing in the workforce. And on integrated care, the eating disorder service review explained that early intervention and evidence-based treatment require an integrated approach with good communication and collaboration between services. In Beat's survey of health and care professionals and volunteers, lack of integrated or collaborative working with other health or social care services and lack of integrated, collaborative working with schools, colleges and universities were commonly identified as restricting the ability of their teams and their services to meet the current demand for eating disorder treatment. There is such a long way to go.

The Llywydd took the Chair.

We'll hear more from my fellow Members on different aspects of what we and Beat and those who are suffering and their families are calling for, and I look forward to hearing further contributions from all parties.

We are agreed here on the principles, we are agreed in the Senedd on the need to prioritise mental health treatment, but, as important as that unity is and as important as positive words and support for principles are, we must also bear in mind that we need to transform services. The words in and of themselves are not enough. Let's use today as an important milestone in the process of transforming services for those who are suffering.

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Deputy Minister for Mental Health and Well-being, Lynne Neagle, to formally move amendment 1.

Amendment 1—Lesley Griffiths

Delete all after point 2 and replace with:

Recognises the challenge of providing eating disorder services that meet the range of needs; that services have been disproportionately impacted by the pandemic; and that improvements need to be made.

Calls on the Welsh Government to:

a) commit to continue the improvement of eating disorder services across Wales, with increased investment to support this;

b) strengthen the clinical leadership required to drive these improvements.

Amendment 1 moved.

Formally.

Thank you. And I call now on James Evans to move amendment 2, tabled in the name of Darren Millar. James Evans.

Amendment 2—Darren Millar

Add as new sub-point at end of point 5:

establish targets and publish monthly statistics on waiting times for mental health treatment, including issues such as eating disorders.

Amendment 2 moved.

I move amendment 2. Diolch, Llywydd, and I move the amendment in the name of my colleague Darren Millar. I'd like to thank Plaid Cymru and Rhun for bringing this important debate forward today on eating disorders. This is an issue that affects so many people right across our society. It does not discriminate, and it can affect anyone. This week is Eating Disorders Awareness Week, and it's right that we highlight this problem and do all that we can to help those who are affected by an eating disorder. I just want to pay tribute to my colleague Mark Isherwood, who will be talking later on in this debate, and the work he has done around raising the importance of this topic.

Eating disorders are a serious mental illness and can lead to devastating consequences for those affected. They don't just affect the person, but they have a wider impact on families, health services and the wider society. Around 1.25 million people in the UK have an eating disorder, and we in this place can do what we can today to support them. As Rhun has said, there are many types of eating disorder, including binge eating, bulimia, anorexia and others. Eating disorders are killers, with anorexia having the highest death rate of any mental illness, and one in six people with binge eating disorders trying to take their own life. People suffering with eating disorders more often than not develop serious physical health problems like heart disease, osteoporosis, and their overall quality of life is diminished. However, treatment and recovery is possible and early access to the right care and support can change someone's life. Early intervention provides the best chance for that person to start on the road to recovery. Any delays in receiving treatment and support prolongs the suffering for individuals, their friends and their families. It also increases long-term costs on the NHS. As I've said, early intervention and prevention is better than curing any problem at crisis point. I've set up my own mental health working group since I've been here, and I'm hearing first-hand from young people right across Wales just how many younger people are suffering with eating disorders and that there are far more external influences that are negatively affecting their mental state than many politicians in this Chamber realise.

COVID-19—that has had a huge impact on people affected by eating disorders. A university survey of people with eating disorders conducted in 2020 stated nine out of 10 respondents said their symptoms had gotten worse as a result of the pandemic, and support services, the great work that Beat do, experienced a 300 per cent rise in the number of people reaching out for help. So, we must put more support into those services to help people who require care. 

So, what needs to change and what can we do here to help those affected? In the Conservative group, we agree with this motion proposed by Plaid Cymru and we look forward to supporting your motion with our amendment later on, as we need to establish targets, publish monthly statistics on waiting times for mental health treatment, including eating disorders, and we need to provide specialist care in people's communities and not make people travel across the border for the help and support they need, losing their family, friends and support networks. 

Llywydd, the Welsh Government amendment, I believe, is not good enough, and it's a shame that they have sought to water down this debate. I think the motion put forward by Plaid Cymru is a very good motion, and it's a shame the Government have done this again. But, wider than this motion, I hope that the Minister, in responding to this debate, can outline what the Government is doing to improve medical training on eating disorders, to ensure that our GPs and medical professionals know how to spot and treat eating disorders, and what wider work the Welsh Government is doing on research to understand more about eating disorders and what causes them. 

Today, Members, we have the opportunity to stand with those who are suffering with eating disorders, to say that, 'We support you, and we will do all we can to ensure you get the quality of care you deserve.' I encourage all Members to support the motion later on tonight. Diolch, Llywydd.

I'm grateful to Rhun for opening today's debate and outlining why we as a group wanted to table this important motion today. And, as has already been referenced, it's timely that we're able to do so during Eating Disorders Awareness Week, which once again provides a spotlight on an issue that affects so many. I'd also like to put on record my appreciation of the work of Beat, who work tirelessly to raise awareness, as well as providing direct support to those that are suffering. 

As has been previously outlined, there are a number of factors that have impacted progress since the review, ranging from limited and uneven investment in eating disorder services, workforce challenges, as well as, of course, the impact of COVID-19. So, the question today is: how can we finally make progress on these issues? In 2009, the Welsh Government published 'Eating Disorders—A Framework for Wales', which helped steer the development of services in the years that followed. The terms of reference for the service review referred to publishing a new framework in 2019, and so far the Welsh Government has only set out initial high-level priorities for eating disorder services. The Welsh Government's 'Together for Mental Health' 2019-2022 strategy commits it to work with service users, carers and health boards to develop a new model of service in response to the recent independent review.

The Welsh Government needs to publish a new framework or model for eating disorder services that contains timelines for the achievement of each milestone, which should focus on early intervention and prevention, integrated care, support for families and other carers and investment in the workforce, including support for staff well-being. The publication of such a framework or model would demonstrate a renewed commitment from the Welsh Government to ensuring that the eating disorder service review shapes future services in Wales. The adoption of an ambitious, long-term vision for eating disorder services would also very likely play a key role in staff recruitment as well as, crucially, retention.

In order to make the implementation of a new framework or service model achievable, changes are needed to ensure sufficient and equitable investment in eating disorder services across Wales. A community child and adolescent mental health services clinician told Beat that, if the Welsh Government wants this development, they need to be very clear and directive to the health boards.

The Welsh Government should specify a minimum spend on eating disorders from the service improvement funding that it allocates to health boards, and hold health boards to account over their investment in eating disorders.

As has been noted, including yesterday in the Chamber, we know that 78 per cent of patients referred to the specialist child and adolescent mental health services are left waiting for over four weeks for their first appointment, and waiting times for mental health services for young people are now the worst on record. These are young people who have been deemed to require urgent, specialist treatment, and yet they’re being made to wait over a month to even be seen. We must have robust provision in place so that patients can receive the best possible treatment at the earliest opportunity, before their situation worsens.

The national clinical lead for eating disorders has provided valuable support to health boards, services and clinicians across Wales. The extent of the challenges facing services and continued variation in service provision across Wales underlines the importance of a central resource to help guide improvements. The Welsh Government should make the position of national clinical lead for eating disorders a permanent post. And during 2021 the national clinical lead has often consulted with people that have lived experience of eating disorders to help inform her work and that of health boards. This must now be built on to ensure that the voices of patients and families are always heard in the development of services, both at the national and local levels.

Beat found that there are significant gaps in the data on eating disorders that is collated by health boards. If this continues, it will limit the ability to monitor progress and deliver accountability. An eating disorders audit is expected to be commissioned in 2022, and at present this audit is only due to cover England, but it could be extended to also cover Wales.

The Welsh Government should fund an eating disorders clinical audit as part of efforts to ensure that all health boards collect and report a standard and comprehensive set of high-quality data. I hope that we can work cross-party to achieve this motion today. Diolch.

There is much better understanding of eating disorders now than there was 50 years ago. I can recall siblings of friends of mine just desperately struggling to understand what they could do, and the medical profession didn't really know what to do beyond force-feeding people who were determined to starve themselves to death.

So, we are now much better equipped to deal with this, and there's also much less stigma attached to it. Very high profile sufferers, like Diana Spencer, the Princess of Wales, make it much more likely that young people will come forward and seek help, but we are a very long way from where we need to be. I think the 2018 review is a perfectly good summary of the problem and the steps that needed to be taken. So, it was disappointing that no formal response was given to that excellent report until September 2019, and it took a further 15 months to recruit a clinical lead for eating disorders. We hear from Beat that this individual has had a very positive impact since her arrival, and obviously that is a positive development. But there are many, many obstacles and difficulties here, which we really do need to be honest about.

One of my constituents, who developed a serious eating disorder during lockdown, was initially hospitalised on a CAMHS ward, then she was discharged because there was a COVID outbreak, and then pretty much left to her own devices, and unfortunately she was told that the nearest hospital where she could go for a specialist eating disorder service was in Wiltshire. There was nothing available in Wales. I appreciate that we were in the middle of a pandemic, but unfortunately she attempted to take her own life, and fortunately was saved by the University Hospital of Wales at the Heath, and now is a fantastic campaigner for ensuring that other people don't have to go through what she went through, so I pay full credit to her.

So, we absolutely can see from the Beat review that the disorder was given rocket boosters by the pandemic. We can see the figures that they quote: a 300 per cent rise in the number of people seeking help compared to pre pandemic, and a 50 per cent increase in referrals in at least two health boards. So, there really are far more patients presenting who need help than there are clinicians to support them.

But we have to start at the beginning. We have to have schools being much more aware of when the signs are appearing. My constituent makes really good points on this front. This really is a very complicated subject. This is the reverse side to the statement we had yesterday on the obesity strategy. How many schools are actively or passively conniving with the problem by encouraging young people to skip lunch due to a lack of time, or lack of space in the dining room to make it a pleasant experience rather than one you want to escape and go and hide somewhere else for? Obviously, that has a major impact on students' learning, as well as long-term potential problems for their relationship with food.

So, that is definitely the place where we need to start, but we also need GPs to be much more aware of what the signs are, so that they will take this seriously and not simply be pushing people from pillar to post. Because it simply isn't good enough to be going to one service and then being told, 'Oh, we've got to weigh you', and then you go to the clinical service and, 'We've got to weigh you.' People get the impression that they've got to become sicker before they can get any attention. Well, that's absolutely the reverse of the way that we need to address the health service. So, I think that person-centred approach, no wrong door, and not having to tell your story 65 times before you can get anywhere.

So, there are some very serious challenges, which I'm sure the Deputy Minister is considering, but we need to know what we are going to do to recruit more psychiatrists, more paediatricians and other medical specialists. Beat says there may be less of them than there were before the 2018 review. This means we are absolutely in the wrong place, not where we need to be. We need to have a recruitment and retention challenge that will ensure that those that we do manage to recruit, that we retain them and we don't burn them out. So, I'm very interested to hear what the Minister has to say, but this is a really serious issue, and I thank Plaid for bringing it forward.

We do know more about it, but we still have a very long way to go, and there are more and more, as we have heard, nuances and types of eating disorder coming to light every day. We do know, given the stats that we've heard this afternoon, that anorexia has the highest mortality rate of any mental illness, 60,000 people in Wales have an eating disorder, and we do know shockingly little, still, about this area of ill health. And major advances are needed in our understanding of what causes eating disorders in the first place, how to prevent them developing and how best to treat them.

Through research, we have come to learn of these different eating disorders, the way they take hold. Awareness of orthorexia, for example, which is an unhealthy obsession with eating pure food, is growing and developing. But, without research funding, eating disorders will continue to represent a significant public health issue, devastating lives, as we've heard, while also leading, of course, to high costs for the NHS. Research into eating disorders is not only necessary but is a prudent investment, because often chances for early intervention, as we've heard, are missed, treatments are then not always effective or properly tailored and, as a result, many patients are admitted for expensive hospital treatment, including in some cases to the specialist units in England, which takes a toll on the individual, of course, as well as the services themselves.

In 2020-21, the all-party parliamentary group on eating disorders conducted an inquiry into research funding across the UK, including Wales, and the inquiry found that, despite the prevalence and severity of eating disorders, they receive very little research funding. The total UK investment in terms of grant funding amounted to just £1.13 per person affected per year between 2009 and 2019. And between 2015 and 2019, just 1 per cent of the UK's already severely limited mental health research funding went towards research on eating disorders. This despite people with eating disorders accounting for around 9 per cent of the total number of people with a mental health condition in the UK.

The inquiry also found that a historic lack of investment has led to a vicious cycle. There are few active researchers and research centres looking at this, and therefore very little research is published. And this has helped stigmatising attitudes persist, which reinforce the small capacity of the field and its lack of funding. A funding target for the UK eating disorder research field should, as an absolute minimum, be based on parity within mental health research, and the Welsh Government should work with partners within and beyond our borders to help realise this aim. 

There is a clear link between eating disorders and social media and the wider media. Often, apps that change the appearance of the shape and size of the body can lead to the exacerbation of eating disorders, by encouraging and normalising an unrealistic notion of what is acceptable in terms of physical appearance. There is pressure on social media influencers to edit their posts, and algorithms reward those with social media content that attracts attention through images of alleged perfection, images that feed a culture that rejects diversity and reality. This leads young people in particular to the understandable conclusion that they have to replicate the false images of perfection that they see on their accounts.

We therefore have to do more to celebrate diversity and challenge the perverse culture and its dangerous messages that can be transmitted to social media users through these images. I hope the new curriculum will provide sufficient space for ensuring that young people have an understanding of how stereotypical images of perfect bodies have developed and how they're encouraged by social media, and, in understanding this, will have the confidence to challenge this and avoid the harm that can come from this. In addition, we need to see action from the Government working with social media companies to reduce the impact of these platforms on the people of Wales in terms of triggering and intensifying eating disorders. 

Eating disorders have long been considered, historically, a female illness—a prejudiced attitude that can lead to deficiencies in terms of treatment and diagnosis, as it's possible to ignore or misinterpret symptoms that may be related to an eating disorder in men or LGBTQ+ people. Indeed, one study found that about 40 per cent of men who suffer from an eating disorder are misdiagnosed, and that the majority of their symptoms are wrongly attributed to anxiety. Research also shows that individuals of different gender identities experience the impact of their eating disorders in different ways.

All of this again points to the need for a new framework that considers the individual journey of each person with an eating disorder, and that there is a need for funding, research and accountability to prevent the cause and effects of these devastating and traumatic disorders—disorders that are preventable. Thank you.

I'm afraid I've been quite busy with my pen scribbling out contributions that have already been made, because the speaking notes that I prepared this morning have already been covered. So, to avoid repeating what's already been said—

It's always a great idea at that point to scribble out rather than repeat what's already been said. 

Yes, but I'll just note at this point that I think the fundamental reality of the situation is that people in everyone's constituency or region will suffer with an eating disorder, and I've got a lot of experience in my 11-year NHS career working in community mental health teams of treating people with eating disorders, and I'm fully, fully aware of all the issues that surround it. But, I'm afraid all of my contribution has already been covered, so, to avoid repeating, I'll leave it there. Diolch, Llywydd.

I commend you for it, yes. Mark Isherwood. It gives your fellow Member Mark Isherwood time to contribute now.

Diolch, Llywydd. That's caught me out a little bit. At the risk of repeating some elements, I'll go forward. But speaking here in January, I challenged the Deputy Minister for Mental Health and Well-being over actions to ensure faster and equitable progress in improving eating disorder services across Wales. I highlighted findings in eating disorder charity Beat's 'The Welsh Eating Disorder Service Review: 3 years on' report, published that week, and called on the Welsh Government to support the report's recommendations. The Welsh Government's eating disorder service review in 2018 set out an ambitious vision on early intervention, evidence-based treatment and support for families, with eating disorder charity Beat playing a key role in the review.

But, their report published in January found that progress towards achieving that vision had varied widely across Wales, and when I asked the Deputy Minister whether the Welsh Government, in line with Beat's recommendations, would publish a new service model or framework, including timescales, to set out what they expect from health boards, and if so, when she would expect this to happen, she replied that the Welsh Government would be using Beat's report to inform their work going forward. We therefore need to know where, when and how. 

As this motion states,

'improvements in eating disorder services in the last three years have been uneven, continuing the inequity documented by the review', and

'treatment for those affected in Wales varies greatly depending on age, diagnosis and location.'

When I met Beat's national officer for Wales in early January, ahead of publication of their three-years-on report, she told me that Beat had been calling for the full implementation of the 28 eating disorder service review's recommendations since it was first published by the Welsh Government. These included the allocation of sufficient funding, workforce and staff training, accompanied by an implementation plan and timescales for when the recommendations will be fully implemented across Wales. I therefore again urge Members who genuinely care about this issue to vote in favour of our amendment calling on the Welsh Government to,

'establish targets and publish monthly statistics on waiting times for mental health treatment, including issues such as eating disorders.'

As with so much else, without this, the Welsh Government's designer fortifications will lack foundations.

It must also be emphasised that Beat's campaign theme this year, 'Worth More Than 2 Hours', is about the current lack of training on eating disorders for students studying at medical school. Their top key policy ask in Wales for this Eating Disorders Awareness Week 2022 is for eating disorders to be appropriately taught and assessed at all medical schools, and for all junior doctors to gain clinical experience during foundation training, where learning about eating disorders is generally overlooked in medical training, with severe consequences for the prognosis and safety of patients.  

When I met Beat's national officer in early January, we also discussed the need to strengthen the connection between eating disorder services and other specialist services including autism and diabetes, increased waiting times for specialist treatment, with people becoming vulnerable in the meantime, and the need for both early intervention and greater support for families. She subsequently sent me further details about avoidant/restrictive food intake disorder, or ARFID, and how it can co-occur with other conditions such as autism. ARFID is a condition characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both. Someone might be avoiding and/or restricting their intake for a number of different reasons, including sensitivity to the taste, texture, smell or appearance of certain types of food, or only being able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake. As Beat state, ARFID can be present on its own or it can co-occur with other conditions, most commonly anxiety disorders, autism and attention deficit hyperactivity disorder. As Beat's 'The Welsh Eating Disorder Service Review: 3 years on' report states, the eating disorder service review explained that

'early intervention and evidence-based treatment require an integrated approach, with good communication and collaboration between services.'

In particular, it focused on improving integration between eating disorder services, primary care, weight management services, diabetes services, autism and neurodevelopmental services, mental health services and the voluntary and community sector. However, their survey of health and care professionals and volunteers found a lack of integrated, collaborative working with other health or social care services and a lack of integrated, collaborative working with schools, colleges and universities,

'restricting the ability of their teams/services to meet the current demand for eating disorder treatment.'

That was in January. If the Welsh Government is sincere, it must commit to the real action this motion calls for accordingly.

I call on the Deputy Minister to contribute to the debate—Lynne Neagle.

Thank you, Llywydd. I'd like to thank all Members today for their contributions and for bringing forward this debate on such an important topic. There is much in this motion I agree with. I am acutely aware that improvements need to be made to eating disorder services and I am sincerely committed to driving this forward. I also welcome the spotlight that Eating Disorders Awareness Week gives to the impact that eating disorders have on individuals, their families and their friends. We all have a role to play to support and encourage people to access appropriate support.

Jenny Rathbone said that we need to be honest, and I agree. The 2018 independent review was important, but some of their recommendations were aspirational, providing a long-term vision of services. Our engagement with services since the publication of the review has demonstrated their commitment to improvement, and whilst there is universal support for the high-level aspiration within the review, there is more to do to shape the service model and approach that best fits our service in Wales, and clinical buy-in for that model is absolutely crucial. I will continue to prioritise eating disorder services in my own ministerial work, including scrutinising the improvement progress in meetings with vice-chairs. I also welcome the review by Beat and look forward to working with partners to improve the full breadth of support needed for people with eating disorders, not just NHS services.

Whilst I share the frustration about the pace of these improvements, we do need to recognise the pressure services have been under for the last 18 to 24 months. Eating disorder services have been disproportionately impacted by the pandemic, needing to focus on immediate pressures to ensure services provide a safe and appropriate response for those who need them. With unprecedented levels of demand, higher acuity and more complex patients, prioritisation based on clinical need has been more challenging for our workforce. I'd like to personally thank all of the NHS staff working in eating disorder services, who continue to do all they can to meet patient needs in this most challenging of times. I also recognise the increased demand that has been placed on the third sector as a result of the pandemic, and the vital role the sector has played.

Despite these pressures, there is progress. I visited two eating disorder teams last week in Betsi Cadwaladr University Health Board, and saw the work they are doing to improve support in the community and to prevent young people being placed out of area. Whilst describing the key challenges they'd experienced throughout the pandemic, they demonstrated a child-centred and system-wide approach, using a mix of skills to deliver services—the type of service we all want to see across Wales. Our additional and recurrent investment has led to an increase in workforce numbers in specialist ED services, and we have provided additional training for staff. There has also been extensive work to engage those with lived experience and their families and friends across LHB-led eating disorder services, and I am determined that this engagement will underpin our plans for future improvement.

At a national level, we responded quickly to the increased pressure and demand that we saw at the start of the pandemic, and significantly strengthened a range of tier 0/1 support. This support provides early open access to help and advice, with specific support for eating disorders through our significant investment in the Beat helpline and their other services. Our additional investment in Beat provided over 7,000 support sessions in Wales during 2021. These are sessions not just targeted at those living with eating disorders, but also friends and family, who are so key to supporting individuals through diagnosis and treatment. We have also taken concerted action to raise awareness of and interest in eating disorders amongst medical professionals. I give way to Rhun ap Iorwerth.

Thank you very much for taking an intervention, and I apologise in advance if it's a premature intervention. I can't wait until the end of your comments, for obvious reasons, because it will be too late then to ask a question. I don't disagree with anything you have said so far. I have recognised that there have been gains, and the three-year review by Beat recognised that there have been gains. Whilst I appreciate you saying that there is much you agree with in Plaid Cymru's motion today, will you be explaining what it is exactly that you're disagreeing with in the motion? Because we have heard nothing but common ground now, and no reason as yet why you would not support our motion.

Thank you for that intervention. I am conscious of time, Rhun, but I think the key bone of contention, really, is the need for a new framework, because we know exactly where we need to get to in eating disorder services. There is clear NICE guidance that we have to ensure is met. We're also putting in place new clinical governance arrangements, and there will be a work plan below that. So, I suppose, in summary, that is where our key difference is—that we don't see the need for a separate framework, because that work is already in hand.

As I said, we've taken action to raise awareness of eating disorders, and that includes the development of clinical resources for GPs and paediatric clinicians, to increase understanding and interest in this speciality, to assist with identifying the signs, assessing eating disorders, and accessing appropriate referral pathways. Building on our previous investment, I have been clear that we must continue to prioritise eating disorder services, with the increased funding from the additional £50 million we have secured for mental health in 2022-23. This is significant additional and recurrent funding for mental health services that increases the baseline funding to support services to meet changing mental health needs as a result of COVID.

However, funding is just part of the solution. Recruitment into specialist ED services remains a challenge. We must continue to develop a sustainable workforce for mental health services in Wales. Workforce issues impact across mental health services, and that's why we've commissioned Health Education and Improvement Wales and Social Care Wales to develop a strategic mental health workforce plan for Wales. We are currently consulting on this plan, and I can't emphasise enough how important it is to engage with this consultation, including to ensure we have the right future provision to support those living with an eating disorder.

We also recognise the need to have comprehensive data, and our ongoing work to develop a mental health core data set will improve data across mental health services, including eating disorder services. Following the omicron variant, we are now at the point where we need to reset and recover mental health services, which we must remember have remained available throughout the pandemic. Of course this includes eating disorders, and my officials are already working with the NHS collaborative to reset the NHS eating disorder network's work plan to support the improvement of eating disorder services. As a matter of priority, this will include strengthening the national clinical leadership to drive this change. Without delaying the improvement work that is already under way, we want to implement an ED network model in Wales that can make the transformational improvement that we all want to see for these services.

As we emerge from COVID, we will also test the progress that has already been made against the priorities that were set for services based on the independent review. This will give us a clear picture of progress to date on where each health board is on its improvement journey. Based on this, health boards will now be asked to refresh their current plans with clear milestones to reconfigure services towards earlier intervention, to meet the NICE standards and to achieve a four-week waiting time. The NICE quality standards are evidence based and set out six quality areas. They are supported by key stakeholders and we will use these as our framework to support improvement, rather than developing a separate framework of our own. Members will also wish to note that we have been in discussions since the summer of 2021 with a key partner to schedule a formal national clinical audit for eating disorder services covering England and Wales, and I'm happy to update Members further on that in due course.

I recognise today that we have focused on NHS services, and that is only part of the transformation that we need. Eating disorders are complex and the risk factors are varied. We are working with schools on healthy eating and body image workshops through our whole-school approach, and it is so important to me that we are able to intervene in an early way and at a critical point in the development of young people. I remain absolutely committed to driving forward the change needed in our specialist eating disorder services, but we all have a role to play in the transformational system-wide changes that are needed to reduce the complex risk factors that cause eating disorders. This is not something that the NHS can or should do alone. Diolch.

Rhun ap Iorwerth to reply to the debate.

Thank you very much, Llywydd, and thank you to the Deputy Minister for her response to the debate and thanks to everyone who's participated in this afternoon's discussion. As I've said, there is agreement on the need to strengthen services, and I'm pleased that I did have an opportunity to intervene on the Deputy Minister's comment and to ask what exactly her objection was to the proposal before us, because now we understand. 

The key bone of contention is the need for a new framework, because this is work that's already in hand. It's not us saying that we need a new framework, it is Beat; it is the leading organisation that understands where the deficiencies are in current provision for those suffering from eating disorders in Wales. I tend to listen to those who understand, in the same way as I work with and listen to the cancer charities when they're pushing for and asking for a new cancer plan. When Beat tells me, 'You know what? The frameworks that we currently have; they're not really doing it for us, we need to build something new', I think that is a clear message to us that we need to move in that direction.

There have been some wise comments made from Labour and Conservative benches. I will frame my remaining comments around what I was told by one sufferer of an eating disorder. You will know that I've been doing work recently, speaking to young people about access to mental health services more generally. This individual had waited 12 months to start a series of support sessions for eating disorders, and I appreciated and could identify in this context with the comments made by the Member for Cardiff Central, who said that we shouldn't allow there to be a wrong door, and people shouldn't have to explain themselves time and time again as this young person had to do: 'I've just been discharged from primary mental health services after waiting 12 months for it. I've only had eight to 10 sessions. I have learnt a little, but I'm still struggling and I'm alone now. If I want further care, then I have to apply again through my GP and wait a very long time again.' Those are her comments. It's not acceptable within the current frameworks that our young people, and people of all ages, feel that those are the kinds of barriers facing them. We do have to have clear models in place to provide that early intervention. She goes on: 'It is a mental health problem.' And I think of Sioned's comments in this context in terms of social media and social pressures in terms of images. 'Because of the society we live in now, behaviours around eating disorders are normalised, even complimented.' Those were the comments of this young person. But it is a mental health problem, and things do have to be taken more seriously.

When one thinks that an illness that is a burden on their lives isn't taken seriously, that's also a message for us that there may be something wrong with the frameworks that we're working within. So, in order for everyone to get the help that they need as swiftly as they need it, then we must give more attention to getting the right systems in place.

I'm asking you today to support the Plaid Cymru motion that is very specific in what it requests. We support amendment 2 too that recommends targets so we can identify the milestones as we reach them. As I said, an agreement on the need to do things better in and of itself doesn't mean that we have the road map as to how we get to that point. So, support this motion today as a statement that we are serious about moving towards the kind of provision that the population of Wales needs.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there is objection, and therefore I defer voting until voting time.

Voting deferred until voting time.

That will follow a short break that we will need to take now to prepare technically for that vote. So, we'll take a short break first.

Plenary was suspended at 17:32.

The Senedd reconvened at 17:35, with the Llywydd in the Chair.