Thank you, Minister. We will now move to our second short debate, and I call on Siân Gwenllian.

Thank you very much, Dirprwy Lywydd. I want to give time to Jane Dodds and to Rhun ap Iorwerth, and I very much look forward to hearing their contributions. 

Maternity and childbirth are positive experiences for many of us, but in some circumstances, it can be a very challenging and difficult time, and in this evening’s short debate, I want to focus on the mental health issues that face some women, particularly those issues that are related to maternity and childbirth. We must ensure that perinatal mental health services are provided in an appropriate manner across Wales, putting the needs of women, their babies and their families at the heart of the conversation. The provision is not consistent across Wales, and I am concerned that many women in my constituency, and in north Wales more broadly, are suffering due to a lack of provision and resources.

Over one in 10 women develop mental illness during pregnancy or within the first year after the birth of their child. This is one of the most common health concerns experienced by pregnant mothers, and without the appropriate treatment, it can have a highly detrimental impact on the mental health of women and their babies, and can place families under huge amounts of strain. But with the right treatment and support, women and their families can get better and can cope.

May I turn first of all to community perinatal services? It is a requirement that every woman be allocated a designated health visitor and midwife to monitor any issues that arise and to provide her with support, including referral to the appropriate specialist perinatal services, according to need. I have not been satisfied that this referral happens consistently in the Betsi Cadwaladr health board area. 

It is a cause of great concern that Betsi Cadwaladr health board has no budget set aside for low-level or moderate perinatal mental health services, even though £3 million has been allocated for this every year across Wales. This is a significant gap, and it's truly concerning. I ask the Deputy Minister to investigate this and to rectify the situation at once. This funding gap means that women are deteriorating very quickly, developing into serious cases, with significant implications for them and their families, but also financial implications.

This situation exists despite the commitment that improving perinatal mental health has been a priority of the Welsh Government since the previous Senedd term, following a report by the Children, Young People and Education Committee. A commitment was made that every health board would have an accessible community service, as well as a commitment to improve access to and the quality of perinatal mental health services. There are weaknesses in the community provision across Wales, which is having a detrimental impact on too many women and too many families. But, these failings are painfully clear in north Wales, so we must move at pace to rectify this.

I'm also aware of a lack of spaces for community appointments and that many of these take place in unsuitable settings. This means that it's difficult for Betsi Cadwaladr health board to meet the required standards, not to mention being very discouraging for the staff and women involved. 

I now turn to services for the more serious cases. Five out of 100 pregnant women will develop a serious mental health condition. Between two and four out of every 1,000 women who have a child will require hospital care. A mother and baby unit is the appropriate place for this care to be received, but far too many women have to be treated on general psychiatric wards, and this means that they’re separated from their babies. This can only exacerbate the problem, surely. 

We know that a unit has been opened in south Wales, and that is wonderful to see. It's time that we saw data on that unit. I would like to ask the Deputy Minister to publish any report produced as a result of a review of the unit since it opened in April 2021. The Government had committed to undertaking a review in April 2022, but, to date, I haven’t been able to access any publicly available data. So, I look forward eagerly to seeing these reports and data, as well as the outcomes and the lessons to be learned, as we discuss a unit for north Wales.

The Children, Young People and Education Committee’s report noted that an MBU in the south would not necessarily be appropriate for mothers and their families in mid and north Wales. It was noted that options should be discussed with NHS England, with a view to establishing a centre in the north-east—the north-east of Wales, that is—that would be able to serve mothers and their children on both sides of the border. The argument that we hear is that there aren’t enough cases in north and mid Wales to justify a dedicated unit for the area, but beds in such a unit could be filled through coming to an arrangement with health boards nearby that are part of NHS England. Unfortunately, the decision made was to continue with an eight-bed unit in England with access given to families from north Wales, rather than proceeding in the other way and in the way, indeed, that was recommended in the committee’s report.

I understand that the intention is to build a unit in Cheshire, which is expected to open in spring of next year, as I understand it. However, it is very difficult to find any further details on this development. The mention made is that this unit will include two beds for women from north Wales, and that Betsi Cadwaladr health board could commission additional beds as demand increases. In my view, this is the incorrect model for meeting the needs of women in my constituency and beyond. It's the wrong model, when there was an alternative option of a model that would have been able to meet the needs in the same way.

Aside from the totally unrealistic distances that many mothers would have to travel, there is a further key and fundamental problem that arises in terms of meeting many families’ Welsh language needs. I can only begin to imagine how horrendous it would be to have to be far from home at such a time of vulnerability. If Welsh is your first language and it is, therefore, the natural medium of communication with your newborn baby, imagine how alienating that would feel in Cheshire, where the workforce would be monolingual English. If the unit were located in north Wales and it provided beds for women from England, there would be no language barrier or issue because Welsh speakers speak English too. So, we must give urgent attention to the linguistic element in the new model, if this is the model that will be pursued, or I'm afraid that the Government’s 'More than just words' strategy will be exposed as empty and meaningless. If it isn’t too late, I would ask the Deputy Minister to review the ill-advised decision to establish a unit for women from north Wales in England.

I have taken the opportunity in this short debate to outline the fundamental weaknesses in perinatal provision in north Wales, the deficiencies in community services, and the wholly inadequate and unsuitable model in the pipeline for serious cases. I do hope that the Government will take what I've said this evening seriously and will see that I'm trying to improve the situation. My hope is that, by putting this issue under the spotlight here in the Senedd, the Deputy Minister will ask her officials for an urgent report on the situation in north Wales, with firm recommendations for improving the situation for mothers, babies and families across north Wales. Thank you.

Thank you to Siân Gwenllian for raising this most important issue.

This is an issue that we don't hear much about or discuss publicly. It demonstrates still the significant stigma around mental health, especially for new or expectant mothers. I know, through my own experience of being a child protection social worker, how devastating this is in relation not just to mothers but to fathers as well. So, to families, this issue is perhaps a shameful and stigmatising concern and we have to improve services to ensure that we identify those people and actually offer them the right services. My region covers part of Betsi Cadwaladr and Dwyfor Meirionnydd. Representing Mid and West Wales as well, we just need more facilities and more options for our women and parents who are facing significant issues once a baby's born. 

The new 'Saving Lives, Improving Mothers’ Care' report shows that 18 per cent of all maternal deaths in the first year after a baby's birth are due to suicide, and postpartum psychosis is the leading cause of those deaths. The report found that 67 per cent of these suicides could have been prevented if there had been improvements in care. In April 2021, we know that the Uned Gobaith in Swansea opened, providing the first six mother and baby unit beds in Wales. But, that's in Swansea; we need more, and we need them certainly in north Wales. And there’s a really particular reason we need them in north Wales, and that’s because of the language.

Research has shown that expressing and discussing sensitive, emotional and complex issues such as mental health issues is a far easier experience, is more natural and is less frustrating if you’re able to do so in the language of your choice. For many Welsh speakers, doing that in English, never mind how fluent you are in that language, can be extremely difficult. Mental health patients often get more benefit from services provided through the medium of their language of choice, as there are no linguistic barriers to their expression. So, it’s hugely important that there is provision in north Wales, and that that takes account of the language used by the families affected.

Cymdeithas yr Iaith Gymraeg, in their evidence to the Senedd committee inquiry on mental health inequalities, raised concerns that, despite the measures put in place to improve access to healthcare in Welsh, access to mental healthcare in Welsh remains poor. I do hope that the Minister will consider this issue and be able to respond to some of the concerns that have been raised. We need to make sure that families, when they have that baby, have the most wonderful experience, and we know that postpartum psychosis can really be such a devastating experience, and that we have the services both to identify and support prior to the birth and, if necessary, then continue after the birth, and they need to be fair and consistent across Wales. Thank you—diolch yn fawr iawn.

Thank you to Siân Gwenllian for bringing forward this very important subject at the Senedd today. I’d also like to thank and pay tribute to my former colleague and Member, Steffan Lewis, for the excellent work that he did in this field, shining a light on the need to ensure mental health support in the perinatal phase. Childbirth is an exciting time for many people, but it is a time that places a great deal of strain on others, and what we must ensure is that the level of service provided is sufficient and is consistent in all parts of Wales. It’s clear, as we’ve heard from Siân this evening, that there’s a lack of provision across the north of Wales in particular. I agree that the model, if it is the model we will have, of service provision over the border is the wrong one. We know that there’s an ongoing conversation about provision of cross-border services, and where expertise has been rooted for many years, such as in Alder Hey hospital, of course, there is an important relationship to foster there. But this is exactly the kind of service that we could and should be providing within north Wales, and why not offer services to those from over the border to come here? The linguistic element is such an important part of it—not just giving geographical proximity, but cultural proximity, at a time when people are at their most vulnerable. So, I too call on the Deputy Minister to ensure that we don’t let these women down at such an important time for them.

And I call on the Deputy Minister for Mental Health and Well-being to reply to the debate—Lynne Neagle.

Thank you, Dirprwy Lywydd. Can I thank Siân Gwenllian for bringing forward this debate today? I know that Siân has a long-standing interest in and commitment to perinatal mental health. I’d also like to thank Jane and Rhun, who’ve contributed to the debate, and to recognise Rhun’s acknowledgement of the role that Steffan played in raising this issue up the agenda in the Senedd. It was incredibly important.

I also want to take this opportunity to restate my commitment to doing everything I can to ensure that mothers and families get the perinatal mental health support in Wales they need and deserve. As Siân knows, I chaired the Children, Young People and Education Committee’s inquiry into perinatal mental health in the last Senedd. I am acutely aware of how vital perinatal mental health support is, not just for mothers, but for the babies who are in that precious first 1,000 days of their life. We know that their development in that time can be critical for their lifelong life chances. I'm also committed to ensuring the recommendations that came from the inquiry are implemented.

We are making significant progress, but we also recognise there is more to do, and we remain committed to improving perinatal mental health services, and this has been a priority area for action within our 'Together for Mental Health' delivery plan 2019-2022. We're now working on the development of the successor to the plan, and I can tell the Chamber that perinatal mental health will continue to be a priority in the successor plan. We will be engaging with the perinatal mental health network as we develop this work. As part of this, we'll also be looking to see how we can develop the pathway approach, recognising that specialist services are one element of this. 

As part of our maternity and early years care and support, health boards already work with families as part of an early intervention approach. Every mother and family has a named midwife to support them in pregnancy and postnatally. This includes consideration of perinatal mental well-being, and pathways are in place for those who need a referral to specialist services. All health boards now have a specialist perinatal mental health midwife in post who can support mothers and families to ensure they receive the care and support they need. 

Since 2015, we've invested in specialist perinatal mental health services across Wales, and, as a result, significant progress has been made in provision. There are now services in every health board area, and over £3 million of mental health service improvement funding is supporting these services annually. From a north Wales perspective, over £800,000 of this funding has been allocated to support perinatal mental health. I was really pleased to get the opportunity a while ago to visit the perinatal mental health team in north Wales. Their commitment to the mothers they support was palpable, and I want to pay tribute to them for the work they do day in, day out supporting mothers in north Wales. 

Can I give Siân Gwenllian the commitment that I will look at what she has said today about the lower level support? It's not something that has been picked up in my conversations about perinatal mental health in north Wales, but I will pick that up with officials and provide you with a further update.

All health boards are also working towards meeting the relevant Royal College of Psychiatrists' quality standards, and we've also made service improvement funding available to support this work. Health boards have made good progress towards these standards, including in north Wales, but there is more work to be done to ensure the care provided is of the highest standard. In Betsi Cadwaladr University Health Board, services are currently compliant with 91 per cent of type 1 standards and 75 per cent of type 2 standards. Our national clinical lead for perinatal mental health is continuing to work with services to identify where there are gaps in meeting the standards, and to put plans in place to address this. Welsh Government continues to be committed to supporting services to meet these standards. 

Common themes that have been identified for improvement include the provision of clinical space that is family orientated, which you've highlighted, adequate office space for teams, and the provision of information around carers' rights and advocacy. Over recent months, the all-Wales perinatal mental health clinical lead and the perinatal mental health network have developed a pathway of care. The aim of the pathways is to standardise practice, to provide clarity around roles and responsibilities, and reflect a preventative early intervention and evidence-based approach. As well as providing equity, these pathways should ensure that the right care is provided by the right people and at the right time. 

As Members have highlighted, in April 2021 we opened a mother and baby unit within the Swansea Bay University Health Board area. This marked a really important step forward in providing improved perinatal mental health support for mothers in Wales. This centre is an important part of improving the experience of new mothers, as they will be able to get the specialist support they need for themselves and their babies closer to home. I was able to visit the south Wales MBU, our Uned Gobaith, last year. It was fantastic to meet the hugely committed team, but also to meet some mothers, who spoke really powerfully about the difference having MBU support had made to them.

The Welsh Health Specialised Services Committee have undertaken a review of the south Wales mother and baby unit, where it was agreed to continue to support the service on the current Tonna site, and to keep this under review. Whilst I am really pleased we have this service in south Wales, I recognise that this is too far away to be an appropriate service for women living in north Wales, and I am committed to providing provision closer to home for mothers in north Wales. The modelling undertaken in Wales has evidenced that we do not currently have enough demand to have a standalone unit in north Wales, and that's why we've been working with NHS England in order to develop a joint unit in north-west England that enables access to mothers from north Wales. As such, there continues to be significant engagement between Betsi Cadwaladr University Health Board, the Welsh Health Specialised Services Committee and NHS England regarding the development of this new unit.

The business case was signed off in December 2022 and we're expecting the service to be operational in summer 2024. I recognise that this is some time away, and officials are working with WHSSC to identify any opportunities to accelerate these timescales if possible. We're also working with the provider to support the Welsh language needs of patients when developing the unit. And can I assure you, Siân, that I entirely recognise the importance of being able to communicate—and to Jane as well—through your first language when you are in the situation where you are needing such acute mental health support?

So, establishing this provision for north Wales will be a key priority over these coming months. I hope that this provides some reassurance to Members about the support that is currently available for mothers in north Wales and the progress that has been made on developing provision across Wales. I recognise—

Would you take an intervention?

Yes.

Did you look at the alternative model, which was the one that the committee recommended in the report that you chaired—the alternative model of providing the unit in Wales, and therefore the Welsh language needs would be met and it would obviously be nearer to home for many women, rather than the model that is now on offer, which is going to create a lot of problems around the linguistic needs of mothers and their families? And to be honest, Chester is a really long way from Amlwch.

Well, Siân, when I came into post, the plans for the unit over the border were already in train, with WHSSC having done a piece of analysis to identify the potential levels of need in north Wales. So, it was on that basis that the decision was taken to have the unit just over the border. And I know that Jane made the point about having these readily accessible services, but they are specialist services, so we would never be in a position where we'd have MBUs scattered all over the place in Wales. They're highly specialised, with multidisciplinary teams, and they serve the women who have the most acute problems—so, as Jane said, postpartum psychosis, which is incredibly serious. So, it preceded my time, the analysis of it, but that is my understanding of the work that was undertaken to identify need. And from my point of view, Siân, I want there to be a service now as quickly as we can get it, and scrapping everything that's been done would be a very lengthy process, and I want the women in north Wales to have access to a service as soon as we possibly can.

I recognise that, despite the strong work that has been undertaken by services, there is more to do, and we need to make further progress to ensure that services are of the high standard that mothers in Wales deserve. This includes the work to ensure that mother and baby unit provision meets the needs of mothers in north Wales. I look forward to working together to further develop perinatal mental health services in Wales. Diolch.

I thank the Deputy Minister. And that brings today's proceedings to a close.

The meeting ended at 18:45.