Children, Young People, and Education Committee

Thank you, Chair, and thank you for the opportunity of giving evidence in relation to the health and social care budget. The budget for health and social care in the next financial year will have seen significant increases, which the committee will have seen from the budget documentation and the evidence, and that's in addition to the additional funding that's been made available this year to tackle, in particular, waiting lists, access to services and women's health. The priority for the budget for next year is to make sure that we can put the service in all its facets on a sustainable footing, recognising the increasing demands on the budget and the inflationary impact on the costs of the national health service more generally. A significant element of the new funding is in relation to pay and pensions for the workforce, and that obviously enables the service itself, in general terms, to be more sustainable, but clearly supports children's health in a wide range of other ways as well. There are specific elements in the budget, as I'm sure we'll come on and talk about in more detail, in relation to the childcare offer, in relation to Flying Start, the points that you have mentioned today. We have commitments to the Designed to Smile programme for children in school for their dentistry, which I know many colleagues would have seen at first-hand. So, there are a number of specifics in the budget where children and young people will benefit by virtue of putting children's health on a more sustainable and stable footing as part of that overall approach.

Thank you. Are there any contingency plans that have been put in place for children's healthcare services so that children's healthcare services are not cut and will address an immediate crisis in other areas of the NHS?

You mean the risk of cuts in children's services at the expense of other services?

Yes.

Well, we have a requirement that—. The way the budget works, as colleagues will know, is we delegate funding to NHS health boards and other organisations, and they then discharge that budget, spend that budget, allocate it to reflect population needs, including the needs of children and young people. We expect them to do that having taken a full account of the particular needs of their particular local population. Alongside the budget there is a planning and performance regime, part of a planning framework that I've issued this year, just before Christmas. It has some specific things to say about children's health, which I'm sure the committee, if it hasn't yet had a chance to consider, will be keen to look at, and if a health board is planning on making a material change, then we would expect that to be the subject of a risk assessment, as any change of that sort would require to be made across all disciplines of the health service.

Brilliant, thank you. What independent reviews or audits are in place to assess where the funding for children's healthcare is adequate and being used effectively?

Well, I guess the answer to that is in a sense the same answer. We have the planning framework, which sets out our expectations of the system. This year we've tried to strike the balance between saying there are some absolutely key priorities that the NHS needs to focus on for the next planning period, and I've set out in my letter very specific requirements, as I said, many of them, or some of them, specifically in relation to children and young people. There is then a planning process that flows from that that enables us to evaluate the plans that health boards present to us, and we have an opportunity to challenge that to decide whether we are happy to approve those plans or otherwise, and sometimes they're approved, sometimes they're not. So, there is an iterative process that enables us to satisfy ourselves that the judgments being made in general by health boards are ones that are sound and ones that we can support as a national government.

Okay, thank you. My next question is on unhypothecated funding to health boards. This committee is interested in whether children get their fair share of the significant amount of unhypothecated funding to health boards, and when asked about this by us last year, the Minister then, Eluned Morgan, told us that children and young people are ring-fenced within that planning framework. Subsequently this was corrected by the Minister in writing, and we were told the ring fence was not financial. So, as the new Cabinet Secretary, have you reconsidered ring-fencing a specific portion of the health budget exclusively for children's services?

Well, I think that would be a challenging approach, Chair. The premise of the system that we have in Wales is that the Government sets the policy requirement for the health service, and the outcomes that it expects the health service to deliver, and the health service is held accountable for that through a very comprehensive range of accountability mechanisms, but the principle at the heart of it is that local health boards are in a better position to assess the health needs of their local population than the national Government is. That’s the central premise of how the health service operates in Wales, and so it's challenging, then, to be specific about ring-fencing pots of money for particular purposes. It is true to say that at a very, very high level there are some mechanisms in place—so, mental health is one where there is a floor; it's not a ring fence, it's a floor, effectively—and when we have committed additional funding for particular purposes—. So, the planned care programme, there's a very significant sum of money dedicated specifically to that and it is ring-fenced, but that's at a very high level. What we don't do is systematically ring fence funding for particular groups or demographics within the community. We expect health boards to assess the needs of their local population and, frankly, that can vary in different parts of Wales, and they're better placed to do that.

I should say, just for completeness, there are particular examples of much smaller grants where, clearly, they are for a specific purpose. I mentioned Designed to Smile, for example. That is, effectively, ring-fenced, but at a general level we feel that's not the best approach.

Thank you. Thank you for those comprehensive answers. Do any other Members have questions for the Minister? No. Over to Carolyn Thomas, then, please.

Sorry, I've—

Sorry, sorry, it's Cefin Campbell. Sorry, I wasn't thinking then, sorry.

You caught me on the hop. But I would like to come in, though, just on that point.

Sure.

Okay. Very often, it comes across that Welsh Government is accountable and you get challenged, don't you, in the Senedd regarding funding and why aren't you intervening on this, that and the other.

Yes.

So, that was a really important point that you made that Welsh Government is there setting high-level policies and budgets, but on certain matters the health boards are the delivery body, so it's up to them to make sure that they use that funding in the best way possible. So, that was really, really interesting, the way you described how certain grants and budgets work. So, as a new member to the committee, for the second time, I thought that was really interesting. Thank you.

Could I just supplement my answer there? At the end of the day, what we are absolutely most interested in is the outcomes. So, ring-fencing is about inputs, isn't it, effectively? But what we are all, I'm sure, most interested in is outcomes and we have a very comprehensive range of ways in which we measure whether health boards are meeting their obligations to children, so vaccination programmes, healthy weight initiatives. There's a whole plethora of those and we are able to measure, obviously, outcomes against that and, to some extent, the spend that children and young people can benefit from after the event, if you like.

I should just say as a general approach, Chair, that there's a new clinical lead for child health that has recently been appointed to the national executive, which I think will help us bring a lens to all of these questions that relate to children and young people, even stronger than we do at the moment. We are developing at the moment a quality statement for children's health as well that will bring a number of these things together, and it may be that the committee has an interest in that in due course.

That would be good. Thank you.

Thank you. Thank you for that information. Now over to Cefin Campbell. We haven't had two 'Cs' on the committee before, but now we have. Cefin Campbell.

Diolch yn fawr iawn. Bore da. Dwi'n mynd i ofyn y cwpl o gwestiynau cyntaf yn Gymraeg, os caf i. Un gwahaniaeth barn sylfaenol sydd rhwng barn y pwyllgor yma a barn y Llywodraeth yw eich bod wedi ymrwymo i gynnal asesiad effaith ar eich polisïau ar blant drwy'r Mesur Hawliau Plant a Phobl Ifanc (Cymru) 2011, ond rŷch chi wedi gwrthod, dros gyfnod o 10 mlynedd, i gyhoeddi canlyniadau'r asesiad effaith yna. Mae'r pwyllgor yma a rhanddeiliaid eraill wedi gofyn yn gyson am weld yr asesiad effaith yna. Felly, byddwn i'n licio gwybod pam dŷch chi ddim wedi gwneud yn y gorffennol, ac a fyddech chi'n fodlon ymrwymo i wneud y tro yma ar gyfer y gyllideb nesaf?

Rŷch chi'n iawn i ddweud, pan fo datblygiadau polisi penodol yn digwydd, fod asesiadau effaith hawliau plant yn cymryd lle o ran hynny. O ran proses y gyllideb, mae'r broses yn un sydd yn gydlynol. Mae asesu effaith cyllideb yn rhywbeth rŷn ni'n credu fel Llywodraeth sydd yn fwy synhwyrol, yn fwy ystyrlon wrth edrych ar bob elfen ar y cyd. Felly, ein safbwynt ni yw mai edrych ar asesiad integredig ar draws y gyllideb yn gyffredinol—dyna'r ffordd orau o wneud hyn. Rŷn ni hefyd o'r farn bod hynny'n fwy cyson ag anghenion deddfwriaeth cenedlaethau'r dyfodol, oherwydd mae hynny'n gofyn inni weithredu mewn ffordd sy'n integredig. Felly, dyna'r meddylfryd y tu cefn i'r penderfyniad hwnnw, a gallaf i ddim rhoi sicrwydd i'r Aelod ein bod ni'n bwriadu newid o'r safbwynt hwnnw.

Iawn. Fe wnawn ni nodi hynny. Diolch yn fawr iawn. I symud y ffocws rywfaint bach at y gwariant ar dai a llywodraeth leol, rŷch chi'n cynnig mwy o arian refeniw i awdurdodau lleol, o bosibl, ar gyfer cynyddu gofal cymdeithasol i blant. Allech chi roi efallai ryw amlinelliad i ni o beth y byddech chi'n ei ddisgwyl i awdurdodau lleol ei wneud o ran cynyddu a gwella gwasanaethau i blant?

Wel, fel rŷch chi'n gwybod—ac fe wnaf i ofyn i Dawn Bowden wneud sylw ar hyn—mae cyfrifoldeb polisi yn y portffolio hwn, ac ariannu'n digwydd, ar y cyfan, trwy gyllideb llywodraeth leol. Mae elfennau yn y gyllideb hon hefyd sy'n mynd tuag at ofal plant yn benodol, ac elfennau eraill hefyd. Mae gyda ni fframwaith polisi, er enghraifft, i sicrhau bod plant a phobl ifanc yn aros gyda'u teuluoedd yn hytrach na mynd mewn i ofal, er enghraifft. Ond efallai y gwnaf i ofyn i Dawn ddod mewn ar hynny.

Thank you, Cabinet Secretary. The Cabinet Secretary is absolutely right, of course, the local authority budget is set by the local government main expenditure group, and that includes, primarily, the funding for social care. And it's the local authority's statutory responsibility to deliver social care services for children. However, they do that within the framework that we set as a Welsh Government. So, much of the children's services, children's social care services, of course are governed by legislation. So, they're regulated, they're covered by legislation, whether it's the Social Services and Well-being (Wales) Act 2014, the Children Act 2004, whatever it might be. So, there is a statutory obligation on the authority. What they then have to do is to work within the budget that's allocated, to make sure that they deliver within the terms of the statutory requirements and within the Welsh Government policy around how those services are best delivered within the legislative requirements.

So, as the Cabinet Secretary has already alluded to, we do have currently a significant programme of transformation for how we deliver children's services, and we work very closely with the local authority to ensure that that transformation programme is delivered by them. How they do that, and within their budgetary constraints, is a matter for them, but we've got very clear objectives, which we speak to the local authorities about on a regular basis, and, I have to say, in a very co-operative and collaborative way. And since I've been in post, I've not had discussions with any local authority that says that they don't agree with the direction of travel that we're trying to take in terms of transforming children's services, which is all about preventing children going into care unless that is absolutely necessary. So, yes, the budget is set by local government, but the policy direction is from us, and we work very closely with local authorities to ensure that that policy programme is carried out.

What I'm trying to tease out of you is, by giving them some policy direction, and potentially giving them more money, what exactly are you expecting them to do with that extra funding?

We absolutely expect them to be delivering the policies that we're setting out. So, I'll give you a 'for example'. We're currently taking a piece of significant, quite groundbreaking, legislation through the Senedd, as you know—the Health and Social Care (Wales) Bill on the elimination of profit in children's services. Now, to a large extent, Welsh Government is having to support local authorities to deliver that, and that is what we are doing—we have put additional money in to deliver those very specific objectives.

Okay, that's useful. Thank you. My final question is about the role of the Minister for children. In advance of this session, we asked for an explanation of that role, in terms of monitoring the spending on children outside the health and social care portfolio. So, we are deducing from the response that the Minister holds no specific role in relation to the draft budget, for example in holding other Cabinet members to account in terms of making sure that children get their fair share of funding. Is that correct? Are we reading that in the right way?

Well—. Again, I'll defer to Dawn in a moment, but the role of the children's Minister is to be the voice of children around the Cabinet table, effectively, and that is my experience of the conversations we have at Cabinet. I think of my own former role as Welsh language Minister: I wasn't responsible for every single thing the Government does that touches on the Welsh language, but I did have a role in making sure that all other Cabinet colleagues recognised the centrality of that policy area to their work. I would have regular discussions with them, I'd bring papers to Cabinet to make sure that we were all focused on that. I suppose it's a version of the point I was making earlier: it's about the outcomes rather than the inputs. But I won't put words in Dawn's mouth.

No, no, no, no. But that is absolutely right, and I think it's probably important to say the Rights of Children and Young Persons (Wales) Measure 2011 requires all Ministers, regardless of their portfolio, to have due regard to the United Nations Convention on the Rights of the Child when they're exercising their functions. So, it's not for me to scrutinise other Ministers, or hold them to account for their budgets; they have their own responsibility for that, and through the scrutiny process, they will be scrutinised and held to account for what they do with their budgets. But the Cabinet Secretary is absolutely right: in Cabinet, when any Minister or Cabinet Secretary brings forward proposals that would impact on children or children's rights, then I would contribute to that discussion and to the development of that policy and how it's delivered. I think having a Minister with 'children' in the title gives that focus. It gives a focus that makes sure that all other Ministers are more conscious of the need to take account of a specific element. It's a bit like if it's not said, if it's not spoken, it's kind of ignored. But, clearly, all Cabinet Members know that there is a Minister that has a specific interest and responsibility for ensuring that children's rights are considered by everything that they do.

Ocê. Iawn. Diolch.

Thank you. Could I ask the Cabinet Secretary, please? You mentioned a children's health statement. Is there a time frame for when this will be published? A quality statement.

I'll ask one of my colleagues to—. We might need to write to you about that.

Yes, that's absolutely fine.

It's in development at the moment, certainly, but we might need to let you know separately, if that's okay.

Yes. Fantastic. Thank you. Now questions from Vaughan Gething, please.

Thank you. Bore da, Cadeirydd; bore da, pawb—good to see you all. My questions are directed at the Cabinet Secretary around children's health early intervention and prevention. You touched on this a little earlier about the additional money the overall department has received and the priorities you've set out on waiting times and access. I'm particularly interested in how you're looking to accelerate progress in reducing paediatric waiting times, but in relation to diagnostic and specialist services. First of all, you've talked earlier about inputs, outputs and outcomes. What outcomes do you expect, not just in terms of reducing the waiting times, but what outcomes do you expect in terms of helping to address long-term development delays for children? So, how you've assessed the money you've got, the money you've allocated to the area, what you expect to see happen, how you expect to hold health boards to account, and what that will do in terms of waiting times, but then your expectation of what that will actually deliver for better outcomes for children.

So, I suppose there are two aspects to that. On the waiting lists aspect to it, if you look at the reduction in two-year waits over the last, I think, two years, the cohort in which that has reduced fastest is in paediatrics—children and young people, essentially. That's the kind of age range in which it has reduced more rapidly, and that's because there's been a particular focus on it. But, to your point about how do we make sure that remains the focus and how we are accountable for that, I met very recently, before Christmas, with the new clinical lead in the NHS Wales Executive with responsibility for children's health, and one of the things that I think we do need to do is bring that lens more consistently across all waiting lists, to make sure we understand the different experience of children and young people on those lists from adults, and that is work that she is going to be leading on for us.

For the additional funding that's been put into the system, there are specific targets that we are monitoring on a weekly basis with the health boards, so we can make sure that they are on target, or if not, that we are able to address that. So, there's a very specific monitoring arrangement in relation to that. I suppose one of the areas that has been most focused on—I'll defer to Sarah in a moment, if I may—is on neurodevelopmental assessments, where there has been a specific allocation of funding to all health boards in relation to that. That funding is being allocated on the basis of presented plans rather than a general allocation, and those plans also have very specific outputs in terms of numbers of additional assessments over the time frame. So, there's a very rigorous framework for us to look at that.

And just on your outcomes point, I absolutely recognise that tackling waiting lists is one aspect to it, and I think it's fair to say, in the ND space, what we really need in that space is a transformation of the service, really, and there is a programme under way to deliver that as well. But perhaps, on the detail of that, I can bring Sarah in.

Yes, absolutely. So, to answer about the outcomes, I suppose the outcomes with the waiting lists for neurodivergence is that we want them to come down. But, ultimately, the real outcome is—and you will all know this from the inquiries that you've done—that it's not a diagnosis, it is an assessment, and that assessment means a lot to children, young people and their families. I was talking to the National Autism Society yesterday, and they were saying, 'We've raised so much awareness, but now we have to ride that wave towards understanding and acceptance.' I guess it comes back to the point as well around the money. This is a whole portfolio, and this is a whole Cabinet piece of work, but we do recognise—and that's why that £3 million has been allocated.

Now, this was based, then, on health boards coming back to us with plans on what was actually realistic for them to be able to deliver. So, off that now, it's actually opened up the door for really having those serious conversations, because the assessment that we've got from the NHS executive is that we're going to see, by March 2027, between 41,000 and 61,000 people waiting for these assessments. So, the awareness has led to that need for that assessment. So, the £3 million, then, we will know by the end of March, they're working very hard, and I think there was a lot of enthusiasm, honestly, in the system, to give that real boost, to bring down the longest waiting times. It will benefit the children and young people who have been waiting the longest, and the money then is dependent on the delivery.

So, it'd be useful, given you've mentioned the impact you expect the clinical lead to have, once that work has been done, for the committee to be informed, not just about the work in discursive terms, but what you expect the impact of that work to be. And with the plans to be delivered, it would be useful to know what your expectation actually is. So, not just, 'We expect things to get better', but have you got a measurable impact or expectation? Because, as Sarah Murphy has pointed out, the NHS executive review points out that demand is increasing, so how you expect that the service transformation and the money going into that will actually make a difference, and over what sort of time frame. And if you don't have those figures available now, then when you expect to get them and how you measure that against the budget you're allocating, to understand whether the budget you're allocating meets the need that you understand isn't currently being addressed, and I understand that's why the service transformation work is looking to take place.

Absolutely. So, some of that information is already available and we can certainly provide that, but, to your point about the work of the clinical lead, it's a comparatively recent appointment, so we'd be very keen to keep the committee updated on that work and provide whatever information you find is helpful.

And I'm still interested in how you measure wider outcomes in developmental delays and impacts on children, and how you expect changes in waiting times to make a difference to those wider—. And, again, how you measure them and how you understand them. The difficulty always is, because the health service does so much for so many people, there will always be someone who probably has a poor experience or a story to tell, but to understand the overall picture and how you understand and measure that, and then what you look to do to address the issues that aren't the services that we'd want to see provided. And we don't have that in the budget, but I need to understand how the budget looks to get you to that point, and what you as a Cabinet Secretary expect to see happen.

So, there are two stages to that. We can provide the information about the outcomes we're expecting, and then the separate piece of work, which is a slightly longer piece of work, is the quality statement, and we can keep the committee up to date on developments in that.

And the next point is about the workforce. Because, in most of what we say, you need a workforce to deliver it, and we know there are challenges in the workforce. The Royal College of Paediatrics and Child Health have called for a review of the child health workforce, lots of stakeholders talk about a crisis, but no-one can get around the fact that there's a real challenge. So, to deliver what we've got, how you expect to both keep the staff we have got, how you expect to be able to develop those staff and to introduce new ones, both in training new staff, but also recruiting new staff. So, I'd like to understand how you expect the budget to help you to do that and whether you have any measures or milestones in place, in terms of what you expect to see happen with that workforce and the scale of the workforce to address the scale of the challenge.

Sure. Well, I think, in paediatrics generally, over the last decade, probably, there's been a huge increase, certainly at the consultant level, in terms of paediatrics, and the number of training places has increased consistently over the last four or five years—recognising that. But I absolutely accept the point that you're making, Vaughan, around the need to have a holistic understanding of what the workforce needs are, and that is in, as you've just said yourself, a complex organisation, operating in a changing environment, with new levels of demand coming in, both in ND, but also more broadly. But there is also new technology and the opportunities—. It is unlikely to be like-for-like replacement of posts into the future. Health Education and Improvement Wales are doing a review of the paediatric workforce for us at the moment. We will look to see what that review tells us about changes we need to put in place in the future.

And will that review of the workforce be published and available? I'm sure the committee would be interested, not just to see what they say, but then what the response from you as a Cabinet Secretary is, and how that goes into what you're looking to do, both for training new staff in the future as well as the potential for recruitment.

I'd be very happy to share that with the committee if you'd find that helpful.

Great. And then you mentioned new opportunities and different ways of working. There's a point here about investing in infrastructure and, again, the Royal College of Paediatrics and Child Health have made a specific call for better utilisation of child health data and how child health records can be digitised. It's a long-running challenge for every health Secretary to try and get a better health record, for understandable purposes. I'm trying to understand if you've got a portion of the draft budget that you expect to go into this area, to both improve the infrastructure available, the use of the records we already have and the infrastructure we already have, but in particular whether you're looking at new technology, facilities or research to be used to try to make sure we do get to both high-quality and preventative care in its broader sense for children and young people.

So, the budget contains a number of allocations in relation to digital initiatives. Some of those are broad-based initiatives. The national data resource is a good example of that, and that will support all services, including paediatric services. But there are some projects under way that have a specific relevance to children and young people. So, the Welsh nursing care record has in development a specific module for paediatric in-patient forms in particular. So, there's a mix, really.

I think what has, frankly, been a challenge in the past, as you will know very keenly yourself, is that the lack of availability of capital has been a massive constraint on our ability to make the progress that we want to make in digital. Things are beginning to change in that space, so there will be more capital available next year, but there are still a lot of calls on that, and it is not adequate to meet the level of our ambition in digital, generally.

Sarah leads on digital and I'll ask her to come in in a second, but, on the data point, this is exactly one of the points that I raised with the new clinical lead. Clearly, to understand the impact of waiting times on children or the configuration of services on children, we need to have, I would say, a better way of collecting data specific to children and young people, to identify their particular experience. We discussed specifically how we can bring that lens to the data that we capture. It isn't just about what data we capture—we're pretty good at that—it's about having an intelligent analysis of the data that you've got, so that is also one of the workstreams that the NHS executive is taking forward under her direction. But do you want to come in on digital?

Well, again, I think the committee will be interested in what that work delivers.

Sure.

Because you're right, the NHS collects lots and lots of data, but the use of it and how you expect that to improve outcomes, and again how the budget helps you to do that, would be of real interest in the updates from the clinical lead.

Certainly.

Absolutely. Just to come in as well, just to point out that it is not just out of the Welsh Government budget either. I recently met with Cardiff and Vale, and through the work with the Welsh Local Government Association, which invested money, and the regional partnership board, which invested money, they've now got a really good child-centred link-up between all of the data from community, from education, and that they collect from social services. So, that's giving them a really good picture of that child and their needs. So, I think the committee would be really interested to find out more about that, but also how they funded that—they took responsibility for that. And that gives you a picture then. And as we know, and as you'll know, the link between being in school, between mental health, between attainment—. It's all really linked.

So, I think that that’s been excellent, and that’s the kind of best practice that we’re looking for, but also looking at other ways of funding and it being the responsibility of everybody. And, then, also, just to add on that we have the electronic health record as well, which is moving ahead. And we have an EHR club that is very much leading on this. So, that will also be of huge benefit, because we’ll be joining up all of the data, and having that across the nation.

And I’m interested in how the data then leads to better services, and how the money flows to deliver those, or indeed, a better organisation. I won’t get into how you save money, or whether you just spend money more efficiently—I’m sure Hywel could talk to us about it for a long time. [Laughter.]

But, on additional money, the vaccination programmes have got another £2 million.

Yes.

The draft budget obviously doesn’t tell us what you expect that to deliver, or why the £2 million figure has been chosen. So, could you tell us how those funds have been allocated, why the £2 million figure has been chosen, what particular vaccination programmes, and how children and young people will benefit from those, because, obviously, vaccinations aren’t just for children and young people?

No, indeed. So, the funding is there to do a number of things. It’s obviously to meet the requirements of the national immunisation framework in general terms, and to meet the costs of inflationary pressures in terms of vaccination as well. There are some new changes in the system—either recent changes that require funding next year, or the new changes next year, which have a budgetary implication. So, for example, we’ve just introduced the new RSV vaccination a few weeks ago, which obviously benefits newborn children specifically. That requires funding into next year as well now. And there will be some changes to the vaccination schedule next year as a consequence of Joint Committee on Vaccination and Immunisation advice. We’ll share information about that in due course, but that does have a budgetary implication, which this is intended to address.

What I would say on that particular point is that Public Health Wales, as you will know, do an annual report on vaccination, and I’m very concerned. Uptake, as ever, is good across Wales, but we will all be concerned about the inequities or inequalities that underlie some of that. And, as you would probably expect, unfortunately, the uptake in more disadvantaged communities is not as high as it is in other communities. What I want to see is whether we can use that rescheduling next year to find ways to try and close that gap to some extent, so I’ll be asking PHW to help us with that as well.

One of the things I’m interested in is vaccine take-up, because, overall, you’re right, the level across Wales is good, and, in lots of areas, better than in England, for a number of different reasons. But the inequality that exists—. And every time there is a measles outbreak, which sometimes happens—England have had more, so they’ve lost their measles-free status, which has affected the UK with the World Health Organization—it is largely about people not taking it up in less advantaged communities. So, I’m interested in the money you’ve allocated and how much of that goes to address that, or whether, actually, you’re looking at different ways, that aren’t necessarily about money, to try to improve uptake, because we all understand that vaccines are a hugely effective public health intervention.

So, specifically then, part of that will be to fund the new scheduling, because that has a budgetary cost. And what I’m hoping we’ll be able to achieve is, through that new scheduling, to find ways of using that to increase uptake, really. And I’ve tasked PHW specifically, on the back of the report that they’ve provided, which is annual—I’m sure the committee will see it if it hasn’t already—to help us think about how we can think of new ways to try and close that gap, and to understand what the practical interventions are. They’re not—. There’s a bit of a temptation sometimes to think this is a sort of behavioural challenge. It’s not just behavioural; there are systemic challenges as well. So, I want us to have a fresh look at what we can do, and, again, I’d be very happy to share that with the committee as well.

I think that would be very interesting for the committee, to understand the work that Public Health Wales have done, your response, and your assessment of what’s behavioural and what’s systemic, and, again, how money can and can’t help that, and what else you then expect to see happen, because that will make a difference in outcomes.

Sure.

But the final question from me is about obesity—a really significant challenge for the whole country. I can’t understand from the draft budget whether you’ve allocated money specifically to address childhood obesity, and, again, how much of this is about money, how much of this is about systemic challenges, behavioural challenges, the wider food environment, attitudes to exercise—all these things matter—but to understand how you’ve allocated the money to try to address what is a really significant public health challenge for today, which will make a big difference to the how the health service is able to run and function for a long time to come.

So, I’m interested in what that looks like, and then I may have a follow-up.

Sure. The budget for the healthy weight programme is generally sustained at the same level as it was last year. However, in the many discussions I've had with the team since I've come into this role, the one statistic, the one piece of information and data, that I found most terrifying is that about 27 per cent of five-year-olds in Wales have issues with overweight or obesity. Now, that's a terrifying figure, both for those individuals, but also for our ability as a system to deal with that in the long term and the consequences of that. That's one reality. The other reality is that internationally there is no country in the world that has been able to reverse the growth in obesity. There are two or three countries who have been able to make a material difference in slowing down the growth, and they're countries with particularly healthy food cultures, I would argue.

So, the position is very stark, but the conclusion that I've drawn from that with the team is that where that leads you is that the most urgent work actually needs to be in childhood obesity, because actually that's where you do see international success, and we also see that can change the behaviour of parents as well, indirectly. I also happen to think—this is a personal view—that when we talk about the importance of making sure children are healthy and not obese and not overweight, those messages are better received by the public than the messages Government is able to give in relation to overweight and obesity generally, and I think that provides an opportunity for us to reframe the discussion to some extent. So, whilst the budget overall remains the same, what I think you will see when the plan is published in the spring is more of a focus on childhood obesity and overweight. And, you know, that isn't principally in the behavioural space, is it? As you were saying yourself, that's around, I think, the new opportunity we have in schools with the universal primary free school meals policy, to reconnect healthy food with the life of children, but also the high in fat, salt or sugar advertising work that's already under way.

I would be interested in how you're looking to implement measures in the framework you've got, but also the evaluation of it to understand the impact of those. And the final question from me is just to pick up on what you said about being frightened about the figure on childhood overweight or obesity at the age of five, and to understand how that leads to the budget choice to essentially keep the budget at the same level. So, is it that you don't think the budget is the challenge, and you think there are other interventions, and, if so, I think it would be useful for us to understand what those interventions are, and how you expect them to be effective, and equally over what time frame? Because parents of young children are likely to be much more motivated to do something; I think your broad point is a fair one. But how does that then lead into both the budget allocation and then how you're then setting priorities where the budget isn't necessarily the only thing that can deliver change?

Absolutely. Well, there are two points to that. Firstly, the overall budget is set at the same level, but what you will expect to see is a larger proportion of that being spent on tackling childhood obesity, but I don't think it is just about budget, and it definitely isn't just about the health budget, certainly. Actually, it's about a broader range of interventions across the Government, in truth, so partly in education. You could make the case in planning. I think Wales is the part of the UK with the fastest growing hot fast food presence on the high street. So, there are not behavioural, just structural, choices that can be made. Those are often really difficult to do, but I think that's where some of the solutions are. The active travel budget, for example, will be important in this, won't it? So, I think it's a cross-Government approach. When we publish the new strategy in the spring, we'll obviously have more to say then about metrics and evaluation, and obviously we'll be happy to come and talk to the committee if it finds it helpful.

You're going to want to keep people with you, because part of the challenge is that, for a lot of those interventions, there will be a group of people who will say, 'This is the Government telling me what to do with my life—why on earth should you make these choices about my life, as opposed to supporting me and helping me?'

Absolutely.

And there's a danger, isn't there, that it sounds like lecturing, not helping?

There is a real danger of that, and that's really why I started in the way that I did, talking about the opportunity that I think—. And I hope I'm not being naive or overly optimistic about it, but I do think there is something in the quality of the messaging that authoritative voices, or whoever they are, give in relation to supporting the health of children, which is heard differently from Government messages in particular about, 'Do more exercise', or 'Eat less fatty food.' I think people do hear that very often as preaching. It's really complex. But I think that people hear it differently in the context of children. So, I think that there's an opportunity for us to look at it from that fresh perspective, I hope.

I'll stop there and I'll resist the temptation to give anecdotes about my own life as a parent. [Laughter.]

Can I bring Carolyn Thomas in?

I was just going to say that the Petitions Committee are looking at a petition calling for a ban on smartphones in schools, and we heard that, rather than using the word 'ban', schools have smartphone-free areas or they're a phone-free school, rather than saying that they're banning phones. And we're hearing that children are attending school non-verbal, having too much screen time and are taking information from their mobile phone devices, maybe on health issues as well. I was talking earlier to that lady over there. So, I think that's part of it as well, myself. Sorry, it's not a question, it was just a—[Inaudible.]

If I can come in as well, I also have responsibility for the Food Standards Agency and energy drinks, and so we have recently been able to publish the consultation that we did on energy drinks for under-16s. There's a lot of research there to show that that is having a huge impact on young people, from a physical perspective and obesity, but also hugely for mental health as well. So, that's something that I would like to keep the committee updated on—

Yes, please.

—as we progress that, because I think that that could be very significant. But it comes back to all of the comments that have been made and the comments that you've made, Carolyn Thomas: how do you present that in a way that doesn't feel as if you're lecturing people? It's true.

Can I just make one point, finally? I think the other point, Vaughan, to say, is that I think that, by looking at it from a children's perspective, that helps rebalance the contribution that behaviour change and structural systemic change can make to the challenge. I think that that takes us down a route that says, 'Well, actually, we have to make it easier for people to make the right judgments', rather than be trying to change individual behaviour quite so much.

Thank you. We now have some questions from Joel James, please.

Thank you, Chair, and thanks, everyone, for coming in this morning. If it's okay, I just want to pick up a few questions with the Minister for Mental Health and Well-being, just regarding your responses to some of Vaughan's questions. Did I hear correctly you mention that the waiting lists for neurodivergence could be up to 41,000, 46,000?

Yes. So, currently, as of September 2024, there were 20,770 children on the waiting list. We don't have the more recent data at the moment, as we're going through this period of trying to bring those waiting lists down. But, yes, modelling then, using demand and activity data up to March 2024, it suggests that the number of children and young people waiting for assessment could increase to between 41,000 and 61,000 by March 2027 without further intervention.

You mentioned there then 'without further intervention'. So, what are you looking to do, then, to intervene, if that makes sense, to sustainably manage that figure?

Absolutely. So, obviously, I've already touched on the £3 million—up to £3 million—for the health boards to bring down those longest waiting times, and that was very much in line with the exercise that the First Minister did over the summer, and knowing that this is an absolute priority. But, at the same time, we have done a national accelerated design event, which was really good. It was over a couple of days. It brought together stakeholders, health boards, everybody who has a part to play in this, because we all recognise that this cannot continue and we have to change. So, part of that—. I've had the initial response back, but I will be able to share, then, what's come out from that design event.

You mentioned there, then, that one of the responses that the health boards have done with that extra £3 million is to bring forward plans, really, as to how they're going to look to tackle this. Can you give us an idea of what has been included in those plans, and have there been any other outcomes from that funding? And also, is that funding just a one-off funding, then? Could these health boards expect more in future?

No. To be very clear, the £3 million is one-off funding, and that was because, again, it was part of the overall objective of the Welsh Government to find the areas where we feel that the waiting lists are having the biggest impact and to bring those down across every health board. So, the letters then went out to all of the health boards in early November, and they've had to bring back plans on the likelihood of them meeting the targets that we have set. A lot of this has been bringing in capacity, and it has been bringing in capacity from the private sector as well. But, obviously, that is just not sustainable. I think what’s been really helpful throughout this process has been looking at the health boards and the ones that have the longest waiting lists and really getting into those discussions with them, with my officials, meeting on a weekly basis, about, 'Why is this the case, and what extra do you need to be able to address this going forward?' And some of this will be around the changing of the model—using the work sector that we have currently more effectively. It will also be planning more for the future and it will also be about collaboration across health boards and across Wales.

With that in mind, I know that the Welsh Government have said that they want to do 2,000 additional assessments by March this year. Is that a target that's being met?

At the moment, we are getting the data through; we need to validate it, though. They are meeting with officials on a weekly basis. If it’s okay, Chair, I will bring Albert Heaney in at this point, as he will be the person who will be leading on this.

Thank you very much, Minister. Thank you for the question. You're absolutely right: the health boards have put plans together, working with officials and the NHS executive, as requested by the Minister, and there is confidence that they will deliver an additional 2,000 assessments on the longest waits by the end of March. Importantly, the money is on condition that those are delivered. So, it’s coming the other way around, shall I say, on this occasion. So, it’s not money that’s given out and then they ask—the money is on delivery, which is really important. There’s a lot of confidence around that. That is really helpful for those with the longest waits.

But, really importantly, as the Minister says, the energy—. And I’m really pleased that there is a lot of co-production, there’s lived experience, there’s a real energy around this, because I think there’s recognition from all parts of this that it can’t just be about focusing on assessment—there has to be a focus on the models, the earlier interventions, the different pathways. So, I think we’re really pleased that there was an accelerated design event held towards the end of November; there’s a comprehensive report that’s just landed on that, Minister, which we will be going through, and we have a day set aside in January to analyse and then offer further advice to the Minister on next steps. Thank you; diolch yn fawr.

Thank you. Chair, if that's okay, I was just hoping I could ask a few questions on child and adolescent mental health.

Absolutely, yes.

I know from the budget that £820 million is being ring-fenced now for mental health services. What sort of metrics will you be using to track that progress, and in terms of reducing the waiting times and improving the service and expanding the access?

As you said, the money is set aside for mental health. It has parity with our health budget, which I think is really important. I think it’s really good in this space to go back to when the committee heard evidence last year from my predecessor’s predecessor, who is now the Cabinet Secretary for Education. Lynne Neagle set out that she wanted the waiting times, including child and adolescent mental health services waiting times, to come down—that’s been achieved; a delivery unit review of CAMHS, which we have done; the rolling out of the '111 press 2’ for mental health across Wales, for 24-hour needs—I’ve had the most recent figures saying that 5 per cent of calls that come through are from people who are under 18, so this is something that we would like to improve.

We also have things like the Meic helpline. We also then have the eating disorder services, including the joint commissioning committee scoping of an in-patient unit for eating disorders in Wales, which we now have. And we also have worked to improve the transitions between child and adult mental health services, which we’ve done extensive work on. This came under the recommendations that the committee made—4 and 5—which we have completed. That’s what the funding was that we told you we were going to use last year, and that is what we’ve delivered.

In terms of what we’re going to be doing, going forward, we have, as you know now, the two mental health strategies that will be coming out this year. We are doing them as ‘all ages’ and it will be based on need. But on your specific question about the money—the £820 million, which does sound like a huge amount of money, but it’s spent very well—it comes back to what the Cabinet Secretary said at the beginning, which is that the majority of this is allocated to the health boards, and then they're the ones who decide the services.

You mentioned eating disorders; what impact do you think the £2.2 million will have that's been allocated to the NHS executive's strategic programme for mental health? What sort of impact will that specifically have on tackling issues such as eating disorders?

Joel, my hearing's going a little bit. I can't hear you very well when you're speaking, I'm sorry. Can you speak a little bit louder?

Sorry. Cefin, you were struggling there as well, I think, weren't you?

And I'm sitting next to you. [Laughter.]

I speak quite quietly. And this is on a loop, so when I speak I hear my voice, and I don't really like the way I sound. I'll try and speak a bit louder, then. That question I asked there about the £2.2 million, you heard that okay, though?

Yes, I always put my headphones on.

Good point. I'll put mine on. [Laughter.]

It does really help. I have a wonderful lead on this area on the NHS executive, who I meet with regularly. As you probably understand, I have a particular interest and focus on eating disorder provision. I think that a lot of the work that's being done in that space is on prevention and on the tiers, and where health boards allocate that money. As I've said, we can't instruct necessarily health boards to do that, but we can do quite extensive modelling of where we think the benefit of that money will go. So, that's a huge part of it.

But also, of course, we do give money to Beat, which run the national telephone helpline, so that people can be directed to the services, and I think that going forward, it's more about now doing the scoping to ensure—. As you know, I'm very passionate about people being able to receive care at the earliest opportunity as close to home as possible, and so that is a huge focus of that work, but also the peer-to-peer support, which I think is very prevalent now across all of the health boards.

And I would say as well, in my experience, the money that is now genuinely put into eating disorders and the outcomes that we see as a result have really increased. I think that many people in the mental health space will tell you that they always felt that eating disorder service provision and funding was the poor relation in that space, and that's just not the case any more. I hear that from across the system. That early intervention and that prevention is a huge part of that, and you'll see that as well in the strategies as they come through.

Thank you. Chair, if there's time, I've only got two final questions. You mentioned in answer to one of my previous questions the £820 million ring-fenced for mental health; what percentage of that is for CAMHS? Can you give an idea on that?

And my final question: in the evidence that we've taken, concern has been expressed, especially by the Royal College of Psychiatrists, about a postcode lottery in terms of school mental health services, and I was just wondering what's being done to try and bring consistency to that, to address those concerns.

Absolutely. A postcode lottery is something that I see across my whole portfolio, because obviously, I have neurodiversity, I also have learning disability and I have mental health and dementia. So, these are things that, again, with the NHS executive, I've found very helpful in having those leads on each, so that we can learn the best practice and we can ensure that the needs of the communities and what they want and what's effective is being met. So, that's something that we're doing through the modelling of that. If it's okay, I'm going to bring Alex Slade in here to talk a little bit more about that £820 million, if that's okay.

Thank you, Minister. In terms of the segment we see in the outturn data and the allocations for specific areas, obviously, in terms of the budget, as the Cabinet Secretary described at the outset, we're not specifying how much of the ring fence for mental health is going to CAMHS, but we'll see that as that gets spent through the health board returns.

The Minister mentioned performance in CAMHS in terms of improvements there. In terms of the referral to assessment, we're at 93 per cent, all-Wales position, against the 80 per cent target. It's a really good position in terms of the CAMHS performance, and showing that that money is reaching those individuals and supporting them.

If I can come in and add there as well a little bit on the inreach programme that we have in schools. I work quite closely with the Cabinet Secretary for Education on this; of course, we have quite a lot of crossover. There has been a decision made that that will be brought under the NHS executive as well. So, CAMHS is hugely improving, and that will be something now that in schools will also come under the CAMHS umbrella, as opposed to it being under Public Health Wales and being separate. The funding for that was always within our budget. It was off and came back, so now it will remain with us.

Thank you.

Thank you, Joel. Could I ask the Minister, please—? The mental health strategies were due to be published last year. Is there a timescale of when we can expect to see them?

They will be with us by the end of the financial year. There was a decision made on that, I think, because, as many people will say to me, strategies and plans need to have the funding to go with them. And so, that's something that I've talked a lot about with my officials. I think that what we'll do now, though—. There was an expectation that the suicide and self-harm prevention and the mental health and well-being strategies would come out at the same time, but we are going to separate them out so that they're given their own moment to bring those into the system and to get that feedback.

But, again, to assure you, many of the reports that this committee have done will be absolutely feeding into that. I think it's been quite transformational in Wales, we really do co-produce, and even though that takes time, it's worth it, because this will be a 10-year plan, and it's really important that it feels as though it belongs to the people of Wales.

Thank you. Carolyn.

Earlier, when we talked about neurodiversity and a lot of young people coming forward needing assessments, what support then do we have in place to help families and young people, because of the anxiety, as well, once they have that diagnosis? Albert, you mentioned earlier—did you say that you're working on a programme? I know that in north Wales, there's an organisation called Your Space that helps hundreds of families and young people, but they've got a funding crisis. They're told the rent's trebling and they've got to move, so I'm really worried about them. I think they do get a little bit of funding from the health board, I'm not sure. The council don't. So, I'm just wondering, going forward, about what the plan is to help sustain this, to help with support going forward.

The RPBs do get funding that they use for the waiting well, for the assessments, which I think is really crucial. And also, then, as I said, I work quite closely with the Cabinet Secretary for Education on the additional learning needs and how that all works together. I do think, though, that the assessments are really important, because they really do set out, 'This is where the child and young person excels, these are their skills and this is where they will just need that additional support.' So, a lot of that, then, is brought in through education and through those settings.

And then, also, we do have a wonderful stakeholder, charity and third sector around this as well that offers that support. But I would argue too that we have raised an awful lot of awareness, but this is a whole-society transformation that we also need of that understanding and acceptance. When I met with the National Autistic Society this week, one of the key things we actually touched on was the upcoming Mental Health Bill that will be coming through from the UK Government, because what they would like to do, and which I agree with them on, is that it's another opportunity to set out that when people who are neurodivergent get overwhelmed, that is not an excuse to section them under the Mental Health Act. That is something that I think is going to give us an opportunity, honestly, to talk more about that as we bring that through. I will bring in Albert, though, in case I have missed anything in terms of the additional support that's given after the assessment.

Thank you, Minister. I think you've covered it really well. Probably just a couple of comments from me on the back of the really helpful question. I talked about an accelerated design event—a bit of jargon, that, so apologies. I can understand why there was a supplementary question. Basically, that's an event where professionals, those affected in terms of services, are really looking at how we become assessment focused. So, you're right, until you get the diagnostic, until you get the assessment, all the anxieties are held. What this is about is really looking at what are the models, what are the type of services that we need across all of Wales, earlier, that give confidence to parents and families in relation to their children. That's where we're hoping, then, to analyse that report from the information this January and then to take plans forward. So, it is a range of different types of support services that the Minister, quite rightly, has in place, but, at the moment, we want to make sure we move from—. As you've mentioned today on a number of occasions, we don't want to see a postcode lottery here, we want to see a consistent approach in the way we do business in Wales. Thank you.

Thank you.

Natasha, please.

Thank you so much, Chair. My question is actually for the Minister for Children and Social Care. I'll begin by asking about funding for the full roll-out of the Flying Start childcare, if that's okay with you.

I'd like to know why there isn't a commitment in the draft budget to fund the Wales-wide roll-out of Flying Start childcare to all two-year-olds, given that this was actually a co-operation agreement with Plaid Cymru, and that the draft budget narrative actually states that those obligations would be honoured.

Yes. Well, I think we do have the obligation to roll out the Flying Start programme and before I answer that question in detail, it's probably important to explain what we have done with that, with the additional funding that has been in over the last two years. So, over the last two years, the expansion into phase 2 of Flying Start has seen more than 9,500 additional two-year-olds being taken into Flying Start settings. So, we've moved beyond the original targeted interventions in particular postcode areas to a wider intervention and outreach interventions as well, that deliver those places.

I think it's probably important to say that, although £20 million of additional funding was identified for childcare as part of the budget, the childcare offer, this was about, basically, uplifting the hourly rate from £5 to £6, because we hadn't reviewed that for three years, and what we knew was that the sector was in considerable danger of falling—a number of settings were saying that without an increase in that rate, they wouldn't be able to continue. And, of course, we had to bear in mind that a number of those childcare settings also provide Flying Start. So, it was important that, within that £20 million budget that we allocated for childcare, we gave that uplift in the childcare sector for the childcare offer, but, at the same time, that was also supporting Flying Start.

So, the commitment is absolutely there, it remains there. It is part of our programme for government. We have seen the expansion into phase 2. We have now commissioned all local authorities to present us with their plans for phase 3. We've had all those commissioned plans back from them, and some of them have identified considerable challenges that are not necessarily related to funding; they are about capacity in the sector. And we're seeing this across the whole of the childcare sector, and this is not just unusual in Wales; we've seen, with the childcare offer in England, that the challenges of rolling out that new childcare offer in England are primarily about how you find the childcare workers to deliver the expansion. So, the £20 million absolutely does include support for Flying Start, as well as nursery education.

Okay. Thank you for that. I'll stay on the same theme. So, for the full Flying Start programme as well as child poverty now, we're all aware on this committee, and I think beyond, that children are more likely to be living in poverty than any other age group. We are aware that 28 per cent of children in Wales are living in poverty and are being hit the hardest by the cost-of-living crisis that people have experienced. Why have you decided to fund the expansion of the childcare offer, which is targeted at working parents, rather than the full Flying Start programme targeted at children in the most deprived areas, because there are many of them across Wales?

Yes. Well, to a degree, I think I've just answered that in the previous question, so maybe I was anticipating where you were going with this. But, to be clear, we haven't expanded the childcare offer; what we have done is we've uprated the hourly rate and we've had to put that into the system to protect the system—that was the point I was making previously. The hourly rate in Wales for childcare settings was £5 an hour; we've uprated that by 20 per cent to £6 an hour, so that it's now on par with a vast majority and actually better than a vast majority of childcare settings in England, in fact. So, it was not about expanding the childcare offer, it was about sustaining it, and as I said, the importance of that is not only the importance of having affordable childcare for working families and parents who are in training and education, which, of course, is not available in England, but it is also to sustain those childcare settings that provide Flying Start places as well.

Okay. My final question is about access to childcare for disabled children. I'd like to know in what way, if any, have you used allocations in this draft budget to address the wide-ranging concerns about childcare, as set out in the report previously.

So, within the budget—. I’ll start by saying that we do, actually, acknowledge that childcare places for children with disabilities is a challenge, and we noticed that from the report that you did and we responded to that. So, what we have to do, in terms of the delivery of childcare places, is that we work very closely with local authorities, who have got the responsibility for doing their children’s assessments, their assessments for childcare places. Within those, they need to take account of the delivery of, or the provision of, support in childcare settings for children with disabilities. So, we would expect local authorities to take that into account when they are producing that assessment. In response to the childcare assessments and the work on the previous report that this committee has undertaken, we would be looking primarily for local authorities to identify the sufficiency that they have in the system, what they need within the system, how many particular places they would need for children with disabilities, and we fund that within part of the childcare programme and, of course, the local government funding through the rates support grant.

It's really about ensuring that the childcare offer is sustainable in the sector generally, and that the local authorities can provide in the systems that they have in place, that they can provide adequate places for children with disabilities. But it is very much, as I say, a question for local authorities to deliver that sufficiency assessment and make the provision within their settings.

Thank you, Chair.

Thank you. I have supplementary questions, please, from Joel, to begin with.

Yes, sure.

Thank you, Chair. I don’t know who might be best to answer this, and I know Natasha raised some good questions there about Flying Start, and it got me thinking. So, with the initiatives like Flying Start, Families First and Nest, what is being done to make sure that there is no overlapping of the services provided and that there’s sort of consistent and comprehensive support for families?

I think that’s a very good question, actually. The Families First programme and the new online family support programme, Teulu Cymru, is aimed at doing just that. So, Teulu Cymru is a new online service for all families to access to find out where is the most appropriate place to go for the most appropriate support that they need. So, if any particular family is saying, ‘What is available for me in terms of childcare, Flying Start or any kind of assistance with education or provision of school uniform?'—anything that may be available through Welsh Government funding to support families—people can be directed absolutely to the right place through Teulu Cymru. So, that’s the kind of all-encompassing family support online network, and they will feed into Families First and all the other support mechanisms that we have. But it’s about ensuring that those families go to the most appropriate place and are pointed in that direction.

Thank you.

Thank you. Can I bring Cefin in here then, please?

If I can go back to Flying Start as well, you mentioned that the uprating to £6 an hour was necessary, and I agree and that is to be welcomed. So, in the overall picture, given the commitment to rolling out childcare to all two-year-olds through the Flying Start programme, are you saying that by uprating that we will not be able to achieve that aim?

No, not at all. The aim is still there, the objective is still there, it is still a programme for government commitment. It was part of the co-operation agreement, as you know, and we’re still committed to that. We’ve made very clear that we’re committed to continue delivering all of those areas that were part of the co-operation agreement. What I’m saying is that the—. And that will be delivered through our normal funding process, because this is—. We’re talking about additional money; the £20 million was additional. That doesn’t mean to say that there isn’t money still in the system to be delivering Flying Start. The £20 million was additional, over and above what we would be having in the budget in any event.

Okay. Right, okay.

Thank you.

[Inaudible.]—Flying Start under the childcare inquiry we did on another committee, and they asked, because of the inflationary pressures, the difficulty of delivering it then and getting enough staff, et cetera, they asked if you could just concentrate on ensuring that the Flying Start areas were sustainable before extending the roll-out. The increase in the hourly rate is really welcome. Did you say in the budget that you’re going to look at increasing it on an annual basis, or review it on an annual basis?

Yes.

Because that’s really important for all these settings and for local government and everybody to know that, going forward with their planning.

Yes. I did a written statement on this a few weeks ago, when I announced the uplift in the hourly rate. Within that statement, I committed to an annual review of rates. Previously, it had been every three years, which is why things had fallen behind to the extent that they had, and the sector was saying—. I mean, it was a difficult three-year period, wasn’t it? Because in the middle of that three-year period we had horrendous inflation, which we hadn’t seen in previous years. In previous years, three-year reviews were probably okay, but, in light of that experience, the 20 per cent uplift, we feel, did cover the losses that the sector felt through that high inflation rate. And committing to an annual review means that we can now judge what the appropriate rate is based on and what the cost-of-living increases might be in any given year, rather than having to wait three years.

Great, thank you.

Thank you. Just finally from me, the Bevan Foundation has estimated that, without the final roll-out, 40 per cent of two-year-olds won’t access childcare. Do you agree with that assessment?

Absolutely. We know that we've got an awful lot of children that are still not covered by Flying Start. Flying Start is very different from a standard childcare offer. I think it's important to note that. We have two aspects of our childcare offer, don't we? We have Flying Start and we have the universal childcare offer for three and four-year-olds, and they are different. One kind of follows the other. Our objective absolutely is that every two-year-old in Wales will be able to access a Flying Start setting in phase 3 of the roll-out. And as I've said, we have already commissioned local authorities to plan for that phase 3 roll-out, and we have had their plans back. As I explained in the answer to Natasha Asghar earlier, there will be financial challenges within all of that, and we can only ensure that we deliver when we know that we’ve actually got a budget to deliver it. But we are planning for it, and the local authorities are in the process of preparing for that eventuality. The biggest challenge that we have, probably a bigger challenge than finance, as I’ve said to Natasha, is actually getting people in the system. The shortage of childcare workers and Flying Start workers is something that is the biggest challenge in delivering the roll-out.

Okay, thank you. Before we move on, I’d like to welcome the young people that have just joined us in the viewing gallery. You’re very welcome. Lastly, we have some questions from Cefin Campbell, please. Sorry, I’ve done it again—it’s Carolyn. We’re going to have to put big name badges on you. [Laughter.]

I'm changing my name to Kaz with a 'K'. [Laughter.]

You'll have to change your names. [Laughter.]

Could I ask about assurance for long-term grant funding? The National Adoption Service and Foster Wales were given grant funding for three years, and that comes to an end. The WLGA have also expressed concerns. When they employ people to do these projects, then they’re very concerned, aren’t they? If it’s the end of the three-year period, or if it’s a rolling one-year programme, it’s really difficult for them. So, if you could give me some information on that.

On the National Adoption Service and Foster Wales, there’s a very specific pot of money that’s available to them. We’re absolutely committed to supporting foster services in local authorities. They’re an integral part of our transformation of children’s services programme. When we look at what we’re trying to do with the elimination of profit from children’s services, moving children away from residential care, having fewer children taken into care, the role of foster services is absolutely critical to that. So, there is no doubt from our point of view, from the Welsh Government’s point of view, that we will be continuing to support Foster Wales and our adoption services.

What we did in 2019 is we provided a core level of funding, which was £2.3 per annum. That was to help develop that tailored care that is needed around adoption services and the needs of adopted families, which is quite different. And the funding that ADSS and the WLGA are talking about was not this core funding. They were talking about additional funding that was provided over and above that for specific periods to deliver particular activities, and, in respect of Foster Wales, what that was was an additional £4.3 million over four years to provide further support, to focus on the key priority areas. And then from April 2022 to 2025, there was an additional investment of £1.6 million to the National Adoption Service to deliver its time-bound three-year plan. So, that was what they were talking about, and that was the 'Adopt Cymru 2025 and Beyond', which focused on the modernisation of the adoption agenda in Wales, and that was a time-bound programme. But, as I said, I completely recognise the key role that the adoption service and Foster Wales play in delivering our vision for children's services, and I'm absolutely committed to sustaining that funding going forward.

Okay. Thank you. Regarding placement costs and NI contributions, I know it's not Welsh Government's decision, but it's having an impact in relation to third sector foster and residential care providers. They're projecting a £38 million overspend. So, really, your view on that, going forward.

Yes, and you're absolutely right, Carolyn, that, of course, national insurance is not devolved. It was not a decision taken by the Welsh Government, but the UK Government has confirmed that it's going to provide funding to public sector employers to cover the cost of national insurance. I met yesterday, actually, with the Cabinet Secretary, with Mario Kreft, who's the chief executive of Care Forum Wales, and he, as you would expect, raised this issue with us. This isn't an issue that is specific to the social care sector; this is a wider issue that we're having to look at across all providers that the Welsh Government is responsible for supporting. Perhaps I'll ask Hywel Jones from finance to talk about how we're responding to that as a Government, across the whole Government, really.

Yes. Thanks, Minister. I'll just supplement that point to expand. So, obviously, UK Government have confirmed that Welsh Government will receive additional funding for those that meet the definition of a public sector employer. I'm aware the Cabinet Secretary for finance has written with an initial assessment to the Finance Committee of what those additional costs would be to devolved public sector employers, which is around £253 million. We absolutely recognise, as the Minister has said, the challenge this presents to partner organisations.

Our assessment for other areas outside of public sector employers across multiple partners, as the Minister described, given it impacts third sector grant funded bodies, packages of care, is much more complex. So, we do not have a total assessment of that potential impact across that range of providers at this stage of the planning process, but I know, through mechanisms, the Cabinet Secretary for finance and Treasury colleagues continue to be in active dialogue with the Treasury on the approach here.

I think the WLGA have been able to present some figures, haven't they, from third party organisations that they use as well, and purchasing, from the care provision, so, hopefully, that will help with your call for ask to UK Government as well going forward. You're just looking at me; I just think, if we've got this benchmark figure to go to UK Government to say, 'This is the impact', it might help with those conversations.

We do have an initial estimate of the insurance costs for the devolved public sector employees in Wales. We think it's about £253 million. That was what Hywel just said. But, beyond that, how all of that is going to be dealt with is going to be very much down to what we get from UK Government when that decision is made.

And that's predicted to be June time, isn't it?

Is it in June? I don't know.

It was originally.

Before that—. Before the spring statement, I think, yes.

Okay.

Did you also raise—? You were raising the question about three-year funding, was that specifically in relation to the ADSS and WLGA?

It was, which you responded to earlier, thank you very much, yes.

So, voluntary sector funding, I mentioned earlier an example with Your Space, and we have a lot of volunteers as well. So, the sustainable social services grant scheme allocates £3 million in 2025-26 for grants relevant to children and young people, and £9.7 million in care-experienced children change funds. Again, one-year commitments there for those, so, again, any assurances to the voluntary sector?

I mean, there are a number of grants—. You're quite right, Carolyn; there are a number of grants that are that are allocated on an annual basis, but we do we do also allocate a significant number of grants on a three-year basis, particularly through the sustainable social services grant. Actually, the last phase, the second phase of the sustainable social services grant, has run from April 2020 to April 2025. So there are a number of organisations that have been in continuous receipt of those grants for five years, and what we've what I've just done is extend the allocation of that funding, so all of those organisations that are in receipt of the sustainable social services grant under the second phase have had that extended to April 2026 while we look at a more simplified, streamlined grant process that will come into play from 2026 onwards. I was particularly concerned and keen that we should do that for a number of reasons; not least of all is that what I saw in terms of the allocation of the sustainable social services grants was that we were we were issuing those grants to organisations doing absolutely amazing work in lots of areas across Wales, and delivering in large part programme for government commitments on behalf of Welsh Government, but they were quite often in pockets. They were quite often incredible schemes that we saw in a particular part of Wales, and that was because there was a particular organisation in that area that had the capacity or the vision or the wherewithal to be able to do it.

As a Minister trying to deliver these programme for government commitments across the whole of Wales, I found that a huge frustration, that we just saw these real good pockets of practice that weren't rolled out across the country. So, what I'd like to see is, going forward, that we have our sustainable social services grants being funded to deliver that kind of high-quality provision right the way across Wales, and we'll be looking at organisations that are best placed, then, to be able to deliver things not just in pockets, but across the country. Now, it may not be the same organisation, it could be lots of different organisations, but if we're going to say that we want something delivered—this is important; this is a programme for government commitment—we can't just be having them delivered in parts of Wales and not across the whole country. So that's why I'm looking to change the way in which the social services grant will be delivered going forward.

I know social services departments in local authorities in north Wales would welcome that, in a way—that partnership working, learning best practice—if Welsh Government could help facilitate that a little bit more.

No, that's absolutely right, and we've had conversations with the third sector around all of this, and it is something I think they would welcome. I had a meeting with them relatively recently where we talked about just what I'm saying now, the pockets of excellence, and it can't be what we talked about earlier on—postcode lotteries. We can't have postcode lotteries for pockets of excellence. If we've got excellent projects that are delivering what we want to be delivered, we've got to see that rolled out across the whole of the country.

And local authorities, 10 years of cuts—a lot of the services they may have provided in the past, each year they've had to look at maybe not providing. So, volunteers and charities, third sector, have had to step in.

They've filled the gap, yes.

And that's what's happened, so that's the model we have now, very often. So that's why we need to sustain them going forward, to help them and to grow, like you say, share that best practice.

Yes, and I think it is a real challenge, isn't it, at a Government level, and it’s the kind of conversations that are taking place with the UK Government. Our budgets are set on an annual basis, so it's very, very difficult. As a Welsh Government we know what our budget is going to be this year; we don't necessarily know what it's going to be next year. So, it's very difficult to plan three or four years ahead when you only know what you're getting from year to year. So, we understand how that feels, and we absolutely understand how that is from the third sector perspective. It's something that we're very much in tune with, and hope that we can develop a new kind of system that will help in that area.

After 12 years of being a county councillor, moving here, it felt like this was a big council, in a way, because you rely on funding from UK Government as well. Does Welsh Government itself have sufficient staffing capacity to support its own policy ambitions in terms of children's social care, going back to that you rely on the UK Government for funding as well, and me saying it feels like it's a big council? There would be different budgets, but it's difficult.

It's one of these quirks of Welsh Government, Carolyn, that Ministers actually have no say in the staffing issues around departments; that is within the purview of the Permanent Secretary. What I can say is I have an amazing team that work with me in children and social care, and they do fantastic work. They go above and beyond the call of duty quite often. So, from a ministerial point of view, of course I would love to see more officials in my team, but that is absolutely a matter for the Permanent Secretary.

And I echo that as well—[Inaudible.]

And Jeremy does.

Certainly, Chair. [Laughter.]

Thank you. Those were my questions.

I'd like to thank the Cabinet Secretary and Ministers for joining us this morning. We really appreciate your time and that of your officials as well. Thank you very much.

Diolch yn fawr.

Thank you very much.