Health and Social Care Committee

Thanks, Chair. Good morning, everyone. Lynne Neagle, Deputy Minister for Mental Health and Well-being.

Thank you. And Julie Morgan.

Julie Morgan, Deputy Minister for Social Services.

Lovely. And I'll ask the officials to introduce themselves.

Bore da. Good morning. I'm Ed Wilson. I'm the deputy director for public health improvement.

Bore da. Good morning. I'm Tracey Breheny, deputy director for mental health, substance misuse and vulnerable groups, Welsh Government.

Good morning, I'm Julie Annetts, I'm head of neurodiversity at the Welsh Government.

Thank you, all, ever so much for being with us this morning. Perhaps I can ask the Ministers: what's needed to create good mental health?

I think there are a range of things needed to create good mental health. I know that the committee has taken lots of evidence around the importance of relationships and relational approaches to good mental health, and I personally think that that's very, very important. I've done attachment and trauma training myself; I've seen the impact that building strong relationships can have on mental health. But it's also obviously very important that people's wider needs are met. People need to feel safe, they need to have food, they need to be warm, and if people don't feel safe, then they aren't going to have the prerequisites for good mental well-being.

So, that's why, as a Government, we have taken a cross-government approach to mental health, and if you look at our 'Together for Mental Health' strategy, you can see that it's very much not just about services, it's about all of the factors that can impact on mental health, whether that be our support to keep people in employment because of the importance of employment, not just from an income point of view, but from the point of view of having protective factors and connecting people, good housing, income maximisation, support for debt, as well as all the services that we need. So it's a very holistic approach and we've been working across Government to try and tackle those challenges. And I think that that's evidenced by the very significant extra investment we were able to secure for mental health this year, and for the following two years: £50 million this year rising to £90 million in two years' time.

Thank you, Minister. Do you think that, to date, the Government has got the right balance in terms of preventing mental health conditions, and also treating those with, perhaps, mental health problems as well?

It is, as you say, a balance, and I'm very conscious of that. I've talked a lot since coming into post about the need for prevention and for early intervention, but I've also been very clear that we have to meet people's immediate needs as well. We can't just wait for all the factors that would improve people's mental health to be in place; we have to deal with the here and now, as we have it. And I think we are making really good progress. If you look at the relational side of things, we have our whole-school approach, and if you look at our whole-school approach, you will see that that is not a medical model, it is based on ensuring that young people have access to safe, trusting relationships. Our NEST framework, which is our early help and enhanced support mechanism for Wales, is also very much based on the power of strong, trusting relationships for children and young people. I'm sure that Julie will talk about 'Connected Communities', but that's also a recognition that people need to be connected in a human way for their mental health to prosper. And I think it is about striking that balance.

There's obviously more that we can do, and we are reviewing our 'Together for Mental Health' programme, and we are very keen to look at what more we can do, going forward, to improve mental well-being, but obviously at the same time making sure that we meet people's needs in the here and now as well.

It sounds like you're saying that you're striving to get to that right balance; you perhaps don't think that you're quite there yet, but that's what you're striving to get to—is that fair?

I think it's always a challenge, isn't it, with finding the right balance, especially when we've been through a massive public health crisis, and we're now in a cost-of-living crisis where people are going to be struggling to survive, and we will have to respond to that. But I think we are making really good progress. We have had an evaluation of our 'Together for Mental Health' programme; that has been presented to Welsh Government and we're considering that now. We will look at that, as well as consulting with stakeholders to go forward to see what we can do to make sure that we continue to maintain that balance in the most optimum way.

Thank you, Minister. Ken Skates.

Thanks, Chair. Thank you, Minister, it's good to see you this morning. I'm just going to ask about the hierarchy of human needs. Minister, you've already mentioned that the Government has a responsibility to meet various needs in order for people to enjoy good mental health. Maslow, of course, famously produced a hierarchy of needs. Is there any sort of framework that guides ministerial decisions across all portfolios in terms of policy when decisions are made, whether they are actually made in a way that meets that hierarchy or any hierarchy of needs that the Government might have produced? And, do you think that Welsh Government has a particular role in meeting certain needs, and perhaps other Governments have a role in meeting different needs, for example the need to feel secure in employment or the need to feel that you've got those basic resources to hand, like heat and food? To what extent does Welsh Government have a role in meeting those needs?

Thank you very much, Ken. I think that you're right to point to the importance of the hierarchy of needs. Obviously, I'm not a clinician, but I'm very well aware of the importance of people having their basic needs met and feeling safe in order for their mental health to prosper. And if people are living in a constant situation of having to survive, constantly in fight-or-flight mode, then people's mental health is not going to prosper. I think we are very mindful of that as a Government, and I've given some examples of that already: the whole-school approach is based upon safe, trusted relationships, our NEST framework, and we are increasingly driving cross-government work in mental health.

So, for the budget process this year, which led to that huge increase in funding for mental health, we had a series of cross-government discussions—at Cabinet level, at official level, and, specifically, with the finance Minister. And all departments were asked to consider the mental health impact of their policies. So, we are making good progress there, but there is more to be done. I think it is very important, though, to highlight that, as hard as the Welsh Government is working to meet people's needs, to keep them safe and comfortable, a lot of the levers for that lie with the UK Government. And I think that it is really important that the committee considers to what extent the UK Government are contributing to meeting people's hierarchy of needs as well. Because it can't just be the Welsh Government—this has to also focus on what the UK Government are doing, in terms of the macroeconomic factors and basic things like making sure that people can eat, heat and survive.

Thank you, Minister. There may well be a role for a research institution in examining the effectiveness of Governments in meeting those needs. Just out of interest, do ministerial submissions now contain any requirement to assess decisions or proposals to Ministers against the need to improve mental health? For example, submissions do include a requirement to consider the Welsh language, I think equalities as well, I think possibly environmental impact. Might it be helpful, do you think, if submissions to Ministers across all portfolios required assessment and consideration of mental health impacts?

Thank you, Ken. As you highlight, there are already well-developed processes to identify the impact of policy, such as child rights impact assessments, equality impact assessments, et cetera. There's not currently a formal mechanism in place for a sort of mental-health-in-all-policies approach, but I think we are increasingly seeing that happening on the ground through the progress that we're making with cross-government working. And it's something that I'd be very keen to pick up as we look at our successor to 'Together for Mental Health'.

Thank you, Minister. Just one more quick question from myself, and it regards trauma and the new trauma-informed framework for Wales. How big a cultural shift do you think is going to be required in order for the aims of the framework to be met? And when I talk about a cultural shift, I mean across all organisations in Wales. And how are you intending to measure success?

Thank you. Well, I'm hugely enthusiastic about our new trauma-informed framework for Wales. I was very pleased, with the Deputy Minister Julie Morgan, to speak at the launch of the strategy. It's a huge milestone in our journey to becoming a trauma-informed Wales. But as you highlight, it is a big cultural shift, and we're seeing lots of progress on the ground, with organisations working in a more trauma-informed way, but, clearly, there is a lot more that we can do, because we want that to be a coherent, consistent approach across Wales. It is incredibly important for people's mental health that services operate in a trauma-informed way, and it's also vitally important because we want to avoid re-traumatising people who come into contact with services. So the work is absolutely vital, and I know that the framework is also a really important part of the Government's new adverse childhood experiences plan.

Just to say that, in terms of implementation, I recognise—and I said this at the launch—that any policy is only as good as its implementation. So, implementation is absolutely key. And Welsh Government are currently working with Traumatic Stress Wales and the ACE support hub, who did such a brilliant job on developing the framework, to develop an implementation plan for Wales, and that's going to consider what further work is needed to roll out the framework, how we measure success. And that's bringing together all the officials across Government who have an interest in their services operating in a trauma-informed way. And officials are meeting this week, aren't they, to look at that, and the focus will be on plans for the implementation process, which the ACEs hub and Traumatic Stress Wales are going to lead. Vitally, they're going to lead it in the very co-productive way that they developed the framework in the first place, which is very important, and they're going to have an expert reference group, which includes those with lived experience of trauma. And just to add that, as well as, obviously, the drive for implementation, we've allocated some £300,000 to support the implementation of the framework and the ACEs plan, but both the Deputy Minister and I are really committed to this agenda.

Thank you, Deputy Minister. In a moment, I'll bring in Julie Morgan, but, Joyce, did you have a question you wanted to come in on?

One question, and I'm really pleased with everything that you've said. But one area of trauma for young people particularly is domestic abuse and the experience of domestic abuse. And, of course, linking up education, with the new curriculum, I just want to ask, really: is there a consideration, a joined-up thinking between you and the mental health of the young people, who will disclose in schools, their experience, because they'll have an opportunity, so that that is seen also as a trauma in people's lives? That might be an ongoing situation that they are going to have to live with, but that they will really need help with, to continue into a successful life.

My question is kind of linked to that, so if it's all right, if I ask my question and perhaps bring in Julie Morgan as well. But, you know, what Joyce has touched on there, we heard a lot of that in terms of our evidence sessions, and in our informal engagement as well, about the importance of early intervention, but particularly for those who may be neurodivergent as well, and I think the whole conversation is around getting in as early as possible into schools, so there's that balance on prevention there at that very early age. I'm just wondering and it's probably useful to bring in Julie Morgan at this point, and, Julie, if you wanted to comment on any of the other earlier comments that were made, or questions as well, then please do. Julie.

Thank you very much, Chair. Yes, I certainly support all the things that the Deputy Minister has said. I do believe that we are working in a holistic way, doing our best to take a holistic approach right across Government, and I think it's absolutely crucial, looking at mental health, that we do this, because every area is involved. And I, for example, have done a lot of work with the ACE hub and am working very closely with the Deputy Minister to ensure that the trauma-informed training is rolled out. And I recently visited an establishment where every person in that establishment had recently had training, and they said that it had really transformed the way that they looked at things, and I'm very confident that, as this is rolled out, it will make a significant difference.

But then, to go on to the point about early intervention and trying to work with neurodevelopmental services to reach children in particular at an earlier age, when I took on the brief for neurodivergence, I met with groups of carers and parents, who in particular were involved with children who had Tourette's and children who had ADHD, and I've had a lot of meetings with parents, and I have been so struck by the fact that it is support that they need. We need to get in very early. I think there's a real danger that parents and families are waiting for diagnoses and, in the meantime, there's this huge stress that is occurring. In the meetings that we had, that was one of the overwhelming points that came over, that these families are so much in need of support. So, in terms of neurodiversity, we have completed a demand and capacity review of neurodevelopmental services, which also highlights the need for early help and support for families, and we've surveyed families. And again, the overwhelming response was that early help is needed and, of course, early intervention is absolutely crucial.

So, we do have a programme, a new programme, to develop neurodevelopmental services over the next three years, and we've put £12 million in. So, I think that's very important, that we've shown our commitment to developing these services. We're developing work streams, and the first and the most urgent work stream is to provide cross-cutting early help and support for parents and families. Crucially, these services will be co-designed with families because we are taking the whole-system approach, and any additional support provided will ensure the schools do have a central role in delivering this support. And, it so happens that I've established a neurodevelopmental services ministerial advisory group to provide expert advice on the development of the programme, and the first meeting is actually this week, on 29 September, and, again, that is jointly led by people with lived experience. So, we're at a very important point in the development of neurodevelopmental services, where we've got the money in, we've got the people there to work and to help, and early intervention is one of the first things that we'll be tackling.

Don't feel you have to, but did you want to come in on anything that Joyce or I said?

I just wanted to add that although obviously neurodiversity services sit with Julie now, we continue to work very closely together. I am acutely aware, from the work that I did on the 'Mind over matter' inquiry, that lots of the kids that we described as 'missing-middle kids' are kids who are awaiting assessment for neurodiversity, et cetera. So, it is absolutely crucial that that support is put in place without a diagnosis being necessary, and that is exactly what our whole-school approach and our nurturing, empowering, safe and trusted framework is designed to do. We've got a new co-ordinator now in Government to drive the NEST framework, and that co-ordinator is working to both myself and Julie and to our two sets of officials. So, we're working across Government on that.

I just wanted to respond briefly to Joyce's point, and I know, Joyce, that this is an area that you're passionate about and campaign all the time on. Just to assure you that there have been cross-Government discussions about the framework, which I know you've been involved in, to make sure that children are covered by that framework. Things like our whole-school approach, and, vitally, our reforms to relationships and sexuality education, which are based on encouraging respectful, strong relationships, will, I think, give that focus to enable young people to come forward to share any experiences they've had and to address those.

Thank you, Lynne. Perhaps to Julie Morgan: in regard to the programme that you talked about, is there scope, do you think, to enable more neurodivergent people to access training, so that they themselves can contribute to providing early support to children?

With all the programme that we're developing, all the work streams that we've got, all of those work streams will include people with lived experience so that we do have that valuable insight into the development of services. I think, as I said earlier, we will develop early help and support services co-productively with neurodivergent people, to ensure that lived experience informs services, so that they are there in everything that we do develop. Our national autism team has developed a large range of resources for neurodivergent people and for practitioners, and they're regularly reviewed and updated, working in partnership with neurodivergent people. So, we have got the tools there for neurodivergent people and we're making a real, determined effort to make sure that they're completely a part of this planning. I'm really looking forward to this advisory group when we'll be starting on the journey to discuss this later on this week.

Good to hear. I know that that was a very specific question and some of the stakeholders in our engagement sessions were keen that that question was asked. Sarah, did you indicate that you wanted to come in at all? No. That's fine. Joyce Watson.

I want to talk about how mental health is made in the communities. You've already started that conversation. We've got the Welsh Government's 2020 'Connected Communities' strategy. We're interested in knowing how the commitments in that strategy will move forward in terms of providing funding, particularly through the loneliness and social isolation fund, because ultimately they could be the most vulnerable set of people and produce mental health inequalities, and exactly what outcomes are being looked at when you’re assessing that particular strategy.

I think—. Julie.

Julie Morgan.

Thank you, Joyce. 'Connected Communities' is our strategy for tackling loneliness and isolation, and it’s an important step to build stronger social connections in Wales because we do know that loneliness and isolation do have a huge detrimental effect on people’s mental health. So, we’re implementing the strategy and we've done this working very closely with external stakeholders, such as Mind, Public Health Wales, Samaritans Cymru, and we’ve got an advisory group that is advising us on how we do it. That’s to quality assure the implementation of the strategy’s 80-plus commitments, and to consider what more can be done, because obviously it’s a huge agenda and what we’re trying to do is to tackle it, but we’re aware that we can’t influence the whole—. Tackling loneliness and isolation is a such huge agenda that we can, really, only make steps in it.

So, a key commitment is the three-year 'Connected Communities' loneliness and isolation fund. So, this is a £1.5 million fund, and I was very keen that this fund should go to grass-roots groups—front-line, local, grass-roots organisations—so that individuals would be able to have those immediate connections, and the sorts of organisations that bring people of all ages together, helping them to make social connections across communities. We will actually be evaluating that and reporting on the progress of the strategy, about how it's benefited communities. We will be doing that later this year, so certainly the committee will be able to see how people have benefited from it. Our strategy certainly recognises that anybody can experience loneliness and isolation at any age, but we know that at certain points in your life you are more at risk of being lonely and isolated, and there are certainly groups who are more at risk. So, we bear that in mind in terms—. And when we evaluate and report about how it’s getting on, we will be looking at those particular groups as well.

Thank you. I took part in a conversation with Solva Care, who are doing all the work that you’ve just mentioned. And, of course, the impact of it is keeping people out of acute services, keeping people out of hospital and helping people to come back from hospital, and reducing the anxiety about the situations they're in. But one of the key questions or points that have been raised in all the evidence that we've received is the need for longer term, sustainable funding, which, in turn, keeps the people who are employed in providing that care and the service user knowing that it's there without creating another area of anxiety for everybody, and too much time being spent, actually, on trying to find money rather than providing services. So, I'd be interested to know what plans Welsh Government has to address that cycle of short-term funding and anxiety.

Yes, thank you for that, Joyce. This issue about short-term funding is a major issue, because local voluntary bodies often, as you say, have to spend all their time trying to raise funds instead of being able to be free to do the work that they want to do, and Welsh Government has recognised this and is aware that we do need longer term funding, so we do now have three-year funding. The sorts of grants that I’m involved in, we are able to do those for three years. And the new regional integration fund, which is health and social services and other sectors working together, that actually has five-year funding. So, we do recognise these important points, and we are moving towards longer term funding.

Lynne.

Yes, just to add to that that, obviously, our ability to provide long-term funding does depend on having three-year settlements from the UK Government. So, I think that's an important condition to set out, but we absolutely recognise the challenges facing the third sector, who do a brilliant job at providing services on the ground. And in this area, as well as the regional investment fund, which is five years, which a big step forward, in mental health we have undergone a mapping exercise at primary care level to look at what services are out there to have a comprehensive picture, and we have used that information then to target some £5 million to local—. It's gone out to health boards, but with the express view that that needs to be spent on third sector organisations. And, in addition to that, then, we are also funding projects nationally like the national mental health conveyance project, things like SilverCloud, our call helpline. So, we are very much working towards trying to provide that sustainable funding for third sector organisations.

Thank you, Deputy Minister. I know, Julie Morgan, you have agreed to attend the first 30 minutes of our session this morning, so we understand if you leave the meeting. Feel free to stay, but we understand if you leave the meeting, of course, at the appropriate point. Is there anything else you wanted to add before you do leave, Julie Morgan?

I think, on this particular point, we do recognise the importance of longer term funding, and I think the move to five years for RIF is very crucial, because that's a very large budget in RIF, and the sort of projects that they are taking forward are the very sort of projects that will benefit people in terms of their mental health.

But, just to conclude, because I will have to go in a few minutes, I think that it's great that you're doing this inquiry, and I think that there's greater and greater awareness of mental health in the Government and in all the Government's policies, and the Deputy Minister for Mental Health and I are working very closely together, which is why we were keen that I came along for the first half hour at least.

Thank you, Deputy Minister, for joining us this morning. Thank you. Sarah Murphy.

I'll be asking some questions around evidence that we heard that services need to be more accessible and person centred. So, to begin with, we've heard, in terms of ethnic minority communities, that there are concerns about a lack of culturally aware counselling services, and especially a lack of translation services, which is creating a major barrier to accessing the appropriate support that they need. So, have you yourself come across these barriers, and how will the next mental health strategy address the need for more accessible, culturally appropriate mental health support?

Thank you, Sarah. And yes, I—[Interruption.] Rhun's broken the desk.

He has, yes. [Laughter.]

I have definitely come across those barriers and would agree with those barriers. As Welsh Government, we have set up a task and finish group jointly with the Wales Alliance for Mental Health to specifically look at the issues around mental health services for black and minority ethnic communities, and we chair that jointly with the Wales Alliance for Mental Health, and that is an issue that has come through that. Establishing the task and finish group has been a really important commitment included in our anti-racist Wales plan, and the task and finish group is going to play a really key role in developing our new strategy, because we're not in any way complacent about the challenges that we face in relation to this.

Just to give you some assurances about what we're doing already, we already fund Diverse Cymru to deliver a cultural competency scheme across Wales, which has had very good coverage, and promoting cultural competency will remain a key priority in the new mental health strategy for Wales. And that's also going to be supported by the Health Education and Improvement Wales workforce plan and training framework. The anti-racist action plan for Wales actually has a plethora of initiatives designed to make sure that mental health and all health services are actually more representative of the communities that they are serving. We're continuing to make resources available in multiple languages to support access to healthcare. For example, we've recently translated resources such as the National Centre for Mental Health toolkit for people who have been exposed to trauma, and materials to promote the CALL mental health helpline in over 20 language. The CALL helpline also uses LanguageLine, which means that anybody contacting the helpline who doesn't speak English can access the services.

Importantly, we've continued to invest in Time to Change Wales. We announced jointly between me and the Minister for the economy £1.4 million to continue that programme for another three years. Although it has ended in England, we are continuing that investment. A key aspect of that, a key pillar of that work, is for them to work with the Ethnic Minorities and Youth Support Team Wales, EYST, who I think you've taken evidence from as part of this inquiry, Race Council Cymru, and an independent research company to better understand the attitudes, beliefs and experiences of black, Asian and minority ethnic people towards mental health and accessing health and support services, because we know, and I know from the discussions I've had with people from BAME communities, that there are different drivers, and people feel stigma within communities, and we need to address all those barriers. So, Time to Change Wales have amended their delivery and campaign materials now to be more inclusive. That's included translating them into Arabic, Bengali and Urdu, and they're going to continue to work with EYST to raise the profile of the campaign with community organisations in BAME communities. But just to say that we're not in any way complacent, and you can't afford to be complacent when it comes to equality issues, and we're looking all the time at what more we can do, and this will be a key feature of our successor mental health plan.

Thank you. Another group that was focused upon is people with sensory impairment and loss. In particular, we've heard concerns that there is a lack of specialist deaf mental health services in Wales, so how does the Deputy Minister intend to improve mental health pathways for deaf people?

Thank you, Sarah. We recognise there is more work to do here, and I read the evidence that you took on this. Our mental health delivery plan includes an overarching theme of reducing inequalities and promoting access to mental health services, and within that delivery plan there are specific actions, and health boards and trusts have to evidence how they will deliver services equitably and ensure access to information in whichever way people need it. As I say, they have to provide evidence of that and report that to Welsh Government. But continuing improvement is already a focus, and, as part of the work we're doing around consulting external stakeholders on the aims of the disability action plan, we're going to look to make the all-Wales standards for accessible communication and information for people with sensory loss compulsory for the NHS and social care in Wales, improve access and rights for deaf people who use British Sign Language, and there will be a comprehensive review of mental health provision in Wales for deaf people of all ages, with clear action for improvements highlighted. But, as I say, we recognise that there is more work to do, and I can give you the commitment that we will be looking at this as part of our successor plan and will specifically engage with community organisations and people with lived experience so that we can be sure that we're doing that in an appropriate way.

Thank you. I just wanted to ask one more question about joined-up services and different models of care. So, some of the consistent messages coming through are that mental health and other services, including social services, need to be much more joined up and address people's needs in a more holistic way. Also, a key concern of some of the groups and the advisory group is that it's not always felt as if it's being learned from. Good things happen and then it's about how that gets spread out across Wales. So, if you could just talk to us a bit more about how Welsh Government is moving towards more joined-up working, learning, spreading the good stuff, and having a more holistic approach, really.

Okay, thank you. What you highlight is key, really. We want there to be no wrong door for people. That's a key part of our programme for government, at whatever interface people have with services. Obviously, there are challenges with joined-up working, but I think I've demonstrated in some of the examples I've given how we're trying to work in a very joined-up way as a Welsh Government, and we are starting to see that on the ground as well with organisations like our regional partnership boards. Obviously, there is a statutory duty to work in partnership, but we're seeing that on the ground as well in terms of them working together to deliver mental health services, to make bids according to the RIF and on the implementation of our NEST framework.

As you've highlighted, it can be the case that good practice doesn't travel well, and we are acutely aware of that, and that's why we are looking at new ways of making sure that good practice does travel. So, there have been communities of practice established as part of the models of care under the regional integration fund. We've established and are promoting a good emotional health and well-being community of practice as part of that fund, and the early work they're doing is looking at a single point of access, which is obviously key in terms of that 'no wrong door' approach. But also, in terms of the engagement that I and officials have with organisations on the ground, I've met with all the RPBs individually to discuss their NEST implementation and support in other areas, and I am constantly challenging them on the need to share good practice and also, vitally, to listen to the people they're providing services for. And I'm going to bring Tracey in on this as well.

Thank you, Minister. I was just going to come in on the sustainability of that funding, if that's helpful, because I think we recognise that the regional investment fund, which as we heard earlier is available over five years—. But, the sustainability of that integrated working I think is key, and there's a recognition that the large budgets are in health and in social care, and that's the reason that there was a decision taken to taper the funding on the regional investment fund so that, for the longer term, that integration happens in a sustainable way and services are provided in that joined-up way. Because I think, otherwise, there is a danger that things work for a while, new models of care, and then it's not an 'adopt or justify' approach that's taken. Thank you, Minister.

Thanks, Tracey.

That's helpful. Thank you. Gareth Davies.

Thank you very much, Chair, and good morning. I'd like to cover social prescribing, if I may. We're aware that you're currently consulting on a national framework for social prescribing, so can you update the committee this morning at all and give a progress report on how that's going, and give us any assurances that the findings of the inquiry will be fully considered by the Welsh Government when finalising the framework?

Thanks, Gareth. Obviously, the social prescribing framework is a key programme for government commitment. I've been chairing a task and finish group looking at social prescribing and, as a result of that, we have developed a national framework, which is currently out for consultation until 20 October. So, we are talking to people and hoping to get lots of views in about what they think of what we are saying about social prescribing. We've been really clear that we don't want to be really prescriptive, because there are really good examples of social prescribing operating out there anyway, and it's vitally important that people can respond to local need. But, yes, the consultation will close, we'll have a report that we will consider on that, and then we'll take forward the next steps. But I'm very happy to give the committee the assurance that we would be very keen to take on board any views that you want to feed in.

Okay. I appreciate that answer. And one of the issues with social prescribing, or social prescribers, I should say—and they can often be referred to as link workers or community connectors—is that they're often unregulated, It's an unregulated workforce with no standardised training and with a wide variability in salaries and, typically, short-term contracts. So, is that something that's under consideration in the national framework, and how will that address the issues in terms of that workforce?

Thank you, Gareth, and, as you've highlighted, there is a lot of variation out there and I've seen that, going to see projects. Social prescribers are doing different things—they're called different things and they have different training and backgrounds.

I know Julie's gone now, but there is already a commitment within our 'Connected Communities' strategy to develop a national skills and competencies framework for the social prescribing workforce in Wales. And Health Education and Improvement Wales are leading on this work. And the core competencies framework will comprise statements of knowledge, skills and behaviours that need to be applied in order to deliver high-quality, compassionate and personalised social prescribing services, be structured in a way that is consistent with other core competency capability frameworks, be applicable to employers, trainers and those employed in social prescribing roles and enable entry-level staff to train as social prescribers and progress to high levels of skill and responsibility.

And that core competencies framework will be available in English and in Welsh and will link to national occupational standards. And as part of the consultation, we're also looking at what more we can do to support the social prescribing workforce. And obviously, when the consultation is concluded, we're also going to look at the funding issues around social prescribing, but the RIF that we've described already is available for social prescribing purposes. So, there is the potential there for social prescribing to benefit from the longer term funding. Did you want to add anything, Ed?

Thank you. Just to say that lots of the evidence we've heard as we've been undertaking the consultation, as the Minister said, was that they don't want Welsh Government to impose a standard social prescribing service. But there are lots of things that we can do on a 'once for Wales' basis around the workforce, particularly one of them, as we've talked about, is a competency framework; also helping with common job descriptions. Sometimes, terminology as well is confusing—you'll know there are different names for the same job across the country, and that causes some confusion. And similarly on a digital front: so, what can the Welsh Government do to support a 'once for Wales' solution on the digital front?

So, if there's no—. If they don't want standardised guidance from the Welsh Government, does that mean there will be regional variations to that or would that be local-authority led or would that—? What would the set-up be in that circumstance then?

Yes, so our intention is not to create a common framework that would be for the delivery of services, because there will be regional variation across the country, depending on what the need is in local areas. What we would like to try and do is to be able to understand how we can support the harvesting of that data. So, one of the digital solutions that we could look into, as a result of the consultation, is how we harvest the data at the moment, and that's a bit of a patchwork across the country about who is using the services, what services are available. And if we can harvest that data in the right way, that will help local authorities, local health boards, regional partnership boards to be able to plan better what the services are that need to be provided.

Thanks for that. And just finally, in terms of digital technology, are the right systems there in place to support those aspirations—so, obviously, services change, contact numbers and websites and everything—so that it's almost a live directory in a sense? So, are the right digital systems in place to support that eventuality?

Well, as Ed has said, there is a mixed picture across Wales in terms of the use of digital technology and also different views on the appropriateness of a single resource. And you'll have heard, I'm sure, about national resources such as Dewis Cymru and Infoengine, and some organisations have invested in software solutions specifically designed for social prescribing, while others have developed an in-house solution.

Clearly, the technology can play a key part in social prescribing and, as part of the consultation, we are seeking feedback on access to online information in order to understand what we can do at a national level to support the commissioning process and also to help engage the public in developing that national level model that meets the needs of their communities. And we're also seeking feedback on the existing digital solutions as well. But we want to make sure that the framework responds to local need, that we don't displace activities where there is already really good practice. And personally, I've been really keen, in terms of the skills that we're promoting, to have a strong relational focus in our social prescribing framework: that it's person-centred is vitally important.

Thank you.

Ken Skates, you wanted to come in on this point. Ken Skates, you wanted to come in on this point. There's a delay on the mike. Ken.

Thank you. Yes, I was just going to ask about comparing the impact of innovative social prescribing schemes. How are you able to compare the various innovations that are taking place? Because the concept of social prescribing is still relatively new, and, to drive best practice, innovation and creativity, it's often important to directly compare the impact of different services and provision. Is Government able to do that?

Personally, I think it’s challenging, because there are so many different models out there. I met social prescribers a few weeks ago in north Wales who were providing, basically, mental health counselling, and then, at the other end of the scale, you’ve got people who are literally putting people in touch with organisations that can help them, so there is a huge variation. We’re hoping that will be picked up as part of the consultation and we’ll get a clearer sense. There’s been a mapping exercise, hasn’t there, as part of the 'Connected Communities' programme as well, to look at what’s out there already. But, as we do with all policies, we’ll be looking as well at how we evaluate, and, when I was in north Wales, that was one of the questions I was talking to the organisations about, and organisations are already using different mechanisms to evaluate the success of what they’re doing. Did you want to add to that, Ed?

Just to say I think you took evidence from Professor Carolyn Wallace before the summer, so we work closely with the Wales School for Social Prescribing Research at the University of South Wales and recognise it’s one of the challenges, which is how do you follow somebody who’s gone through that pathway to understand whether the social prescribing service they’ve been referred to has the desired impact. So, that’s something definitely that we want to pick up as part of the 'once for Wales' solutions that we can support.

Thank you. Rhun ap Iorwerth.

Thank you, Chair, and I want to ask some questions about the workforce. I hope that my desk is not going to fall apart as I pursue these questions. I have to say, even though we have recognised for many years how important workforce planning is within the NHS generally, I’m concerned that we’re dragging our feet in terms of developing a mental health workforce plan. I hear in the paper that the Government has given us about the work to prepare. We’ve had Health Education and Improvement Wales telling us that the work is proceeding. But, simply, when will this plan be ready to be implemented, and what resources will be available behind it to ensure that there is a plan that can make a serious difference?

Thank you, Rhun. And you are quite right that workforce is absolutely key. We’re investing all this additional money into mental health services and we have to have the workforce with the right skills in the right places to deliver on what we’re trying to achieve.

The development of the mental health workforce plan was a key action in our 'Together for Mental Health' delivery plan, and, despite all the challenges of COVID, HEIW and Social Care Wales—sorry, I've got an echo—have led a comprehensive engagement process to develop the new workforce plan. That’s been presented to Welsh Government. I’ve also had a presentation myself from HEIW, and I think it is a very comprehensive and impressive document. Obviously, it comes with a price tag and we’re still considering the financial resources that are going to be needed to implement the plan. But also to be clear that, right from the start, we viewed the mental health workforce plan as a two-stage process. There are things that needed to be done immediately to tackle some immediate pressures that we need to action now, and then the longer-term planning to make sure that we have the workforce that we need in mental health for years to come.

So, there have been some immediate actions taken around peer support, supervision, interprofessional learning, leadership, mentoring, volunteering roles and the allied health professional pathfinder. And that’s in addition to existing actions that support attraction and recruitment into the mental health workforce, and you’ll have seen things like the Choose Psychiatry campaign. So, right from the start, it was in two phases, and we've also asked HEIW to focus, as part of that immediate work, on three key areas: children and young people, perinatal mental health and psychological therapies. So, HEIW are now developing the more detailed implementation plan, as well as establishing a number of steering groups and work streams that, following the formal launch of the plan on 7 November, will oversee and support its delivery. But just to assure you that driving this workforce transformation is absolutely fundamental to achieving to the mental health reforms we want to see.

I acknowledge the work that is going on, and it was great that workforce planning was made a key part of the 'Together for Mental Health' plan. But when I hear HEIW telling us that they're still working with Government on the priorities, I'd like to think that those priorities have been set out. You mentioned those three key areas. Are they your priorities? Are you able to tell us now that you have now agreed on the priority areas and that they are those that you mentioned there?

Well, those are some immediate priorities to tackle some immediate pressures. Going forward, it's—. When you see the plan, you will see that it is a very broad, wide-ranging document that focuses on all aspects of workforce planning in mental health. So, we do need to look at a prioritisation exercise for how we take that forward. Tracey, did you want to come in on that?

Just briefly on that, I think one of the issues is that HEIW are not just, as the Minister says, helping us invest in the workforce now, it's about looking at future demand and different roles in some cases in order to meet the type of mental health demands that we're expecting to see. So, there are different roles that are being looked at and developed to make a wider multidisciplinary team. As the Minister said, the plan is very comprehensive in that, and those are the things that, obviously, will take some investment in terms of education and training linked to those roles.

To give you an example, infant mental health is something that's been picked up as part of the plan, which is something that I am personally really, really keen on and is something that, perhaps, there hasn't been enough focus on in the past. We look at perinatal mental health, we focus on child and adolescent mental health services, but that nought to five age group, for me, is vitally important, because that is the bedrock of lifelong good mental health, as far as I'm concerned. But obviously there are huge workforce implications for that; you're talking about growing a new type of staff member. So, those things can't be done immediately, and we do have to scope out how much all that is going to cost, but HEIW are working with us as well on the priorities that we need to address now.

We're coming up to the business end of the budget process, and I'm sure we'd like to help you as a Deputy Minister to encourage the finance Minister to give you the resources that you need to implement a solid plan. How close are you to being able to define the costs? Is the proposal that has been made to you by HEIW more resource heavy than you had originally planned for? Are you looking, as you knock on the finance Minister's door, to ask for more? Where are we? Is there a figure?

Where they have provided costed plans, they are quite high costs, I think it's safe to say, and I'm also very conscious that we are staring down the barrel of a gun here in terms of Welsh Government in terms of our budget being worth much less than we had originally thought when we got the funding settlement. So, there are challenging discussions to take place across the Government. I've been really pleased with the extra funding that I've had for mental health, the £50 million this year, growing next year and the year after that. But we need to have those discussions across Government.

Is that going to be enough to—? It's never enough, but is that enough, do you think, to be able to deliver on the kind of plan that you think is impressive that's been presented to you by HEIW?

Well, the £50 million that we've got now has been allocated anyway to other things, hasn't it, Tracey?

Yes, and I was just going to pick up that point about whether all of it can be funded. Quite helpfully, when we've been talking to HEIW and Social Care Wales, in presenting the costs to us, they've graded them in a 'must do / could do' way. So, there will be a menu, and there will be some difficult choices, as the Minister has said. But, obviously, the education and training elements of that plan, for example, have to be looked at within the wider education and training costs that HEIW are coming to the Minister for Health and Social Services for at the same time. So, the mental health bit can't be completely disconnected, is what I'm saying, from that. But, as the Minister said, we'll be putting the strongest case possible, and there is some policy money in the £50 million that might be able to pick up non-education and training elements of the workforce plan.

If I could just run through two or three specific elements related to workforce and training that stakeholders have brought to our attention as areas that need focus. Do you agree with concerns that perhaps we're still not taking advantage of the wider workforce? Occupational therapists, for example, and other health professionals have been suggested to us, could be brought more directly into the delivery of mental health services. If you don't think we're doing enough, what are you doing to address that?

Absolutely, I think there's much more scope to involve the wider workforce, and you're right to highlight occupational therapists. I think they can play a really important role. As I've been going out and about across Wales, I've talked to some of the staff who are fulfilling those innovative roles, and it's important that we use all those skills. It's also important, from a prudent healthcare point of view, that people don't always need to see a psychiatrist or a clinical psychologist. That is very much part of the work that we're doing, but it's also going to be an important feature of our new mental health plan as well.

On training opportunities, it's not always the fact that there aren't the opportunities, for example, to teach the workforce additional skills around matters to do with cultural sensitivities, with neurodiversity, all these elements that make a more holistic workforce; it's often that you don't give them the time within their working week to do the training programmes. It's something that the RCN tells us all the time in relation to the nursing workforce in general: you're just not giving the flexibility for the workforce to take on additional skills. Is that being addressed when it comes to the kinds of skills that would be useful within the mental health workforce?

Thanks, Rhun. I read the RCN's evidence, so I was aware of their concerns. Obviously, this has been an incredibly challenging time for the workforce in Wales with COVID and everything, so there are huge pressures. The purpose, though, of our mental health workforce plan is to deliver a transformative workforce vision, and the workforce strategy for health and social care identified three fundamental principles: well-being, inclusion and the Welsh language. It's also really important to recognise that employers have a key role to ensure that they've got local mechanisms in place to ensure that staff can undergo things like training on equality et cetera, and that they're meeting the actions of their statutory responsibilities. In our leadership role, we're going to ensure that equality, diversity and inclusion are included as core topics and areas of focus for all our leaders. As I said, we're also working with Diverse Cymru et cetera, to make sure that that cultural competency training is available, and the anti-racist Wales action plan has a variety of commitments to try and drive improvements in the multicultural field.

And linked to that also, if we're not providing enough time, if there's so much pressure on the workforce that they can't do training, there are issues there that lead us to think about the well-being of the workforce. There are concerns about the well-being of the workforce. I was going to ask, 'Is there a need to focus more on the well-being on the workforce?' Of course there's a need to focus more on the well-being of the workforce. What are you doing to try to focus on that?

The new mental health workforce plan has a strong focus on well-being, which I was very pleased to see. But, that is already a priority area for Welsh Government. We recognise the pressures people have been under. Specifically in terms of the NHS, we have funded the Canopi programme, which provides support to not just doctors now, which was how it originally started out, but to anyone working in health or social care. So, that's been a major investment that we've made.

We also fund Healthy Working Wales, which is a programme to ensure that employers across the board can make sure that the workforce is as healthy and supportive as possible. That's led by Public Health Wales, and that programme is currently undergoing a transformation. There have been new developments in terms of mental health; the website now has new resources on there in terms of mental health. This is absolutely a priority for us, as Welsh Government, going forward. I think you have to set that in the context of all the other reforms the Welsh Government is undertaking to make Wales a fair work country, the social partnership work that we're doing, the legislation we're looking to bring in, because we know that if people have agency in their working lives, that can make a really big difference to their mental health.

We're taking a really holistic approach to trying to improve mental well-being in the workforce. The Time to Change programme that we're funding also has specific tools and training that it implements in the workforce, and in this iteration of the Time to Change programme, they're focusing particularly on workforces in our most deprived communities. So, absolutely, we're very focused on driving change in that field.

One final question if I may, Chair, again related to the well-being of the workforce, but also very much to the well-being of the patient. I could not, on the day that we discuss a Petitions Committee report on safe staffing, not ask you why is the Government not moving towards the immediate extension of section 25B of the safe staffing legislation of 2016. In-patient mental health nursing is one of the specific asks now, and surely, as I say, for the well-being of staff and patients, that needs to be done quickly. What are you doing to push for that?

It's absolutely emphatically not the case that we're not moving on it. I have been a long-standing supporter of that legislation from when it was introduced by Kirsty Williams, and I'm also on the record as a backbencher highlighting the importance of safe staffing levels in mental health units where we have some of our most vulnerable and voiceless citizens. The Welsh Government is working on taking that forward. There's been a group set up, which is developing proposals. It's challenging to work out the kind of staffing that we need, so there's been a decision taken to do that in a phased way. But, absolutely, we are continuing to take that work forward. I don't know if you want to say any more about the detail on that, Tracey.

I think the most helpful thing is if we offer on that one to provide the committee with the latest position on where we are on the mental health aspects of that, if that's all right.

Thank you. We'll be able to explore this further in Plenary this afternoon.

Absolutely. Ken Skates.

Thank you, Chair. Minister, I'm going to ask about suicide prevention, if I may. First of all, how will the new approach to suicide prevention, described by you in the letter to the committee that we received back at the end of August, address the increased risk of suicide amongst those groups and within those communities that are most subject to mental health inequalities?

Thank you, Ken. I think you're aware that suicide prevention is something that is particularly close to my heart, and in particular the prevention of young suicide. I think what I described when I wrote to the committee was a step change, really, in our approach to suicide prevention.

The committee will be aware that we now have an operational real-time surveillance system for suicide in Wales that will enable us not to have to wait for inquests, which can take many months and, in some cases, years, for us to recognise that somebody has, in all likelihood, taken their own life. That will enable us to identify opportunities for future prevention, but also, crucially, to target support immediately to people who are bereaved by suicide, because we know that people bereaved by suicide are at a much higher risk of dying by suicide. We'll be able to get that support to those families quickly, and we'll be making further announcements about that in due course. But that work is being driven at pace.

You will be aware that I also convened a new cross-government suicide and self-harm prevention group to drive the cross-government working in this area. I've always believed that suicide prevention is everybody's business and that we all have a role to play. It's a public health challenge that we have to address. So, we've brought officials from right across the Government together to really drive change and focus action in this area.

Of particular interest to me is how we prevent young people dying by suicide, and I was aware of how often young people were raised as being on the receiving end of mental health inequalities in your evidence, so I'm really pleased that education are fully engaged with that group, and I'm determined to drive that work forward.

As part of the review that we've done of our 'Together for Mental Health' plan, we've also had an evaluation of our suicide prevention and self-harm prevention plan, 'Talk to me 2'. We're going to be working with partners to develop a new strategy going forward, but I am very committed to driving the suicide prevention agenda in Wales and to make sure that we target it at the groups that we most need to.

We've referred a little bit to poverty today. We know that there are really strong links between socioeconomic deprivation and not just mental health, but actually people dying by suicide. We've got officials from social justice engaged in that group. So, we really are working right across the Government to try and prevent suicide in Wales.

Thanks, Minister. That point you made at the start about the real-time surveillance is really, really welcome, because, as you say, inquests can take so much time. To be able to take a proactive approach immediately after a tragedy is just so valuable. I'm just going to ask a question about need and, also, unmet need. First of all, when will the mental health core data set be finalised? When will it be published? What do you expect it to tell us in terms of level of need and access to services? Then, aligned to this, what assessment has been made of the level of unmet need for mental health support services across Wales, for example those people who require help that haven't yet presented themselves to services, or are looking for information and support perhaps online, instead of actually formally seeking support from services?

Thank you, Ken. In terms of the mental health core data set, obviously, the committee will be aware it's taken longer than we would have liked, but I'm very pleased to say that the draft core mental health data set has now been impact tested with health boards and we're considering that approach. We're strengthening the programme arrangements to drive the core data set, and my expectation is for this work to move from development to implementation over the coming weeks. I'm very happy to share more detail with the committee on that. We're training health boards to strengthen the recording and use of individual patient experience outcomes and data, although that work has suffered because of the pandemic. We've also commissioned a piece of work from the University of South Wales on outcomes, because we're really keen that we're not just counting who goes into the service, but that we're looking at the outcomes and experience of patients that are on the receiving end of our mental health services. I didn't quite catch your final question, Ken.

Sorry, Minister. It was regarding unmet need, whether an assessment has been made of unmet need—for example, people who require support, but haven't presented themselves to services, and perhaps are instead seeking support and information and advice elsewhere, for example online, from free or paid-for services.

Thanks, Ken. Obviously, we're doing what we can to measure unmet need. Since the pandemic, the Welsh Government's knowledge and analytical services team and the national collaborative commissioning unit undertook a piece of work on mental health demand, and that informed the budget discussions, and, therefore, led to us gaining the extra money that we secured. There are ongoing Public Health Wales surveys that assess mental health and well-being across the population. There are things like the school health research network study that looks at the mental health of children and young people in schools, which informs our work in that area. But this is going to be a key part, as well, of the work that we do as part of our development of our successor strategy, because we want to make sure that we are picking up all the unmet need.

Thank you, Ken. Minister, can I just come back to one of the earlier questions as well? I know we’ve talked about—. Sorry, Joyce, did you want to come in?

I thought you might ask the same question.

No, I'm just going to ask about those perhaps suffering from severe mental health. We've had quite a bit today about early intervention, but what I'm particularly thinking about is those who, perhaps, have ongoing mental health problems. And, really, in terms of—we've had quite a bit of evidence around a lack of specialist services and in-patient services being available—I wonder if you can talk to that and that's both in children and adult services.

Thanks, Chair. As I said at the beginning, we are striking a balance, really, between early intervention and prevention and meeting the needs of people as they present to services, and obviously meeting the needs of people with serious mental illness is absolutely key to that. We also recognise that people with serious mental illness suffer all kinds of physical health problems as well, and actually live much shorter lives. So, that's something that we're also considering as part of our policies.

We are undertaking work on this. We have had a review of mental health secure provision, which has been undertaken for us, which has made recommendations that we are implementing in terms of children's child and adolescent mental health services in-patient provision—that is a key priority for me. And we've invested—is it £1.8 million—in driving improvements in our CAMHS provision. We are also focusing on ensuring that adult services are as they should be as well. We've made progress with our early intervention in psychosis services, but this area is one that we will want to focus on as part of our successor strategy as well, and we're going to be having discussions with all the royal colleges and stakeholders—and, vitally, people with lived experience—to make sure that their views inform the successor strategy, going forward. But to assure you that we're not just focused on prevention, it's also about delivering services for people who need them today.

Thank you, Minister, and I'd invite your colleague Julie Morgan in as well, and we talked about that cross-government working, but do you think that there's a need for a cross-government strategy in terms of mental health?

Well, we do have a cross-government strategy on mental health. 'Together for Mental Health' is a cross-government strategy, and it covers housing, employment, debt advice, income maximisation—

Does it cover the inequalities aspect? I suppose that was—

Yes, it covers inequalities. It's a key part of the programme, to reduce mental health inequalities.

Thank you. And we've touched quite a little bit on poverty today, but perhaps I just want to come back to that subject as well. We know, of course, the implications of rising costs, and the cost-of-living crisis, and I'm particularly thinking of, perhaps, those vulnerable groups—those older people, disabled groups of people. Do you think that the Welsh Government is using all of the levers at its disposal to support people in these groups, particularly as regards to that link between poverty and mental health outcomes?

Well, as I said, poverty is a key factor in driving mental health problems, and indeed, in some cases can be a driver of suicide. The cost-of-living crisis is the primary concern of Welsh Government at the moment, and I think the importance we attach to it is demonstrated by the fact that the First Minister has set up a Cabinet sub-committee that he is going to personally chair to look at what we can continue to do to support people at this time. We are doing absolutely everything that we can to support people through the cost-of-living crisis, which, I have to say, hasn't been made in Wales. We are picking up the pieces on it. We've made £90 million available to run another Welsh Government fuel support scheme in 2022-23; that went live earlier this week. That will support people on low incomes with a £200 payment towards their energy bills, and that's been extended to cover a wider range of people, so will cover households on child tax credits, pension credits, disability benefits, carers allowance, contributory benefits and those benefiting from the council tax reduction scheme. We're taking special steps to ensure that carers can benefit from it, recognising that if they've got overlapping benefits with their carers allowance—that might previously have knocked them out of eligibility. The discretionary assistance fund we've increased funding for, which provides support for vulnerable families, and we've also invested in the single advice fund that can offer wider and holistic financial support in order to improve circumstances in the long term.

So, to date, in 2022-23 up until the end of August, more than 123,000 people have been supported with £13.7 million in grants, and over £8.5 million of this has been cash payments. In this financial year alone, we've been spending up to £1.6 billion both on targeted cost-of-living support and universal programmes to put money into people's pockets and help alleviate this crisis. And allied to that, we're also doing lots of work around income maximisation, public campaigns, et cetera, which I can talk about if the committee would like me to. But I think it is very important for the committee to remember that a lot of the levers that are driving this cost-of-living crisis are made in Westminster and not in Wales, and we are doing absolutely everything we can to mitigate the impact of that, but this cost-of-living crisis is one that is made in Westminster.

Minister, the strategy across Government that you refer to, I know that the royal colleges are calling for a strategy particularly to cover inequalities, as I understand it. In terms of what they're calling for, is that incorporated in your strategy?

I think what you're referring to, Chair, is that some of the royal colleges have called for a health inequalities strategy in Wales, and obviously they've made similar calls to the Welsh Government. I don't think we need a new strategy at the moment. As we know, strategies do not always guarantee delivery, and we are driving forward work in this area anyway. I've referred to the work that we're doing around mental health inequalities. We've got things like 'Healthy Weight: Healthy Wales', our tobacco control plan, and the Minister has also set up a specific group jointly with Welsh Government and the NHS to look at health inequalities to make sure that NHS services—as, obviously, providers of services, but also big employers in their local communities—are doing absolutely everything they can to reduce health inequalities. So, I think the important thing now is to focus on action. I think we know what we need to do and we need to get on with it, and we don't need another new strategy.

Okay. Thanks for that answer, Minister. Any other questions from any other Members? No. In that case, I would like to thank our advisory group, by the way, that has really supported with their experience, inputting into this morning's session as well, so to put that on the record. But, if I could thank both Deputy Ministers and officials for being with us this morning—diolch yn fawr iawn.

Thank you for having us.