Children, Young People, and Education Committee

We'll move on to the first main item on our agenda, which is mental health support in higher education. This is our sixth evidence session. I'd like to welcome the witnesses who've joined us here this morning. We have Ben Lewis, director of student life at Cardiff University, representing AMOSSHE; Kirsty Palmer, director of student services at Cardiff Metropolitan University; and Sharon Jones, director of student services at the University of South Wales. You're all very welcome. Thank you. We've got some questions from Members, and the first set of questions is from Buffy Williams.

Thank you, Chair. Good morning and thank you for joining us this morning. What is your assessment of the current situation with regard to student mental health, and how useful do you think the proposed changes to the national student survey will be in improving our understanding of student mental health needs? Is there anything else that the Welsh Government could do to add to our understanding on this issue?

Who'd like to make a start? Kirsty.

I'm happy to pick up on the NSS question. There is a proposed new question in the national student survey about awareness of mental health and well-being support in universities, and I think certainly we welcome any conversation that addresses the happiness and success of our students across all universities. I think the way the question is proposed to be worded at the moment speaks more of awareness of service rather than necessarily satisfaction of service, and there will be some challenges around the language that's used, because not all universities will describe services in the same way. But it will be interesting to see in the first year—the question's being deployed in January—as to how that plays out, and certainly we welcome the conversation. I think it would be interesting also to have a broader conversation around things like specific learning disabilities and other things that affect as many students if not more so in the student population. But certainly I think as a first question it's interesting to have it included in NSS on the basis of that awareness.

I think part of the issue speaks to the fact that it's quite hard sometimes for a student to define, when you talk to them about support, whether that means their personal tutor and their academic department or whether it means the kind of professional support that we would lead. I think those sorts of questions can be quite difficult for the student to understand what's being asked, and therefore it's quite difficult to get clear and useful information out of them.

To come to Buffy's wider point about what more could be done, I think the funding that's being provided to the sector has been really beneficial, but also I think there is an opportunity to create a more long-term approach to that kind of funding, enabling institutions to be innovative, but also to embed change over time. Maybe we'll come to that more in other questions, but I think that's a key opportunity that Welsh Government could engage in improving with the sector.

Just picking up the context, I absolutely welcome any discussion around student mental health and well-being, but I do think there's a challenge of understanding, of the conflation of well-being, mental health and other conditions as well. I think there's room for dialogue across those different aspects as well to help understand and manage expectations of learners. I think there's a lot of work to be done. We are doing a lot of work, we've got teams across our institutions who are diligently working across that, but I think there is a wider dialogue about the expectations of support around student mental health, well-being, early intervention, promotion of aspects as well. I guess we'll come on to that throughout this session. But, the understanding, I think, of what we're talking about is really critical here.

Thank you. Do you think that student support has changed since the pandemic, and what are the challenges and benefits of such changes? For example, is it possible, or desirable, to deliver more student support services in online spaces?

It certainly is, and all institutions switched to delivering their student services online, effectively overnight, in March 2020, which was an interesting experience at the time. But, we've certainly sustained that in lots of parts of the work. To pick examples from my institution, we know that student access to financial support engagement is better and failure to miss appointments is lower with financial aid with remote appointments than it was in person. I couldn't really say why that is, but it's a fact that that is the case.

With mental health support, we do see a greater desire for in-person, but that doesn't mean that you can't innovate and do things online and retain that work online, which I think all our institutions have done. And the other bonus with online working, particularly with students on professional healthcare programmes, is that it enables you to deliver services that are more easily accessible for them, especially if you're on placement in a different part of Wales or something. So, there are a lot of bonuses to it and a lot of reasons to retain it, and I think we've all retained significant aspects of it across Wales.

There is a student choice aspect to it as well, and I think the sessions previously have understood the wide, diverse demographic that we are referring to when we talk about higher education students. And in order to be able to cater across the board and be inclusive, as we try to offer our services, then the aspect of choice there, so retaining some of that flexibility for online access, digital resources, and so on, has really progressed our ability to meet need. What we are seeing, certainly at USW, is that many students are still choosing those appointments through the virtual rather than in person, but that as well could be because of timetabling changes during that, as we come out of the lockdown and restrictions as well. So, I think it's still to be seen as we go forward, but definitely, there's an advantage in student choice for a blended delivery of student support.

Thank you. Which students are most in need of support, and what do student support services need to address any inequalities in mental health outcomes?

Can I take that one first? That's a really good question. It's really important always not to other the student population as if they are not part of the wider population of Wales, the UK and the world. At Cardiff Met, around about 43 per cent of our students come from the bottom two quintiles when we're looking at Welsh indices of multiple deprivation. So, we are recruiting a high proportion of students with socioeconomic relative disadvantage, and we know that those groups in society at large are more likely to suffer with mental health issues, mental distress, not least because some of the factors that trigger mental health issues, like financial distress or social circumstances, are more prevalent, obviously, in those groups. So, we are minded that we need to apply a slightly different sort of support to that, and to be aware. We are able to identify those groups in advance through indications through enrolment, and put in place sometimes specific interventions around that. Sometimes, that's to do with our services but, actually, sometimes it's also to do with bursaries or additional support that's available more widely in the university.

I think it's important to think about that in a holistic sense. So, yes, we do know that certain groups—lower socioeconomic groups, black and minority ethnic students—are more likely to suffer issues, but actually, also slightly less likely to seek support in a formalised way through the university. That's something that I know all of my colleagues are seeking to address, and we're exploring how we do that. Similarly, students who identify as LGBT are more likely to come forward for support, and are more likely to be seeking help for mental health issues. So, we would be looking to provide some specific interventions, but we think it's also important that students are viewed as being part of the whole—the whole population of both the university and Wales.

Are you happy, Buffy? Sorry—Ben.

It might be worth adding as well that I know institutions have all done a lot of work around care leavers and estranged young people, and we've all recognised, I think, the importance of blending the support we provide for those students without stigmatising and finger-pointing towards those groups. And also, coming back to the point about some of the groups Kirsty mentioned, particularly LGBT students, there's been quite a lot of innovation in the sector around that, but you also don't want to require people to feel they have to tell you that information about themselves, particularly pre entry. And you've also got to keep in mind that, for a lot of the population, it might be something that they're still trying to figure out for themselves. So, there are a lot of different issues to balance there, I guess.

Just to add, for the students that present to our services, we offer comprehensive assistance and a range of interventions. I think there's a concern—just to reiterate what has been said about students being part of a society population, but in an institution—around those that are not presenting for support. I think it's really important for us to be able to identify—early identification. There are mechanisms, certainly, that we are putting in place across USW to be able to identify and reach out to the students about the offer of support. I think it's just as important for those who are not presenting, to be able to just reach the population that we need.

Thank you. Thank you, Chair.

Thank you, Buffy. Just following on from that point, talking about early intervention, about what's available, do you think people come to university with many mental health challenges, or do you see that more likely to develop when they're at university?

I think it's a question of both, really. There's certainly a greater level of mental health declaration through the UCAS disability disclosure now; we've seen that change hugely over the last five years. And quite often, there's a co-morbidity with the mental health declaration and some other disability. So, that's one dimension to it. But another dimension is you're talking about a population, still a predominantly young population across the sector, who are more likely, because they're aged under 25, to experience a mental health crisis. They're at the point in life where it's most likely a mental health issue will emerge. And then I suppose you've also got a population, at the moment, who've had a significant degree of restriction on their lives for a longer period, and perhaps things are emerging more as they come to university. We're certainly seeing a greater volume of those crisis presentations across the sector, and that's true across the UK and internationally as well. It's probably something that goes under-reported in terms of the work institutions do to respond to it and the scale of work that's involved, because it's managed, as it should be. But I'm not sure there's an awareness of quite what that scale is out there—and that's not any one institution, that's across the sector.

Thank you. Anybody else?

No, nothing to add.

Just in terms of that, do you think that it would be useful for student support staff to have more information on students' mental health histories from their applications, to perhaps plan care intervention? Would you have any concerns around data sharing?

Through the south-east Wales mental health partnership that the three institutions here have developed with Cardiff and Vale health board, we have a data sharing arrangement with the health board for students that are seen by the clinical service under that partnership. That's certainly worked really very well since it's been in a clinical pilot form, since April. I think where we've got to be careful, though—and colleagues may add to this point, I suspect—is around the definition between the higher education education provider role and statutory health roles. It's useful, in the sense of wanting to help people achieve their best at university, to have that knowledge, but it's also important to be clearer, I think, about the definition between HE provision and statutory health provision. I don't think it's in the interests of the patient who's ill to be relying in any way for their healthcare on the higher education provider, not least because, by definition, you'll eventually leave higher education, and whatever care provision is provided in the HE setting will stop. So, it's a complex space. Do you see my point?

Yes.

Just to build on that, I think it certainly would be helpful not to be solely relying on an individual student to declare an issue in advance of arriving at university. But of course, we also have to be respectful and mindful of the fact that they are, for the most part, adults, and are entitled not to tell us anything that they wish to withhold. I do think there is a question around the transfer of the medical care around the data sharing. I think particularly within Wales it's an issue, but it's very specifically an issue with cross-border students—so, students who are coming from England who may have been supported perhaps by CAMHS in England, or even, if they're mature students, by adult mental health services. And there is a real issue around data sharing and students having to go through the diagnostic and referral process again from the beginning, which will compound their trauma and compound their distress, because they will feel as if they're not being heard and not being listened to. And then that will result in them, to use Ben's word, 'relying' on the university for support in lieu of being able to get that statutory support. So, there is absolutely a question around the information that we might receive from feeder colleges or partner colleges or students, as they come directly into the university, but I think there is a broader conversation around the data sharing for those with ongoing complex conditions in the statutory sector, to ensure that they are able to get the support that they need to succeed and thrive, which is what we're all interested in.

Yes, thank you. Just finally from me on this point: how do you think universities and other education settings can help students when they're transitioning, because we know that that is a key time, and what is the role of student support services in this area? Ben.

I think that's almost a growing agenda across the sector, and you're seeing transition and progression teams being created in student services and elsewhere. One of the ways I think that can make a huge difference is where we try and get those students aware of what we're doing early on, through orientation information and so on before they arrive, and trying to maintain that relationship through. So, that could be through using peer-support mechanisms, which most institutions in Wales do, or it could be through more fundamental awareness raising online across the population.

Yes, I mean—. Sorry. Sharon, go on.

I think an important point within that is how we—. Talking to my early comment about the expectations, the expectation to study in higher education is really critical to prepare students in advance, notwithstanding what you were saying about data sharing and also disclosures of any conditions and support needs, but what is expected of the individual when they arrive. I think that's a really key point through those different connections, formal and informal, through the education system.

Yes, I think that's right, and I think it's really variable according to a particular condition or set of challenges that a student or group of students might present with. So, at Cardiff Met, since 2017, we've been running dedicated transition events for students with autism spectrum disorder diagnoses, and they happen over the summer and they're residential, and it's about demystifying and setting the expectations, so that it isn't that, when they walk in on day one of freshers' week and there are thousands of people, it becomes a very overwhelming experience in an unfamiliar environment. So, I do think that there is a role for us to play in that demystification and expectation setting, but again, we are reliant on students coming forward and presenting and understanding the value of that. But what we've seen, as we've developed that peer-support network, is that that has been really powerful in terms of encouraging students to disclose and to engage early, so that that transition in is as smooth as it can be, and so that the challenge is around the academic challenge and not around the sort of day-to-day existence.

Yes, Ben.

But I think it's also important that we recognise that the peer-support work is great for increasing awareness and destigmatising, but when we're talking about these most unwell people and people presenting in crisis, that's not where that peer-support stuff needs to be. So, in Cardiff University, it's very positioned; it's an academic orientation style of work, but with a referral on to professional services, if somebody is behaving in ways that make the peer supporter think that they need other support. And it's just important to be realistic about how much that can do.

Yes, and make that distinction. Thank you. James.

Yes. On that point, you've got quite big student bodies in your representative institutions, so what proportion of those students need that specialist NHS support, and what proportion of those students can be helped by the institution that you're from? I'll start with you, Sharon, I'll start with this side of the table.

Okay. So, the proportion—. One of the things that has really been insightful from the south-east Wales mental health partnership, the mental health university liaison service project, is to get under the skin of that to understand the proportions coming through and also the severity of how they're presenting, and that's been really useful. We're having regular data insights—data is a big aspect of this—to inform us and to be able to shape our services going forward. So, I think that that's been telling, not only at an institutional level, but at a partnership level as well. And from the NHS, I think that's been really critical—50 per cent, or roughly half of the referrals of students into that liaison service have been referrals through the NHS. What we're trying to establish, and certainly of curiosity to me, is were we aware of those students before they came through that route. And I think that's really an open door for us to be exploring. So, the data, I think, has really come forth within that project. I don't know whether anybody wants to pick up on that.

So, the mental health liaison service went into a clinical pilot working with the health board in April, and they'd seen 181 patients by 1 October, by referral—about half from the institutions, about half from health board services. So, we reckon that, by the end of the planned pilot period next summer, it will see about 500 people by referral. And I suppose it's important, in terms of the wider context, to recognise that some of those people are coming out of services for the community and being dealt with separately from that and, therefore, creating capacity in the community. So, I definitely want to draw focus to that.

In terms of overall institution university services, just to quote Cardiff stats at you, because I happen to know them—

Good.

Cardiff has about 33,000 students, and last year, our mental health services collectively had engagement with about 5,800 of them. But that doesn't mean that those people were all presenting in crisis, because, increasingly, institutions do work to skill build around capacity, to get the most out of your studies and so on. So, a lot of those thousands of people have engaged with workshops or are engaging with some sort of low-level anxiety training and all the things that we rightly should be doing to help people get the best possible degree outcomes. I think where the crunch in the sector is around that interface with the NHS and the 200 people I just referenced previously. And some of that is getting into literally suicide prevention with some of these cases, at the very sharpest end, and that's where we want to do as much as possible, really. And I think that's where Wales has a unique opportunity in the UK, because of the size of Wales, to do something quite different, building on this south-east Wales mental health partnership.

Thank you.

From a Cardiff Met perspective, we're about 12,500 students, and we have a combined disability and well-being team, because we recognise the comorbidities, and we don't want students to have tell their story twice. So, last year, they saw about 2,800 students, and that's for everything from dyslexia and specific learning disabilities through to the crisis presentation and all points in between. What we're seeing, through the mental health university liaison service, is that about 18 per cent of mental health referrals are at what we categorise as category D—so, we've got categories A to E, least severe to most severe. So, about just under one in five of them are in that category D presentation, which is what we would term to be pre-crisis, so not actively about to harm themselves, but certainly living with complex and complicated mental health issues, which require NHS intervention over and above what universities can provide.

Ben and, obviously, Kirsty, you said 5,000 students from your side of things and 2,800 from your side of things. Are those people who have been referred by GPs as well, or are they just straight-up referrals?

They're often self-referrals.

Self-referrals or referrals by tutors, personal tutors—that sort of thing.

That probably leads me on to my second question now then, because those people have come and asked for help, and that's great, we want to encourage more people, if they are struggling, to come and access help, but it is also creating that environment, isn't it, where people who aren't very confident, who are a bit nervous and scared about the stigma surrounding mental health would rather struggle on on their own in silence without seeking help. So, what sort of environment are you trying to create within your own institutions to allow people to come forward to seek help and advice so that they're not suffering on their own in their dorms, or wherever they are, just suffering in silence, really?

Can I start with two points on that? The first one is the physical, which, I think, all of our institutions have invested in, the kind of facilities that these services are delivered from. And there's certainly a trick to that in terms of them not looking too corporate and being accessible, being accessibly located and so on. With the student that you're describing who perhaps doesn't feel ready to talk to somebody or is worried about talking to the institution—and that can be particularly health and social care students, for example, who are worried about professional stuff, although they don't need to be—some of the private sector partners we can work with enable us to provide spaces online to talk, so there's TalkCampus, Big White Wall and others. And the bonus of those private sector companies is that you can add, buy in that safe space to talk that's separate from us. But in the case of both of those examples, it's moderated, so, if somebody talks about suicide risk or something like that, something riskier, then a referral is made to the institution. And I know that that works because it literally happened two weeks ago from the provider that we use. So, there are two dimensions, there's building the physical space and preferably using peer support just to make it accessible and then those online but moderated safe spaces to talk, which will be quite bespoke to the institution setting, so, the one that I described suits Cardiff, it might not suit another institution.

I think the other thing to bear in mind as well is that, often times, these issues present as behavioural challenges in the first instance. So, whether that's non-attendance or disruptive behaviour, rather than somebody coming forward and saying 'I am struggling with my mental health'. So, at Cardiff Met, anyone in the university community can refer any student into our services anonymously, confidentially, and we will follow up with the student for any reason—so they haven't been attending, their behaviour is problematic, whatever it might be. So, that creates an environment where it's not necessarily the student themselves who need to come forward.

But the other thing we have is a dedicated team that is around student progression and retention and that focuses on students who have just dropped off the radar. So, they've ceased attending for between two and four weeks, and that specific team will follow up with them, and around about one third of the students that we followed up with in that team last year had an undisclosed mental health issue, and we were able, then, to bring them into support. So, it's recognising that not everyone will express their struggles in clinical or mental health language; it may simply be through behavioural differences or non-attendance. And that's where we're relying on our colleagues—personal tutors, academics around the university to whom we offer training and support and guidance on these things—to be our sort of eyes and ears, because, however well resourced all of our teams might be, we simply cannot see every student all of the time. So, it's about just supporting the idea that it's not necessarily about what someone says that tells you what's the matter; it may be about the way that they're behaving.

Okay. Thank you.

As well as the initiatives that Ben and Kirsty have spoken about, I mentioned earlier the 'knowing' in the student population and the indicators that might come through, so learning analytics to be able to identify if students are not attending, as Kirsty was saying, and then being able to smartly refer into services I think is a real critical one.

Over the last two years, particularly within COVID, it's responding to the aspect of isolation. So, being more proactive in going to the students and asking where they're at in a space where they're comfortable as well. So, our residents life programme for example, putting on lots of different activities to bring different groups together, building community and the sense of belonging that we know is also part of the narrative at the moment. And they are proving quite useful to be able to direct students in as well.

We've established a team of what we are calling 'students navigators', who are employed students, but they're out there in different assignments with students, having those conversations and being able to literally navigate them into support services as well. And part of that is off the back of the social prescription model, which is another project that's been funded by the Higher Education Funding Council for Wales. So, it's bringing those sides together and, certainly, where we're at is moving our services to be responsive in that domain to the students and those conversations, as well as, as Ben has been saying, the referral and the crisis cases and those who are in need of NHS intervention. And it's the spectrum. And, actually, students may go in between, and I think it's for us to be sophisticated in our service delivery to allow that journey with the student.

Okay. One final question, if I may, Chair, thank you. Students now face a lot more different pressures to what they used to—the cost-of-living pressures and the social pressures that are put on students. What more support—. Are you gearing up with more support services for those students who probably do come to you with those societal pressures or cost-of-living pressures? How are you managing that going forward?

I think that varies by institution, so it's difficult to give a whole-sector response. But institutions have invested in new kinds of activity, and over the last, probably 10 years, there's been a much greater movement to having integrated provision. So, I think all institutions now manage student funding, disability, well-being, mental health, welfare advice, specific learning difficulty, learning and teaching support, which all fall in one department, which would be the kind of departments that we lead. And there's also a lot of partnership working with student unions around destigmatising accessing support and so on. But it's quite bespoke to each institution how much development there's been. So, I could—. Certainly, at Cardiff University, we've introduced a new student intervention team and model that is around managing cases where people are in crisis—

I'll come on to that later.

There we go. And I know that there have been new innovations in Aberystwyth and in north Wales around Welsh language access to support. So, it's quite bespoke to where you are, really.

Okay. That's fine.

Okay?

Yes, lovely. I'm going to take a break for a minute, Chair, if that's okay.

Thank you, James. Sioned Williams.

Bore da. I'm going to be speaking in Welsh, so if you'd like to put your headsets on. Okay?

Right, thank you. I've got a couple of questions on the mental health of staff in higher education. We heard from the president of the students union, Orla Tarn. She said,

'you can't pour from an empty cup',

when she was talking about the support that's required by staff for students, pointing clearly to the pressure on them in terms of pay and workload, and how that affects the kind of support they can provide to support student mental health. So, how do pressures on staff affect that support and the ability of providers to promote a whole-university approach?

Who's going to start? Ben.

I suppose there are two parts to that. There's the staff occupational health/well-being function that I'd be less qualified to speak on, and that's not a huge part of my day-to-day work, but also there's the element of the workforce within student services in each of our institutions as well, and we certainly do see a—. Recruitment is certainly a lot more challenging, and that leads you to carry vacancies, and that leads to greater pressure on the people that you have remaining, and that certainly seems to have become, speaking for Cardiff, as a city-wide issue, more of a pressure in south-east Wales over the last two years, and it's certainly something I'm sure all institutions will be actively considering what they can do about.

I think the wider point about staff, I'd feel less qualified to talk about.

Kirsty, did you want—?

Absolutely, you cannot pour from an empty jug. If individuals are not properly supported, they cannot support other people. I don't think there's any dispute about that, whatever context you're in. We, certainly, at Cardiff Met have tried to put the focus on what is the expectation on academic staff and academic colleagues in terms of the kinds of support and signalling and referring that we would want them to be doing, and emphasising that we're not asking them to take on the professional responsibilities of counsellors or mental health advisers, and in fact we really discourage them from doing that. But, the truth of the matter is students will present where they present, and so we do, I think, have a responsibility to our colleagues who are tutors or academics working on that front line, to provide them with support and guidance and training and allow them to develop and build their own boundaries, such that they are not being dragged into areas where they feel uncomfortable or it's placing additional pressure on them, when it's not directly really part of their job expectation. But I think it would be fair to say that's a work in progress across the whole of higher education, and there would be colleagues in organisational development departments and occupational health and HR teams who could speak in more detail to the work that's been done on the whole-staff population, I think.

Sharon.

So, definitely there is a need to demystify mental health and well-being across the community, and we're talking the higher education community but society as well, and, by doing so, bringing individuals' awareness together. So, initiatives to support staff in their awareness of early signs in themselves, in their colleagues and in students is only going to serve the community better.

The whole-university approach, and also listening across the sector at the moment—so, the whole-education approach, then—to address mental health and well-being, I think, is really welcome and we need to focus on that and look at it as a community, because there is not a dichotomy of status that staff and students remain as that. I think, if we're educating and we're in the business of educating, then it will help longer term there. But, certainly, adopting a whole-university approach as the Universities UK framework, the Stepchange framework, endorses, which all institutions across Wales now have adopted under the guidance of HEFCW, I think is really bearing some fruit. There is lots of work to do, but it does bring the dialogue together, whether that's responding to situations of urgent need and emergency, of staff and students in a similar way, or just allowing those conversations to take place. An example that we have at USW is that our governance really is looking at the colleagues and the staff side as well as the student side and seeing where there is commonality. Indeed, like the diverse demographics of students, there is a need to be putting bespoke different initiatives in, but actually, overall, if there's a commonality of language that we can bring together and take the opportunity to share, then why would we not do that? So, we are on that journey.

Sioned.

So, to go back specifically to staff in student support services rather than the wider staff community, you've mentioned the gaps and the difficulties in recruiting. Is there anything else that's required by those services, by those staff working in support services, from universities to provide the best possible support to students?

Ben.

I think staff in student support services across Wales—. There's a great deal of dedication to the cause there, if you like. Staff, particularly people who work in counselling and so on, often identify very closely with being a counsellor or whichever student services profession they're in. I suppose that the wider points that we're making about boundaries around the difference between the higher education sector and what we're doing and statutory services, and the points about resources, all help contribute to making those colleagues' work lives easier and makes them able to fulfil the professional objectives that they have. I think it's a resource and an understanding question, if you like, and that doesn't necessarily just mean money and it doesn't just mean resourcing the sector, either. To pick those cases we talk about that the mental health liaison service is picking up, those individuals are often presenting in very chaotic ways, and staff who work for us would want to do the right thing for those people, but the right thing can be very stressful and time consuming to deal with, especially if you're struggling to get them into statutory services, or whatever. And I think that's perhaps an area where we could all do more together, I guess. I'm not sure if that answers your question, Sioned.

Ie, diolch.

Can I just add—

So, is there anything—

Sioned, Sharon wants to come in.

Can I just add, to really make the point there, we talk about resources, but what I hear from the team within my department is that recognition goes a long way—recognition for the professional delivery and the standard of service, care and support that they offer? And that's not just within the institution but that's in the partnership with colleagues in the NHS as well—so, understanding the remit to be able to refer into specialist professions also in the NHS, and that's partly our role and where we are, working in partnership with NHS colleagues. But recognition and understanding, I think, is certainly a step in the right direction.

Kirsty, did you want to—? No. Sioned.

Thank you. You've answered the question that I did have, partly. Is there anything else, then, that providers can do to improve the experience of staff in universities to support them in supporting students' mental health?

Kirsty, do you want to start?

I think it's the eternal question, isn't it? None of the three of us sitting here would turn down more resource and investment into our services, were our vice-chancellors to be kind enough to offer it. So, I don't think we should be disingenuous and pretend that we would refuse additional funding or additional staff were they to be made available. The reality of the matter is that every penny that a university spends on mental health support, disability support or other issues is a penny it's not spending on learning and teaching or some other critical priority, and I think this is where the conversation around a whole-Wales approach, working in partnership with Welsh Government, working in partnership with the HEFCW and the commission that will eventually replace it, in terms of looking at that sustainable funding and sustainable models, and the sustainable expectations of what we want our universities to be doing in terms of supporting student mental health, I think becomes the crux of the conversation, because the more resources we have and the more services we provide, the more students will come forward. These things are often self-generating, and that's where the conversation about boundaries and responsibilities and the difference between the higher education setting and the statutory setting I think becomes evermore critical. But, certainly, none of us would say no to any additional resources if we were able to secure them in line with the priorities of our respective institutions and the sector as a whole.

Lovely. Okay, Sioned?

Yes, thank you, Chair.

Has anybody else got anything to add? James Evans.

Diolch, Cadeirydd. I've got two questions, if that's okay. I'll try to roll them all together. I think the role between the NHS and university providers can get a bit blurred sometimes and I actually don't quite know where the NHS kicks in, and how far your teaching staff can go on certain issues. We're told that collaboration is an issue, data sharing can be an issue and communication is another issue. So, do you think that a national set of guidance from the Welsh Government to universities and the NHS could be a good thing so that everybody knows what they need to do, how they need to do it and how far each organisation needs to go in terms of supporting each other? Do you think that's something that the Welsh Government should be doing or do you think that should be done more on a local level between institutions and their local health board? I see a couple of raised eyebrows. I think there may be a difference of opinion here, but we'll see.

I think, to take the example of the South East Wales Mental Health Partnership and the mental health liaison service that's established as a consequence, that uses a common—. So, all of the universities in the partnership, which are the three represented here plus the health board, have agreed a common understanding of what risk measures are relevant in the cases that are referred to it, and there's a threshold where somebody is presenting in a certain way and then they'll be referred to that service, and all of our professional staff use the same risk measures. And it means that somebody in A&E, or somebody in the community mental health teams, when they see a student, don't need to worry about which institution the student is from. And I think, at that higher risk presentation, what you're describing would be very beneficial, because it would mean that people on the statutory side don't need to worry about which education setting the student's come from—they know that the student's at risk in that way. And I'm fairly confident our health board colleagues would voice that if they were here.

I think, when you get below that level of risk, where you're into emotional well-being, counselling for low-level anxiety and that sort of thing, that can be more bespoke to the population. So, to pick my institution, there are specific needs around students doing healthcare and professional programmes that would be less relevant in some other institutions. So, it's difficult if you get more locally relevant stuff, I suppose, to the institution. But the principle you're describing, personally I'd be completely at ease with—I think it could be very helpful—and possibly the evidence from the mental health partnership in south-east Wales would be able to inform that.

Certainly, I agree with that. A national guidance framework would be helpful. The lessons that we've learnt from the partnership have really come to bear there. I think it's about informing the depth of that guidance and making sure that it doesn't become a tick-box or that it serves the purpose that we intended to, which I think we've developed through the partnership in dialogue, narrative, in true collaboration, and it's how we create that, I think, going forward, would be my wish.

I think guidance is great as long as it's got the resources to support the enaction of that guidance across the board. The mental health in partnership is brilliant—it's been a brilliant piece of work—but it's £650,000 to set up and to get to a pilot phase, and that was funding through HEFCW, and we're very grateful for that and it's been really wonderful to be able to access that, but we could not have done it on the goodwill of NHS staff or university staff—it wouldn't have been possible. So, if we are to have guidance, which I would certainly welcome, particularly at the point that Ben has described in that gap, or that pressure or that overlap with that crisis presentation, or pre-crisis presentation, it would be terrific, but it will need to be resourced in order that it is a real thing that benefits students and the wider population and is not easily produced words. Sorry, to be the devil's advocate on that.

Ben, did you want to come in?

Can I just make two follow-up points that just occurred to me? The first one is, if that were to happen, it would have to have some kind of interplay with the QAA code for HE, because the regulatory code has stuff in it around this sort of area, so it would have to not clash with that—it's a fundamental thing.

And the other point is, I'm sure colleagues from Aberystwyth and Bangor would remind me that anything like that would have to be framed in such a way that it worked for rural campuses where statutory services can be further away and so on, and that would be very different to our setting in Cardiff. So, if we were going down that road, that would be important.

Yes, and that probably comes to my final question. You talked a lot about the mental health liaison service pilot that is in Cardiff, and I'm very supportive of it. So, what would your assessment be of the wider benefits of it and also the limitations of it? I just picked up there on rural campuses, for example, and the distance-learning people as well, who aren't always on campus all the time. So, just on those points, where do you think it sits or how could it be improved or adapted to try and suit everybody across Wales?

I can start on that. So, as a piece of work, it's definitely had a great deal of impact with the most unwell students. So, although we talked about the 200 patients that have used it so far, those are potentially very chaotic, complex presentations that would be very time-consuming if they were held within the higher education institution. And then also, some of those individuals, for whatever reason, hadn't accessed statutory support previous to them engaging with that service, despite having quite involved and complex mental health symptoms, so it's capturing something there that was being missed before. I don't want to talk about specific cases on the record; I don't think that's right—

No, no, that's fine.

—but hopefully that illustrates the point well enough. I think we're all fairly confident that provision has prevented some potential suicides. It's at that level of risk, so that's the benefit of it, I guess. I think, as a provision, it can be made to work. We've already had early conversations with Aberystwyth, for example, about how it could be made to work in a different kind of setting, and I think there are ways you could do that with the relevant health board. There's a lot of interest in Swansea as well and I've spoken to Bangor about it. But it would be a bit different. So, you might, for example, have the mental health nurse down the line on Zoom or something, rather than in person, if there isn't a community mental health team that can easily travel to be on site. So, there are ways to deal with that. Where it's more difficult is we have a data-sharing arrangement with the health board here, and I guess, if your boundaries potentially cover more than one health board, that's more difficult, but I don't think it's impossible.

And the other point that is more difficult again is if you do have distance learners who are registered with a GP in their home location and that home location is very separate from where their institution is, that adds complexity too. But I don't think it's impossible to overcome it. We've just had a conversation about a student using the liaison service in Cardiff whose home address is in England and who is currently living in England, and that involves a dialogue between the NHS here and the NHS there at that point. But those are always going to be a small minority in a provision like this anyway.

I think, just to build on that, one of the benefits it has had actually is to decouple access to mental health services from GP registration, because that is a challenge for students, who are a highly mobile population. It's not top of their priority list when they arrive for their first year at university to register with a GP, because they think they're going to be fine—as did we all we were 18, so we shouldn't judge them through our more experienced eyes in that sense, I think. And actually, to be able to refer people directly in without having to ask them to register with a GP and then book a GP appointment and then be referred through that, which introduces delay, is really helpful, because it does bring them in to that system, and I think that does address some of the issues, potentially, of those more rural locations where students may not be registered with a local GP.

We need adaptation, but it's certainly been really beneficial, and I think, in terms of that partnership working with the NHS, breaking down the boundaries and the mutual understanding is an enormous benefit. There's a huge student population in Cardiff and the Vale, and we know that sometimes the perceptions of those students is not 100 per cent positive. I sit in a lot of meetings about bins and antisocial behaviour and traffic and parking, and I'm sure you've all heard that from your constituents if you're local to the area. So, to build that partnership with the NHS that says, 'Actually, there is a way that we can support this population to be the positive contributors that we know they are to the local community and the local economy,' I think is something that's really worth bearing in mind, and especially picking up on the fact that half of the students who are being referred into the service are not coming from statutory services, so there's a benefit to NHS provision of those students not bouncing from A&E to A&E to A&E to somewhere else, and being picked up. So, yes.

Thank you.

Sharon, did you want to—?

Just to talk from the perspective of an institution that does cross the borders of different health boards, it really has given the benefit to see the art of the possible. A national approach would really be welcome, to be able to take some of that learning and apply it, really, and advantage the students. And that's what we want to achieve.

Great. Thank you.

Just to note, Chair, there are some specific views on GP registration in our written evidence that you'll receive.

And we thank you for that, yes. That's very much appreciated. Thank you. We've got questions now, finally, from Laura Jones. Laura.

Thank you, Chair. I just want to ask a few questions on policy, legislation and funding, and, firstly, say sorry for running late. Forgive me and forgive me if you've already said this. This could be more of a sort of sum-up on what you've already discussed, I'm sure.

But, as Kirsty Palmer quite rightly just put—as you said, guidance is great, but resources must follow. So, to what extent have student support services got the resources they need to provide effective mental health support to students, particularly in the context of cost-of-living pressures, and what, if anything, would you like to see from the Welsh Government in terms of funding for this work?

So, to pick on student mental health specifically, the strategic mental health funding through HEFCW over the last three years has made a big difference to all institutions. Our written evidence will reflect as well that we think, collectively, it would be beneficial if there was a longer term view taken on that kind of funding allocation, partly because it's a very competitive job market, and for this kind of work you need qualified people sitting in a chair doing the work and, if you're only offering a rolling year-on-year contract, it's harder to keep them. So, on a very basic level, that's helpful. But, also, we want to embed change and embed improvement, and, again, you can't really do that in 12 months, so you need that kind of certainty going forwards. So, having a dedicated funding stream—I think anyone that works in student services would welcome that, be very pleased to see that, but it's having that sustainability, I guess.

I think it's also—. One thing that has been beneficial, certainly with the mental health partnership, has been facilitating us working together, because all the people that do this kind of work in Wales, we all meet every month regularly now, thanks to the post-COVID way of working. But having that kind of incentive to work together in a funded way, I think, has been really beneficial. It's led to wider benefits for all the institutions and our students. Does that answer your question? I feel like there's part of it I missed.

I think there's something about cost of living that the Member mentioned, and, look, you can have all the counselling and mental health support in the world, but if, at the end of your session, you still can't pay your gas bill, what you need is money. So, I think there is a conversation about—you know, we want to alleviate the symptoms, but we're not necessarily addressing the cause. Now, certainly at Cardiff Met, we've put more money into our hardship fund, but that cannot meet everybody's requirements; it would need to be an infinite amount of cash. So, I think it would certainly be welcome if Welsh Government were to have a look at how students are funded, the means testing and the arrangements around that, that would present a longer term solution to alleviate some, perhaps, avoidable stresses around the day-to-day expenses of life.

Yes. Thank you.

Can I just bring James in? Sorry, Laura. It's on that point.

Yes, it's on that support and funding and everything else, and I do 100 per cent agree with you on wider mental health support—just across the piece, it should be longer than year-on-year funding. How do you use the third sector to support you—Mind Cymru and others, whatever charities there are out there—to try and support you in delivery of these services? Because, obviously, if you are struggling for funding, there are also the third sector organisations that can help. Do you signpost out in that direction as well, if you can't provide that level of support because of funding constraints and everything else?

We certainly do. We certainly work in partnership with Mind and with specialist support services around eating disorders, various things. They are also struggling for funding and capacity—

I know that, yes.

Before I came into higher education, I worked in the voluntary sector for 10 years, and their work costs money as well, and I think that's also important to remember. While they are an excellent, excellent resource, and just like the people who work in student support in universities, they want to do the right thing and they want to help as many people as they can, if we're talking about a whole-system approach, then I think some joined-up conversations about the expectations and the needs and the funding across all sectors would be very welcome.

Just to mention it, one invaluable partnership has been with the Samaritans. I think all of us probably work with the Samaritans on postvention after a suicide, and that's incredibly valuable. So, the work is there, but I'd echo all the challenges Kirsty described.

Thanks. Laura.

Thank you. You've said—you've definitely tried to put across—that one size doesn't fit all, and we've talked about the rural areas and things like that, so how should the commission, the new commission for tertiary education and research, how should it balance the need for consistency and a whole-system approach to mental health with the diversity of individual student needs and providers in post-16 education?

I think that's where the focus has to shift to outcomes, not activity—so, what experience and achievement do we want our student population to have, whether they are studying at Wrexham Glyndŵr, Aberystwyth, Cardiff Met, USW, wherever? How are we supporting them to achieve the outcomes? We're often asked—or we're always asked—when we're writing bids for funding from Welsh Government to address the Well-being of Future Generations (Wales) Act 2015, and we talk a lot about a more prosperous Wales, a more healthy Wales, a more sustainable Wales. I think if the conversation is had in that space and it becomes about outcomes, then it's for each institution or area to define the pathways and the particular support that takes our students into those outcomes, which are for the benefit of the whole country in the end.

Sharon, did you want to add anything?

Just to recognise that we are privileged in Wales, I think, in terms of our size and our contribution to continue the dialogue and make sure—. I do agree with Kirsty about outcome focus and have that principle, and then for those conversations to come in. It's been proven, I think, through COVID, that we have collaborated and we've worked as a collective. So, that continued communication I would really welcome.

Yes. You've said—you've touched on—that there should be a national framework. It feels to me a bit like the national curriculum—the framework is there and we want the outcome and they can individually decide how to get there. I think that's quite a good idea.

I suppose that, with that, what you're describing there could facilitate a better definition between statutory services and higher education provision, and that is a key issue. Coming back to Sioned's question about staff, that kind of definition would certainly make staff feel safer in terms of how they're working with somebody who perhaps is presenting in a very chaotic way. That could certainly be very impactful.

Yes. The new commission for tertiary education and research will be empowered to prioritise the oversight of matters such as student welfare. How would you like to see the new regulatory arrangements developed, particularly in regard to the condition of registration relating to well-being? And have you any other things you'd like to suggest that the Government do? Thanks.

I think there's a key element there around partnership with the sector, because the sector is relatively small in Wales. There's an opportunity there to use expertise in the sector in a partnership relationship, developing that, which, perhaps, if you look at some other parts of the UK, that's been perhaps less obvious in terms of how policy has developed. So, I think there's an opportunity there to use expertise in the sector at the core of that, really. I guess there is—. Coming back to your question, Laura, about financial hardship, there perhaps is a question about a national approach to hardship funds, which used to exist in the past, up until about 10 years ago, and whether there's a moment to relook at that. That might be something that institutions collectively would want to look at with the commission. But it's—. That had a moment some years ago, and it would be something that perhaps would require a lot of discussion as to whether it would have its benefits and negatives.

Okay, thank you. That's useful. Thank you, Chair.

Does anybody else want to add anything? Your last—. I think the point about your last question, if there's anything you'd like to see from Welsh Government, is there anything else you'd like to—? Have we covered everything?

I think the key—. Coming back to it, I suppose the key things are around that boundary of risk question and around the definition between statutory services and the sector. I think those two key things are important to emphasise, and the point around partnership with the commission as it develops its role as well.

Okay. Lovely. Brilliant. Thank you, Laura.

Thank you very much for coming to give evidence this morning, we really appreciate you taking the time, and the paper as well—papers. We very much appreciate it. You will be sent a transcript in the coming weeks just to check for accuracy. Diolch yn fawr.

And we'll now break—. For Members, we'll just break for a few minutes as well to get our next witnesses in.

I'd like to welcome everybody back to the seventh evidence session on mental health support in higher education. I'd like to welcome the panel that we have this morning, which is Lynne Hackett, lead officer for higher education, Unison Wales, and Jamie Insole, policy official, University and College Union. It's really good to see you both here with us. Members will be asking succinct questions, but please feel free to—. Don't repeat answers, or just give succinct answers; we'd really appreciate that this morning, because there's a lot to get through. So, we'll make a start, and the first set of questions is from Buffy Williams. Buffy.

Thank you, Chair, and thank you for joining us this morning. My first question is: what is your members' assessment of the situation with regard to student mental health? Aside from the proposed changes to questions in the national student survey, are there other tools that the Welsh Government could use to enhance our understanding of the extent of students' need with regard to mental health support?

Lynne.

Thank you. Good morning. We've submitted our written response and the survey that we've done with our members, and what is clear from the responses we've had is that the business support staff, who we represent mainly, don't feel that they're having the training that they require that would assist with the increasing need for mental health support that they see in students, which is due to a number of factors, obviously, in recent years. One of the problems—I'm not sure if I'm saying too much on this, Buffy, so I apologise—for the business support staff certainly is that the access to training is more difficult for them. But that's certainly something that they've identified would really improve the support for students.

Jamie, did you want to add anything?

We haven't surveyed recently in Wales, but we can point to the evidence provided in our briefing, which I think provides a relatively accurate picture of where we are at the moment. As I say in my briefing, there is a problem with workload. There was a problem with workload prior to COVID, and there is certainly a problem now. Indeed, there is—[Interruption.] Forgive me. There is evidence that this problem has grown worse.

In terms of identified solutions, we talk about the work that UCU and Welsh Government have undertaken in further education, in three colleges, a scheme that is now embedding with a second round of funding. And in terms of identifying solutions, both around measuring the extent of the challenge and also coming up with practical solutions in social partnership, we feel that we have this template in place and it would be a good idea to see if this can now be generalised and rolled over into higher education. Thank you.

Thank you. Buffy.

Thank you. Flexible teaching and learning practices, including more widespread use of virtual tools, increased during the pandemic. How do staff feel this has affected their relationship with students and their ability to identify where students might be struggling with their mental health? And are there benefits to this additional flexibility in terms of supporting students' mental health?

Lynne.

I think that's possibly a question that Jamie should lead on, because UCU represent lecturing staff who are more likely to have a response to that.

Jamie.

Again, I can't really give you an extensive response to that. The one thing that we have picked up is challenges surrounding pastoral support, and certainly pastoral support seems to me in many ways be the backbone of well-being. It certainly supports well-being. In terms of clearing space in workloads, I imagine that's something that institutions would want to prioritise.

Okay, thank you. Are there groups of students, for example, those who are from ethnic minority backgrounds, or mature students, who are more vulnerable to mental health challenges? How can university staff work to identify and address any inequalities in mental health outcomes?

Jamie.

Again, we have what in my view is an excellent anti-racist plan. We have a good LGBTQ+ equality action plan, and of course we see the First Minister's disability taskforce going forward now. Really, I think it's quite straightforward. The question of mental health and well-being needs to be understood through the prism of those plans, and that work needs to be brought together. I would argue that the virtue of all of these plans is that they are genuinely co-productive. They rather depend upon conversations with the groups that they affect, and whose interests they hope to take forwards. So, really, rather than seeing disaggregated responses around the institution, mental health needs to be understood as an intersectional issue, and to my point, why reinvent the wheel? We have these plans in place. Let's use them.

Okay. Lynne.

In the response to our surveys, they certainly identified that—[Interruption.] Sorry.

That's okay.

In the response to our survey, students who were struggling financially have certainly been identified as then being more likely to come forward with mental health issues, as you could imagine, and also international students. We've got a response that says that international students are not usually equipped to financially be in the UK, and a lot of them are struggling, and they're only allowed to work 20 hours a week, and there's a lack of affordable accommodation. Unfortunately, it is the groups that we would expect to be more challenged that, it seems to be, in this case, are.

Thank you, Lynne. Okay?

Thank you, Chair.

Thank you, Buffy. Just a couple of questions from me about transition, really. We know that transitioning students to higher education is a particular pinch point, really. How do you think that university staff can support students transitioning, including students arriving from further education and those coming from the workplace or other routes? Who wants to start? Lynne.

Yes, I'm happy to do that. I think that the business support staff have the skills and knowledge to provide the support, which is pastoral care, signposting, referrals, advice and so on. The problem they're identifying is that they haven't got the resources to do that, due to understaffing, and the training that they would like about mental health in particular. They're also identifying that students' needs, in terms of mental health and support, are increasing. We all know that the pandemic's affected people's mental health, so they see a higher demand level coming into the institutions, but they see a lower resource level available, with the resulting effect on the business support staff's mental health as well.

Jamie.

I would largely echo that, and have little to add. Certainly in terms of information sharing, that is something that we need to look at from time to time, and moreover, as I said, just creating this institutional space and adopting a whole-university approach. But I think that Lynne has pretty much nailed it.

Okay, thank you. How can university staff contribute to building links with other education providers, particularly further education colleges and schools, to support students arriving at higher education providers?

Shall I take that?

Yes, Jamie.

There are all sorts of ways and all sorts of models of collaboration. The one thing that I would certainly say is that we need more collaboration. In a very practical way, the commission for tertiary education and research, the new commission, is going to be the engine, the pivot around which all of this now comes together. So, again, it's just a case of having those core focuses, that thread, that run throughout, and ensuring that the commission is planning, both in terms of funding and its other roles, to ensure that that collaboration actually takes place.

Thanks. Lynne.

We've got some points relating to this, identified by our members, about students who may reach crisis point with their mental health. They're very often exacerbated by insufficient preparation for the new term by the university and the university systems, but I think what needs to be added is what you said, about how that collaboration between other institutions and organisations is increased. I suppose the answer is resource; I don't have a specific answer to that, but it's the resource of the universities and the other organisations to do that collaboration. We all know that trying to reach out and do more work is challenging if the resources aren't there.

Thank you. Now questions from Laura Jones. Laura.

Thank you. The role of personal tutors has been raised as an important factor in supporting students, but we have heard that this role may not always be well understood. Are there any training needs for tutors and other support staff that would help them deal appropriately with students who are struggling with their mental health? Thank you.

Lynne. Oh, sorry.

Shall I go first?

Go on then, Jamie.

Okay. This is obviously a question for us. Other than the pressures that I've already outlined around pastoral support, many of which seem to crystallise around workloads, that isn't a question I can answer today. However, if it would assist the committee, we could put out a question to branches and see what comes back, if that would be useful.

I think that would be very helpful.

Can you hear me?

Yes, we can, Lynne.

In terms of personal tutors, that would normally be academic staff who would be part of UCU, but the business support staff, we're talking about people who are security staff, who are housekeeping staff, who are cleaners, and those are the people who may be more likely to see a mental health crisis or identify that there was a concern. And what we've been told by our members is that they really, really want training. They want training in suicide awareness, they want training in mental health first aid, they want training to spot issues and signpost. So, I think the personal tutor role is very important, but that requires someone going to see their personal tutor. When someone's experiencing low mental health or mental illness, that might not be the route they take, or they might not turn up for those meetings. So, I would really say that it needs to be done across the board, so that everyone in the institution has got an understanding and awareness of what they might look for, and what they might assist with.

The issue with that training is that, as I say, those security staff, those cleaners, those housekeeping staff are the ones who find it very difficult to access training. They're not released from their duties to do training, and they're the ones who are least likely to read updates because they're going in to do their job; they don't have time to read e-mails and look at things. So, it's a real concern, and a concern I have is, obviously, for the students who are ill, but also if something happens and a member of staff is affected by that, and they haven't had the right training and they don't take the right course of action, that's a real concern when our members' well-being is affected as well.

Okay. Laura.

Thank you. How would you propose doing that? Would you use third sector organisations like Mind, et cetera? Thank you.

There are a number of different ways that training could be provided—to all staff, but I'm talking about our business support or professional support members. Obviously, there's the Wales Union Learning Fund, and we can offer training through that. There are very good organisations, as you were saying—Mind, Adferiad, other organisations—who can provide that, but it is the access. So, if someone's a cleaner, going into student accommodation, and coming across all sorts of potential issues, are they going to be provided with the training? Is time going to be paid by the employer? And is it going to be done at a time they can do it, when they may be juggling multiple jobs? And the feedback we have from more admin-based staff is that they want to do training, but unlike other staff who may be backfilled to do their job, they're not. So, they want to do the training, but if that training's three hours in the week, that's three hours they have to make up doing the job that they're already struggling to do. So, I don't have the answer, unfortunately; the answer is funding, isn't it, but that's not within our gift here. But it's how do we overcome those barriers. You can do online training, of course, but then not all staff would have that access to technology in their jobs. So, those are the barriers, I suppose, I'm giving you, rather than the solution.

Jamie.

I was just going to add very quickly, in addition to resource, I think we also need to look at process and culture, and ways in which we can be—forgive me for saying this—cost-effectively systematic. And again, I would draw Laura's attention to the 'Well Aware' research, the report that I included in our evidence pack. What we demonstrated there—and I go back to what the NUS president said when she provided evidence to the committee three weeks ago—you can't pour from a glass that's half empty. And so, having a scheme that actually enhances staff well-being, which necessarily entails awareness training and other forms of training, necessarily augments the conditions for students and brings up a level of institutional awareness, which I think tends to be more effective than piecemeal offers, where staff might choose to pick up or not choose to pick up training as they go along. We have to affect the culture, and it occurs to me that we have quite an effective template here, which could be relatively easily applied to HE through social partnership. Thank you. Sorry, my nose is very blocked, so I'm finding it difficult to speak at the moment.

No, it's okay. Thank you for joining us anyway—I know you're poorly today. Laura.

That was very clear and very helpful. My next question was: do staff have sufficient capacity to be able to do these things? So, you've answered that very nicely then. My last question is: what have staff members heard from students about their concerns about the cost-of-living pressures, and what do your members need to support students experiencing stress as a result of factors outside their studies, like financial pressures? Thank you.

Who wants to start? Lynne.

Thank you. I think we all know that the pandemic and the cost-of-living crisis have had a negative effect. The feedback we have is that the resources available to staff, the training for signposting and the resources—. In terms of cost of living, yes, there is an increase in financial pressure on students coming to university and, going back to what I said earlier, the students who are coming from lower income families are the ones who are most likely to be struggling, and then experiencing the knock-on effect that is inevitable on their mental and physical well-being. So, what our members are saying is that they would like to have clearer training on how to signpost and the different ways they can support students. They don't seem to be having training or clear guidance on that. I'm sure there are some whose job it is, but there's a wider group of staff that the students would speak to and go to.

Jamie.

I mean, again, we haven't had a union-wide conversation around this as yet, so I can't point to specific data. What I can point to are a number of anecdotal conversations, where these issues have been discussed. We're talking largely around extrinsic factors, as you will imagine. We're talking about high rents, we're talking about increasing emphasis on the need to work, and how that might impact upon study time, matriculation and other issues. A conversation with Orla, the NUS Wales president, indicated that there were serious issues and, unfortunately, really, the only way in which we can address these is through more emphasis on hardship funds—money, basically. I have to say that I find it incredible to think that some students, having paid their rent and other upfront costs, are left with, in essence, £10 a day—no, no, £10 a week. Apologies. It's £10 a week. In terms of equity, in terms of inequality—and, remember, we're going to see the weight of these difficulties spread outwards now and more families are likely to be affected as it moves up. Really, I do think that we need to have a strategy in place, and, quite frankly, I think it probably needs to be, in terms of how we organise it—task and finish, whatever else across Government—if things do begin to bite, as we suspect they well, it needs to be on the scale of the organisation that we put into COVID. Because otherwise, we're going to see a lot of poor learners and a lot of learners being driven out of education through poverty. And, quite frankly, if we wish to be a learning nation, I don't think that's a tenable position. Thank you.

Laura.

I've finished. Thanks, Chair.

Okay, thank you. Now some questions from Sioned Williams.

Thank you, Chair. We know that you have been balloting your members on industrial action. Can you give us a brief outline of your concerns as they relate to this inquiry and what you're asking for? And is there anything that Welsh Government or the higher education regulator could be doing to intervene in this action?

Jamie.

Shall I go first or—? Okey-dokey. Yes, we have balloted, and the results of that ballot came through on Monday, and it seems very likely that we will now be moving to industrial action. The action is UK wide. I would argue that the relationships with institutions are sometimes better in Wales than we see elsewhere, but there we go. I mean, we have three concerns: concerns around casualisation and equality; we have concerns around pay and pensions; and then we have further concerns around the situation of our postgraduate researchers, for instance, which I would like to speak to briefly at some point in this inquiry, if we get the opportunity.

In terms of what Welsh Government or in terms of what this place can do to assist: prevailing upon vice-chancellors, where possible, to negotiate. I mean, we have a ridiculous position—forgive me, I'm supposed to be neutral. We have a position where a pension actuarial investigation suggested that the scheme should be cut at the point where the markets had hit rock bottom. This is certainly something that I think we could usefully reopen and resolve, if we were to take a position on where that fund now lies. Really, moral support and also, as I said, ensuring that universities are working as social partnership.

Lynne.

Yes, in terms of Unison members, there is some action in England, but in Wales our members didn't reach the threshold to take strike action. I won't comment on how I feel about that. But I know many of the reasons, when we were out talking to members about whether they were going to vote and how they were going vote, it's because people feel they can't afford to take strike action. They're so worried about losing money, and it's very easy for us to say, 'Well, you know, if you take action, you'll get better pay increases.' So, we didn't reach that threshold, so we're not in dispute in Wales.

Some institutions in Wales have given, as you're probably aware, non-consolidated payments to staff as a thank you for the work they've done. That varies across institutions, based on how their finances sit. So, the ones who have got better financial positions have made those payments, but, of course, that doesn't apply to all, and it's not added to their salaries.

But in the survey we did, which was about mental health to our business support staff members, 62 per cent of those who responded agreed or strongly agreed that below-inflation pay awards had negatively impacted their mental health. So, it is a real issue. I know the pay is negotiated across the UK—it's not down to Welsh Government, and rightly so that it's a larger bargaining group—and people have received the pay award, but I don't think any of us would say it's enough to keep people having their—. The cost of living means they’ve got less to spend, and those most vulnerable to that are the ones who are least likely to vote for industrial action.

Before you come back in, Sioned, perhaps it's a good time for Jamie to expand on the point around postgraduate researchers now.

Thank you. Excellent. So, the position of postgraduate researchers in Wales, and certainly across the UK, is not a happy one at the moment. Some of the evidence that I rely upon is contained in the report that I believe that I shared with you, which also included a survey of Welsh universities or some Welsh universities.

Really, the problems that postgraduate researchers experience are pretty predictable: insufficient income and funding, and associated workload problems. In some cases, we see postgraduate researchers putting in three times as much work as they're paid for—absolutely incredible—and having very little time and support to carry out these tasks. Now, other than that being a difficulty in its own right, in our response to the Welsh Government’s innovation strategy we did make the point: 'Well, you know, we've talked about innovation in all these other areas, but how are we actually treating the backbone of Welsh innovation, which are postgraduate researchers?'

There is another problem. As we know, postgraduate research, that very much is the inlet, the gateway to a career in academia. So, what we can see is, on the one hand, a situation where researchers from non-traditional backgrounds simply can't keep up with it—there isn't enough money, there isn't enough support. Those who perhaps can't draw resources from their families, or depend upon social capital, are not going to get through. So, what you see there is, either in terms of class or background, a discriminatory atmosphere. The other problem, of course, is that if this is the gateway to academia, what happens here normalises relations throughout and, in terms of looking at our approach to institutional well-being and trying to create this culture, it would seem odd to think that we can intervene in early career and late career and still have this situation where what our postgraduate researchers are learning is that they're paid very little and work three times as hard as they're paid for. What it's doing in effect is instilling a culture and an expectation, and I think we really do need to address that.

Thank you, Jamie. Sioned. Oh, sorry—Lynne.

May I just add something about our student members? Would that be okay?

Yes, absolutely.

We haven't had an opportunity to consult with them about this, but we have student nurses and student social workers as part of our Unison membership. We offer a £10-a-year membership whilst they're training. But what that membership also covers is if they are working in social care or healthcare during the time they're a student. Many student nurses are working as social care assistants, healthcare assistants, and the same with social work students, which is excellent because it expands their understanding and their experience. But most of them—and we know what they're doing because sometimes they have problems at work that we represent them on, unfortunately—are doing that because they need the money to fund their studies. So, I think it's worth noting that there are people who are students who are also training for really worthwhile, important professions in Wales. I know that student nurses are paid differently, but it is still an issue for them, to keep their financial lives going, that they have to work more outside than they would wish. Thank you.

Thanks, Lynne. Sioned.

Thank you. So, what you're saying then is, clearly, the workforce isn't happy; they voted in the case of UCU for industrial action. In terms of Unison, you're saying that people want to and that they're not happy, but they feel they can't afford to take industrial action. So, this, and what you've also described as the pathway for staff, and that that isn't without its challenges, perhaps contributes to creating a culture that doesn't support staff to support students' mental health. Therefore, if we want to create this positive culture, how should the Welsh Government ensure this whole-university approach of supporting students' mental health, and supporting the mental health of staff?

Who wants to start? Lynne? Jamie.

I will come back very briefly on that, and thank you for the question. It called to my mind that when Orla, the NUS president, gave evidence, she characterised—and I wrote it down here—the sector as mentally unhealthy in its own right. I think she did a very good job of providing a systematic story as to how and why that had come about. I don't want to be glib; my job, as far as I see it, is to propose constructive solutions to this. So, there are several things that we can say, and they're very big things and they lack specificity in some ways.

The first thing is that we have the Social Partnership and Public Procurement (Wales) Bill now. We need to see social partnership in our universities. Looking at comparators in Germany—I look at Germany quite frequently, and elsewhere—social partnership is the backbone of innovation on the one hand, and, I've got to say, job and learning satisfaction on the other. We have that. Let's use that. Let's take that forward.

I don't want to bang on about it, but we also have the template that we're taking forward in FE. Really, I think it would be a good idea now to sit down, as the second stage of that goes forward in FE, and see how it can be applied to HE. It won't be a perfect fit. There will have to be some adaptation, but it's something that we have, and it's something that we know works in a different education context. So, that's the second thing that I would say.

The third thing is more of an appeal than anything else. What I was saying—there are two more things in fact—earlier about the equality action plans, the anti-racist plan, that is something that we need to do. With these things, it's not so much that they're too big to fail, but if they were to fail that would be catastrophic, because what that basically demonstrates is that discrimination is beyond our touch and beyond our ability to affect. So, in terms of resources but also in terms of having that prism through which policy and decisions and all sorts of other things can now be shone, let's take that forward.

The fourth thing, I almost forgot. It seems like such a trite point, but there is a proven link between poor physical health and poor mental health and well-being. Post COVID, we've seen all sorts of challenges. 'Post COVID'—what am I on about? It's still going on. Post pandemic response, if anything many of our workplaces are just as unhealthy as they were a year ago. There are some very simple mitigations that we can retain in place. One is ventilation. It probably is the chief mitigation that we have left, the chief remaining mitigation. In Europe, there is almost a right to fresh air. They do not have freshers' flu. They do not have illness on the scale that we have. There will be a temptation, I know, as we move into gloomier economic circumstances, to turn down ventilation and maybe even trade off mitigations against, perhaps, the perceived value of keeping spaces open so that learners can remain warm. We mustn't do that. Not only will that punish the most medically vulnerable staff and students in our institutions, but also it's a false economy, because we will see more sickness, more consequential poor mental health, reduced well-being, more lost learning and more lost teaching. So, I think we really need to keep on top of the physical aspect of this as well. Thank you. I'm going to cough now.

We all seem to be of the same view that students have an increasing need to be supported. There is low mental health and well-being in the staff. We've evidenced the business support staff. You can't separate those two things from the health of an institution. I mean, the trite answer is that it needs more staff and more money, but that's not the workable answer, I suppose, is it, in terms of resource, and it's not infinite. But certainly, the feedback we have is about poor recruitment rates in the sector, which is partly due to the pay and the other terms and conditions; too much work; not enough paid staff; high workload and not enough staff on the ground. All employees—I do it myself—will say that there's not enough staff, but these are real concerns that are affecting people.

I do think, as Jamie says, social partnership is really important, really working together with higher education institutions and trade unions and Government to really ensure the resources are used well and wisely. There is always resentment with people at the top being paid a lot more than people at the bottom, but there are stark differences and our members see that and they're struggling. I don't think I've answered your question, Sioned, and please ask me again if I've forgotten the question, but it's too few people having to do too much, certainly in terms of our members. I haven't got the page in front of me, but nearly 50 per cent of them are thinking of leaving higher education because they feel that they'd be less stressed and equally well paid elsewhere, which is a tragedy, isn't it, to lose that experience.

Thank you. You've answered the question. Thank you, Chair.

Thank you. Questions now from James Evans.

I've got two questions but I'll try and roll them all into one in the interests of time. Do you think university staff understand the boundaries between the responsibilities they have with regard to mental health within the student population and what the NHS has to do? Communication has always come up as a bit of a boundary between the NHS and university staff. Do you believe this could be improved if the Welsh Government put in a set of national guidance so that everybody understood what university staff's boundaries are and where the NHS can step in, so there is that clear definition of what people need to do and how they need to do it, rather than perhaps individual universities doing it piecemeal and perhaps with individual things that they do on the ground elsewhere? That's my question, Cadeirydd, and hopefully we'll have quite a succinct answer as well.

Thank you, James. Who wants to start? Jamie.

I can provide a very succinct answer to that. I would largely support that, certainly. In terms of awareness, we've already explored the need to create space in workloads. The one thing that I would point to is the position of university mental health liaison officers, who are peculiarly well placed to—I don't know, I said I was going to be succinct, perhaps I won't be—

That's fine.

—focus on those students who perhaps are too poorly for university but not poorly enough for the NHS. And that is a big concern, I think. That is a big concern for everybody. On the definition, those points of demarcation, specific points of responsibility are not a bad thing in their own right. But in terms of addressing the issue itself, we really don't want to be losing those university mental health liaison officers and, indeed, perhaps there is an argument for that to be systematically expanded and maybe have more of them.

Thanks. Lynne.

I think the mental health services and support for mental illnesses provided by the NHS are absolutely excellent within the resources, but there's a middle ground, isn't there, between someone who is mentally ill and needs to have support from a psychiatric unit, for example, and people who have low mental health that is diminishing or could cause them to harm themselves or make decisions that are not the wisest to make. So, I think that whilst, yes, guidance would be useful, there is a whole not-for-profit sector that fills that gap. Yes, of course, someone needs to call an ambulance if someone has self-harmed or if they're having an episode, but as I said, there's that middle ground in between where, ideally, all the staff at a university would know how to signpost and how to take action and how to put people in touch with the correct services, and that doesn't come without cost and effort, which is what we're saying the staff don't have the capacity necessarily to do. So, yes, I think guidance would be useful—guidance is never not useful—but there is a whole raft of resources out there that people could turn to if they knew what they were, if those were suitably resourced. And, as I said, at present, they are not being provided by the NHS, unfortunately.

Thank you, and thank you, James. Just finally from me, you've touched on this in terms of resources, but is there anything in addition, really? Do you think that universities have got the resources they need to adequately support staff with their own mental health and well-being and also students? As I said, I know you've said about extra resources, but is there anything else that you would like to see or anything else that can be done in the meantime?

Jamie, do you want to speak on that?

I was rather hoping you would go first. [Laughter.] I'm just going to reiterate a few points. Firstly, there's the work that I've already told you about, the Well Aware work in FE, which is something that we could undertake in social partnership relatively speedily. Social partnership in its own right I think is absolutely crucial. There are the points I made around the cost-of-living crisis and our response to that. So, monitoring on the one hand and also ensuring that we have a cross-Government response on the scale of COVID, not necessarily in terms of resources—I don't know if those resources are there—but certainly in terms of planning, mitigation, ensuring that, as I said, we aren't losing a lot of learners to poverty, which will of course create massive scars in the future. So, those are the three immediate things that I can think of.

As I said, Wales has taken a distinct path, certainly distinct from England, and it is a path that many of our European neighbours would recognise and welcome. That is the path of social partnership, and, quite frankly, whether in terms of learner mental health or well-being or staff mental health and well-being, that is the crux; that is the thing that will take us through. So, quite frankly, I think these are the relationships and processes that need to be developed.

Thank you, Jamie. Lynne?

Yes, just to add to that, I've said about how, of course, our staff are under pressure in lots of ways, but what they care about is the students. That's why they're there, that's why they do that job, and I hope you get an opportunity to read the comments in the survey. But the issues that they're dealing with daily—. And I do think that, in terms of resources, they're more than a resource. Training is really, really important and key, and, obviously, we're talking about education, so of course it is. But the training can be provided at low or little cost, can't it, in theory? We have, as I said, the Wales Union Learning Fund, and there are other organisations who will do that, and we've got the opportunities obviously online now, which is not always perfect but I think blended learning is a better way forward. In terms of resources, if people could access and be given that training, given that opportunity without a cost to themselves—cost as in meaning having to do it in their own time—that would just make a huge, huge difference. I suggested to one of our university branches that we put on a learning day and they said, 'Yes, but people would only be able to come for half an hour at lunch time. They wouldn't have the time to come.' So, those are the barriers that we face, and it is resource, but I think it isn't if, through social partnership, we worked together in the right way to enable that.

Brilliant. And just finally from me, as well, in terms of the new commission, how would you like to see the regulatory arrangements developed, particularly with regard to the condition of registration relating to well-being? And are there just any final thoughts that you have that you'd like to leave us with? Jamie.

Thank you for reminding me. I mean, certainly in terms of the well-being condition, I think it's absolutely essential that that covers staff as well as students. As Orla said, we can't pour from a cup half empty, and other than the scaffolding work that is going to be taking place around that, and the role for social partnership—which thankfully already seems to be switched in—I'd be happy to leave it at that. That condition needs to cover staff as well as students. And, to be honest, that is a method that we would like to see applied throughout.

Thank you, Jamie.

Thank you.

Lynne.

I don't have any more to add, but I do think that the staff need to be very—. That needs to be a key part of the commission, and the role of trade unions, because we can give you this survey, and tell you what people have said,but people aren't going to come forward without being reliant on their trade union to protect their anonymity and to put their views forward. So, yes, I have nothing to else to add. Thank you very much.

Lovely. Brilliant. Well, thank you very much for joining us this morning to give evidence. We really do appreciate your time. You will be sent a transcript in the coming weeks to check for accuracy, and, as I said, thank you for taking the time to come and join as this morning. And I hope you get well soon, Jamie.

Thank you.

Thank you very much.

Thank you so much.

To Members, we have a short break now, just to bring in the other witnesses.

I'd like to welcome everybody back to our committee meeting this morning. We're on our eighth evidence session on mental health support in higher education. Welcome to our panel for this session, which is David Blaney, chief executive of HEFCW, and Harriet Barnes, director of policy and funding at HEFCW. Thank you for joining us this morning. You're very welcome. Members have a number of questions to put to you this morning. We'll make a start with Buffy Williams.

Thank you, Chair. Thank you for joining us this morning. Are there any tools that you as a regulator of higher education have to improve our understanding of the condition of student mental health, and will the addition of a new question in the national student survey be enough to improve our understanding of student mental health, or should there be a bespoke approach for Wales?

Thank you. Thank you for the invitation. We're very happy to help your inquiry as best we can this morning. If I start with the first part of that question, Buffy, and then I'll let Harriet pick us the NSS bit. We have been issuing policy guidance on well-being and health since 2013 and we launched a well-being health policy statement in 2019, which the Wales Audit Office looked at and found was driving collaboration between providers. We require fee and access plans to include support for mental health and well-being as well, and we fund support of mental health and well-being activities in this sector with about £2 million per year, but that funding is dependent upon submission of acceptable strategies and implementation plans by the HE providers, by the universities, and we analyse those plans and use that information to inform our policy interventions. We require institutions to take a whole-university account and approach for the provision of well-being and health, and, as part of that, they're also required to have a student charter, which is developed in partnership with their student body, and that too is required to include information about well-being and health and how the institution supports a safe and inclusive environment for learning.

Then, we collect and analyse data on the prevalence in the student population, and that encourages institutions to record information about the number and proportion of disabled students reporting a mental health condition each year in a consistent way, using national data sets. We collect and publish case studies on how providers promote well-being and support student health. So, there are a lot of activities that we're engaged in that both allow us to gain information from providers and also to share that information back to them. So, that helps us to understand the issues that we're confronting here.

In terms of NSS, Harriet.

The addition of an extra question in the NSS is a helpful addition, although it has to be, obviously, understood in the context of what the national student survey is. It's a survey of all students in their final year of study, so the responses are going to need some contextualisation to understand them, because obviously not all students will necessarily have gone looking for mental health support or student services, and may not even have needed to go looking for it, and therefore may not be aware of what's being provided. So, a negative response is not necessarily going to indicate that providers are not providing those services. So, there's going to need to be quite a lot of interpretation in how we understand the findings that come out of that additional question.

However, it will be a useful source of data for the providers themselves, because it will give them an indication of how much awareness there is within their student body of their promotion of their services. It will be useful information for the wider community, such as you as a committee and us as a regulator. But, in terms of other ways of understanding the issue of mental health support amongst the student body, we'd suggest that probably the better way to do that, rather than creating additional tools, other ways and new forms of data collection, would be to build upon those existing tools and functions that David has just described in terms of what we already have in place, rather than trying to start something from scratch.

Thank you. Your submission says that 4.3 per cent of students have disclosed a mental health condition to their provider. How confident are you that this percentage accurately reflects the extent of student mental health challenges, and do you have any concerns about the long-term impact of the pandemic both on students themselves and also on the quality of provision that universities offer?

Okay. Well, if I kick off on that one, I think the 4.3 per cent figure, it's safe to say, is almost certainly an under-representation of the scale of the issue. It relies, of course, on students sharing information about their own mental health conditions, and we know that some do and some don't, so the likelihood is there is more out there than we are aware of. And it's probably worth making the point that, just as in the broader society, we know that mental ill-health conditions are increasing generally, but also fluctuate. There's no reason to suppose that the student body is substantially different in that respect, and also important to note that just because somebody has a mental health condition, it doesn't mean that they're not always coping; they can be managing it. And, of course, a lot of this conversation is about how the institutions put in place the machinery to help them do so.

We know that women are more likely than men to share information about their challenges, but we also know that there's a higher rate of male suicide than female suicide. So, there are clearly issues about people being comfortable to share, and we, collectively, need to create a culture that encourages further the sharing of information, although it is already improving, so we just need to keep working in that respect. And part of that will be that students who do share such information need to be confident that it's going to be handled sensitively and appropriately, but also that something will happen as a result of sharing; you don't want to share twice if nothing happened the first time. So, we just need to make sure that there is positive consequence for people in sharing.

In terms of the COVID pandemic, I think it's fair to assert that we think the pandemic is going to have a lasting impact on a broad range of aspects of higher education. We know that the proportion of the population as a whole with mental health conditions was increasing before the pandemic started and has increased still further since—and, again, no reason to think to think that will be different for students. And that means that we can expect demand for support to continue to increase, and that the funding of that provision will be spread evermore thinly.

We will expect, I think, a knock-on impact from where children and young people were unable to access existing services during the pandemic, because of movement restrictions, and might still be struggling to access the services they need because of the resultant pressures that remain on the NHS, and that could have a knock-on effect in terms of how they can engage with higher education and the scale and type of support that they might need. And we also know that there's inequitable distribution of the impact with existing socioeconomic and other inequalities increased as well. So, the short answer to your question is 'yes'—sorry, maybe I just should have said 'yes'—but, for all of these reasons, we do expect the pandemic to have a lasting effect.

Thank you.

Buffy.

How can you and the Welsh Government support and require universities to do more to address inequalities with regard to mental health support in higher education?

So, if I can pick that one up, I think we should start by recognising that there is already a lot of very strong activity going on within the sector, but it is vital, in the context of your question, to recognise that that needs to take into account the diversity of the student population, the range of protected characteristics, not make assumptions about what particular groups might require, and to make sure that students and student groups are consulted in trying to understand what sort of provision is appropriate and what is needed. But, obviously, there are challenges to doing that in a diversified way within the limits of budgets as they currently are.

Our role as the funder and regulator is to provide that funding that enables higher education providers to put in place well-being and health plans and support, and we also challenge them in our regulatory function to make sure that they are thinking about all those groups of students that they should be supporting, and making sure that all of that is taken into account. There are a couple of tools that I think are particularly important in how that is done. Although we aren't the regulator in relation to equality legislation—that's the Equality and Human Rights Commission—we still engage with institutions on a lot of equality and diversity activity. We encourage them to produce their strategic equality plans, which should tie into their well-being and health plans. That's part of our approach to a whole-institution approach—that you try to make a join-up wherever possible. And we also, in our requirements for the well-being and health strategies, require institutions to have carried out equality impact assessments as part of those, and obviously there's a duty on providers to do that and to use those equality impact assessments to inform the provision that they're giving in terms of mental health student services, so that they know which groups of students need support and are adjusting their provision to reflect that.

Then I think, finally, the other area is to think in a broader sense that it's not just about the support that's provided for mental health conditions, it's about all the other things that could happen to students—particularly students perhaps from those groups that share protected characteristics—such as violence and harassment, other inequalities, socioeconomic inequalities. All of those things will have an impact on their mental health, so we need to address the other factors as well as focusing on treating their mental health conditions, and that's another area where we keen to, we help to, share practice between providers and engage with third sector organisations, with local authorities and so on, and do that joining up and that collaborative working.

Thank you.

Okay. Thank you, Buffy. We know that many young people who come to university have mental health conditions before they get to university. How can you work with universities, further education providers and schools to ensure that they're supported during that transition from all phases of education?

So, I can obviously answer at the moment for what we do currently as HEFCW, but I think this is definitely an area where the new commission for tertiary education and research will have a big role to play in trying to produce that more joined-up post-16 sector and perhaps formalising some of those links. Because, obviously, yes, this is a challenge, to get that transition. Students come into higher education from all kinds of places. You can't assume that it's one area, one geographical area, that goes to one particular university or one particular type of provider and so on. It's a very diverse, very complex set of transitions. And also, recognising that students are mobile, they may not necessarily come to university and be there permanently for 12 months; they'll go backwards and forwards. So, there are a lot of things that need to be taken into account in trying to think about what provision we might be making to address those transitions.

So, I think the important role for the higher education providers is to make sure that they're providing information for students and prospective students about what sort of provision they have to support mental health conditions, making sure that students know how they can access it, making it as easy as possible to access. As I say, it's something about the information that the provider needs to have available from that first point of contact that a student might have with them, whether that's an open day or via information on websites and so on, and then continued in a coherent fashion as the student goes through that process of applying to university and being accepted, and it might become more structured as the student becomes closer and closer in their relationship with the university. But it's also important to assume that the student isn't necessarily going to provide some of that information in the first instance, so it's that iterative process, and giving plenty of opportunities, and, of course, also student needs will change over time, so we can't assume that once a student is there we know everything we need to know about them. Things may change over time.

The transitions—the point about transitions and supporting transitions is a key component of the Universities UK Stepchange framework, which, as part of our well-being and health funding, we have asked all institutions to carry out a self-assessment of how well they align with that. That framework advocates this integrated approach that links up before application, the recruitment process, the induction process and ongoing, and that whole transition approach is seen as a really important part of that provision.

Then I think a final factor in that that can help with this transitions approach is making sure that we have as much consistency in terminology and sharing of terminology between the different actors in the system who are involved in supporting young people with mental health challenges—so, across health services and schools and the other sectors—because we know it can be quite disjointed, that, if things are described and used in different ways, that doesn't help a student in accessing a continuation of support. We need that consistency, so that they're not unnecessarily having to go back several steps to understand their condition if that information could be passed on in a way that is easily understood.

Brilliant, thank you. Just specifically on those transitioning not from further education but from, say, work or studying in later life, is there anything that universities can do to support their transition specifically?

Shall I pick up that? In many respects, it's a very similar set of issues to the ones that Harriet has just covered in terms of young people moving from school or FE to university. So, the key is giving information about what is available, encouraging sharing, confirming confidentiality—the same issues, really. But universities would have to recognise that these students will be different in the sense that they're probably not, in the main, going to be residential in the university, so their engagement with the university is more fleeting. They're probably living locally and supported by their own GP or local mental health services as well, and they will have, very often, family and community support around them in different ways from young people who are living away from home for the first time. So, there are, clearly, differences, which give rise to different challenges.

But they might also be coming from a cultural environment or a generation that has been less encouraging in terms of openness or sharing, or where sharing has led to some disadvantage at some point in the past. So, there will potentially be, actually, a greater need for confidence building to share with the university machinery what the issues are that they might be facing. And of course, many of them also have their own caring responsibilities, so there is the usual need for greater flexibility in terms of the way in which support services are made available to them—caring, or, indeed, employment commitments as well.

So, very similar, but different in the sense that the students themselves present with different contexts.

Thank you, David. You mentioned earlier about how information is used and having a positive outcome in sharing data. We've had some concerns that some students are not declaring a mental health condition at the point of application, because they're worried about how their data might be used. What can you do to address this misunderstanding and support higher education providers to make clear to students how their information can be used?

We've touched on some of the aspects of that, I think, in that it's about creating that culture that encourages the sharing and communicates why that information is needed. There are, I think, quite a lot of examples of good practice in institutions of explaining to students that they can only be—or they will receive the best support that's available if the institution knows what they need, and it's encouraging them to realise that that's an important part of helping them access that support once they reach the institution. So, it's a culture change. I don't know; there aren't, really, any, I suppose, practical things or specific things that necessarily could be done differently, but just building that culture that encourages the sharing. And I think, as David mentioned earlier, also being able to demonstrate why that sharing will make a difference, by being able to show that, actually, there is support available, that they will be able to access that help. Otherwise, there would be no reason for doing that.

The point I was making earlier as well about making sure that you've got multiple opportunities, recognising that not all students will share that information during their admissions process—so, capturing it at induction and even beyond that, making sure that there are ways in which students can communicate that to their university subsequently, whether that's via a person's tutor or via student services; there are lots of different ways in which they can do that. So, again, it's an awareness-raising issue for students once they're into higher education.

Thank you.

We shouldn't forget in all of this that there's an important role that can be played by the student unions in institutions as well, so it's not just the institution and the institution's services, but the student unions can help by the provision of support services, but also by signposting, and can also work with the university in terms of encouraging sharing. It might be sometimes be more effective messaging coming from the student union than from the institution, and they do work together in the Welsh institutions. I'm not saying this is a deficit; it happens.

Brilliant. Thank you, David. Questions now from Laura Jones. Laura.

Okay. Thank you, Chair. In your paper, you mention that current fee and access plans are

'blunt instruments with limited regulatory power to challenge or improve sector performance.'

What can the higher education regulator do to hold universities to account for the quality of the mental health provision and ensure that universities strive for improvement?

Perhaps if I kick off on this one, we have discussed with the CYPE committee several times in the past the issues about the fee and access plans. But, in this context, I think it's important to contextualise this, in that, obviously, we have a good relationship with the FE sector [correction: HE sector], we have effective dialogue, and we take seriously the prevention aspect of the well-being of future generations Act's five ways of working. So, a lot of what we do with the sector is not about bringing to bear regulatory machinery because of failure, it is about dialogue and shared ways of working and trying to avoid getting into the space where we have to use the heavy machinery of fee and access plans and so on. And so, in that sense, we are mainly pushing at an open door in this space. The conversation is about how best to configure the services, how to get people to work together, both within the sector and with other healthcare providers and so on. So, holding to account is not really the issue in this context—they're doing what they can do, and they're working well together and with us.

But, just to talk through the machinery, equality of opportunity is one of the two fee and access plan priorities, and our regulatory function involves us approving or not approving fee and access plan commitments to protect students with protected characteristics. We have a challenge and support process, we require submissions of plans, and that is, I suppose, partly regulatory and partly to underpin funding. And there are other actions that we require of institutions as part of our funding and as part of our challenge. And if they don't give us responses that we think are appropriate, again, we tend to engage in a way that is about encouraging them to have another go and think a bit harder about it, rather than say, 'Right, you've failed to satisfy us, we'll throw the heaviest regulatory punishment we can at you.' It's not about that.

We undertake, formally, an annual risk assessment of the regulation of higher education institutions—so, the universities. And in that process, we also take account of processes for managing, governing and supporting equality and diversity and the student experience. So, all of these play into mental health support. And then we support collaborative projects, including the development of Welsh language online resources in the general well-being and health and mental health area. And we produce guidance, and that guidance is about sharing not HEFCW expertise per se, but the good practice that we see from around the sector, and including in a UK context. So, this guidance is not a regulatory tool, but it's an important part of the machinery that we use. And I would be very surprised and very disappointed if we ever had to have a serious regulatory imposition as a result of failings by institutions in this space.

Thank you. We've heard of—. Well, you just talked of equality of opportunity, and I suppose that comes to support as well, and we've heard recommendations that there should be—or had recommendations that there should be an agreed minimum expectation of support for students, wherever they study. Given that universities are autonomous bodies, how can the regulator work to create that consistent standard of support? Thank you.

So, I think it's quite important to try to be clear what we mean by 'consistent standard' in this context. So, they are autonomous institutions; perhaps probably more importantly, they're dealing with different student cohorts, and the support needs to be right for the students and to reflect the different external support available regionally from public health bodies and so on. So, actually, one size does not fit all. And if we get to specifying expectations at too detailed a level it won't work. You have to have consistency, but that consistency needs to be at the level of common expectations in broad terms and principles, but that then allows institutions to work within that framework to respond to the context within which they're operating. So, we think we need to focus on the outcomes that we want to see rather than the process. There are loads of different ways of providing support, and again, that will vary according to the particular context. Even in the sense that some universities are very firmly sat within the footprint of a single health board; others are spread between several health boards, with different resource availability and different ways of doing things. So, you just have to be careful that you don't make assumptions that the world is consistent around, even in the space of Wales. So, we think that there is work that can be done in terms of common expectations and principles, but we just need to guard against getting too far into the detail, because that will then become constraining.

Thank you. Thanks, Chair.

Questions from Sioned Williams.

Thank you, Chair. A few questions with regard to the mental health of staff in higher education: what, if any, are your concerns about the capacity of the higher education workforce to deliver high-quality mental health support for students?

Diolch, Sioned. I think it's an important question. I mean, obviously there's been a lot of press coverage in the last two to three years during the pandemic about the pressures that have been on staff within universities, as well as the pressures on students. An important dimension when it comes to talking about what support that staff provide around mental health is to recognise that academic staff, for example, are not experts in this area, and their role, really, is to be able to point students to other places for support. And that might not just be mental health support; it's the wider student services, functions around finance, housing, academic support, potentially, if students are struggling on their course. And it shouldn't be the role of academic staff, necessarily, to diagnose what it is that the student needs; they need to be able to point them to the people who are the experts in this area.

We know that those services are under pressure, and an important aspect of that in terms of recruiting staff—. We've heard from institutions in particular that recruiting staff who are able to provide that support through the medium of Welsh is particularly challenging, just in terms of the capacity, the number of people with that expertise who are available. So, if those resources are under pressure, we need to make sure that they are being used as efficiently as possible, and that comes down to ensuring that we're identifying the needs of students appropriately and not necessarily—well, putting students in the right place for that support, depending on what level of need that they have. Could some be supported, for example, by online resources, freeing up time of members of staff to support those who have more complex needs essentially? And that's one of the reasons why we as HEFCW fund the UK-wide initiative Student Space, which provides a full range of online resources that can be accessed by any student, and it means that every individual institution doesn't have to provide their own material. We're not requiring them to reinvent the wheel; there's a common resource there.

And then, I think it's important to mention that, again, work and that whole-institution approach is an important part of that Stepchange framework, which I mentioned earlier, making sure that staff are supported and trained to do this. It is as important as the support that is provided for students via the student services function.

Yes. So, it's a question of training and a question of resources and having the right processes in place. But what is needed to ensure that staff are not 'pouring from an empty cup', as it was put very memorably by the president of NUS Wales, Orla Tarn, in terms of providing student mental health support? We know that the workforce isn't content; they've been having votes on industrial action recently. We heard in our previous evidence session about the concerns with regard to academic staff, but also those staff who do provide support. So, how can you as regulators hold providers to account, not just in terms of the output with regard to mental health support for students, but also mental health support for staff?

David, or Harriet?

So, part of our approach to well-being and health strategies is that we do encourage this whole-institution approach, so it's not just about the students; it is about what providers do to support staff as well. I think, as you've mentioned, it is a question of resources and training, and we've already mentioned that the resources do only go so far, and that is part of the challenge on staff. So, there is a question of how much funding is available to provide that support within the system to provide adequate levels of staffing and to reduce the pressures on existing staff. There are a lot of training programmes that are in place within institutions—mental health first aid training, for example. We know that all of the institutions in Wales provide some kind of training along those lines that helps staff to support each other. But, really, yes, I think it's an important question of not just focusing on students, and making sure that we challenge providers to be thinking about what they're doing for their staff as well. So, that is already captured within our well-being and health implementation plans, and they're all committed to doing that through those plans and through their signing up to the Stepchange framework as well.

We heard from Unison in the previous session that a number of their members, for example, aren't being released from their duties to attend training. Is that something that HEFCW would be able to tackle with regard to that being an expectation for universities?

I think, if I try that one, we can certainly have conversations with institutions about how it would be rather helpful and sensible for them to allow staff to attend training. We can't get directly involved in what are staffing matters—that lies formally outwith our powers. So, we won't go there; we have to be a bit careful about it. But, clearly, if all of us want to improve the quality of the services that are on offer, then allowing staff to attend relevant training sessions seems to me to be helpful.

Thank you, Chair.

Thank you, Sioned. James Evans.

Thank you, Chair. I've got two questions. The first question is: the mental health university liaison service in Cardiff is a good example of how joined-up working can actually deliver great outcomes for people who are suffering with mental health. So, how do HEFCW encourage the Welsh Government, universities and the NHS to work together to encourage more joined-up working in the interest of the student population in Wales?

Okay, so I'll have a go at that one as well. So, we need to be clear that our role in all of this is to try to avoid getting too involved in the detail. HE providers have the expertise in the institutions, but also, they are more alert to the specifics of their context than we are. Neither is it our role, really, to engage directly with healthcare providers—that's a local matter again for higher education institutions. But we do have a role as a facilitator in this space. So, we try to make sure that universities are enabled to have the conversations and, certainly, from our engagement with universities, we are able to distil the consistent messages that come from those conversations, and we share those back to Welsh Government, from providers.

And then there's a piece of work in Welsh Government, in terms of joining up the pieces as well between education and health. We encourage joint working—consistently, we encourage joint working. So, the collaborative projects that we've funded—it's in the name, they're all collaborative—they were collaborative not just between HE providers, but also asking them to work with other support services within their region, within their geographical footprint. And those projects are now embedded or being sustained in other ways, so we have, if you like, pump primed the initial work required to try to get the joint working together with particularly healthcare providers.

And we also facilitate the sharing of practice, as we mentioned earlier on in this meeting. So, we have lots of examples from all of the institutions of working with local health boards and other local services. And in sharing those examples with the sector as a whole, which we do, we can encourage, if you like, or stimulate universities to think about ways in which they might be able to adopt some of that practice in their particular context.

As I said earlier on, the local healthcare provision varies across Wales, so it does have to be something that is sensitive to context, but there are good ideas that can be picked up and used elsewhere, which would be helpful. And even down to the level of making sure that we have, as far as possible, a shared vocabulary to describe particular conditions and the extent of and the intensity of particular conditions. If you're using the same words to describe these things, you've got a much better chance of focusing the intervention more appropriately. So, there has been some really good work on that. But our role is to facilitate this and also to act as a conduit for messages back to Welsh Government.

Okay. Thank you. You did make the case for the creation of a student mental health passport. Do you think that there's more that higher education could do to encourage and improve date sharing between health and education providers, or is this something that you think the health service needs to evolve? I know that you said in a previous answer that it's hard for you to comment on these matters, but is this something that you want to comment on? If you don't, I understand why.

I'll just offer a few words, I think, to say that we're very much in this space where we're supporting the recommendations that have been made by others for the creation of a student health passport. And I think that's important because data sharing is a complicated area, and all the protections that are in place around data sharing are there for a reason, and therefore, any data sharing agreements need to deal with some of those issues of protection and confidentiality. So, it is a challenge, and it does need that co-ordinated approach.

There is definitely a role for higher education providers to play in that, and that's making sure that they're able to deal with the structure of data, the categories, the terminology that David was just referring to, in ways that will work in terms of a transfer into health service systems. I think our view is that, probably, the technicalities, the grunt work in actually getting that health passport up and running is probably more for the health service to take into account, and you can see that it's potentially transferrable into other contexts as well, so there would be a benefit to the health service for putting something like this in place. But there definitely is a role for higher education in making sure that, on their side, they're set up in a way that will enable them to engage with that health service provision. And, I think, the terminology that David was just talking about is also an important part of that, and that adopting of a shared vocabulary is a vital underpinning to any kind of data sharing, as well as more obvious categories of basic personal characteristics and so on, and information about conditions.

Okay. Thank you. Diolch, Cadeirydd.

Thank you. Just a final few questions from me. Your submission notes that funding for the mental health and well-being strategy is having to stretch to meet increased need. What do you think is a realistic request to Welsh Government on this?

Well, I don't think I can put a number on it. It's a great question, but I'm not going to be drawn into putting a number on it. You might expect us to say more, not because that's what we always say, but because there is clearly increasing demand coming through, and if we're not careful, you could see yourselves getting into a position where we're letting people down because we just can't provide the support that's needed.

I think there are other bits to this, though. The quantum matters, but also having some sense that it's going to be there for a while matters. So, even if it's not as much as people would want, knowing that it's going to be there for a few years rather—. And, certainly, the funding that we're putting out, we have committed to that being part of our ongoing recurrent funding. And, in a sense, what that means is that it's one of the first calls on future funding settlements. But the kind of consistency is important because it takes time to develop the kind of interventions that we've been discussing this morning, and you need to be able get expertise in, you need to be able to get relationships built properly. And all of that is not helped if the money then stops after 12 months. So, yes, probably more money, but I won't tell you how much, but, actually, a sense that there's going to be financial support for a long period, I think, is really important.

Thank you. That's really helpful. The new commission has a crucial role of oversight of vitally important matters such as student welfare. What specific recommendations can you make about the development of these new regulatory arrangements, particularly the condition of registration relating to welfare?

So, I think, certainly, we see the new commission and its legal framework as a real opportunity for creating a more joined-up post-16 approach in relation to mental health conditions. We talked earlier about that transitions piece and the ability of the commission to work across all the sectors within the post-16 sector, within the post-16 area. It should be really helpful in that respect because it is a complex landscape—schools and further education colleges, young learners coming in, but also, work-based learners, apprenticeship providers and so on, and more adult learners as well—and CTER will be working in that context of all of those providers. So, I think that's an underpinning to say it's not necessarily going to be a straightforward task to work out exactly what these conditions of registration, particularly around welfare, should look like. There is a question around precisely what we mean by welfare and the extent to which we are requiring providers to demonstrate the support, and so on, that they provide within the boundaries of the universities in particular, for example, being autonomous providers in that respect. So, there is going to be some careful questions of definition that are needed. It's also, I think, important to note that we don't want those conditions of registration to necessarily be too specific. We were talking earlier about how one size doesn't fit all, and we need to work at a level of principle rather than the details of the process, because this is such a complex landscape, both from the perspective of the providers involved in it, and also the students whose needs we're trying to address. All of that needs to allow for quite a lot of flexibility in terms of exactly what that condition might be.

Oh, you're on mute, Harriet.

Sorry. Yes, I was just going to say that I think that they are probably the key things, that flexibility and recognising the complexity.

Thank you. Just finally, then. How should the commission balance the need for consistency and a whole-system approach to mental health with the diversity of individual students and provider needs in post-16 education? And is there anything, finally, that you'd like to leave us with this morning?

I think we've already touched on the need to seek consistency at a relatively high level of principle and strategy, and not at the level of individual interventions in particular geographical spaces or specifying approaches. Whatever it does, it needs to allow enough flexibility for people on the ground to actually do things that will work in that particular context. It ought to carry on trying to provide the mechanisms to encourage joined-up approaches in the way that Harriet was just discussing, but particularly transition points from school to FE, school to HE, FE to HE. The point of the commission is precisely to deal with those interface issues, and this is a brilliant area where it could make a difference, I think; carrying on the work that we've been starting on supporting the sharing of good practice and challenge, where that's appropriate, and also to make sure that the commission has on its own staff the expertise. The expertise also has to sit with the sector, but in order to be able to engage the sector in this you need people in the commission who know a bit about it. Just continuing to encourage—. The Government should encourage the commission and the commission should encourage all of the players to take a whole-system approach, both within institutions and within the sector as a whole.

Brilliant. Thank you. Well, thank you so much for taking the time to come to this evidence session today. We really appreciate the evidence that you've given and the paper that you provided. You will receive a transcript of the meeting to check for accuracy in the coming weeks, but thank you very much. Diolch yn fawr.

Thank you very much.

Diolch yn fawr.

Thank you. Diolch yn fawr.

So, we'll now move on to item 5 on the agenda, which is papers to note. Full details of the papers are set out on the agenda and in the paper pack. Are Members content to note them together? Yes. So, we're content to note those; everybody's happy with that.

So, now we move on to the next item, and I propose in accordance with Standing Order 17.42 that the committee resolves to meet in private for the remainder of the meeting and for item 1 of the meeting on 17 November. Is everybody content? Brilliant. Okay, so we will now proceed in private.