Children, Young People, and Education Committee

The first item on our agenda is the general scrutiny session with the Minister for Health and Social Services, Eluned Morgan, Deputy Minister for Social Services, Julie Morgan, and Deputy Minister for Mental Health and Wellbeing, Lynne Neagle. You're all very welcome. I see there are a number of officials with you today. Perhaps your officials could introduce themselves. Who's going first?

Shall I go first, Chair? I'm Tracey Breheny. I'm the deputy director for mental health, substance misuse and vulnerable groups, Welsh Government.

Thank you. Who's next?

Shall I go next?

Shall I—? Sorry, Claire.

Claire.

Sorry. I'm Claire Bennett. I'm the director for communities and tackling poverty in Welsh Government.

I'm Chris Jones. I'm the deputy chief medical officer.

Irfon Rees, director of population health.

And do we have Albert? I think maybe Albert—. Maybe Albert will be joining us. That is Albert Heaney, Chief Social Care Officer for Wales.

Can I just remind Members and Ministers—we've got so much to get through today—to be succinct in their answers and their questioning? Like I say, we have so much to get through.

The first question I'd like to ask is on COVID-19 and winter planning. When will the Welsh Government publish its winter protection plan for 2021-22?

Thank you very much, Chair, and thank you for the welcome.

Thanks for the invitation to come and speak to you today. It's the first time, I think, we've been in front of your committee, so I'm very pleased to be here.

I think the first thing to say is that, actually, we've been planning for this winter for a very long time. This is nothing new. It's been—. As I outlined in the Chamber yesterday, we have had very comprehensive plans that have been implemented early, because actually winter has come early in this sense, but because of COVID we've had to just be a bit more flexible and just make sure that we're responding to the difficulties that are in front of us now. So, we will be producing a winter plan in the week of the 18 October, but the priorities, I think, are already very well known, and they're already being delivered, to a large extent, at a local, regional and national level. And of course, the focus is on trying to reduce the risk of people needing hospital treatment, to try and keep them safe and well, in particular, in the face of what is going to be one of the most gruelling winters we've undergone in the history of the NHS.

I think, just in terms of the key priorities, obviously the constant battle against COVID is going to be key—the fact that we have a vaccination programme that is very comprehensive. We also have a flu vaccination programme that is also being undertaken. We've got to make sure—and I know your committee's going to be interested in this—that the services for children and, in particular, paediatric critical care, are able to withstand the pressures as we go into winter. We've got test, trace and protect, so we need to isolate cases, especially when we're talking about really vulnerable children—how do we protect them in those instances? There are respiratory illnesses that are always difficult in winter, but it looks like respiratory syncytial virus has come early to Wales. We've also got to try, I think, to get a cultural shift in terms of where people go to access the support. So, traditionally, people have gone to their GPs, they've gone to accident and emergency departments—you've all seen the pressure on these services. There are alternatives and there's a huge programme that we've undertaken at the moment to try and direct people away from these services. For example, there's a 111 service where people can go for information, there are pharmacies and, of course, there's a lot of extra money that we've put on the table as well: £140 million in terms of recovery investment for the health service and £48 million for social care. And you'll all be aware of the issues of flow in our hospitals and a lot of that is down to issues of getting people out of hospital, but that's a whole new world that I'm sure you'd be interested to explore at some point.

Thank you, Minister. What assurances can you give the committee that resources for children's health services will be protected amidst the need to deal with the surging demand that you have just outlined to us for adult services and other escalation processes this autumn/winter? How can you ensure that those children's services are protected?

Well, what I can tell you is that we are preparing for extreme pressure this winter. And, of course, we will try and protect those services for children as far as we can. You will be aware, I'm sure, that we've already had a task and finish group that has been looking at the issue of critically ill children, and one of the things that we're very keen to do is to make sure that we keep the focus on that as we go into winter, in particular the kind of transfer of those critically ill children to the specialist places that they need, and then, when appropriate, to give that care back as locally as possible so that they can get the support in their communities.

How confident are you that children's health services have the capacity to respond to the anticipated winter pressures, particularly the childhood respiratory infections and other childhood illnesses?

Well, I was really surprised, actually, when I first took on this role, at how early we were preparing for winter. So, the particular issue for really young children is RSV. We've had an RSV plan in place for a very long time—since the beginning of the summer, really—and this is a very common respiratory virus that affects children. Most children will have had RSV by the time they've had their third birthday, and so what we've seen this year is that RSV has been circulating already for a number of weeks, and the flu hasn't, actually, so we're expecting to see—. In fact, what we've seen is a small decrease in recent weeks in terms of the numbers of cases of RSV in children and those under five years of age. But they do remain above the threshold that we would normally see, and I guess we've just got to be aware that, last year, everybody was isolated and we didn't see that transfer of flu and things that we've seen before.

Levels of hospitalisation in relation to RSV are still fairly low, so that's a good thing, but every single health board has had to develop a plan so that they can surge if it comes to emergency planning in relation to this and other areas. So, that funding is there; they've been given additional funding and they should be targeting that funding to respond to that surge if it comes.

Okay. To what extent has the paediatric and the wider child health workforce been restored to pre-pandemic levels?

Well, I think we've got to be honest and put our hands up and explain that, actually, when it comes to trainee doctors, a lot of them were redeployed during the height of the COVID pandemic. We're not expecting to see the same scale of disruption in terms of education and training as we did in the first and second waves. I think Health Education and Improvement Wales—which is, of course, our key body that deals with training in the NHS—they're making sure that they learn from those experiences, trying to make sure that that training can be protected as far as possible. I think one of the things that we have learnt—all of us have learnt—is how key technology is and the opportunities that are there for technology. So, our plan is to see that we can, as far as possible, continue with that education that is so crucial for the paediatric and child health workforce.

Thank you, Minister. Can I just go back to the initial question around the winter protection plan? Are there any plans to publish a specific children's health and care plan?

We're unlikely to produce a specific health and care plan for children. Obviously, we keep an eye on all of these things, but I think it is an area where we need to be aware that—. In relation to COVID, obviously, we're aware that children don't generally suffer in the same way as the adult population. But what we have to keep an eye on is the broader harms that can come in terms of children. Of course, you'll be aware that we are just embarking on vaccinating children from 12 to 15 years old, so that is a whole new programme that we're just undertaking.

Thank you. We'll now move on to questions from Buffy Williams.

Thank you, Chair. The questions I'll be asking today will be regarding social care and care leavers post-18. The latest statistics show that 7,170 children were looked after by Welsh local authorities in 2020, compared to 4,535 children four years ago in 2016. What are your views on this? Are you confident that the £20 million allocated to prevent children on the edge of care going into the system is being targeted in evidence-based ways, as outlined in the Minister's paper?

Who's taking that?

I'm assuming that Julie will take this. Is that right, Julie?

Yes.

Very pleased.

Julie—Deputy Minister.

If I can get unmuted—.

Deputy Minister.

Right. I'm sorry, I missed a bit of that question. Could you just repeat that, Buffy, please?

Yes, no problem. The latest statistics show that 7,170 children were looked after by Welsh local authorities in 2020, compared to 4,535 children four years ago in 2016. What are your views on this? Are you confident that the £20 million allocated to prevent children on the edge of care going into the system is being targeted in evidence-based ways, as outlined in the Minister's paper?

Thank you very much, Buffy, for that very important question. The high numbers of children who are in care in Wales have been a huge issue for us. We have been making a concerted strategy to try to bring down those numbers. We've been working with the local authorities for a number of years, urging them to have targets in order to bring down the numbers that are there. The figures for the last three quarters show that there has been a definite slowing down in the numbers of children who are coming into care, and we've certainly been doing all we can to make sure that as few children as possible come into care.

But Wales has got more children in care than comparable countries, so it is a huge task for us to carry out. But there is a slowing down, and I really think that the local authorities are working flat out to try to support children in their own homes, so that means children on the edge of care. We are certainly putting in the money to support those edge-of-care services, because I think we all know that many children eventually do go home in any case, and we know that for some children the outcomes of coming into care are not good. So, we are putting in a greater effort to try to keep the children at home.

Thank you. It's estimated that the pandemic has cost local authorities £325 million in the first six months of 2020-21. There are real concerns about the levels of safeguarding referrals dropping and becoming hidden as a result of this, as well as children not being seen face to face by front-line staff. It's vital that statutory safeguarding services meet the demands of children in need of care and support. What is the latest position on the number of safeguarding referrals for children in need of care and support and are local authorities meeting the pressures?

Thank you, Buffy, for that question. There was a great deal of concern during the pandemic that the safeguarding numbers, the number of children referred, were low, were going down, and we were very concerned about that because of the situation of the pandemic and the concern about children not actually being seen. But, in fact, the numbers now have stabilised and are back nearer to what they were before.

We know that, as you say, the pandemic has cost £325 million in the first six months of 2021 to local authorities, and there was this concern about children not being seen face to face. But, at the moment now, the concern is whether we'll be able to meet the demands of children in need of care and support, including responding to any of the particular stresses that came up in the pandemic, such as domestic violence that may have been hidden, poverty, neglect, which haven't been picked up. So, there is a great deal of concern about that.

I can give you the numbers of the safeguarding referrals and the increase that I've referred to. For the week ending 26 September, children's social services received 1,099 safeguarding contacts, and that was an increase from 1,053 in the week ending 15 September. So, that was quite a big increase. And over half of local authorities report an increase in safeguarding contacts compared to this time last year. So, there is definitely an increase. Additional grant funding of £1.6 million was provided to local authorities in 2020-21 to support the direct work and practical support to families who were on the child protection register or at risk of registration, and another £2.8 million has now been awarded to continue this additional support in light of the impact of the pandemic on families and services.

We've had very close contact throughout the whole of the pandemic with the heads of children's services, and with the chairs of the regional safeguarding boards so that we're updated about the present situation. There are biweekly meetings with the heads of children's services, so we're trying to keep in touch with all the data from the local authorities. But there is now a rise, yes.

Statistics show that, for the year ending March 2020, 625 young people aged over 16 left care. What are your ambitions for children leaving care in Wales, and how will you measure if they're receiving the right support?

We are very concerned about children leaving care in Wales because we have the responsibility for them because they've been in our care, and we want them to have the same opportunities as any other child would have. So, we are working with our partners to develop policies that will help care leavers transfer to independence, and, during the Senedd term, we will ensure that all care leavers have an entitlement to a personal adviser, and that will be up to the age of 25, and we will see that that is set out in legislation. So, I think having a personal adviser will be a great advantage.

And we're going to continue to work to develop a range of good-quality accommodation options, and we'll be continuing to offer the additional support to care workers that we have traditionally given, to move towards independent living, and this includes the support offered through the St David's Day fund. Also, we will be looking very carefully at placements that are being used for under-16s because of the policy that's happened in England of banning the use of unregulated placements for under-16s, and we'll use that learning to explore options for use in Wales.

So, we have a range of things that we are planning to do to help support care leavers because it is crucial that we do all we can to give them as good a start in life as we can.

Thank you. Thank you, Chair.

We'll now move on to Siân Gwenllian, who's going to ask some questions around COVID recovery and access to health services. Siân.

Thank you very much. These are questions to the health Minister. Are there any specific child health services that are finding it difficult to return to normal?

Well, first of all, we need to say that paediatric services have always been essential services during the pandemic. But what we've done, just in order to ensure that we keep a close eye on what's actually happening on the ground, is that we had a deep dive into children's services. And we have to accept, generally speaking, that the direct impact of COVID on children is less than it is in adults, particularly older adults, but their ability to access services has been disrupted. So, what we have done is to ask our focus group to look particularly at services—looking at immunisation, CAMHS, general and specialised services, and safeguarding. And we've looked at those in detail to see exactly what the situation is. And as we've now received those results, we have asked the health boards—and the director general has written to the health boards—to take into account the findings of that deep dive and to ensure that they take those into account as they draw up their recovery plans.

From the initial work that you've done, do you have any specific concerns about any particular service, or any other services—anecdotally perhaps? Is there a picture starting to emerge before you've completed this piece of work?

Well, I think there are some concerns. For example, on the one hand, in terms of immunisation, some of the findings are better than we would have expected. We have managed to maintain immunisation rates relatively high, in terms of very young children. But some of the problems emerge when it comes to teenagers in schools. So, one of the things I'm concerned about is the HPV vaccine uptake in teenagers—it's only around 60 per cent that have received that vaccine. So, what we're going to do now is to have an immunisation catch-up programme, in order to ensure that we catch up there. So, that's one example of the concerns that we have.

And what about CAMHS services?

CAMHS, clearly, is an issue, and you will be aware that there's quite a transformative programme in place when it comes to children's mental health. And Lynne Neagle is the expert here, of course. But what we're trying to do is to intervene at a far earlier stage in our communities, in terms of providing the help needed at an earlier stage. But, of course, there are pressures on CAMHS. The pressures were there before the pandemic, and they're still there now of course.

In terms of the review that you're conducting, when will you be publishing that?

Well, the results of the deep dives have already gone to the health boards, so they're available to them.

And will it be available to this committee?

I don't see any problem with that, in providing that information to you. That shouldn't be a problem, if you do want to follow that up—that's no problem.

Thank you very much. And then, is there any new specific funding provided for paediatric care, in general terms? And if there is, how much is it?

Well, a great deal of funding has been provided to help in relation to COVID. We've had some £380 million in addition over the past few months. So, just to give you a few examples as to where some of that funding has gone, since October, the child development fund has received £11.5 million, and that's been of assistance to local authorities in helping families and children who have seen the greatest disruption as a result of COVID. A sum of £7 million has been provided to the children and communities grant fund, and that seeks to ensure that we can actually manage pressures so that we can do more on waiting lists. And we have provided flexibility for health services in Wales to work within a framework where they have options. Because we have to understand that COVID is still with us and perhaps it isn’t quite as intensive in some parts of the country as it is in other parts. So, we provide a framework and they can flex within that framework. But we have said that we’re not expecting paediatric services to be interrupted when they carry out that flexing.

As winter progresses, of course, we will just have to ensure that that is all in the right place. But a great deal of funding has been invested—funding has been provided to Hywel Dda University Health Board for dentistry services, funding has been provided to Aneurin Bevan University Health Board for learning disabilities and ensuring that there is funding available for respiratory syncytial virus too. So, a great deal of money has gone into the system.

Are you therefore confident that health and social care services for children and young people have had their fair share of COVID funding?

They've had quite a lot of funding. If you just look at something, for example, that will be of great interest to Julie Morgan, which is what we've provided and put in place for children over the summer in providing opportunities for children to play, because we're very aware that children have had a really tough time. A sum of £5 million was provided for Summer of Fun, and now an additional £20 million has been provided to ensure that children have opportunities to deal with emotional and physical problems as a result of the virus. So, a great deal of funding has already been provided and it’s possible that there will be more to come.

You have already touched on immunisation rates. We heard this week from one of the Government's scientific advisers that he was concerned that children's immunity levels were low because they hadn't been mixing much, because of lockdown and so on, and that there was also the risk of co-morbidities, namely that a child could catch a cold or flu whilst also contracting COVID. Can you expand on those concerns and what kind of steps you are taking to mitigate those risks?

Well, we've all been preparing for the flu for many months now and we are highly aware that immunity levels haven’t been there because we didn’t see many cases of the flu last year. The fact is that flu isn’t particularly prevalent at the moment, but we are expecting that to develop. The fact is also that we don’t know what impact that, mixed with COVID, will have. So, we’ll have to keep an eye on that. We’re trying to see if there is a way to test for COVID or flu in a single test. So, a lot of work’s being done there. But the fact is that we haven’t seen this in the past, so we’re still learning when it comes to seeing how COVID and flu mix—we have a great deal to learn in that area.

Regarding child immunisation rates, you mentioned earlier that the situation is better than you expected, but can you tell us a little more on that? We know that there is a vaccination available for a number of preventable infections, particularly measles, mumps and rubella. Can you share any data with us that shows the numbers taking up vaccinations for those kinds of infections?

Well, I can give you an example on MMR, for example, which is usually given to children of around two years of age, and the rates are around 94 per cent in this quarter. So, that's relatively high, I would say.

What's the usual figure? What's the usual average figure? Is it higher than 94 per cent?

I would have thought it would be slightly higher. Irfon is on the line—perhaps he can help us here.

Thank you, Minister. Yes, on MMR, that is comparable with pre-pandemic levels. A key measure is the percentage of children that have had all their immunisations by the age of five, and we're at around 91 per cent currently, which, again, is comparable with pre-pandemic levels. So, across the early years programmes, the quarterly data is encouraging.

Many of those programmes are delivered through primary care, and, as the Minister rehearsed earlier, we've got more of a catch-up effort in some of our immunisation programmes for older children, and those will be prioritised for the new year, recognising that the flu programme needs to take precedence, for the reason the Minister outlined, for the coming months. Thanks.

So, are the school-based immunisation programmes back to normal?

Not yet. We have tried, but, of course, many children have missed a lot of school, and that's why we need that catch up—and that's our programme. But, as you've just heard, not only do we have to deal with the flu, but we also have to provide the COVID vaccine for those between 12 and 15 years of age, and that's going to be a priority of ours over the next few weeks. We hope that everyone will have had an opportunity to have that vaccine—or will have been invited, at least—before half term. So, it will be over the next few weeks.

So, what does the data show, in terms of immunisation in those older age groups?

Well, for example, with HPV, ages 12 to 13, the rate at the moment is around 60 per cent. So, we would like to see that being higher.

Okay. Well, perhaps you could provide the committee with a note demonstrating the various kinds of vaccinations and what the data is on them so that we can get a general picture across the age ranges, if the information is available.

Okay. Well, generally speaking, what's provided within primary care seems to be holding up well, but things that happen in schools aren't where we'd like to see them. So, that's where our focus will be. But we do have to prioritise now, in terms of when we put these things in place.

So, there's no way of running the COVID vaccination programmes in schools along with other immunisations, is there? You do have to do COVID first and then restart with the rest of the work.

The situation is quite complex already, as I'm sure you can imagine, and what we don't want to do is to undermine the rhythm of the day in schools. They've suffered enough in terms of the impact on pupils, and that's why most of the COVID immunisation is being carried out, for the most part, outside of schools in mass vaccination centres, so that we don't interrupt the school day.

And finally from me, Chair—

Can I just—? I wasn't sure if Irfon wanted to come back in. But, just to remind everyone, if you want to indicate, please just raise your hand—not a virtual hand, but your normal hand—and we'll bring you in that way. Irfon, did you want to come in initially? I saw your hand up. No.

Thank you, Chair. The Minister largely covered the points. It was just that I could have provided more detail on some of the uptake levels across the programmes if that would have been helpful, but the Minister covered HPV. The other thing I would say, just in response to that question on, 'Are they back to normal?'—of course we're seeing a significant expansion of our flu programmes covering all primary school aged children and secondary school this autumn, as well as the two to three-year-olds. So, that is an expensive effort over the coming months, with catch-up for some of the secondary schools programme beyond flu then being planned for January to April.

Thank you. I'll just bring in Ken Skates.

Thanks, Chair. I was just wondering what sort of consideration is being given to compulsory immunisation for children—so, where there would only be exemption for proven medical reasons? And is there any sort of citizens' panel or people's assembly being considered for assisting in considering these really delicate, ethical health decisions?

I think our instinct on compulsion is always to try and resist it and try to persuade—it's worked phenomenally well when it comes to vaccination. You look at those rates in relation to MMR and other things—we're getting up to 95 per cent. So, we're already doing really, really well. And you have to make a judgment call, then, whether—once you start making it compulsory, sometimes that can backfire for the tiny, tiny minority that is left. So, I think persuasion is always our instinct when it comes to vaccinations.

Thank you. Siân Gwenllian.

The final question from me in this section: Minister, would you consider a universal vaccination programme for children under 12 years of age if the Joint Committee on Vaccination and Immunisation were to recommend that?

Well, we'd have to wait and see what the JCVI would have to say before we'd make any decision. I do think that we do need to understand in general terms that younger children don't suffer particularly badly if they do catch COVID. They can spread the virus, of course, and that's a consideration, and that is why we have followed the CMO's advice in terms of providing the vaccination to those children over the age of 12.

I do think that we have to consider the rest of the world too. I am slightly concerned that we are moving forwards to do so much in Wales, and we have to bear in mind that many parts of the world haven't seen the first vaccine yet, and we need to consider those; I think that's a responsibility on us.

Thank you.

Thank you. Moving on, now, to mental health provision, and Ken Skates.

Thanks, Chair. I've got a number of questions, so I'll try to get through them as quickly as possible. First of all, is consideration being given at all to the establishment of a ministerial board or a cross-Government working group for mental health? Certainly, from experience, those cross-departmental boards were incredibly helpful in progressing vitally important issues. I'm thinking of the ministerial board on decarbonisation, which Lesley Griffiths chaired, which was hugely, hugely helpful in breaking down departmental barriers. So, I'd be interested to know whether any consideration is being given to a mental health ministerial board. I think it would be really helpful drawing in, particularly, Ministers from the education department, economy, social justice and local government, as well as, obviously, health. So, that's one question or suggestion.

And then specifically with regard to the whole-school approach, which I think is incredibly valuable, and the focus on the new curriculum and the development of better emotional resilience, I think, is hugely, hugely important for lifelong benefits, but is the focus on that whole-school approach putting at risk the work that needs to be done in terms of promoting specialist health support for young people with complex needs and those who are in a crisis?

Thank you very much, Ken. If I can deal with your first point first, just to assure you that I am already chairing a ministerial oversight board for 'Together for Mental Health', which is designed to give me assurance across all our programmes that we are delivering on our 'Together for Mental Health' strategy. But I'm also engaged in some very productive discussions across the Cabinet about how we can all work together on mental health, and I think there is a recognition that mental health is something that has to be everybody's business. We've taken a different approach to budget planning this year, and have had some thematic discussions about mental health, so that we can make sure not only that we're making the right investment in mental health, but also that there are no unintended consequences on mental health from disinvestment in other areas across Government. And, of course, on top of that, then, I'm having very focused discussions, with people like Jeremy Miles, around the whole-school approach, which is something that we're working on very closely. But, in general terms, I'm very pleased with the way the cross-Government work on mental health is developing already, and that's something that I'm very committed to driving forward, because we can't achieve the sort of reforms that we want to across the whole system without everybody working together.

Just in terms of your question on the whole-school approach, we've made good progress on the whole-school approach; there's more work to do. The funding that's been provided for the whole-school approach is different funding, so that hasn't impacted on our delivery across the rest of the mental health system, including specialist services. But I think there was a recognition, following the previous committee's 'Mind over matter: Two years on' report, that we did need, after having such impetus behind the whole-school approach work, to redouble our efforts at the specialist end of services. That's why we responded positively to the committee's recommendation that the task and finish group on the whole-school approach should become a whole-system task and finish group, and that is very much taking forward that work across the board. I'm very clear, as Minister, that I want to focus on prevention and early intervention, but we can't do that at the expense of providing services for young people who need more specialist help. The whole system has to be kept in balance.

Brilliant. Thanks, Minister. That's great to hear about the work that you're doing with colleagues across Government.

Moving on to paediatric mental health and patient beds, are you able to give an outline of what sort of pressure is in the system, and what proportion of paediatric in-patient capacity for children and young people has been lost to adult services? And do you believe that there is sufficient paediatric in-patient mental health workforce?

Thank you. Obviously, the pandemic created pressures, but we haven't lost capacity due to adult services, because they are different beds, really, and we wouldn't have adults on paediatric wards, because of a variety of reasons, including safeguarding issues. We do have designated CAMHS beds on adult wards, which are either there to admit a young person who's over 16 who expresses a preference to go on to an adult ward, or they're used a last resort, really, if we haven't got a CAMHS bed. We are constantly reviewing the CAMHS in-patient capacity, and we've had an in-depth review of our CAMHS tier 4 service. We've also invested an extra £1.8 million this year in our CAMHS in-patient provision, and, at the moment, I think the capacity is being managed very carefully. We've got a bed panel that looks at that all the time, and, at the moment, I think things are managing in a fairly good way, and we only have two young people who are currently placed outside of Wales.

Excellent. Thanks, Minister. Just briefly, with regard to Ty Llidiard, do you believe that it is a safe place for vulnerable young people to receive treatment, given the obvious problems that the facility has faced?

Thank you, Ken. As the committee, I'm sure, is aware, the escalation level at Ty Llidiard was raised a few months ago, and that is a cause of great concern to me. I would like to assure the committee that I immediately asked for assurances about the safety of Ty Llidiard, and have received those assurances. I'm having weekly updates from officials about the position at Ty Llidiard, but there are a range of measures in place to ensure that Ty Llidiard is safe. This has involved running the unit at a reduced capacity; there are weekly reviews of patients and there is a strengthened case management. Both our CAMHS units in Wales are reviewed by the national collaborative unit against robust clinical standards to ensure the quality and safety of care. But just to say, again, that this is something that I'm taking a very strong personal interest in, and I'm discussing on a weekly basis with officials.

Excellent. Thank you. Now, our understanding is that the Together for Children and Young People programme has a short-term funding model. If that is correct, are you able to outline what the long-term strategy is for children's mental health?

Thank you, Ken. Can I take this opportunity to place on record my heartfelt thanks for the work that the Together for Children and Young People programme is doing? I worked closely with them in my previous role as committee Chair, and now as Minister, and I think they're doing some really important work with young people. As you're probably aware, our strategy is, over the longer term, to move towards a position of early intervention and preventing mental ill health for children and young people, and that's what our whole-school approach is about, but also the development of our NEST framework, which the Together for Children and Young People programme are leading on. And, of course, both those things came out of the recommendations of the previous committee's 'Mind over matter' report.

The Together for Children and Young People programme is taking forward the NEST programme, but what is really important is that all regional partnership boards in Wales actually realise that they have to take ownership of this agenda themselves. We know that some of them are at different places in Wales, and that's a concern. I want to be in a position where all RPBs recognise that this is their responsibility to develop that comprehensive early help and enhanced support for young people. It's vital that's co-produced with young people in local areas. At the moment, I'm focusing on driving that, and I think it's important that they've got a sense of urgency about that. I'll be taking decisions about the Together for Children and Young People programme at a later date, but just to assure the committee that the area of support for children and young people is my absolute top priority, and I would never do anything as Minister that would in any way destabilise or endanger our progress in this area.

Thank you, Minister, that's really reassuring to hear. Can I ask you about neurodevelopmental services now? They're under review, I believe, and the review is due to be concluded and a report published in March of next year. Given the work on the review, is there a risk that neurodevelopmental services are perhaps not being given sufficient urgency in terms of the support that is required? Can I also ask, alongside that: do proposals for an autism-specific code of practice risk sidelining these children and overlooking their needs in mainstream services?

Thank you, Ken. I'm going to bring Julie Morgan in on this in a second, but just to be clear with the committee that the NEST framework that I referred to also has a really key role to play for children who are neurodiverse, and our approach is very much one of not putting children and young people in boxes. So, I recognise what you're saying, and that's why we've had a fundamental look at this across Government and are taking a more integrated approach to ND services and autism. Julie is going to come in on this, I think.

Thank you very much, Lynne, and thank you, Ken, for the question. You asked whether we were addressing the issue with sufficient urgency and you referred to the review that commenced in February. This was delayed from 2020 because of COVID-19. There is going to be a working paper, due this month, when the review finishes its first phase, and then the review will report by March 2022, as you said. But this working paper will be putting us up to date in the meantime, and that will provide options for improvement from within existing budgets, and if additional resources can be found.

You raised the issue about whether the autism-specific code of practice risks sidelining children with other needs, and I think Lynne has touched on that in her response. But I think that having the code of practice does give us a solid base from which we can then make sure that other neurodiverse children are considered in what we've learned from doing the autism code. So, I think that will be very helpful. Because underpinning all of this, we have set up a new integrated team in the Welsh Government, which brings together policy for neurodevelopmental services with autism and with learning disabilities. So, it's all going to be together under one new integrated team.

Our national autism team, which is jointly hosted by the Welsh Local Government Association and Public Health Wales, provides a neurodevelopmental section on its website, as well as providing information for children and young people, and parents and carers. So, I think that this concentration on autism has given us a solid foundation, and we will be able to consider the wider needs of the neurodiverse population. But I think, as Lynne said, we don't want children to be in boxes, so we have them all together now, under one team, all the neurodiverse conditions, really, and we want to make sure that we do the best for all of those children.

Excellent. Thank you, Minister. Just one last question, just briefly: what sort of improvements do you anticipate to perinatal mental health care, given that only two of the seven health boards in Wales currently meet the College Centre for Quality Improvement perinatal quality standards? Obviously, there has been progress, but what further progress do you anticipate in the coming years?

Thank you, Ken. Well, perinatal mental health is a priority in our 'Together for Mental Health' delivery plan, and it's a priority for me personally. As you've identified, there has been some progress, but there's further work to do in terms of making sure we meet the royal college standards on a uniform basis across Wales. And obviously the pandemic has had an impact on our ability to do that. But, we are investing heavily. We provided £3.4 million additional resource to perinatal mental health services, and that's on top of a very significant recurring investment in perinatal mental health services to try to make sure that, going forward, we can meet those standards. Some members of the committee will be aware as well that the work of the network co-ordinator for perinatal mental health is going to be continuing beyond the time we'd originally anticipated, at the end of this financial year, in order to ensure that that work can be consolidated and completed. And obviously we've also now got our mother and baby unit open in Tonna, which is absolutely wonderful to have. And work is continuing on provision for north Wales, which I'm very much committed to as well. So, we've got some work to do, but this is very much a priority for me and the Welsh Government.

Thank you, Minister. My questions are concluded. Thank you.

Thank you. We'll now move on to some questions around public health prevention and early intervention. James Evans.

Diolch, Cadeirydd. I just want to thank you for allowing me to take part in this session with my camera off. The staff at the University Hospital of Wales did look after me very well when I had my operation, but I wouldn't want to shock anybody. I look as white as the wall behind me and I'm still lying on my death—I say 'deathbed'; I'm still lying on my bed. So, thank you.

My first question is quite cross-departmental, really. Could somebody, one of the ministerial team, tell me what improvements have been made on a range of public health issues, including childhood obesity, preventative dental health, smoking in young people, physical fitness and illegal drug use, please?

Shall I start, James? I hope that you feel better soon.

Thank you.

That's quite a wide-ranging question, but I'll try to cover what I can and then maybe we can write to you with more detail. Obviously, the pandemic has affected our work in the area of preventative public health. We're trying to build our understanding of the impact on children's health and compare data pre pandemic, and our school health research network is a really useful resource to enable us to do that. We're also taking other information such as the children's commissioner's 'Coronavirus and Me' report and Sport Wales's report to build a picture of what's happening to children and young people. And that, then, is informing our policies, going forward.

In terms of the obesity situation, we recognise that the pandemic has made that more challenging for everyone. So, we've got a renewed focus on our 'Healthy Weight: Healthy Wales' programme and there are specific measures within that that are focused on children. We've got a children and families pilot, we've got renewed efforts in health boards to ensure that children who really need an NHS intervention in relation to their weight—to ensure that's available. I'm also pleased to say that the child measurement programme has resumed now that some more normality is in place in schools, and we're also looking at adding some additional measurements to children in older years, so that we have got a better sense of what's happening on the ground.

In terms of substance misuse, substance misuse services continued throughout the pandemic, and we invested very heavily in making sure that they could operate, and that includes the support for families, because of lots of children and young who are impacted by substance misuse are impacted within their families. We're very aware of the impact of adverse childhood experiences on families. We've continued to support the Wales police schools programme, and invest £1.98 million in that each year, and match funding for that is provided by the four Welsh police forces. There is work ongoing now to look at how the curriculum can expand its offer in relation to that. And just to say that we're looking to introduce a substance misuse treatment framework for children and young people next year. I don't know if you want me to go into any of the other areas, James, because it was quite a wide-ranging question.

The one I'd like to pick up on—thank you, Minister—is physical fitness. As you know, physical fitness does reduce obesity; it also helps a lot with people's mental health. I was just wondering what conversations you'd had with the education Minister to see how much more we can do to put sport into the curriculum, because I think it has wide-ranging benefits for mental health and tackling obesity.

I do recognise that this is a problem, particularly in quite a crowded curriculum. Just to assure you that there is work ongoing in this area. The Daily Mile Foundation in Wales has 545 schools signed up across Wales, and I know from my own personal experience what a popular initiative the daily mile is. But we're also looking through our 'Healthy Weight: Healthy Wales' programme to develop a daily active programme for schools. There's a task and finish group that is working to bring forward some further ideas in relation to that. And obviously, we've got some really huge opportunities with the new curriculum coming up, in particular with the AoLE on health and well-being. But I absolutely recognise that there's more to do and that the pandemic has made those challenges more difficult.

Thank you, Minister. One other area I want to touch on around public health is sexual health in young people, because I don't think sometimes we highlight this area enough, and just how much of a risk it can have to public health that people aren't getting regular sexual health checks, et cetera. So, I was just wondering what work the Welsh Government are doing to try and promote this more, to make sure that people are taking precautions and are making sure they're getting tested for sexually transmitted diseases, because it can have massive impacts on people's long-term health.

I'm probably going to bring an official in on this in a moment, but just to say that, as you know, all young people have access to relationship and sexuality education in schools, but it is very much part of the Welsh Government's agenda to really enhance that. That's becoming a legal obligation to provide that for children and young people in Wales, and that will be going right the way through school, so I think that's a very important step that we'll be taking that will really enhance work in this area. But I'll ask Irfon to come in on the issue of sexual health checks.

Thank you, Minister. This is another priority for this Senedd term. A commitment to develop a sexual health action plan is in place, and that will cover a broad range, including access to services and reducing stigma in terms of access to services. So, there's further planned work in the sexual health space too.

Okay. Lovely. I know there are others who want to ask questions, so I will finish there. Diolch, Ministers, thank you.

Thank you, James. Siân Gwenllian.

Could I just ask a question on the change in the law on physical punishment of children? How confident are Ministers that parents in Wales are sufficiently informed about the change that will come into force? What guarantees can you give that it will be implemented in a practical way, and that there's sufficient funding available for the campaign related to all of this? I've seen some advertisements on the television, but is enough being done, and are there sufficient resources behind that?

Thank you very much, Siân, for that question. Yes, we are doing all we possibly can to make sure that parents in Wales are aware of the change in the law. We've had, as you said, extensive advertising on tv and radio, and we've had digital advertising and engagement. We've also made a particular effort to reach out to particular groups in the communities where we need to communicate, perhaps, in specific ways. For example, we prepared resources in 14 languages, including Welsh and English, of course, and so we are making every effort to reach every part of the community.

During the summer, we targeted digital advertising, and we've particularly targeted where we understood audiences had lower levels of awareness about the change in the legislation. We also had an ad van that visited more than 40 tourist hotspots in Wales. I went with it to St David's, and it was very effective, I thought, and that was over the school holidays, because it was highlighting that the law will be changed in 2022, so the time is creeping up. In a way, there were other things that were on everybody's minds with COVID, so there was, I think, a bit of a gap. So, we have made a big effort to try to make it more upfront.

So, on 21 September, we launched our nationwide advertising campaign, and we're also ensuring that professionals who work with parents and children are prepared for the change in the law, with specific leaflets going to the sectors, and additional information being passed out to all the relevant officials. So, we are making a big effort, because I think it's so important that people must know that this change in the law is happening, so we're trying to reach out in every way possible.

Now, will it be implemented, I think you said, in a practical and workable way? That is certainly our aim, and although we've had COVID and we haven't done so much of the advertising and the outreach work, we've been working very intensely with our partners in public bodies and services, including the third sector as well, and we have a strategic implementation group, and then we have sub-groups and task and finish groups on key areas for implementation. This includes parenting support, data collection, monitoring and processes that will fit with the existing safeguarding processes. So, this has been ongoing, and there has been a huge amount of work to do that, and we'll evaluate the effectiveness of the implementation through data collection and monitoring, and also through surveys, because we're doing regular surveys to track the awareness of the law, and to see whether people's awareness has raised as a response to our publicity, and whether attitudes are changing, or have changed, as well. So, we want this to be implemented in a practical way, and we're working very hard with these different groups to ensure that happens.

Thank you for that comprehensive response on what is an important area which will be covered by this committee, I think, as we monitor how it's implemented, and whether the levels of awareness are there among the general population. If we can now turn to early years, and during the early phases of the pandemic, a number of childcare providers were warning that they could go bust as a result of COVID. And I remember raising questions with you, Deputy Minister, on this issue during the first lockdown. So, what kind of picture has emerged? Has the situation now been restored? Are there businesses that have gone bust as a result of COVID?

The situation has improved. It is much better than we originally thought, and the percentage of businesses that have gone bust is fairly small. So, we're very near to what we were originally. However, there is one sector that has been more affected than others, and that is the out-of-school care sector. And that has been particularly affected, and I've met with them on quite a few occasions. It's been affected by the fact that a lot of their premises were on school premises. So, the headteachers have been—understandably, in some cases—reluctant to have an independent body perhaps operating an out-of-school childcare facility on the premises when they're concerned about COVID. So, I think there is still a small problem there. We're hoping it will change now as we move on, and I've been speaking to the education Minister about this to try to encourage headteachers to be welcoming to restoring the out-of-school activities. But that has been drawn to our attention as a particular issue.

And also, with so many parents working from home, it's probably less necessary sometimes for childcare when the children come home from school and the parent is actually in the house. So, I think the childcare sector has been affected, but it has recovered remarkably well, really.

I'm pleased to hear that, but having said that, would you agree that this sector, generally speaking—the childcare sector—isn't as robust as we would like to see it for the future, certainly?

Yes, I would agree that we need to build on the childcare sector. We would like to see the childcare sector expand, and that is obviously something that we are looking at.

And, of course, the Government has a childcare offer that does provide childcare in certain circumstances. Do you believe that this offer is working? Is there a risk that there are some children, particularly those from some of the most deprived families, missing out on their development, because either they live in an area where there is no accessible provision so they can't access their right to free childcare, or the parents are unemployed, or in education? There are sectors that simply can't access this offer, and among them are some of our poorest children.

Yes, thank you, Siân, for making those points. Now, the childcare offer was originally developed as a programme of support for working parents, and you have to work a certain number of hours before you are eligible to access the childcare offer. The impetus behind it was that we heard from many parents, particularly women, that they couldn't take up jobs because of the expense of childcare. So, that was the thought behind the childcare offer when it was set up, but I think we've always said the childcare offer was not set in stone, and we are committed to increasing the number of children that can benefit from high-quality early learning and care opportunities, because we know how important child development is in the early years. Now, of course, we do have Flying Start, but Flying Start is geographically limited, but we are absolutely committed to continuing to support Flying Start. Our programme for government includes a commitment to fund childcare for more families where parents are in education and childcare [correction: and training], and we are looking at the offer to see whether that could be extended to people who are in education.

We did commission an independent report, which drew attention to the vast amount of different ways there are of accessing funding for childcare for those people who are in education and training, and one of the recommendations from that report was that perhaps it would be more beneficial to put money into the existing pools of funding that are available rather than convert the childcare offer. But we do feel that we need to expand the opportunity for children to have more access to early years provision, and we think the offer has been very successful. I think it's succeeded in doing what it was supposed to do, which was to provide childcare for working parents. And also, very pleased that it has reached people that really needed it, because the average wage of people who are using the offer is under the average wage of Wales. So, we are reaching people who do need it.

Do you now think that there's a need to review this whole area? If the main purpose of the childcare offer was to assist parents into work, that's one thing, but shouldn't the focus be on the child and on supporting the development of children in those early years? COVID has reiterated the importance of that period developmentally for children. Has the time now come for the Welsh Government to take a step back from the childcare offer and to look in detail as to what exactly should be focused on in this sector?

Yes, I think we need to always review what we're actually providing. As I say, I think the childcare offer, in what its aim was, has been very successful. The parents are very pleased with the offer. Many of them have said, I think—. Well, we've actually got the findings: 50 per cent of parents felt that they had the opportunity to increase their earnings; 42 per cent of parents said they had more opportunity for training, learning and development; other parents have been able to work more hours; flexibility in the way they worked. So, I don't think we should think that the childcare offer hasn't been successful, because I think that there's no doubt that it has been successful. But I agree with you that we should always look at how we can improve access for more children to this early years experience, which is so important, and we are in the process of doing that. We're looking at how we're going to increase opportunities to provide free childcare for people in education and training and we're committed to supporting and continuing to support Flying Start. But I think that this is an area where we would like to do more, and we have ambitions to do more.

Following on from what I'm hearing from you, which is good news, do you think that early years preschool education should sit within the same Cabinet portfolio as childcare? Wouldn't it be sensible to bring those two aspects together? If one is focused on early years pre-school education, whilst accepting that there are benefits for parents emerging from all of that, doesn't it make sense to bring those two things together, and for you, as Deputy Minister, perhaps to be responsible for that area?

I think the important thing about childcare is that it is cross-Government working. When you think about the different areas that childcare touches, it's obviously concerned with education, it's concerned with social services, it's employment, it's the foundational economy when you think about all the people who are employed in the childcare service, and mainly women as well, it's concerned with equal opportunities; I mean, it does stretch across all areas. So, I would say that it's not necessary to bring it into one portfolio in that way. I think what we really need to do is to work inter-departmentally in a way that takes us forward. So, I don't think that's the key thing—to try to make one portfolio. I think we need to work across departments and recognise the huge economic stimulus that childcare can bring to an area in terms of employment and, as I said, the foundational economy.

Thank you. Finally from me, Chair, if I could turn to speech, language and communication in the early years, what is your assessment of the impact of the pandemic on this specific area? One does hear that there are concerns about children falling behind in terms of speech, language and communication development because of the situation.

There have been concerns about how the pandemic has affected speech, language and communication, because, obviously, that does depend so much on communication and direct communication with small children. And the other point is that it's so important that if there are any problems they are tackled very early, because they can be so easily overcome. Because we do know from our experience that speech, language and communication—people who work in that field are so successful in what they do. You get that intervention in early on and you will be able to ensure that a child's life will be much more fulfilling. So, yes, there is a great deal of concern about this and we are addressing it. We set up the child development fund, investing £11.5 million of additional funding for our under-fives—that was between September 2020 and March 2022. This does include a focus on speech, language and communication development at a universal and at a targeted level.

We've allocated £200,000 in 2020-21 and £250,000 in 2021-22 to local health boards and specialist centres, again to support speech, language and communication needs. Funding was provided for them to get resources and to manage the increased demand. We have had two therapists who've been actually seconded to the Welsh Government and I'm very pleased that their secondment has been extended, because I've met with them and it really is quite inspirational listening to the work that they do with children to bring on their speech. This is something that we know works, and we really need to work hard to make sure that we do get that help in early.

There is lots of other stuff we're doing: work on the 'Talk With Me' delivery plan has continued, we've got a webpage up, and we've got a nationwide campaign to ensure that parents, carers and practitioners are better informed and equipped to understand the importance of speech, language and communication in the early years, so that they can provide richness at home in language for their children. So, thank you for that question. I'm glad we were asked about speech, language and communication, because it is so important. We are aware of it and we're trying to put in as many resources as we can.

Thank you, Deputy Minister. We've now got a question around child poverty from Buffy Williams.

Thank you, Chair. In March this year, statistics published stated that 31 per cent of children in Wales are living in poverty. Recently published child obesity statistics show that at reception age children are significantly more likely than the Welsh average to be obese if they live in areas of high deprivation. Could the Minister tell us what is being done to combat this?

Diolch yn fawr. You've just heard some of the ways that we're looking to tackle this. Let's just be clear that these are absolutely unacceptable levels for a Labour Government. We are absolutely committed to addressing the issue of child poverty in Wales. That's why what we're doing is looking at cross-Government action in this space.

I think one of the most important things, as far as we're concerned, is to make sure that what people have is access to quality services in terms of the early years. We need to make sure that the education systems are there for people very, very early on, and that what we offer is quality employment—that's an issue that is of key importance to us. I think the Flying Start programme is also key; we know that that works, and we're really committed to making sure that we can do what we can with that programme to really give people an excellent start in life. We've mentioned the childhood immunisation programme, and I think those rates are really high, so we're doing quite well on that front.

On the obesity side, obviously this is an area that Lynne Neagle has a huge interest in, but there is an issue here that we absolutely need to address. I can give you an absolute commitment that this is an area where I'm going to park my tanks. I think it's absolutely unacceptable that 20 per cent of our children go to school obese or overweight by the age of 5, and we need to do something about that. There is a correlation, I'm afraid, between poverty and those rates, and we need to break it.

We need to address the system, and we've got lots of ideas. We've got the 'Healthy Weight: Healthy Wales' plan that's looked into this in detail and looked at how we can break this. But, one of the key things that I'm determined to do is to give more responsibility to health boards to really understand that this is part of their responsibility as well. This is not something for other people to do; it will make a difference to what they are able to do in future in terms of healthcare. So, I'm absolutely determined that this is an area that we should focus on.

Just a couple of other things. We know that universal credit is just about to be cut by £20 a week. That is going to really hurt a lot of children in Wales, in particular in your constituency and other constituencies where there are huge levels of poverty. We're seeing an increase in fuel and energy prices, and we're seeing the Tory cost-of-living crisis really start to bite already, and it's going to get worse.

So, this is really difficult for us while the Tories are in power in Westminster making those kinds of cuts. I can see James is interested in coming in here, but I'd just like to say that I do think that the cuts that are being introduced by the Tory Government are absolutely unacceptable. We can go as far as we can, but if we're fighting against a Tory Government that is cutting the legs from under us at every opportunity, then that's going to be difficult for us to deliver on.

Thank you.

Thank you for that answer, Minister. I think you can be assured that the committee will hold you to those assurances as well over time because it's something that we are very much interested in as well.

Can I just ask quickly around child health strategies? The previous CYPE committee identified recurring challenges including a lack of data and financial information relating to children and young people. Do you have any plans to publish a child health strategy?

We're unlikely to publish a child health strategy. Just to be clear, children's health is absolutely a top priority for the Welsh Government, and, of course, we want to make sure that there are excellent integrated services that put their needs first. But we do think that producing a strategy for every section of society is probably not the way to go. We do a lot of collecting data, and we could probably do a bit more to break down where we're spending that money, but I don't think that we'll be going down the route of doing a specific child health strategy, as I said, because once you start down that route we'll be having them for everything.

Okay. And just finally from me, Minister: what discussions has the Deputy Minister had with the Minister for Social Justice about the policy implications for Wales of the UK Government's Police, Crime, Sentencing and Courts Bill, specifically in relation to youth justice? Is there a risk that changes brought in could result in young people being unnecessarily criminalised or ending up in custody?

It's probably one for Julie, but it's really one more for Jane Hutt, really, isn't it, Julie? But I'm sure you know more about it than I do.

Well, obviously, justice is not devolved, and youth justice isn't devolved. But we do have, obviously, a very close relationship with those people working within the youth justice sector, and we do work closely with the Ministry of Justice to deliver the commitments that were made in our youth justice blueprints to improve outcomes for children in or at the edge of the criminal justice system. So, we do have that very close working relationship. And there are parts of the police, crime, courts and sentencing Bill that do cross over into areas that are devolved. So, the Minister for Social Justice has got the main responsibility, as Eluned said, and she laid a legislative consent motion on 28 May setting out the Welsh Government's position. So, discussions are really ongoing through the Minister for Social Justice's officials.

Thank you for that answer, Deputy Minister. I'd just like to thank the Minister and Deputy Ministers and the officials that have joined us. A transcript will be sent to you all for checking.

We now move on to item 7, which is papers to note. Full details of the papers are set out in the agenda and meeting papers. Are Members content to note the papers? Yes. Everybody's content.

Item 8 is a motion under Standing Order 17.42 to resolve to exclude the public from the meeting for the remainder of the meeting and for the whole of the meeting on 18 October. I propose, in accordance with Standing Order 17.42 that the committee resolves to meet in private for the remainder of the meeting and the whole of the meeting on 18 October, in which we will be having a strategic planning session. Are Members content? I see that all Members are content.