Children, Young People, and Education Committee

Okay, we'll move into the first main item on our agenda, which is the mental health support in higher education—our ninth evidence session. I'd like to welcome the Minister and the Deputy Minister here this morning, and we've got officials. So, we've got Jeremy Miles, Minister for Education and the Welsh Language; Lynne Neagle, Deputy Minister for Mental Health and Well-being; Sinead Gallagher, deputy director for higher education division; and Tracey Breheny, deputy director for mental health and vulnerable groups. So, you're all very welcome this morning.

We've got a number of questions from Members, so we'll get straight into that, but I'd like to thank both of you for the comprehensive paper that you sent through that you did jointly. So, thank you very much for that. All Members have had a chance to look at that. We'll start off with questions from Buffy Williams. Buffy.

Bore da, and thank you for joining us this morning. My question is to both Ministers. How do the Ministers work together on the issue of student mental health? Where should responsibility lie—is it with education, health or with the institutions themselves?

Okay. Jeremy.

Thank you. Well, I think the answer to that is that every part of the system has a role to play, and unless every aspect of the system is playing its part, then I don't think we will meet that shared objective that we have, which is to make sure that students have the best support available to them and can flourish at university. So, I think it's a shared responsibility, if I can put it like that.

Lynne and I jointly chair a task and finish group that was set up to oversee the implementation of a whole-system approach to mental health in education in Wales. I know Lynne will want to come in on this answer as well. So, from a Government point of view, we work very closely indeed together, and the responsibility is in both our portfolios for this. But universities obviously have a central role to support students and to provide that excellent student experience, and very supportive student experience, when it comes to mental health and well-being. I'm sure we'll look at the relationship between universities and health boards during this discussion, but, from my point of view, also I just want to flag the important work that the Higher Education Funding Council for Wales have done in this area. Since 2018, it's been part of their remit to work with higher education institutions to address student mental health and well-being, to strengthen the approaches that institutions are taking, and we can see the development of that in the years since then with a number of initiatives, both at institutional level and collaboratively across the sector, and a refresh of those strategies this year. So, I think there's a role for players, as it were, in all parts of the system, and it's only by doing that in a collaborative, joined-up way of working that I think we will meet the goal that we all have.

Lynne, did you want to—?

Thanks, Chair. Well, I think I've been really clear since coming into post that I see mental health as everybody's business. I see it as everybody's business within Welsh Government, but I think the same applies to institutions, and if you look at the policies, like the Stepchange policy that is on mental health in higher education, then I think that principle of everybody's business is very clearly embedded in there. As Jeremy said, we have worked very closely together around the work on the whole-school and whole-system approach, but I've also now agreed to chair a new cross-sector policy advisory group looking at mental health in the tertiary education sector, to build on that really good work that we've done in schools, and to build on the work of the ministerial task and finish group. So, that new group, which we're hoping to convene in the new year, will have a particular focus on strengthening our approach to mental health and well-being across the post-16 sector. It'll link in with the work being done to establish the commission for tertiary education and research, and I'm hoping that it will provide an opportunity to look at some immediate issues where we can make further progress, as well as doing some really important work to inform the successor to the 'Together for Mental Health' strategy.

Okay, thank you. Buffy.

Thank you. My next question is to the education Minister. Your written paper draws on UK-wide data for information on the prevalence of mental health concerns among students. What is your understanding of the extent and nature of this issue in Wales?

The recent research and analysis that we have in this area shows us, as the evidence paper was saying, that there's been a marked increase in the numbers of students declaring, either through the Universities and Colleges Admissions Service itself, or, once they've enrolled, at whichever institution they're at, a mental health condition. You'll have seen from the paper that organisations like the Education Policy Institute, for example, say that that could be due to a number of reasons, including demographic change in the composition of the student body. But I think we also need to recognise that there will be students who have poor mental health who will be reluctant to declare that at any point, really. So, we need to be very conscious of that and make sure that there is a culture and an environment where students feel safe to make that declaration, and share their concerns at any point, really.

But on the question of the difference between UK-wide data and Wales-wide data, we've actually got Wales data as well that we can share with the committee. The last figures that I saw, which were for 2018-19 through to 2020-21, showed around 4 per cent of students declaring a mental health condition. We can share that data with the committee. I do think it's important, though, if I may say, that clearly the data is essential, but I do think we need to look behind that as well and understand the human experience that underlies what we are discussing today. And I think that the work of the committee, if I may say, in relation to this inquiry will be very helpful to us in having a qualitative understanding, as well as looking at the data.

Thank you. How is the Welsh Government addressing any gaps in your understanding of mental health concerns among students? That's to both Ministers.

I'll start, if I may. We talked in the earlier question about the whole-system approach. Obviously, lack of support for mental health and well-being will be a barrier to those people who suffer from poor mental health in accessing the education that they're entitled to. So, I guess there are two levels. Firstly, we need to make sure that providers are focused on this, and they're attentive to the challenges that arise in this area. I mentioned the work that HEFCW has been doing with institutions earlier. I think that has really driven a very significant change across the system in the last number of years.

But, looking forward as well, we have, obviously, all just voted on the new legislation for post-16 reforms, and the establishment of the new commission, CTER, provides a new opportunity, I think, to take a more holistic, if you like, joined-up approach to identifying mental health and well-being concerns and challenges for learners. It's obviously put the learner journey at the heart of the reforms, and so we all know—and you'll have heard this in the evidence that you've received—that those transition points are often points at which challenges can arise or be identified. And I think the fact that the commission is looking at this holistically will help us to identify challenges. Obviously, there are particular responsibilities on the part of providers, which the commission will want to see are satisfied in terms of their commitments to mental health and student welfare more broadly, as part of the registration arrangements. So, I think there are new opportunities for us as a result of those reforms.

Okay, thank you.

I don't really have anything to add. Obviously, we've got a range of population-wide measures that were used to monitor mental health in the community—we've got public health surveys in schools, we've got the School Health Research Network surveys. But, as far as I'm aware, they wouldn't particularly identify students, other than the SHRN one. The work that Public Health Wales does as well is very important, but, obviously, the student data that Jeremy has referred to is particularly important.

Thank you. Buffy.

Thank you. My next question is to the education Minister. Do you agree with HEFCW's view that it would be better to build on existing data collection methods rather than introduce new systems to gather information about student mental health? And how could changes to the national student survey help us better understand and tackle mental health problems for students?

Well, I definitely think we don't need to reinvent the wheel if we've got existing mechanisms that can help us. So, I guess my starting point is that I think HEFCW's suggestion is very sensible—that we should definitely start from building on the existing arrangements that we've got. Whether that can capture all the ranges of data that we will need, ultimately, is a separate question, but that should definitely be the starting point, it seems to me. And I think, looking at what the NSS can do for us in this area is, obviously, another positive suggestion. So, as you will know, I think, there is a new question on mental health and well-being in the national student survey, which will help us understand students' own views on services and get the perspective from them on whether they feel that they're getting what they need, if I can put it in those terms. As you may also know, we can interrogate that data at an institution level, so that gives us both a Wales-wide picture and also at institution-by-institution level. So, that will, I think, help us significantly better understand students' own perspective on the services they're getting. I think we should probably just also say, though, that we need data that extends probably beyond higher education solely in this area, to fully understand the needs of students. I don't think one data set is likely to give us everything that we need, but, basically, I definitely believe that we should start from HEFCW's suggestion.

Thank you. And a question to both Ministers: how is the Welsh Government working to identify and tackle mental health inequalities among the student population?

Do you want to start, Lynne?

Well, Jeremy will talk specifically about higher education, but, from my point of view, 'Together for Mental Health' has a really strong focus on mental health inequalities. It's a cross-Government plan that recognises that the impacts on mental health are things like poor housing, economic adversity, debt—things like that. So, it's very important that we have that cross-Government work. We're also doing lots of work to tackle inequalities like racism and LGBTQ issues, but I really want to see a stronger focus on those issues when we develop the new strategy as well. So, in relation to culturally competent services, we've had Diverse Cymru, who have done training for us across sectors on making sure that services understand the particular needs of black, Asian and minority ethnic communities. We're working across Government on the LGBTQ action plan. Obviously, there's a lot of work to do in ensuring that people can access services through the medium of Welsh, so we're very much embedding that into our work. But this is going to be a key area of focus in the successor to 'Together for Mental Health'.

Thank you. Minister.

Just to add to that, from an institutional perspective, a HE-specific perspective, the plans that we were talking about a little bit earlier, which have resulted from the new HEFCW approaches of a few years ago, in order to develop those plans at an institutional level, universities are undertaking equality impact assessments, which will give them a better understanding of some of the particular inequalities in this area, which obviously will vary between institutions, to some extent, because the demographic mix of student populations will vary between institutions as well. So, it's really important that that happens in a bespoke way at an institutional level.

There's been significant investment in the data gathering and how to use data analytics in this space as well, through the funding that Jisc has received, for example, so that issues around early identification can be identified, and how that then translates through to individual student outcomes. That's been quite a successful area of investment. So, in December, we're expecting that universities will submit to HEFCW their implementation plans for their mental health and well-being strategies, and that will identify and address the needs of vulnerable groups in particular, which will also enhance our understanding of the equalities dimensions to the mental health strategy. So again, that'll be about identifying what they've learnt from their equality impact assessments, explaining how a representative range of the workforce and students have been involved in reviewing and monitoring the plans, so to make sure that there's a range of voices from a range of demographics and protected characteristics, which are feeding in to both the design, but also, crucially, obviously, the monitoring of the strategies. So, all of that will be part of what's reported now in the coming weeks, and the particular needs of staff and students with protected characteristics, for example, will be part of that analysis.

Thank you, and thank you, Ministers.

Okay, thank you. James Evans, quickly.

Yes. Thank you. It was just on—

Yes, briefly.

—the last question that Buffy Williams raised, and it was actually raised with me, when we took evidence in Trinity Saint David, by a young gentleman who was actually studying there. The biggest killer of young men between 20 to 35 is suicide, and that young gentleman there didn't think that enough was done by Government and agencies to actually help men overcome the societal pressures that they're under to actually explain that they have mental health problems. And a question, actually, to the Minister for education is: what are you doing, Minister, to make sure that young men feel that they can talk about their mental health problems, so that we can actually get on top of the biggest issue of deaths within young men between 20 and 35?

Well, from a HE point of view, I guess Lynne would have a broader perspective on what we're doing more generally, but from a HE point of view—I think you said it was University of Wales Trinity Saint David that you had that evidence from, so that's a good example of the interventions and initiatives that have been taken at an institutional level. So, for example, Trinity Saint David have worked with Swansea University on a project called the CONNECT project, from memory, which has been about identifying people at particular risk and making sure that they're connected to other networks within the university, to make sure that they feel supported and that there's a sense of belonging, and that any issues around loneliness are tackled. So, I think that particular university has demonstrated quite a lot of creativity in tackling some of the issues that you've talked about there.

Lynne mentioned earlier the Stepchange initiative, which obviously requires universities to make mental health a strategic priority and adopt that whole-university approach to suicide prevention amongst others. But, Lynne, I don't know if you want to say something broader about suicide prevention.

Some, Chair. And, yes, you're right and, actually, suicide is the biggest killer of young people as well, and that is a very, very sobering statistic, and the prevention of young suicide in particular is particularly close to my heart and something that I work very hard on.

We are doing lots of work on this. One of the things that we did following the 'Mind over matter' inquiry was we launched guidance in schools on talking about suicide. That was prepared by Professor Ann John for us, and I went to the launch with the then education Minister—excellent guidance to enable not just teachers but any adults working with young people to have those conversations about suicide and self-harm. Across Government, I absolutely see this as an 'everybody's business' issue. We have set up a new cross-Government group on suicide prevention, bringing together all departments across the Government to look at what more we can do on suicide prevention, and education is fully engaged with that work.

You'll be aware, just to add to Jeremy's comments, obviously the new curriculum in Wales gives us a really powerful opportunity for suicide prevention because we've got the mandatory area of learning and experience on health and well-being, and the predecessor committee pushed very hard to have a strong focus on help-seeking in that. But, I think we need to do more, really, because the most important thing is that we have those conversations about suicide. Young people are particularly at risk because they can be impulsive. Often, there are opportunities for intervention that people don't recognise because they don't know that they're opportunities for intervention until, tragically, something terrible has happened. So, we are working across Government to see what more we can do to embed conversations about suicide. They'd have to be appropriate, sensitive conversations, but we want to have those safe conversations about suicide for young people so that they know that help is out there and that they're able to seek that help—it's absolutely crucial.

Absolutely. Thank you. Questions now from Ken Skates. Ken.

Diolch, Chair. Thanks, Ministers, for attending, and for your papers. I'll direct my first question at the Deputy Minister, if I may. It's with regard to 'Together for Mental Health'. To what extent do you think the strategy has been successful in helping people to become more resilient and generally helping people to cope?

Thanks very much, Ken. As the committee may be aware, we've commissioned an independent evaluation of 'Together for Mental Health', looking at it across all the years that it's been operating. Opinion Research Services have undertaken that evaluation for us, and are in the final stages of completing that work. We will be publishing that according to the usual social research protocols that are in place for Welsh Government publications, and I'm very happy to share a copy of that with the committee when we're in a position to publish it.

As I said earlier, it is a cross-Government strategy in recognition of the fact that the social determinants of mental health are absolutely key for us to tackle, so that's things like education, housing, finance, et cetera. All of those issues are vital in order to deal with issues around resilience. 'Resilience' is a word I've been thinking about a lot lately, because resilience is different for different people, isn't it, and someone who is extremely disadvantaged economically is going to have less resilience than someone living in a comfortable, warm home. So, that's why that cross-Government approach to mental health is so important.

I think we've made good progress around our whole-system work with children and young people—first of all our whole-school approach, now our whole-system approach—and I very firmly believe that if we can get this right for young people, we will get this right for society as a whole. So, that's why it's such a top priority for me.

We were also making really good progress prior to the pandemic, but the pandemic has undoubtedly had an impact. We've seen significantly rising levels of people coming forward for mental health support, rising levels of anxiety. But, the independent evaluation is going to be absolutely key in looking at all aspects of the 'Together for Mental Health' plan and how successful it has been. I just wanted to add as well that, in terms of the successor plan, officials are already working with Public Health Wales because we want to develop a policy to support good mental health across the whole population, and we want to very much put that on a par with physical health—parity between mental and physical health is very, very important to me.

The committee is probably aware that, as part of the Well-being of Future Generations (Wales) Act 2015, we've recently consulted on mental health milestones, and their focus is on narrowing the gap between the mental health of the more deprived people and less deprived people, and we've drawn a distinction. We're measuring children as well as adults, and we're going to use the school health research network to measure our progress in that regard. And just to add that, obviously, the issue of stigma is very important, and we've continued to fund Time to Change Wales, which not only has a focus on stigma, but is working particularly in our most deprived communities to tackle those issues. So, I think that's really, really key as well as focusing specifically on black, Asian and minority ethnic communities as well.

Thanks, Minister, that is fascinating. It may be too early to say, but are you planning on having any external or international organisations assist in the development for the successor strategy? There are some fabulous examples of universities in the United States and Denmark and France that are quite incredible in terms of promoting mental health and well-being. Do you have a view on whether there will be any external challenge or contribution to the successor strategy?

Well, there will be very, very wide engagement with a whole range of stakeholders. Obviously, putting people with lived experience at the centre of the strategy is incredibly important. I'm very happy to look at any international evidence that's out there, but I think we've got really good people in Wales as well, people like Ann John who is an expert in this field, who the committee has heard from previously. So, I think that we've got lots of opportunities to draw on expertise from throughout Wales as well, but I'm very happy to listen to any views, and there will be very wide engagement on the new strategy, including, hopefully, with the committee.

Thank you, Minister. Turning to universities—so, this is a question directed at the education Minister—what's the Welsh Government doing to ensure that all universities consistently promote a positive culture of mental health?

Well, I guess this is about two things, in my mind, really. One is about how, as you say, that positive culture of mental health is mainstreamed into the life and work of institutions themselves, so that it becomes embedded in everything that they are doing. That's the first objective. And the second then, I think, is how does that become a system-wide priority. So, how does the system itself respond to support the mental health of students.

On the first aspect of that, I think the requirement for student charters to set out commitments on student well-being, including mental health, and the support and signposting available to students is really important. Obviously, from this year, there will be some additional requirements in relation to commitments to supporting suicide-safer approaches. The kinds of things that Lynne was talking about earlier, about Stepchange and suicide-safer universities—they're all about embedding those approaches in the policies and practices of all institutions, so they're built in, if you like, to the experience of students and how universities are run. But then, the broader work that we are doing, and again we touched on this a little earlier, whether it's specific actions for HE in the LGBTQ+ action plan or the specific requirements on universities in the anti-racist Wales action plan around the race equality charter mark and so on—those interventions are all about how you can embed both preventative approaches and responses through the life of the universities.

And the second aspect, the systemic approach, we've been keen to, and have provided funding for, through HEFCW, seeing how institutions can work with each other on approaches here. So, I touched earlier, in my answer to James Evans, on the work that Trinity St David's and Swansea University are doing, but, in your part of the world, Ken, Wrexham Glyndwr have been working both with the Open University and Adult Learning Wales, for example, on some particular modules for students with, if I can say this, low-level mental health conditions, if I can put it like that. Wrexham Glyndwr are also working with the University of South Wales and Betsi Cadwaladr on developing social prescribing approaches for students with poor mental health.

So, I think—. And there are other examples. The south-east Wales partnership—I know that you've heard evidence in relation to what's been working well there. So, I think that's one of the other priorities in this place, to make sure that institutions are working together. I was speaking to Universities Wales yesterday as part of my regular series of meetings with them, and we were talking about what we can do across the system to ensure that best practice is identified, that interventions are evaluated, and that work is shared between institutions so that we can make sure that the best interventions are being used most widely, really.

Thank you. Just turning to the support that students received during COVID-19, obviously the Welsh Government generously provided additional hardship support for students and higher education providers during the pandemic. Are you considering options to support students in a similar way during the cost-of-living crisis?

Well, as you say, we were able to provide significant support during the period of COVID. That, obviously, partly reflected the additional funding available in the COVID response. That, for obvious reasons, isn't the situation that we are in at the moment, unfortunately, but we are working closely, through HEFCW, to make sure that universities are doing everything they can—again, I was discussing some of these issues yesterday with Universities Wales—whether that's around extended campus opening hours, whether it's around food, you know, discounted food or free breakfasts in some institutions; there are discounted travel programmes being looked at, additional hardship funding, obviously. So, all of those things are areas that we're working with universities on.

We remain committed to making sure that we have as progressive a student finance system as we can possibly have. It's good that we have the most progressive system in the UK. And we'll be saying something more about that shortly in relation to the maintenance and support arrangements. The rates for 2023-24 will be published shortly, and I'll be making a statement on that as well.

Great, thanks. And will there be consideration given to particularly vulnerable groups at all? I'm thinking especially of those who have caring responsibilities, and indeed, international students, who may feel the added burden of being isolated and away from their home country.

Yes, there are a range of concerns in this space, Ken. So, where students come to Welsh universities without the benefit of having the level of support that we provide to Welsh students, then they will often need to make greater calls on the hardship funds that universities have, and my understanding is that that is the pattern that we are seeing across Wales.

International students, we're very concerned to make sure that—. Well, there's a reluctance, I think, on the part of lots of international students to seek support, because of an anxiety that that might impact their visa restrictions, for example. Some of them have requirements about recourse to public funds and so on, so there's a barrier there. But I do know that institutions are alive to that and are looking at ways to make sure those messages are reaching international students particularly.

In terms of other students with particular needs and responsibilities—you mentioned caring responsibilities, I think, in your question—we've got the childcare grant and the parents' learning allowance and adult dependants' grant, which can support a range of the people you were referring to there. And we've been working in relation to young carers in particular, to make sure that absence from courses, which sometimes happens because of the caring responsibilities of young carers, is treated appropriately through the student financing system, so there aren't any unnecessary penalties for absence that come from caring responsibilities.

So, we try and do everything we can to understand the particular blend of issues and responsibilities that particularly vulnerable students face, and then to tailor, if you like, interventions, both system wide, where we can come into it, and also institutions are doing it at a local level as well.

Okay, excellent. Thanks, Ministers. Thanks, Chair.

Thank you, Ken. Questions now from Sioned Williams. Sioned.

Diolch, Cadeirydd, a bore da. Mae fy nghwestiynau i yn fwy penodol i'r Gweinidog addysg, am y cymorth iechyd sydd ar gael o fewn y prifysgolion eu hunain. Rŷn ni wedi trafod tipyn bach am natur y ddarpariaeth, ond hefyd wrth gwrs mae natur y sector yn golygu yn anorfod fod natur y ddarpariaeth a, hwyrach, y safon, yn amrywiol. Mae'r dystiolaeth rŷn ni wedi'i chlywed wedi galw am gytuno ar isafswm, rhyw fath o waelodlin o gefnogaeth, y gellid disgwyl i unrhyw fyfyriwr a phob myfyriwr ei gael. Ond mae hefyd, wrth gwrs, fel rŷn ni wedi'i glywed yn yr atebion ynglŷn â'r angen yna i edrych at y person sydd y tu ôl i'r data, yr egwyddor yna o ddeall a pharchu amrywiaeth darparwyr a myfyrwyr ar yr un pryd. Felly, jest eisiau holi: ydych chi'n cytuno â'r egwyddor o gael fframwaith cyffredin ar gyfer cymorth iechyd meddwl, a'r angen, hwyrach, am fframwaith o'r fath?

Wel, fe wnes i weld y dystiolaeth rŷch chi'n cyfeirio ati hi. Mae yna rywbeth diddorol yn hyn o beth. Rwy wedi cael trafodaethau gyda mwy nag un sefydliad am beth yw'r potensial bras yn y maes yma. Beth fuaswn i'n dweud yw fy mod i'n credu ei fod e'n sicr yn werth edrych ar fframwaith o ddisgwyliadau cyffredin, os hoffwch chi. Felly, byddai gyda fi wir ddiddordeb yn clywed beth fydd gan y pwyllgor i'w ddweud yn hyn o beth. Ond, fel rŷch chi'n dweud yn y cwestiwn, mae'n bwysig hefyd i gydnabod bod annibyniaeth ac amrywiaeth ymhlith y sefydliadau eu hunain. Felly, byddwn i'n meddwl mai'r ffordd fwyaf ymarferol o sicrhau ein bod ni'n cyrraedd y nod rŷch chi'n cyfeirio ato fe, efallai, yw fframwaith o egwyddorion cyffredin, a bod y rheini yn cymryd ffurf, efallai, wahanol, ar lawr gwlad ym mhob sefydliad, os oes angen yr hyblygrwydd hwnnw ar sefydliadau penodol.

Beth hoffwn i ei weld, a beth rwy'n credu sydd yn bwysig i'w gweld, os ydym ni'n gwneud disgwyliad cyffredin o'r fath, yw bod hyn yn cael ei arwain gan y sector, yn gweithio gyda phobl broffesiynol yn y maes, oherwydd, fel rŷn ni wedi sôn mewn amryw o bethau eisoes yn y drafodaeth yma, mae blend myfyrwyr a demograffeg myfyrwyr yn amrywio, ac felly mae angen yr elfen honno o hyblygrwydd. Ond byddwn i yn sicr yn croesawu'r drafodaeth honno ac yn edrych ymlaen i glywed beth fydd gennych chi i'w ddweud fel pwyllgor. Rwy'n credu bod potensial yn hyn o beth hefyd i fwydo i mewn, os caf i ei ddodi fe fel yna, i'r telerau cofrestru o dan y comisiwn newydd yn y dyfodol. Rŷn ni ychydig cyn bod hynny yn digwydd, wrth gwrs, ond gallwch chi weld bod hyn yn rhan o'r broses honno hefyd.

Gallwch chi roi unrhyw ddiweddariad i ni am ddatblygiad y trefniadau rheoleiddio newydd yna, o ran yr amod cofrestru newydd yna yn ymwneud â llesiant?

Ie. So, os nad oes llythyr wedi cyrraedd y pwyllgor eto, mae e ar fin cyrraedd—byddwn i'n disgwyl cyrhaeddiff e chi heddiw—yn esbonio lle rŷn ni yn gyffredinol ar wireddu sefydlu'r comisiwn ac ati. Fel gwnes i sôn yn y datganiad o fwriad polisi gafodd ei gyhoeddi ynghyd â'r Ddeddf, y bwriad yw sefydlu'r gofrestr o'r cychwyn, a bod hynny yn cael ei boblogi yn haf 2025, gyda'r trefniadau rheoliadol newydd felly yn gweithio am y flwyddyn academaidd 2026-27. Felly, dyna'r amserlen fras ar gyfer hynny. Bydd datblygu'r termau eu hunain, wrth gwrs, yn rhan o gyfrifoldeb y comisiwn newydd, ond dyna lle rŷn ni o ran amserlen, ac, fel roeddwn i'n dweud, bydd llythyr yn eich cyrraedd chi, os nad yw e eisoes wedi, yn esbonio mewn mwy o fanylder lle mae pethau.

Diolch. Beth yw eich gweledigaeth chi—? Yn gwerthfawrogi wrth gwrs taw cyfrifoldeb y comisiwn fydd hyn, ond beth yw eich gweledigaeth chi o ran sut bydd y system a strwythurau rheoleiddio'r comisiwn yn dwyn darparwyr i gyfrif am eu darpariaeth iechyd meddwl?

Wel, y brif ffordd o wneud hynny bydd trwy'r telerau cofrestru. Bydd angen i bob sefydliad sy'n cael ei gofrestru sicrhau eu bod nhw'n cyrraedd y nod hwnnw o ran telerau ar gyfer bod ar y gofrestr yn y lle cyntaf a sicrhau bod y telerau yna yn cael eu parhau. Dyma'r tro cyntaf i hynny ddigwydd mewn unrhyw ran o'r Deyrnas Unedig, rwy'n credu, felly mae hynny'n beth pwysig iawn. Ond hefyd, wrth gwrs, bydd gan y comisiwn, mewn amryw o gyd-destunau, gyfle i ariannu'n uniongyrchol, ac mae'n bosib hefyd sicrhau bod y termau sy'n berthnasol i'r grantiau penodol, fod y rheini hefyd yn adlewyrchu'r egwyddorion a phwysleisio darparu ar gyfer iechyd meddwl. Felly, mae amryw ffyrdd y bydd y comisiwn yn gallu gwneud hynny. A beth mae hynny'n creu, wrth gwrs, yw sail. Os oes angen ymyrraeth benodol os nad ydy sefydliad yn cyrraedd y nod o ran amcanion iechyd meddwl, gall y comisiwn weithio, os hoffwch chi, yn gefnogol gyda sefydliad—rhoi cyngor, rhoi cymorth, edrych ar adolygiadau o sefydliadau penodol, neu hefyd gorfodi telerau penodol o ran cofrestru, rhoi cyfeiriadau penodol i sefydliadau, ac, yn y sefyllfaoedd mwyaf problematig, tynnu sefydliad oddi ar y gofrestr. Felly, mae lot o ffyrdd rwy'n gweld bod y diwygiadau newydd yma'n mynd i allu symud pethau ymlaen yn sylweddol iawn o ran strwythur y system sydd gyda ni.

Ar hyn o bryd, mae rhai sefydliadau addysg uwch wedi dweud wrthym ni fod dyraniadau cyllid blynyddol yn ei gwneud hi'n anodd cynllunio ymyriadau iechyd meddwl hirdymor, ac rydyn ni wedi clywed hefyd gan dystion yn y maes seiciatryddol a meddygol pa mor bwysig yw'r strategaeth hirdymor yna. Ac maen nhw'n dweud ei bod hi'n anodd recriwtio a chadw staff oherwydd hynny—staff arbenigol. Hoffwn i wybod eich ymateb chi i'r sylwadau hynny a gofyn sut all Llywodraeth Cymru ymgorffori strategaeth gyllido fwy hirdymor ar gyfer cymorth iechyd meddwl mewn addysg ôl-16.

Wel, y peth cyntaf i'w ddweud yw bod prifysgolion, wrth gwrs, eisoes yn cyflogi staff ar gytundebau hirdymor. Felly, mae hynny'n digwydd eisoes. Felly, mae'n bosib i brifysgolion wneud hynny ym maes iechyd meddwl, fel y mae e mewn unrhyw ran arall o'u cyfrifoldebau nhw. Dyna'r peth cyntaf i'w ddweud. Wedi dweud hynny, wrth gwrs, rwy'n derbyn ac yn deall bod sefydliadau—prifysgolion ond sefydliadau cyhoeddus eraill, a Llywodraeth Cymru hefyd, gyda llaw—yn gweld mantais o gael sicrwydd cyllidebol sydd yn parhau am fwy nag un flwyddyn. Dyw hynny fel arfer ddim wedi bod yn bosib oherwydd mai setliad blynyddol, yn anffodus, yw'r patrwm sydd wedi cael ei sefydlu. Ar y foment, fel rydyn ni'n gwybod, mae gennym ni setliad dros dair blynedd, felly mae wedi caniatau gosod cyllideb mewn un flwyddyn a rhoi arwydd o'r gyllideb fydd yn dod dros y ddwy flynedd olynnol. Wrth gwrs, ar hyn o bryd, mae hynny wedi cyd-fynd ag impact sylweddol chwyddiant ar gyllidebau pawb. Felly, dyw'r fantais honno o allu gweld dros gyfnod o dair blynedd beth yw'r gyllideb ddim wedi bod beth fyddai fe wedi bod heb y sefyllfa honno. Ond, beth rydyn ni wedi ei wneud yw ein bod ni wedi gallu clustnodi arian tu fewn i'r arian sy'n mynd at HEFCW, a wedyn mae hi i fyny i sefydliadau allu dyrannu hynny fel maen nhw'n dymuno o ran staffio ac ati.

Mae'n dda clywed eich cefnogaeth chi i gytundebau parhaol a thymor hwy, achos un ymadrodd trawiadol o ganolog, dwi'n meddwl, i'r ymchwiliad yw'r hyn gawson ni mewn tystiolaeth gan Lywydd UCM Cymru, Orla Tarn, pan oedd hi'n myfyrio ar rôl a phwysigrwydd staff ar draws prifysgol, nid yn unig staff gwasanaethau cefnogi neu arbenigol yn unig, wrth fynd i'r afael â materion iechyd meddwl myfyrwyr—

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

meddai. Ac rydyn ni'n gwybod bod staff prifysgol dan bwysau oherwydd yr argyfwng costau byw, ond hefyd rydyn ni'n eu gweld nhw'n gweithredu'n ddiwydiannol eto yr wythnos yma oherwydd llwyth gwaith, tâl a chytundebau ansicr. Felly, ydych chi'n adnabod y darlun yna ac ydych chi'n bwriadu gwneud unrhyw ymyriad fel Llywodraeth i fynd i'r afael â hynny am fod hyn yn ddiau yn effeithio ar y math o gymorth y mae staff prifysgol yn medru ei ddarparu i fyfyrwyr?

Fe wnes i gael cyfarfod gydag Orla Tarn ac roedden nhw'n esbonio rhai o’r ffactorau ŷch chi wedi bod yn eu trafod gyda mi jest nawr. Wrth gwrs, ŷn ni'n cydnabod yn glir ddigon y pwysau o ran costau byw ar fyfyrwyr a staff hefyd, a’r pwysau sydd ar gyllidebau prifysgolion, fel cyrff eraill, gan gynnwys, yn anffodus, Llywodraeth Cymru hefyd o ran impact chwyddiant. Beth fyddem ni wastad eisiau ei wneud—ac ŷn ni wedi llwyddo ei wneud mor belled—yw sicrhau’r setliad gorau posib a'r gefnogaeth gorau posib. Fel rŷn ni wedi dweud eisoes a dwi wedi dweud y bore yma hefyd, rŷn ni'n gwbl ymrwymedig i sicrhau bod y gefnogaeth ŷn ni'n ei darparu i fyfyrwyr yng Nghymru y mwyaf blaengar y gall fod. Rŷn ni wedi gallu llwyddo cysylltu hynny â’r cyflog byw; rŷn ni hefyd yn sicrhau bod y blend o gefnogaeth o ran grantiau a benthyciadau yn well yma nag yn unrhyw ran arall o’r Deyrnas Gyfunol. Felly, rŷn ni'n ymrwymedig i sicrhau ein bod ni'n gwneud ein gorau i barhau hynny er bod datblygiadau mewn rhannau eraill o’r Deyrnas Unedig a phenderfyniadau Llywodraeth y DU o ran Lloegr, er enghraifft, yn gwneud hynny’n heriol, yn anffodus.

O ran staff, sut y mae prifysgolion yn cytundebu ac yn trin eu staff, a bod hynny'n cael effaith ar y ddarpariaeth y maen nhw'n medru rhoi i fyfyrwyr—rwy jest eisiau eich barn chi ar hynny.

Byddai gyda fi ddiddordeb mewn clywed beth yw casgliadau'r pwyllgor yn hynny o beth.

Thank you, Sioned. This one's for the Deputy Minister. We really appreciate your correspondence on the progress made on the recommendations in our predecessor committee's report, 'Mind over matter'—the committee that you chaired at the time. Are there any further updates that you'd like to give in terms of the Welsh Government's work on the whole-school approach to mental health?

Thank you very much, Chair. As I said in my letter, I'm very happy to come in and do a session with the committee around 'Mind over matter', and 'Mind over matter: Two years on'. As I said in the letter, we have published statutory guidance on the implementation of the whole-school approach in Wales and we are continuing to work with schools to embed that framework. That's being supported with over £43 million available jointly from health and education over the three-year budget period. Myself and Jeremy have recently written to all schools and local education authorities in Wales to remind them of the importance of implementing the statutory framework and also using the toolkit that is available to assess their progress against the whole-school approach.

We've also funded Public Health Wales to employ implementation co-ordinators there, embedded within the Welsh network of healthy schools scheme, and they are working with individual schools across Wales. We've also had an independent evaluability assessment of the whole-school approach undertaken by Cardiff University on our behalf, and that was published in January this year. So, that will help us to measure the impact of the policies that we're taking forward.

As you're aware, we've got the joint ministerial task and finish group that was set up initially in 2018 to look at our whole-school approach, which is now looking at the whole-system approach. Myself and the Minister are currently in the process of refocusing that group so that it is more focused on driving delivery and implementation. We feel that we've got the right policies in place but we really need now to take it to the next level in terms of driving implementation. So, we're in the process of refocusing that at the moment, and I'm very happy to provide a further update in future.

Thank you very much, Deputy Minister. We've heard your offer to come in and I'm sure the committee will want to take you up on that at some point over the coming months as well.

This is a question for the Minister. The new commission is going to have oversight of all post-16 education. How do you expect the commission to approach creating an architecture for a post-16 education system and address any gaps that currently exist in arrangements to support transitions from one phase of education to another?

I think that point about transitions is the key point, really, isn't it? Because we know that that, as I was saying earlier, is a point that is particularly anxious for students and can cause poor mental health.

I guess the first advantage of the new arrangements in place is that the commission will be the regulator and funder of each aspect of that post-16 journey. So, that's new; that is, in a sense, the whole point of the legislation. That's a good opportunity, as I was saying earlier, but I think what is important is that we recognise that's building on work that's already happening. So, that's not entirely new. HEFCW, local authorities, schools, FE, HE all work together. I think, actually, that what we've seen in particular during the COVID period is a sort of step up of that. There's been more of that, which has been very helpful and very productive.

The other aspect, I think, that the new commission brings with it is that enhanced ability to share data, share best practice, and to make sure that learner voice is integral to everything, and that clearly will then shape students' own expectations and experiences of the system, and the commission can obviously respond to that.

Clearly, what we will be doing now, as we move through the implementation phase to setting up the commission itself, is we'll be working with education providers, also with health services, to make sure we've identified all the opportunities where there can be more collaboration in the system. I think again, I'd welcome hearing the committee's own views on where more co-ordination, more collaboration, both within the sector and between education and health, can improve both the services and potentially also the outcomes.

We've got some questions now from Laura Jones.

Thank you, Chair. Thank you for your time and papers, Ministers. Evidence suggests that there is a lack of common understanding about the different roles of university support services and statutory NHS mental services. How are you working together to clarify these roles, and would you consider issuing joint guidance to clarify expectations around these roles in the higher education context? Thank you.

Thank you, Laura. We're continuing to work to improve the understanding of the services and support that are available for mental health. To do that, we have the 111 website in Wales, which has all the details of the mental health support available. I hope that makes it easy for universities to promote to students within their organisations. All health boards also provide information on their websites about how to access mental health services and what support is available locally. We're also doing national work; you've probably heard the 'help us to help you' adverts on the radio. We're trying to promote especially the tier 0. We've got the CALL helpline, which is available 24 hours a day, and we've also got a range of other tier 0 and tier 1 support that is available without referral from a GP. But universities are obviously very well placed as well to promote that support to their student population, and it's really important that they do that.

I do think that awareness still varies, so I am really keen to do some further work with the Minister on what more we can do to promote the services that are out there. Hopefully, that's something that the new group that I referred to can look at. We also need to take account of a range of factors, and that includes work coming out of projects like the mental health university liaison service. I'm also conscious that the group that was established by Universities Wales with the NHS, AMOSSHE and ColegauCymru also made recommendations about how this could be improved, and I think it's important that we take that on board in the work that we're doing as well.

Did you want to come in, Minister?

Not with anything new; just to echo that, really. I think the only thing to add from my point of view is that the information we'll be getting now through institutions for December of this year to HEFCW will also enable us to have a clear picture of what's going on in terms of, as Lynne was saying, making sure that there is less variability, if you like, across the system and that signposting, the recognition of services, is consistent and as high as it can be. So, we'll have more information, I think, in the coming weeks as those reports are received by HEFCW.

Thank you, Ministers. Universal guidance on how to address it does seem needed. The mental health university liaison service, which you've just mentioned, Deputy Minister, has the potential to improve that working between university and NHS services, but has required significant investment, and only benefits students in Cardiff. Can you tell us anything about your assessment of that pilot project and what you see as its potential future on a more widespread basis? Thank you.

Thank you. I visited the service very recently, actually, and I also spoke at the launch of the service back in the summer. As you know, it was funded by £2 million allocated by HEFCW for five innovative projects to improve health and well-being in the university sector back in 2019. I think all of those projects are really good examples of what can be achieved when we work together, when we pool resources and show the value of collaboration.

Personally, I really liked what I saw with the mental health university liaison service. I really like the idea of a bridge to NHS services. I think students are a unique group, really, higher education students, in that they're away from their homes with all the issues that has around access to GPs et cetera. But we do, of course, have to look at the evaluation that's arising from the service. For me, it's very important that we listen to the voices of the young people who've benefited from the service. I don't need to remind the committee how difficult the financial situation is and the choices that we're all facing. But I'm very keen to look at the evidence coming out of the service. It seems to me that it's got a great potential as a safety net for students, recognising the unusual situation that they're in, and discussions are already taking place in Government to look at how we can draw on the learning from that.

Just to say, as well, that when I went to visit the service, the head of mental health at Cardiff and Vale was there as well, and I think that's really important, that really good engagement. It's not just a service, it's a partnership, and that's really crucial—that universities and local health services work together. The Cardiff and Vale health board were really clear, as well, about the advantages of this project from their point of view, as well. So, I think there are lots of positives, and I commend the university and the health board for the work that they're doing in this space. I'm very keen to look at how we can reap the benefits for other parts of Wales. I know that Aneurin Bevan are very interested in it, and there's even been some interest from Scotland. So, there's a lot that we can learn from, I think.

Thank you. I'll just bring James Evans in.

It is on this point about collaboration between health and universities, because we took evidence more than a week ago—Sioned and I went—and, actually, the university said that they have a pyramid system of support. Their crisis point, right at the top of the system in the university, doesn't even meet the NHS's lowest levels of support, so you get people then who are stuck in between. The university can only do so much and then the NHS won't kick in, because they don't meet the level for statutory intervention from the NHS. So, it'd be interesting to know how you think we can bridge those gaps across Wales. Because it's very good in Cardiff, but it's not very good in Swansea, which means it might not be very good in north Wales. There's obviously that missing middle of students who aren't getting support, and I'd like to know your thoughts on that.

The missing middle is a really important group, isn't it? That's why we've worked so hard to increase the open-access tier 0, tier 1 support that's available. That collaboration and understanding of the joint roles of health and education is critically important. As you know, our approach in Government is a 'no wrong door' approach for mental health, and it's really important that that's embedded not just in health services, but across the education system as well. I hope that the group that I'm going to be chairing can look at some of these issues, but I think there are other things coming on stream that will really help as well. We're rolling out our '111 press 2 for mental health', which will be accessible to students as well, and I'm really keen that it's promoted to student populations. I went to see the one in Hywel Dda recently. That's up and running 24 hours a day—absolutely brilliant. I think that will really help with the kind of problem that you've described as well, in terms of really enabling that prompt access to services.

Laura.

Thank you. Thank you, Minister. Data sharing has been obviously identified as a huge problem. How would you respond to suggestions that piloting a digital student health passport, both of you, could be a possible solution to issues around that data sharing? Have you assessed the resource implications of such a pilot?

Thank you. Obviously, I read the recommendation about looking at a student passport in the Universities Wales work that they did. The issues for students are challenging, as we know, because obviously they spend part of the year in one place, another part in another, and they have to make a choice about where they register. It is really important that students register with a GP, and I know that universities and health boards work really hard to promote the importance of that.

The system isn't as fast as we'd like it to be. There is a paper mechanism where records are transferred, but that can take up to 11 days, which obviously isn't as fast as we would like. There is a new system coming on stream, which is called 'the GP to GP'. That's going to be operational in Wales this year, and that will allow a much quicker transfer of records. But it is going to take longer to develop that transfer to other parts of the UK, and I'm advised that that is because we are a very small part of the GP IT market in Wales in the UK. So, we are somewhat reliant on partners over the border to drive this agenda.

What I am keen to do is look at the potential for a passport. We've got a transitions passport from children to adult mental health services, and I'm quite keen for the new group that I'm going to be chairing to look at whether there is anything innovative that we can do, whether it's electronic or whatever, to make sure that students can move and take their data with them as quickly as they need to. So, there's definitely more work that we need to do in respect of that and we're not in a position to cost it at the moment.

Thank you, Minister. Can I ask that you take into account students having a year abroad in that strategy, and the problems around that? Because, obviously, when they go on the year abroad, the problems that present themselves then are almost lost at sea for that year in terms of mental health support, unless we have some sort of transition there.

Okay. Well, that is even more challenging.

I know it's complicated.

I did a year abroad and I know how tough it is, and my son is in Tbilisi at the moment doing his year abroad. We can look at the support available, but transferring records between foreign countries is probably a bit of an ask, really.

I'll just see if the Minister wants to add anything to that section.

Just to say there are students who do time out in work as well, aren't there? So, there are different student experiences, which, if we are able to make progress in this area, we would want to try and reflect in that. I think, from an institutional point of view, one of the key challenges, it seems to me, is making sure that students register in the first place. I think that that needs to be a priority. From my own experience, I don't think I registered with a GP when I was at university, and I'm sure that there'll be lots of students who would say the same. So, I think there are a number of points in the system where we can improve the experience, and certainly from a HE point of view, that's one of the areas where I think we need to focus to make sure that we're supporting students to actually do that in the first place.

And just to add, in terms of students who aren't in direct contact with their universities, like students on a year abroad, or students doing a year in industry, or whatever, I think there are things that we can do. It's about informing them, really, before they go off, about the support that's available, and about looking after themselves as well. I think that's really important—that we give young people the knowledge and understanding of their own mental health, so that they can take some control of that, especially when they're in situations where they're furthest from their support networks.

Thank you, Minister. It's encouraging that you recognise that there are things that we can do to make that experience better.

The 'Together for Mental Health' strategy does not reference higher education or specific provision for young adults. However, we're encouraged to hear today, obviously, that you're setting up this new group in the new year that will hopefully address these issues that we're discussing today. Will that, then, feed into the revised strategy, to fill what HEFCW called a strategic and policy gap in terms of the provision of mental health support for students?

Thanks, Laura. Just to be clear that the 'Together for Mental Health' strategy has been delivered through three three-year delivery plans, and the current plan, 2019-22, does reference higher education, with an action regarding training around mental health and well-being. So, it is in there. But I'm very keen for the future strategy to take a really strong cross-Government approach and, as I've said before, I think young people—. If we can get this right for young people, then it puts us on a really great foundation for everyone else. So, the cross-Government work with education is going to be absolutely critical for that. We have already started the engagement to develop the successor strategy, and I'm really looking forward to engagement from across education in terms of having their views on that strategy. We'll also hopefully feed in the work of the joint working group, and the group that I'm chairing will also have an opportunity to look at that. But I'm very keen that that doesn't just look at the future strategy and that we can also identify some quick wins where we can make progress now, really, and the committee's evidence from your inquiry will be really helpful in that regard.

Thank you.

Now questions from James Evans. James.

Diolch, Gadeirydd. Minister, as you're probably well aware, the terms of reference for our inquiry didn't really want to go in to the performance of statutory services within the NHS with regard to mental health, but, as you're well aware, as a previous Chair of this committee and others, these things do tend to take a different road. We've taken evidence from a lot of people—students and experts—who have said that statutory services and some of the underperformance in those areas are affecting the student population across Wales, and I've got a couple of questions around that.

We've heard anecdotal evidence from students who have sought support within the NHS that the waiting list time for them to get support is actually longer than the term that they're going to be in university studying their actual subject. That's quite damaging to hear, really, that that young person is going to be struggling for the best part of four, five years before they actually get to see somebody. I think they might even be in adult services by the time that actually finishes. So, what are you doing specifically to try and get on top of these waiting-list times, so that when people are accessing support and asking for it, that they're not having to wait years to get that service, when their mental health could deteriorate so poorly that they leave university and stop studying all together? That really would affect their lifelong chances as well, as they go forward into adulthood.

Thanks, James. Can I say that I don't know of any—? None of the data that I see suggests anyone will be—

It's what we've been told.

—waiting for that length of time, but, obviously, I'm really keen to hear the voices that have spoken to the committee. It's really important that we do that. Since the pandemic, we have experienced some major pressures in mental health services. They were earmarked as essential services during the pandemic, so they did continue, but we've seen a higher level of referrals, and also much more complexity and acuity from the people who have been referred.

We have invested well over £20 million of the additional £50 million that we've been lucky enough to have this year for mental health services, to support health boards to recover waiting lists and to develop services in priority areas, like children and young people. All health boards have developed trajectories to recover performance—that's both for adults and CAMHS—and we expect to see significant improvements in performance by April 2023. But I'm very pleased to say that we're already seeing very significant improvements in CAMHS services [correction: specialist CAMHS services], and we're currently on 91.2 per cent, so over the target for the four-week wait for CAMHS [correction; sCAMHS], and, indeed, Powys has 100 per cent of young people seeing someone within four weeks.

Just to assure the committee, we do monitor health boards really closely on their performance. There are monthly performance meetings with the NHS delivery unit in the Welsh Government, and then quarterly meetings with the NHS delivery unit, who, as you know, are doing a separate piece of work around access to psychological therapies and also on specialist CAMHS. We've also included mental health as a key priority in the accountability letters that go to health boards, as part of their integrated medium-term plans and annual plans, and officials are routinely monitoring and challenging progress through the individual health boards' integrated quality and delivery boards and the joint executive team process, and, of course, I also challenge the health boards myself, through the regular meetings with vice-chairs. So, we aren't exactly where we want to be, but we are making progress and we have got trajectories in place to recover performance across the board by the spring of next year.

Okay. One of the things we heard from evidence, especially within the student population, was around certain types of conditions. They seem to be waiting longer and struggle to get access to services more, because they have to be, as I said before, at that crisis point, when they're almost on the verge of death. One of those areas is eating disorders. From the evidence I took—and Sioned was there was well—from students, a lot of those younger people have been in very awful situations. Do you find, Minister, that certain elements of mental health, such as eating disorders, are very difficult, sometimes, for health professionals and universities to deal with? And is that something that you're challenging on, as a Minister, to try and make sure people who present with eating disorders aren't the ones who are being left out from some services?

Well, I absolutely don't want people with eating disorders to be left out from services; that is absolutely the opposite of what we want. I've been really clear that eating disorder services are a priority for me. We've allocated additional money specifically for eating disorders through the service improvement money. We've also been clear to health boards that they've got the flexibility to use parts of the other service improvement money for eating disorders. I've asked all health boards to present plans to me on how they will ensure that they meet the National Institute for Health and Care Excellence guidance on eating disorders and ensure that the four-week target for waiting times is met, in order to reinforce the importance of eating disorder services.

I've also been going around eating disorder services in Wales, and I visited Swansea bay—adults and children—Aneurin Bevan and Betsi Cadwaladr, and I'm going to do the rest of them. But I've got to say that the feedback I am getting from those teams is very positive. So, for example, in Swansea bay, they didn't have a waiting list for adult eating disorder services when I was there most recently, and the commitment in those teams to adults and children with eating disorders, I've got to say, is palpable. I think the interviews were last week for the new clinical lead for eating disorders in Wales, so we'll then be able to move forward with the clinical lead and the eating disorder network in Wales to really make sure that we drive those improvements, but absolutely committed to doing that. And I certainly don't expect to see any young people left out in the cold on that, because eating disorders are incredibly serious.

It’s good to hear you say that, and I think it’s something we could pick up again in, perhaps, a further evidence session, because what we’re hearing from the young people in universities is that they do have to be at crisis point. They present early and they’re not being taken seriously, or they’re being—. I wouldn’t say they're 'fobbed off' by GPs, but what we’re being told is that it’s not being taken seriously, they’re being given different things to sort it out, and they're not actually getting to the root cause of it.

Yes, and there is a programme of work that we’re doing, because it’s not just about the acute services. We’ve got a programme of work around education and eating disorders, and we’re also doing lots of work to educate GPs, so they should understand how important early intervention is for eating disorders. But I obviously look forward to receiving any of your feedback on that.

We were talking to the universities and student services were saying a lot of people go and talk to student services, to the faculty at university about their problems, but the students themselves have to refer themselves to a GP or somewhere else. Student services have asked that they would like a system where they could refer that student to a GP directly, rather than putting all the pressure on that student to have to go and do it themselves. Is that something that you’d be keen to look at or perhaps investigate as the Welsh Government?

Do you mean to refer to a GP?

So that student services can refer to a GP directly about a student.

Well, I think that it’s very important that young people register with a GP. I’m not sure how it would work with students, because there’d be all sorts of issues around confidentiality and GDPR. I mean, this is where there are lessons that can be learned from the mental health university liaison service, where that becomes really, really helpful. But also I'd say that, with the 111 'press 2' coming online, I think that will be a game changer because that service will be able to refer directly into other services, and they’re already doing that in Hywel Dda. So, they’re making referrals to community mental health teams, to crisis teams or whoever, really. So, it really will provide that joined-up, no-wrong-door support for everyone, including students.

Thank you. One thing we also heard when we took evidence was—it’s probably a question for both Ministers here, as to how you want to answer this—that they feel sometimes the induction process at universities to identify mental health problems is lacking. It tends to be a two-minute conversation at the start of a lesson or the start of induction—'If anybody’s got a mental health problem, come and see me.' It’s that type of thing, and they don’t feel that they’re actually having the opportunities or the time to talk to somebody to explain that they have gone through services in the past, that they need a bit of extra support with their extra-curricular activities. We’ve also heard questions of GPs charging students money for asking, you know, when they want to extend assignment dates and different things. So, how do you think you can work with a cross-Government approach to make sure that, when students are coming into universities, they are aware of what support they can get and where it all goes from there?

I’m sure Jeremy will want to come in on this as well, but if I can just say that, obviously, there’s new guidance now that’s been issued by Universities UK on information sharing, which is an attempt to respond to the tragic situations we’ve seen where young people have died and nobody knew that they were struggling from within their families. I think it’s really good guidance because it recognises that not all young people will want to involve their families, and it is about identifying trusted contacts. But what I also really like about it is the fact that it requires universities to keep reinforcing that message, to keep reminding young people that they need to identify someone who can help them. I think that’s really important, because lots of young people see going to university as a clean slate and they won’t necessarily want to identify any mental health issues, and you can see that through the data. So, I think having that constant reinforcement of the availability of support, the importance of reaching out for help, is crucially important, and I know that Jeremy’s got some ideas in this space that I’m very enthusiastic about, too.

Minister.

We’ve touched a little bit earlier on the student charter work with HEFCW, so I won’t repeat any of that, but just to say that a critical part of that is the signposting to other support that's available. Clearly, having those things in place is a start—it's the minimum, really, isn't it? It's the monitoring of that that is really important.

So, that's the regulatory aspect, but I think probably more productively, in a sense, I think there was a suggestion that the committee heard—I can't remember who made the suggestion, actually, but in evidence you heard this—that one way of supporting at a key transition point, just to reflect the challenges Lynne was talking about, is to make sure that first-year students have a mental health awareness module as part of their first-year journey, if you like. I think that's a very interesting suggestion. I think you can see that as part of a broader set of modules around life skills more broadly but, specifically in the context of mental health, I think that's definitely worth exploring. That could then be a concrete moment at which that signposting, that awareness raising of support services, in particular, both generally and in their particular institution, could be formalised, if you like. I think that would be something that is certainly worth exploring. Again, it would need to be institution led, but I would be very interested in hearing what the committee's reflections are on that when you publish your report.

One final question, Chair, if that's okay. Minister, last week, you're probably aware, we took evidence jointly with the Health and Social Care Committee from Mind Cymru about a report they'd done on the transition between child and adolescent mental health services and adult mental health services. I will say that, in the couple of years I've been here, it's probably the most harrowing evidence from young people I've ever heard, and I actually went from that meeting feeling quite upset and a bit ashamed, really, of where we've actually got to in certain services—that some young people feel that, as soon as they leave CAMHS, they're not quite sure how their future is going to be. And some of them didn't see a future after they left CAMHS, and they weren't quite sure if they wanted to continue living their lives. And hearing evidence like that was harrowing.

I've seen your letter back to Sue O'Leary at Mind about what you intend to do. I'd just like a bit more information, really, on where you see the Government can help with the transition between CAMHS and adult mental health services, because what I and committee members, and, I'm sure, you don't want to hear is another report from Mind Cymru like this in 12 months' time stating how bad it is, how poor young people's mental health is across the country, who are using those services and transitioning. I feel it's a job for us, for you as Government, to make sure that every young person who is accessing help and support is supported right through to make sure that they don't have that cliff edge where they feel that they have to, perhaps, go and end their own life because they're not sure where to go. It was harrowing. Talking about it is quite moving, because—. Yes, I'd just like to hear your views, because I'll probably get a bit emotional if I carry on talking about it.

Okay. Thank you, James, and it sounds like it was a very tough session for the committee, but I'm glad that the committee did the session, and it's just so important to put young people's voices at the centre of what we're all doing. From my point of view, I want to see services that wrap around young people, rather than shoehorning young people into the services that exist. That's a very important principle for me. And I am frustrated at the pace of improvements with transitions. We have got the policies in place. We've got the policy framework, the guidance in place. All health boards have transition leads and transition protocols in place, but what is clear is that there is an implementation gap at local level. So, that's what we've got to get to grips with.

I've read the 'Sort the Switch' report. As a Government, we also recently commissioned Tros Gynnal Plant to do a piece of work around transitions with young people for us, and that came back with very similar messages, really, raising concerns that the policies that we've put in place are not necessarily being implemented on the ground. So, from my point of view, I've made it clear this has to be a key focus for our CAMHS national support and that I'm going to be measuring this through the mental health delivery and oversight board that I chair quarterly. Officials have been engaging with health boards on this, and workshops have been arranged to bring together CAMHS and adult mental health services from across Wales to review their protocols and working arrangements, so that we can look at good practice but also review opportunities for improvement. And I'm pleased that both Mind Cymru and TGP Cymru have been invited to join the workshops, so that we can ensure that service users' voices are reflected. So, I very much recognise that we've got more to do and absolutely committed to getting that service right.

Is it okay then, Minister, with that work, that you could keep this committee updated, whether that's on a public basis or a confidential basis, just so we are assured that things are being done to address this point? Because as I said, I don't, and I'm sure you don't, want to see another report like this again, and I think it's important in terms of scrutiny that we keep a very close eye on this, Chair, because I don't want to see this report ever again coming in front of us.

I'm very happy to make that commitment, and I think I've been invited to come in to the committee—

You have, yes.

—to discuss it, which I'm also happy to do.

Okay. Thank you.

Thank you, Deputy Minister. And just to follow on from that, really, those young people were incredibly brave. As James said, it was harrowing, but they were so articulate and the message was incredibly powerful. And just by sharing their personal stories, I think it's going to stay with us all for a very long time, because it was just incredibly difficult to hear. But they were absolutely wonderful, how they came to the committee and spoke to us all, so I just want to thank them again for coming in.

Any further questions? We've got a couple more minutes. Anybody else got any further questions? I don't know if the Minister wanted to say anything, finally, on any point.

I don't think I have anything to add from my point of view, Chair. Thank you very much.

Deputy Minister.

Just thank you for the opportunity to come, and I'm looking forward to receiving your recommendations in due course.

Brilliant. Thank you. So, diolch yn fawr for coming in this morning. A transcript will be sent to you for checking in due course. Thank you for coming in to give evidence this morning. Diolch yn fawr.

To members of the committee, we'll now move on to item 3, which is papers to note. We have five papers to note. All the details of the papers are set out on the agenda and in the paper pack. Are Members happy to note those together? Is everybody happy? Yes, all happy. Lovely.

We'll move on now to item 4. So, I propose, in accordance with Standing Order 17.42, that the committee resolves to meet in private for the remainder of the meeting. Are Members content? All Members are content, so we'll now proceed to meet in private.