Plenary

The next questions are to the Minister for Health and Social Services, and once again the first question is from Paul Davies.

Thank you very much, Paul. Health services, like every health board in the health service at the moment, are under great pressure dealing with record numbers of COVID cases in the community, seeing an ageing population, a fragile care sector, the threat of winter flu and the need to deliver the booster vaccine and vaccines to 12 to 15-year-olds. On top of this, they are continuing to provide essential and key services, and, where possible, they are addressing the backlog that has built up over the course of the pandemic.

Minister, last week I challenged the First Minister on ambulance services in Pembrokeshire, and he accused me of peddling unsubstantiated rumours, which is simply not true. Because the representations that I've received on this matter are from front-line emergency service workers in Pembrokeshire who are very concerned at proposals to reduce local ambulance cover and the impact that the proposals would have on the local population and on the workforce. The proposals to reduce ambulance cover come following the fact that paediatric emergency assessments will not be available at Withybush hospital and will continue to be transferred to Glangwili hospital until at least next year. And, of course, the military is now being asked to support the ambulance service, and so reducing emergency cover in Pembrokeshire simply does not make any sense. So, Minister, will you now intervene to ensure that Pembrokeshire's emergency ambulance cover is not reduced?

Diolch yn fawr, Paul. I'm sure you'll be interested to hear that I'm very aware of your concerns, and therefore I have organised for the representative from the Welsh ambulance service to give a briefing to Members from Mid and West Wales on Friday this week. So, I do hope you'll be present and available to be able to hear directly about the plans in relation to ambulance services in the Hywel Dda area.

Of course, you will be aware that, already, Mid and West Wales Fire and Rescue Services provide some service; specially trained crew from Crymych, Narberth and St Davids are doing an incredible job, and so we're very pleased to see that. But also, as you've heard, we are reaching out now to the military to give some support, and that is because we are seeing an increased demand during this very exceptional period.

You talk about taking services away from Withybush, and let me be absolutely clear: what's happening is that there was a concern about a surge in respiratory syncytial virus, and we've decided to continue, and Hywel Dda have decided to continue, with the temporary removal of paediatric ambulance care from March last year, so that those children can be monitored by experienced staff. And the fact is that any decisions like this always follow the advice of clinicians.

And, do you know what, it really upsets me the way that the Tories keep on stirring in relation to Withybush in Pembrokeshire? In 2007—[Interruption.] In 2007, you raised the prospect of Withybush closing. Do you know what? It didn't close. You did it again, in the election, in 2010. Did it close? No, it didn't. You did it again in 2011. It didn't close. In 2015, it didn't close. In 2016, it didn't close. Over and over again you threaten and you scare people into thinking that something is going to close when there was never any intention to close Withybush. And I think that you should be ashamed of yourself, stirring up—[Interruption.]—stirring up feelings in Pembrokeshire that really don't merit this kind of attention.

My question follows a similar route to the question posed by Paul Davies. At a time when only 48 per cent of red calls are answered within eight minutes rather than the target of 65 per cent across the Hywel Dda area, the ambulance trust intends to cut the number of ambulances from three to two in Aberystwyth and from three to two in Cardigan too, and to do this without informing the public or the local surgeries. And we know that our paramedics are under huge pressures, and are often queuing outside hospitals in Shrewsbury, Swansea, Glangwili, Withybush, and so on and so forth, and therefore aren't available to respond to emergency calls in Ceredigion, where the targets of four, eight and 12 hours are missed regularly. And, unfortunately, the same is the case across the Hywel Dda area as a whole. I'm very pleased to hear that you are going to provide a briefing to Members in west Wales. So, in that meeting, I look forward to hearing whether it is acceptable, in a time of crisis for the emergency services, that the trust is cutting ambulance services in Aberystwyth and Cardigan by over 30 per cent.

Thank you very much, Cefin. As I said, the service is under immense pressure at the moment. The increase in the number of people calling for ambulance services—well, we've never seen anything like this before. The fact is that about 20 per cent of those calls relate to COVID, so it is a period of immense pressure. The rostering—that's the change that's being made at the moment; rethinking about where ambulances will be located. A lot of work has been done on that. I do hope that there will be an opportunity for you to attend on Friday to listen to the ambulance service explaining what they're doing, why they're doing it and why they're responding in this way. So, there will be an opportunity for you then to ask more specific questions, such as the ones that you've asked this afternoon.

Minister, I'd like to highlight the £68 million investment that Welsh Government has made into the primary and community health services in Hywel Dda health board area in recent years, and also highlight that the integrated care centres in Aberaeron, Cardigan, Fishguard, Cross Hands, Machynlleth and Llanfair Caereinion are welcomed very much by the local community, and they've received significant funding from Welsh Government. I've had really positive feedback from the constituents that use those centres, and the fact that they've made a big difference to the way that they can access care and the way that they can use those centres. So, would you agree with me that investment demonstrates the Welsh Government's commitment to delivering quality health services to residents in rural areas served by the Hywel Dda health board?

Thanks very much, Joyce, and I would agree with you; I think it is important for us to understand what we're trying to do in these places. We are trying to increase the investment, understanding that primary care is a key aspect of how we're delivering health services, making sure that we get all the services, where possible, under one roof. And I'm very pleased to see that the investment that has gone in, as you say, to both Aberaeron and to Aberteifi has been extremely well received by people in those areas, and I very much look forward to visiting, just so that I can see first-hand how effective that model is.

Thank you. The Welsh Government is committed to improving perinatal mental health services, which is a priority area for action within the refreshed 'Together for Mental Health' delivery plan 2019-22. We also continue to invest in specialist perinatal mental health services across Wales.

Thank you, Deputy Minister, for that update. It's estimated that in Wales over 9,000 women suffer for postpartum PTSD, and one in five women suffer with their emotional well-being during the perinatal period. Early research suggests that this figure will inevitably rise. This, sadly, doesn't come as a surprise. The difficult but much needed service changes, made by health boards across Wales during the pandemic, ensured that mothers, partners and staff were COVID safe, but this has had a profound effect on their birthing experience. It's absolutely vital that mothers and partners who have suffered throughout the perinatal period receive the correct diagnosis and the correct support. Will the Deputy Minister work with the Wales Perinatal Mental Health Network and national clinical lead for perinatal mental health in Wales to ensure that perinatal mental health is included in pre-registration training for all mental health practitioners and all health professionals working in the perinatal period?

Can I thank Buffy Williams for that question? I entirely recognise the issues that you highlight and also the impact that the pandemic has had on families' experiences of having babies. This is a priority area for us; it's a priority area in our mental health delivery plan. We've now got perinatal mental health services in every part of Wales and we've invested £3 million a year recurrently to support those services. Health boards are also working towards meeting the relevant Royal College of Psychiatrists quality standards and we're investing additional mental health service improvement funding to support that.

In terms of your question about training, my understanding is that perinatal mental health is included across many programmes, although I'm not convinced that that approach is consistent across Wales. I've therefore asked officials to ensure that the perinatal mental health network works with Health Education and Improvement Wales and training providers to strengthen and standardise this approach. And I should say that perinatal mental health is a priority area for HEIW too. We'll also ensure that this is a core element of the training framework being developed by NHS Education for Scotland, which we're adapting for use in Wales. This multimodule training will ensure that all staff coming into contact with families during the perinatal period will receive appropriate training. I'm very happy to give you the assurance that you asked for.

May I first completely concur with everything that Buffy just said—second what she said—and reiterate her calls for more training across Wales consistently, as you said, Minister, in this regard? May I just make a bid for health visitors in particular? Being a mother myself and having been through a difficult birth, I know of the importance of the role that they play in the first year of a child's life and that first year for the mother in detecting postnatal depression or something going on with the baby that we need to be aware of. Those regular check-ins can be life-saving. So, Minister, I'd be grateful if you could outline what the Welsh Government are doing to support health visitors and the declining numbers.

Thank you for that question, Laura, and I'd like to say that I'm a huge fan of health visitors. I had amazing support off my health visitor after I had my first child and I entirely recognise what you've said about the life-saving role that they can play and also the vital safeguarding role that they play.

The training that I referred to for the perinatal period would absolutely apply to health visitors as well, because we recognise that the contact after birth is largely through health visitor contact, which is now returning much more to a normal position. And I will pick up the issues that you've raised around the recruitment of health visitors with the Minister for Health and Social Services.

Questions now from the party spokespeople. Conservative spokesperson, James Evans.

Diolch, Llywydd. Deputy Minister, this is the first opportunity I've had to welcome you to your post and I look forward to working with you over the coming months and years ahead. Minister, we're currently facing a mental health epidemic here in Wales. Referrals are up, section 136 detentions are rising very sharply in young people and more young people are self-harming than ever before. So, what are your Government's priorities, going forward, to tackle this situation, as currently things are getting worse, not better?

Thank you for that question and thank you for your good wishes. Likewise, I'm very keen to work across parties to improve the mental health of everyone in Wales.

I do take issue with what you've said about us facing a mental health epidemic. I think we need to be very careful about the language that we use and that that kind of language can lead to a self-fulfilling prophecy. The evidence was that earlier on this year, referrals rose dramatically, but they are stabilising again. But that doesn't mean that we are in any way complacent about the challenges we will face as a result, especially, of the pandemic, and that's something that I'm focusing on all the time.

My overriding priorities are to ensure that people receive access to timely, appropriate support at the same time as delivering on the reforms that we as a Government are committed to in terms of having a more preventative, early intervention approach to mental health, which will prevent those problems from escalating to the kinds of levels we see occasionally.

Thank you for that, Minister. Actually, the data does state that we are having a serious, serious issue here with mental health in Wales, and I know you understand that. Maybe you didn't like the language I used, but that is where I see us going with this, unfortunately. Many vulnerable young children are still struggling to be seen by a professional—60 per cent of young children are still waiting more than four weeks for a specialist CAMHS appointment. Charities that I am meeting with are telling me this is just not acceptable. So, what exactly does this Government have planned to support those young children, to prevent their poor mental health? Because we don't want to see a generation of young people lost to mental health disorders.

Absolutely, I certainly recognise the scale of the challenge that we face. It's the use of the term 'epidemic' that I take issue with, really, in this context.

Our approach in Wales is very much based on the recognition that we need to promote resilience, we need to intervene early, and all our reforms are based on changing that whole system, to have that early intervention and preventative approach that we need in Wales. The figures that you highlight in relation to waiting times—we did see a spike in referrals for children and young people specialist CAMHS, and the figure that you have highlighted is correct. It does vary across Wales, and I am meeting regularly with vice-chairs to discuss their performance in this area, as well as having focused discussions with health boards where there are particular problems.

The other point that I would make is that we know that a lot of the children who are waiting for specialist CAMHS assessments are not going to meet the threshold for specialist CAMHS, and should really be helped earlier on in the system. I know too that there are lots of really good tier 0 services that are available in Wales, but that families aren't always taking those up. So, what would be really helpful for me, and for children and young people, is if we could all do what we can as well to highlight the value of those lower-level interventions, which in all likelihood are going to be the ones lots of children and young people are going to need anyway.

Thank you for that, Minister. As you can tell, children's mental health and young people's mental health is something that's really, really important to me, and early help and intervention is really, really important. I think, between you and me, to highlight what the third sector can do as well, to really help young people in those early stages, is very, very important. However, with that in mind, Minister, we've seen, obviously, the peak at the minute with younger people with their mental health, and that's been caused because of the lockdowns and firebreaks, and it has had a massive detrimental impact on the mental health of young people. Three quarters of young people said their mental health was worse in the early months of the pandemic, and seven in 10 British teenagers fear the pandemic will make their future worse. With the First Minister failing to rule out any more lockdowns this winter, will you inform this Parliament of the Government's plans on how it's going to prevent any negative effects on young people in any future lockdowns? Diolch, Llywydd.

Thank you. What you ask is a very complex question, because, as I said when we discussed this earlier in the week, these things are all about balance of harms, aren't they? And as much as it harms children not to be in school, it also harms children if COVID rates are really high and lots of family members get affected. So, all these things are about weighing up a balance of harms. We have invested huge sums of money in support for children and young people throughout the pandemic in terms of well-being support through schools, our emotional and mental health well-being toolkit, additional funding for school counselling, and initiatives like that, to make sure that the support is there. But we also have to recognise that we all have a role to play in keeping infections low, so that children and young people can stay in school. At the moment, obviously, they're back in school, and that is great and good for them, and that's what I want to see continued. And as we go forward through the autumn, just to assure you that mental health will continue to be a central consideration for this Government, just as it has been from the very start of the pandemic, and no more so than when it relates to the mental health of children and young people, which is absolutely my top priority, and has been for years.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Llywydd. I got slightly excited last week when I heard that the Government was to make an announcement on e-prescribing. At last, I said, given that we're only 21 years into the twenty-first century. But my heart sank when I saw that what the Government was announcing was that e-prescribing would be introduced within five years. Why is the Government so determined to move so incredibly slowly on such an important issue?

Thank you very much, Rhun. I do agree that it is a shame that we haven't gone further than this previously, but we do have a programme in place now. Forty million pounds has been earmarked for that. It's not as though no work has gone on; work has already happened. If you look at Swansea, for example, a lot of work is being done in the hospital there. I'm asking them all the time, 'Why can't you move more quickly?', and one of the reasons they give to me is that you have to hold people's hands through the system. There's no point having all the equipment and all the resources, if people don't use the system, and you have to provide that training on a one-to-one basis. That's why it takes so much time. That's the explanation I've had, at least, from the Swansea health board. But, of course, that's just one element of that. We do hope, where we can, to go more quickly when it comes to primary care. I do hope that we can see that system. It won't be five years. If I'm in this place at that time, it won't be five years. We'll need to go more quickly than that.

Thank you for that response. I don't believe a word of that explanation for the delay, and I don't believe the Minister herself believes that explanation either. It's 15 years since the Government published its first strategy on e-prescribing. If it's another five years, 20 years will have passed, and, in the meantime, England and Scotland have been able to hold people's hands or whatever needs to be done, and have managed to introduce e-prescribing.

I spoke to one GP recently who was embarrassed when talking to colleagues over the border, or in other parts of the UK, and explaining that she still had to work on paper. To explain the scale of the problem, there was one doctor I was talking to in my constituency who says that he has to deal by hand with 4,000 repeat prescriptions, and that means a lack of time, then, in dealing with patients, and actually seeing those patients. And the question from another GP: why not, in last week's statement, make it clear that you would be willing to prioritise e-prescribing in primary care? Because that's not what they read into that announcement.

Thank you very much. I can confirm that this is one of the 10 priorities that I have listed for my team, in order to ensure that they understand the importance that I attach to this issue. I do agree that we are a long way behind on this. It was a shock to me to see how far behind we are in terms of e-prescribing. I do think that this is very technical work and it is work where you need to have consent to obtain data, and we are seeing at the moment whether it is possible for us to proceed without legislation, because we have to be sure about who owns the information that is owned by GPs very often—so, how are they going to get patients' consent to ensure that the systems all speak to each other.

I do understand that we do need to move more quickly. I think it will save a lot of time, particularly for GPs, for pharmacies. We can improve the system, and it will save us money in terms of overprescribing, and it will ensure that we can ensure—if you give this prescription, something will automatically pop up, saying that you shouldn't give that prescription, because they will counteract each other. That's quite a complicated programme, and that's why it's taking a long time. But I can assure you that I'm on the case with this, and I'm ensuring that we are going to proceed in this area, as quickly as possible.

I am pleased that you said that it came as a shock to you to see us so far behind. I see your predecessor sitting very quietly next to you there, and the health Minister before him was the current First Minister, of course. But, throughout this pandemic, we have seen how services can move quickly and introduce change quickly, when the leadership and the political will are there. We can create services that are appropriate to our needs. And working on paper is holding the health service back. Staff have had enough, and patients, at the end of the day, are suffering as a result of this. So, can we once again have an unambiguous commitment from the Minister to put the same political will into introducing this, and to introduce it now, not within a five-year timescale? Because five years is a very long time for anyone; in the digital age, it's a lifetime.

Thank you. I can confirm that it won't take five years. We are going to move more quickly than that. I can't give—. I don't think we can introduce it now, because it is a complex issue. The technology is very complex, the skills that are needed are very complex. You need people who really understand this technology, and everybody wants the same people at the moment. That's why HEIW is taking this seriously and is putting actions in place so that everyone understands the importance of technology in the future. So, this is a point that the entire NHS understands we need to move on.

Emergency stroke services in Cardiff are the responsibility of Cardiff and Vale University Health Board. Patients attending the University Hospital of Wales emergency department are prioritised for assessment and imaging to diagnose stroke, and are placed on the fully integrated stroke pathway.

Thank you, Minister. One of my constituents was correctly diagnosed as having a stroke by a 999 call handler and obviously confirmed that he needed to be seen as an emergency in the Heath hospital. Because it was unclear how long it would take for an ambulance to arrive, the family informed 999 they would take him to hospital themselves, but, on arrival, they got stuck in the emergency department for 27 hours before he was admitted to the acute stroke ward. Now, I fully appreciate the unprecedented pressures that the emergency services are dealing with, and screening people for COVID who arrive unannounced is an important part of ensuring we keep COVID out of hospitals. But, as Cardiff and Vale pioneered a new phone triage system to stop people backing up in the emergency department during the pandemic, how can we improve the interface between 999 and Cardiff and Vale's 24/7 so that, once diagnosed, they're actually being directed to the specialist clinicians they need to see?

Thanks very much, Jenny. I'm really sorry to hear about the situation that your constituent found themselves in. I think that is obviously wholly unacceptable and very difficult, and certainly nobody should be waiting 27 hours after a stroke. But, obviously, it's difficult for me to go into detail about individual matters. As you say, the pressures on our emergency services continue to remain extremely high at the moment. There is a complex range of national and local challenges across the system that are impacting on that patient flow, and that includes incredible demands that are coming from the public, as well as asking the workforce who have been at it for such a tremendous amount of time now. But, as you say, I think that the triaging system in Cardiff is something that is pioneering, trying to avoid people coming in, getting them to phone first and then trying to get them to the right place. So, it is rather surprising that they weren't directed to a more appropriate place. But it may be that the system is just trying to keep people away from hospital, rather than specific places in the hospital, and it may be worth a chat about seeing if that system can be tweaked somewhat. But I know, in terms of Cardiff, that there are some very innovative programmes when it comes to stroke, that 72 per cent of stroke patients in Cardiff have also access to supported discharge and there has been an award-winning programme in Cardiff and Vale, the Stop a Stroke campaign, and 90 per cent of practices have taken part in that programme.

The Sentinel Stroke National Audit Programme—the SSNAP—published a UK-wide audit of stroke services in our hospitals, and Wales plays its part in contributing data on a regular basis to this important work. Their acute organisational audit report in December 2019 showed that only 30 per cent of hospital sites across the UK had the recommended level of registered nurses working at the weekend. Can the Minister confirm if any of these hospitals were in Wales, and, if so, what is being done to ensure the right number of nurses are in our stroke units? Thank you, Minister.

Thanks very much, Altaf, for that question. Obviously, I'm always very aware, when I respond to you, that I'm speaking to an expert, so I always have to be, probably, more careful with you than anybody else in this Chamber. [Laughter.]

I think it's absolutely right that we have to keep an eye on the numbers of nurses. And, of course, we do in Wales have legislation around that, and that is a unique piece of legislation that has not been enacted across the rest of the United Kingdom, where nursing staff levels are a legal requirement. And I was pleased to be able to speak to the Royal College of Nursing this morning about that situation and the implementation of that. So, we are in a different place from other parts of the UK in terms of nursing. I think there are other things that we can do in relation to stroke in Wales—promoting atrial fibrillation within primary care is something else that I'm very keen to see if we can pursue.

Thanks. The Welsh Government continues to support the Welsh ambulance service to deliver responsive emergency services. I have asked the chief ambulance services commissioner to work with health boards, the Welsh ambulance service and partners to develop more robust whole-system escalation plans and to enable greater operational grip over the winter period.

Thank you, Minister. It was glaringly apparent from our debate last week and from the fact that our post boxes are full of worrying constituents' cases about this that there is a dire need to do something very quickly about this situation. But what I want to ask you today, Minister, is specifically about GPs and supporting face-to-face appointments, as opposed to the online ones, because if we tackle that, then that will obviously help the ambulance service by bringing down the numbers presenting at A&E, as what is becoming apparent more and more from the cases I'm receiving is that symptoms are being missed, and those people are then presenting themselves to A&E and contributing to the A&Es being clogged up and the adverse effect that that's having.

So, Minister, how are we collating the data centrally? Because, from what I'm aware of, there's no central collection of data on this, and it seems to be really important that we do collect that data in order to make the informed decisions on a Wales-wide basis on this, because those people do need to see doctors face to face now, because things are being missed. But we have to contact the surgeries to get that information, wherever we go. We need that data centrally collected. So, what are you doing about that, Minister, please? Thank you.

Thanks very much. Well, I think we've got to be straight with the public: we are not going back to the way we were pre-pandemic. We have introduced new digital services and, frankly, a lot of the public like them. A lot of people like e-prescribing, and certainly that is the response that we are getting in the many surveys that we're carrying out. Of course, there will always be a time when some patients need to be seen face to face, and that is a clinical judgment that our GPs are making every day. And I think it's absolutely right for them to be the people making that clinical judgment. So, what I won't do is what Sajid Javid has done and to just say, 'You've got to see these patients face to face'. We're not in that space. We are not going to be going back to that; we are going to allow our GPs to make that clinical judgment of what's right, and they will determine whether it's right to see people face to face.

And we do have to make sure that people in Wales understand that there are alternatives—that you can go to your pharmacy, that there are other places that people can go, and that they can give you some great advice. You can go directly to see a physiotherapist; you don't always have to go through the GP as a gatekeeper. What we're trying to do is to make sure that we train people up—receptionists—to make sure that they have a better understanding of where to point people.

But certainly, in terms of the information, you'll be aware, I'm sure, that there is a system where we effectively pay bonuses to GPs in terms of access, and about 76 per cent of GP surgeries actually were able to get that bonus last year because the access was actually almost better than it's ever been. Now, it may not have been face-to-face access, but we are keeping tabs on that, and I can certainly send you details of that breakdown if that would be helpful to you.

Ambulance waiting times in the south-east are a matter of great concern, Minister, and this is compounded by A&E waiting times. Figures released this week show that the Grange hospital in Cwmbran has regrettably had the worst performance on record of any hospital in Wales, with only four in 10 patients being seen within four hours there. Many communities in the Rhymney valley have been without an A&E since the miners' hospital closed, and Ysbyty Ystrad Fawr in Ystrad Mynach opened without an A&E. With longer ambulance waiting times, the British Medical Association has warned that patients in Wales are having to use taxis or be at the mercy of their GPs having to drive them to A&E, and this will be worse in the south-east, and the Rhymney valley especially, where people have to travel further to get to their A&E than they would have done when the miners' was open. So, Minister, will the Government open talks with the health board to reinstate an A&E in the Rhymney valley in Ysbyty Ystrad Fawr?

I think we've got to be clear with people that accident and emergency and calling an ambulance have to be an emergency, and too many people are calling ambulances when they're not an emergency. Now, that's not to say that there are lots of people being missed at the moment when it is an emergency, and the reason for that, as I've explained, is because there's a huge increase in demand. Part of the reason for this, of course, is because we're having difficulty getting people outside, taking people out of hospital; people who are ready to be discharged can't be discharged because of the fragility of our care sector at the moment. That's why I'm spending a huge amount of my time working with my colleague Julie Morgan at the moment, trying to see what we can do to address the system in relation to care so we can improve that flow through the hospitals so we won't be getting people waiting outside hospitals in ambulances. But we won't be able to fix that unless we fix the back door of the hospitals, and so that's where my attention is focused at the moment.

In relation to particular opening of A&E, A&E is not just something you can magic up. There are huge amounts of resources that you have to place around that, and don't forget that, actually, when you put an A&E in a particular place, what it means is that if something else comes in, your planned care gets knocked out, and I'm very aware that 20 per cent of the population of Wales are also waiting for operations at the moment. So, if anything, we need to keep the division between those hot and cold areas in relation to health so that we can continue with the planned care where necessary, and opening additional A&E does not necessarily help us with our planned care. All of these things are interconnected, so I will take advice from the clinicians on where best to open A&E facilities.

Thank you, Jane. We continue to re-establish NHS dental services in a safe, phased way. Practices are prioritising care according to need and are treating urgent cases and people who are experiencing problems first. Measures are in place for NHS dental practices to see new patients each week.

Diolch yn fawr iawn, Gweinidog. Dentistry remains one of the most difficult areas of primary care delivery right at the moment—respiratory issues in the pandemic time. Also, on top of that, there have been long-standing issues relating to the provision of NHS dentistry. I've put out a survey and heard back from around 350 people across mid and west Wales concerning the situation with regard to NHS dentistry, particularly in the Llandrindod Wells area. This is a long-running issue, and I'm sure we're looking at a longer term solution to that, but, whilst that's happening, I just wonder if it's worth exploring more innovative solutions whilst the long-term reform is under way. For example, Machynlleth residents have been able to access dental services via a mobile dental suite. Would you agree that a roll-out of similar schemes across rural Wales could potentially offer a short-term solution to this crisis in the provision of NHS dentistry, and, if so, how could we take this forward in an area such as Llandrindod Wells? Diolch yn fawr iawn.

Thanks very much, Jane, and thank you for the championing of the cause on dentistry that you're undertaking at the moment. I'm all for innovation, particularly at the time that we're in at the moment. I'm really pleased to see the innovation that's happening in Machynlleth. I guess the issue with mobile suites is not the facilities themselves, but who we get to do the work inside them. So, it's much easier to get a mobile suite developed than it is actually to train the people to staff them, and that's why I'm really pleased that we are working with HEIW to develop the workforce and to make sure that we're being a bit more creative in terms of the way we use the workforce, so it's not just all about dentists—it's got to be about other people working very much at the top of their licence, and encouraging them to work to the top of their licence. I'm really pleased that, for example, in Bangor we've got the all-Wales faculty of dental care professionals, which is really looking at what we can do in terms of dental nurses, dental technicians, dental therapists, dental hygienists, getting them to do perhaps some of the routine work of checking, or whatever, and leaving dentists then to do the more urgent cases.

GPs are facing great pressures in dealing with the pandemic, and dealing at the same time with high demand because of illnesses not associated with COVID. Access to GPs in Holyhead has been challenging over recent months, but the Betsi Cadwaladr health board is focusing strongly on improving the situation.

Yes, the picture is worrying across Wales, and has been throughout the pandemic, but in Holyhead there's been a significant problem after two surgeries had to be placed in the hands of the health board in 2019, and that, I'm afraid, was because of failures in ensuring a sustainable workforce over a period of many years. I think the success of Plaid Cymru in helping to establish a medical college in north Wales will truly be of assistance in the longer term, but we need to secure resources now in order to attract GPs to Holyhead.

We need a primary multidisciplinary care centre for Holyhead and the area. The patients need it, the staff working there now deserve it. So, may I ask the Minister to give a clear commitment to ensuring that such a centre is delivered as a matter of urgency?

Thank you. You'll be aware that there have been problems in Hwb Iechyd Cybi which, of course, is being led by Betsi Cadwaladr health board and the NHS directly. I'm pleased to say that three GPs have now been appointed—one who has already started, and another starting in October, and another starting in January. So, I do hope that that will improve the situation, as well as three urgent care practitioners who are starting in October. So, it has taken some time to get those people in place, but I am hopeful that you will see a great change because of the ability to recruit those people into those positions.

We are taking a whole-system approach to improve and support the mental health and well-being of children and young people. This includes actions across health, social care, education and youth work, with a focus on prevention and earlier intervention, whilst also ensuring specialist services are available when needed.

Thank you, Minister. One of the frustrations many parents have raised with regard to children and young people's mental health is accessing the right service, and that was highlighted in the Children's Commissioner for Wales report, 'No Wrong Door'. And it found that many children, young people and their families looking for support for a number of issues, including mental health, found the system incredibly complex. Some even fell through the gaps altogether, resulting in them not accessing any support at all. As the Children's Commissioner for Wales put it, many were knocking on the wrong door or were waiting for services in the wrong queue. Minister, what is the Welsh Government doing to support the 'no wrong door' approach to services for children and young people in Wales?

Can I thank Joyce Watson for that supplementary? This is absolutely a top priority for me, and we absolutely need to end the situation where children and young people are faced with the wrong door. That's why I'm working closely across Government, especially with the Deputy Minister for Social Services, on the implementation of our new nurturing, empowerment, safe and trusted framework, which is a planning tool to enable regional partnership boards to deliver that early health and enhanced support that we know is the most appropriate for children and young people. I'm meeting with regional partnership boards regularly. I've arranged to go and visit them. I'm also raising it regularly with vice chairs, and everybody is clear that this is a top priority for me, along with joining with our whole-school approach to mental health.

I should also say that I'm really pleased that the health boards are making good progress with the implementation of their single points of contact, which also make a huge difference and ensure that children and young people get more timely access to the support that they need. And in addition to that, we're increasing investment in our tier 0 support to ensure that that non-clinical support is available as well, because following my answer to James Evans earlier, I think it's really important that we don't medicalise children and young people's distress, especially over things like the pandemic, which has been difficult and stressful for all of us. So, we're trying to put all those interventions in place across the whole system, but while ensuring as well that children and young people who do need that more specialist support get it in a timely fashion.

We all recognise that our health and social care workforce have been under acute, sustained pressure for an exceptional amount of time. We continue to work with partners across health and social care to ensure that we provide targeted funding and services to complement local workplace support.

Diolch yn fawr, Minister, and you're right, and I'm sure that everybody both inside and outside the Chamber would agree with me that the sacrifices made by our wonderful front-line NHS staff over the last 18 months do deserve to be recognised. And that's not just because that's the right thing to do, but it's also because we need them to continue to deliver because, one, COVID hasn't gone away, two, there are other challenges coming to the NHS's battle. A key battle for us and for Government is staff retention and, as you say, you're having conversations, but as part of these pay negotiations with trade unions representing the front-line staff, they have put forward a series of requests on behalf of the front-line workers. Perhaps, Minister, you could update the Senedd Chamber today on how those negotiations are going, and make a commitment that, in the future, those conversations will carry on in a collaborative approach, as it should be.

Thanks very much, Jack, and can I also pay tribute to the incredible work that our NHS workers have done during what is undoubtedly the most challenging time in the history of the NHS? We absolutely appreciate the work that they've done. In relation to NHS pay, then, of course, we had established, along with the unions, to look at the NHS review body and the doctors and dentists review body. They took evidence from all aspects of the workplace, and there was an understanding that they would come up with a suggestion in terms of what a pay rise should look like. They came up with a suggestion of 3 per cent. Of course, we have suggested that we can do that at 3 per cent. It is very difficult for us to go any further because, frankly, we haven't had the money from the UK Government. Were we to get the money from the UK Government, then we would be in a different position.

The discussions with our trade union colleagues continue. We are discussing if there are any additional enhancements that could be complementary to the pay award, and those discussions are continuing. But I think it's important for us also to underline the fact that we have also given that one-off payment of £735 per person, but also we've got to bear in mind that there are care workers, and as I've said before, this is the most brittle part of the whole service at the moment, and I am focused on that. I am also focused on making sure, along with Julie Morgan, that we can deliver that living wage as soon as possible, because that is all impacting on the service that the NHS can provide at the moment.

Thank you, Minister.

We move now to the topical questions, and the first is to be asked of the Minister for education, and it will be posed by Siân Gwenllian.

I recognise that this has been a challenging start to the school year. We continue to work closely with schools, local government, the teaching unions, and public health specialists, to monitor the situation and to decide what steps are needed to ensure our shared goal of ensuring that children can be learning at school.

Thank you for that answer. I do believe that you need to show sympathy with the concerns of parents and young people and staff, and show that you are listening and considering action, if it's necessary—that is, you're willing to tighten the rules, if necessary. Explaining the rationale in terms of who should isolate and who should go to school would be a help, and constituents tell me that the advice that they're receiving either conflicts or they don't get any advice at all, and that needs attention.

Despite the efforts of front-line staff, problems and major inconsistencies exist with the test and trace system. So much more could be done in terms of ventilating buildings as well. Parents and children and young people and staff need to have assurance and certainty that schools are as safe as possible, and there is a duty on you to ease those concerns urgently and show that you are willing to take action as well. Do you agree with that?

I'd like to put on record my thanks to the education sector for the hard work that they've done in keeping schools as safe as possible. I wrote to headteachers and college leaders just yesterday, recognising the work that they have been doing. I acknowledge, as I did in my response to the previous question, that the recent times have been very challenging indeed, with numbers increasing. The interests and well-being of our young people are at the heart of every decision I take as Minister and the decisions that our Government takes. In the letter I wrote yesterday, I explained the current situation and the steps that we are taking—for example, the vaccination plan for those between 12 and 15 is to commence next week. We are continuing to monitor the situation in terms of the advice that we provide, of course, and I do understand that there are concerns about some of the regulations currently in place, and we are looking at means of communicating that more effectively so that people understand what the rules and regulations are and what the rationale behind those is. That's also important.

We have confirmed that the fund continues to support supply teachers in this period, that the carbon dioxide monitors are starting to arrive in schools, or will be arriving next week, and we'll also look at what else we can do to support the test and trace system to ensure that they do their very best too. We have heard from parents and teachers about special schools and pupils with particular medical needs, and there will be further advice in those two areas issued very soon too. I'd also like to say that the context, of course, is challenging for headteachers and teachers looking at how they deal with staffing challenges, and looking at the impact that has on timetables and so on. So, I am fully aware that these decisions are challenging at the moment.

We have seen in the figures published at the beginning of this week that the case rates in children under the age of nine and under the age of 19 have reduced in the past week. That is an early signal, but I hope that it's a hopeful signal for us too.

I'd like to, firstly, thank Siân Gwenllian for bringing this topic to the Minister's attention this afternoon, because I want to focus on my constituency in the Vale of Clwyd in Denbighshire, where even today we've had a school closure due to COVID cases, causing big disruption to children's education. I'm just wondering—. Well, sorry, I want to focus on rural areas and what contingencies the Welsh Government have to provide ongoing education facilities to those people who may be struggling to get broadband connections in rural areas so no child misses out due to COVID cases in schools. Thanks.

On the Member's last question in relation to support for rural schools—indeed, support for all schools—and the need to be able to provide for remote learning as and when that's required, obviously, I think we're in a very different position now than we were at the start of the pandemic, partly because of the very, very significant investment into making sure that schools are able to provide to learners tablets and laptops for them to be able to work remotely, and also the MiFi and other devices that we've been able to fund in order to help with some of those challenges around broadband that the Member identifies in his question.

It's been a really important part of our renew and reform funding, which I announced in the summer—in the last term—and that has been acknowledged by the Education Policy Institute and others as having a particularly beneficial impact in terms of the digital provision. I know that he shares with me the view that that's very, very important.

Minister, following on from what Gareth just said, he's outlined the extreme of what's going on: it's the end of September and we're already seeing school closures and we're seeing whole year groups going off. Another reason for that has been staff shortages, with people going off with COVID, so I'd like to know what your contingency plans are that you've got in place to help those schools affected by that particular problem.

One of the issues also with people missing out on education at the moment is the lack of clarity, as I have raised with you in committee—the lack of clarity that parents have about what to do if they have a COVID case within their families. You say it's very clear, the Government advice, that, if someone has COVID the rest of the family still go to work, school and whatever else, but headteachers are under enormous pressure and coming to me from all angles saying that parents are confused about what's going on, pupils are confused. They're upset by the fact that people are coming into school when they know that someone else in their family has COVID, and there are concerns around that.

I think the three-week cycle is too long, really, to react to what's going on, with COVID numbers rising considerably at the moment. So, how are you going to relook at that and look at the advice? As the Minister for mental health said earlier, I know it's a juggling act, and getting it right is so important. We want children in school, but we also want them to be safe. I know you're under a lot of pressure, but I'd like you to just quickly comment on that.

Also—just quickly, Presiding Officer—we're at a point now where children between—young people, sorry, between—10 and 19 years old are the biggest group presenting with COVID at the moment, with around 2,000 per 100,000 cases now, and that's just the average; in some parts of Wales, that's increasing every day. So, the roll-out of this 12 to 16-year-old vaccine is vital, and I know its delivery is starting on 4 October, but what plans do you have in place to really speed up that delivery of it? Thank you.

We anticipate that all children in that age group will have received the offer of vaccination during the month of October through invitations to mass vaccination centres. Just on the point that the Member made about the increase in cases in the 10 to 19 cohort, just to say that the very, very extensive testing of asymptomatic pupils in that age range will necessarily lead to the identification of more cases. That's obviously what it's designed to do, and I think last week a little over 40 per cent of all the tests undertaken on a walk-in basis were for children aged 18 and under. So, that is partly an explanation for the numbers that we are seeing, and I'm just echoing the point that I made earlier that that particular cohort—the case rate appears to have reduced in the last week as against the week before, which I know that she would also welcome.

Just on the guidance, it is important for this to be clear, and the guidance is set out very clearly on the Welsh Government website, in the communications that we give, but I will take this opportunity of setting it out. We keep this guidance continuously—both in school and beyond—under review to reflect the best, most recent evidence and guidance that we get. At alert level 0, anybody under the age of 18 who is a close contact but who is not symptomatic is not required to self-isolate. So, asking people to self-isolate in those circumstances requires a very special justification, and I think asking young people to abide by rules that are more stringent than the rules that adults abide by, when they're less likely to be harmed and adults have—the vast majority have—been vaccinated, I think that’s a very challenging place to start from.

There is a common-sense assumption, which I completely understand, that all family members will catch, or most family members will catch, COVID from a household case. That isn't actually borne out by what we understand the evidence to be at the moment. Obviously, these things are kept continuously under review, but that isn’t borne out by what we currently understand the picture to be. What is borne out is the sort of thing we heard the Member's colleague James Evans describing in questions to the Deputy Minister for mental health earlier, which is the very significant adverse impact on young people of not being in school. So, that tells us, on our current understanding, that the balance of harm supports the current policy.

Thank you, Minister. The next question is to be asked by Joyce Watson, and to be answered by the Minister for Social Justice. Joyce Watson.

I thank Joyce Watson for that question. Yesterday, I made a statement on women's safety in public places. In Wales, we’re developing our violence against women, domestic abuse and sexual violence strategy to include a focus on violence against women in the street, the workplace and the home, to deliver our commitment to make Wales the safest place in Europe to be a woman.

Thank you, Minister, and I thank you, Llywydd, for accepting my question. As you noted in your written statement yesterday, Minister, it is with great sadness that you should have to issue another statement because another young woman has lost her life. Her name is Sabina Nessa, and we all must remember and say her name.

Women and girls don't feel safe in public places. Public sexual harassment is often described as an epidemic, but it isn't new. You know as well as anyone, Minister, that it's endemic in our society. What has changed, though, is how women and girls, through social media and websites, can now turn their grief and anger into organised resistance, and campaigns like the White Ribbon, Everyone's Invited and Our Streets Now are doing amazing work to raise awareness and lobby for cultural reform.

I very much welcome your commitment to strengthen Wales's end violence against women strategy to include a focus on public spaces and workplaces. But we also need the UK Government to make public sexual harassment a specific crime, and Harriet Harman has tried to do this with the Police, Crime, Sentencing and Courts Bill that is now going through the Lords. Can I urge the Welsh Government to push Westminster on that?

But in terms of what we in Wales can do right now, you said in your statement:

'It is not for women to modify their behaviour, it is for abusers to change theirs.'

And that is absolutely true. But we also need to make women and girls feel safe in public, especially with nightlife reopening and university students returning. So, would you join me in recommending the safe places initiative, which is a network of venues and support where anyone feeling intimidated, at risk or scared can take refuge? It's up and running in Cardiff now, and people can download the safe places app to find the nearest open door on their way home. I know that hotels in Swansea and elsewhere have also adopted similar schemes. It's certainly something we should be looking to expand in Wales, and I would be very grateful for Welsh Government support in doing that. Today, I did write to the Chief Executive and Clerk of the Senedd to ask if we here can use and offer a safe place to keep people safe in Cardiff Bay. I was very pleased to hear that I had a positive response. I call on everyone here in this building to support that application, and I don't expect anybody not to do that. Thank you.

Well, can I thank Joyce Watson for raising this question this afternoon, following my statement yesterday and, indeed, for her long-term, long-standing commitment to tackling violence against women, which was well before she even became elected to the Senedd? And I think, for new Members, it's a really important time coming up, with the International Day for the Elimination of Violence against Women and Children. All parties take part, and what we can do this year, we will see, but it's very important, and the white ribbons will start being worn around this Chamber.

Can I also say that this is very good news, that the safe places initiative—that the Senedd may, hopefully, become one of those? The Commission, I'm sure, will be looking at that very carefully. And I congratulate particularly the businesses in Cardiff who started this safe places initiative—those businesses, FOR Cardiff— recognising that this is all partners—private, public and third sector—that come together to address this scourge, this endemic violence against women.

So, I just want to reassure the Senedd today that our next violence against women and domestic abuse and sexual violence strategy will take on these wider dimensions of violence against women in public places and in the workplace. We've been clear always as a Welsh Government about our ambition to end violence against women and girls. It is a societal problem, as I said in my statement, which requires a societal response, and it is about challenging attitudes and changing behaviours of those who behave abusively. And this is crucial, but also, as I have said in my statement, Wales will not be a bystander to abuse. But I'm glad that police and crime commissioners, public safety boards are all coming together. We're consulting on our draft strategy, and I know that the Live Fear Free campaigns will be taking on this huge issue in terms of awareness of stalking, harassment, abuse and violence against women in all aspects of life, including the street and other public places.

Can I thank Joyce Watson for bringing this issue for us to be able to talk about it in the Senedd? And I of course raised this issue of the need to strengthen the violence against women, domestic abuse and sexual violence strategy in the Senedd yesterday, in light of Sabina Nessa's horrific murder. And I'm glad the Minister issued a statement later that afternoon, stating that the Government commits to strengthening the strategy to include that all-important focus on violence against women in public places as well as the home.

The strategy's specialist and crucially important support services are currently funded through a patchwork of local, regional and national commissioning and grants, as well as charitable funding pots, often with short contracts. Specialist services report that there remain differing funding levels and processes according to different local authorities, health boards, police and crime commissioners. Could I therefore ask for a commitment to implement a sustainable funding model, with a focus on prevention and early intervention, and ask how the Government will ensure that it achieves this end and oversight of that funding at a national and local level, in line with the calls, which are informed by the experiences of specialist services? Diolch.

Diolch yn fawr, Sioned Williams, and I heard you raising the question yesterday in the Senedd, in the business statement. And thank you for raising that all-important issue about early intervention, prevention and the role of the specialist organisations, who are very engaged in helping us develop the next five-year strategy. In fact, we have had a funding strategy initiative, which has been chaired by Yasmin Khan, one of our national advisers, bringing together the specialist services and, indeed, all those who fund the specialist services as well, and moving forward so that we can get a more coherent national approach to funding, which, of course, will include regional partnerships and at a local level as well, but to ensure that we get that comprehensive funding of our specialist services in Wales.

I'm very grateful to be called, and I'm grateful to my colleague Joyce Watson for raising this issue. But it is with sadness that we do have to talk about these issues, but it's right that we are doing so, given recent events. I won't repeat what colleagues have said today, but, Minister, I want to be quite frank and quite clear here: it is men who have to change their behaviour, and it is men who have to encourage other men to change their behaviour. Minister, you mentioned the international day coming up, and the White Ribbon Day on 25 November, and I will encourage all Members of the Senedd, all Government Ministers, and colleagues who work in this building, and those men outside of this building, that we all must make the White Ribbon promise to never commit, excuse or remain silent about male violence against women. Minister, will you use your position within the Welsh Government to continue to spread the message that it's men's behaviour that must change? Diolch.

Diolch yn fawr, Jack Sargeant. That must be the most powerful, I think, response to Joyce's original question, from Jack Sargeant. He speaks up not just on 25 November, on White Ribbon Day, but throughout the year, as a White Ribbon ambassador, about male violence, about the misuse of male power over women. And the fact that violence against women clearly is still very endemic in the home, but in the community, in public places, in the workplace, and also addressing this as an issue that we now feel that we're going to be addressing through our new curriculum, in terms of the responsibilities and opportunities to look at this in terms of our education, educating boys as well as raising awareness amongst girls. This has to be about raising the issue of inequality as well as safety issues faced by women and girls, and ending all forms of violence against women, domestic abuse and sexual violence.

Thank you, Minister.

The next item is the 90-second statements, and the first of those is from Rhys ab Owen.

Diolch yn fawr, Llywydd. As a young boy, the name Betty Campbell came up many times in conversation at home. She was in school with my auntie, and through education and local politics in Cardiff became firm friends with my father. I was always in awe of Betty. At a young age, I knew nothing about her accomplishments—that came later on. But even as a youngster, I experienced this incredible character with a rebellious streak and a great turn of phrase—and she could take somebody down a peg or two very quickly.

She was the independent councillor in Butetown when this place was established, and I'd like to just mention two stories from that time, which I think encapsulate her personality perfectly. There was a bus for dignitaries, taking people back from Tŷ Hywel to their cars. My father persuaded Betty to come on the bus, and Betty persuaded the bus driver to do a detour to the Butetown estate, to take her home. Therefore, the bus went on a detour to Butetown, and there the bus remained, outside her house for ages, as she finished talking with everyone on the bus. She lived at the heart of the community she served. And then around the same time, I remember being at a dinner to mark the occasion, and she was sitting next to an official of the Queen, and they got on very well—she could get on with everyone. But after a while, she asked him, 'Well, what do you do?', and some grand title came back. Quickly, Betty asked, 'Well, how do you get that job? I didn't see that one advertised.' He laughed as much as everyone else did.

Her challenges that she overcame are well known: being one of the first six pupils at Cardiff Teacher Training College, which later became Cardiff Metropolitan University, is incredible; the first black headteacher in Wales, in the 1970s; and an inspiration to thousands upon thousands. I heard Betty say several times that she was proud to be black and proud to be Welsh—the two went hand in hand, they went together with Betty.

I am grateful to the team behind Monumental Welsh Women for ensuring that the statue of Betty Campbell is the first of many statues that will appear to commemorate women in Wales. But, can I say, there is nobody more fitting to be first than Betty? Diolch yn fawr.

And there's probably nobody more fitting to spend two minutes, 29 seconds of a 90-second statement on. [Laughter.]

Sorry, Llywydd.

That does not become the rule; that was unique to Betty Campbell. Jayne Bryant.

The Newport and Gwent Literary Club will begin their jubilee seventy-fifth season when they meet this evening. The club has been meeting monthly for dinner and a talk on a literary theme from September to May, almost without break, since just after the second world war. Although disrupted somewhat through the pandemic, there have been many meetings on Zoom.

Hosting its inaugural meeting at the Westgate Hotel on 23 April 1947, and believed to be one of the oldest literary clubs in Wales, Newport and Gwent hosted many literary figures over the years, including the critically acclaimed author, Lady Healey; the linguist, David Crystal; the soldier and writer, Peter Kemp; and poet, author and playwright, Dannie Abse. Priding itself on nurturing emerging Welsh writers, as well as bringing recognised national and international writers of diverse backgrounds to Newport, the club has a growing membership that's drawn from all corners of the city, as well as nationally and internationally. They strive to discuss a wide range of topics, with this season's talks including 'Crime Cymru', 'Black Writers 1600-1900', and even 'Viking Sagas'.

It's a huge achievement for a group like this to still be going after 75 years, and I want to thank all those who've helped over the decades, with particular thanks to all the current committee, led by Dr Alun Isaac, and to Sue Beardmore, who has helped to keep everyone informed throughout the pandemic. Their enthusiasm and commitment knows no bounds, and, as a proud member, I am very much looking forward to this year's events, and would encourage anyone interested to look them up. This season promises to be a vintage year.

Today marks World Heart Day and, to raise awareness, British Heart Foundation Cymru have been hosting a drop-in session on the steps of the Senedd. It was good that so many Members were able to attend today.

British Heart Foundation Cymru are also launching a new campaign on the impact of heart disease on women. Women are twice as likely to die from coronary heart disease than breast cancer, yet awareness of the risk of heart disease to women is extremely low. Research also suggests that 50 per cent of women are more likely than men to receive the wrong initial diagnosis for a heart attack. Each year, tens of thousands of women are admitted to hospitals here in Wales due to a heart attack, and yet British Heart Foundation Cymru found that the majority of the Welsh public were unable to identify heart disease as one of the leading causes of death in Wales for women.

The UK and Scottish Governments have committed to a nation-specific clinical plan to address the health inequalities faced by women, and it is fitting, I think, that British Heart Foundation Cymru have today chosen to launch their new campaign. They hope, as do I, that the Welsh Government will commit to a women's health equality statement that will address inequalities experienced by women with heart disease. And I would hope that such an equality statement would seek to improve public awareness, timely diagnosis, equitable treatment and equitable access to cardiac rehabilitation for women across Wales. Diolch, Llywydd.

I thank everybody for that item, and we will now take a break to make changes in the Chamber.

Welcome back. The next item is item 5, a Member debate under Standing Order 11.21(iv). I call on Luke Fletcher to move the motion.

Diolch, Dirprwy Lywydd. I'd like to start by thanking the Business Committee, as well as colleagues across the Senedd, for their support in facilitating this debate. Today I look forward to Members' contributions to this debate, which is very clearly a cross-party issue. In tabling this motion in this Senedd, I've done so whilst remembering two women in my family who lived with dementia towards the end of their lives: Dorothy Walker, remembered affectionately as Dot, who was my great-grandmother, and Sandra Lewis, my grandmother, who passed earlier this year.

Dementia is a broad term that is used to describe a number of conditions that affect the brain. The most well-known type of dementia is Alzheimer's. However, each condition associated with dementia affects a person in different ways, which means that each dementia patient's needs can vary from condition to condition quite drastically. My grandmother, Sandra Lewis, was diagnosed with dementia with Lewy bodies, a little-known variant, which is closely related to both Alzheimer's and Parkinson's. Dementia with Lewy bodies means that a patient presents with difficulties of movement, concentration and alertness as well as hallucinations. For my family, knowing and receiving the correct diagnosis was all-important, given the specific care she needed. However, this is easier said than done, and, for some time, there was uncertainty as to what my grandmother was living with. I'm only a layman when it comes to medicine, and in fact calling myself a layman is probably being a bit too kind to myself, but to get to a stage where there have been multiple diagnoses indicates to me that there is room for improvement. There were, indeed, several diagnoses, ranging from Alzheimer's to calcium and thyroid issues, and in the meantime, my grandmother was not receiving the care that she needed and her quality of life was deteriorating rapidly.

Figures provided by the Alzheimer's Society point to the current diagnosis rate for dementia being around 50 per cent. With this diagnosis rate, we only know of about 25,000 people living with dementia, when it is suspected that the actual figure is closer to 50,000 people, meaning that half of people living with dementia in Wales are missing out on the support and access to services that they desperately need. If you look at what my grandmother's condition was, around 5 per cent of patients are diagnosed with dementia with Lewy bodies, but, again, it is estimated that the figure is closer to 20 per cent.

As many dementia charities rightly point out, research will beat dementia. In Wales, it is only fair to acknowledge the work that the Welsh Government is already undertaking in this field. On this point, I would like to thank the Deputy Minister for her engagement on this issue. I do truly mean it when I say this: from our meetings together, I can see the personal drive that you have to tackle this issue and I am immensely grateful. We have seen in Wales an offer of PET scanning, which from what I understand has led to more accurate and timely diagnosis, and the dementia action plan does make provision for the Government to react and fund services when needed.

As I've already mentioned, care needs vary significantly from one condition to the next. They can be physical or mental. Therefore, a correct diagnosis means that those living with dementia, their families and their carers can provide the care that they need. An important part of this care relates to language. Those living with dementia can forget their second language, so Welsh speakers for example can forget their English. When quality of life is mentioned, there is nothing more fundamental than the ability to communicate. It's important that we don't forget this in moving forward, and the importance of getting a correct diagnosis in order to create a personal care plan.

As we all get older and live longer, cases of dementia will only increase, so this is an issue that we need to get to grips with sooner rather than later. We have a long way to go before dementia services are where they need to be, but I hope that my motion can go some way in helping the Government get there. I encourage all Members to support this motion.

I'm pleased to have an opportunity to contribute to this debate this afternoon and I'm grateful to Luke Fletcher for leading the debate. I'm pleased to join Members in all parts of the Chamber calling on the Welsh Government to help to support people living with dementia more effectively. At the moment, it's estimated that some 1,300 people are living with dementia in Preseli Pembrokeshire, and whilst those people live in the community, many of them feel that they aren't part of that community. Many people aren't confident enough to leave their homes and to engage in their locality, so there's a very real problem here, and that's why it's so important that Governments at all levels as well as local communities engage better with those living with dementia.

Indeed, as a society, each and every one of us has a responsibility to help to create a community where current services are more inclusive of people with dementia. In my constituency, there are memory cafes in places such as Milford Haven and Fishguard, which provide a friendly and supportive environment where people can meet, talk and learn more about dementia and access information about the support available. This is the kind of initiative that we must promote throughout Wales. It's crucial that Governments at all levels empower community activity and collaborate more effectively to promote awareness of dementia in our communities by promoting awareness in every shop and business, so that staff and volunteers can better understand dementia. This will certainly help customers living with dementia to feel more confident when they're out and about in the community.

I'm sure that Members are familiar with the dementia-friendly communities initiative, which aims at creating communities across the UK that are more friendly to those living with dementia, and more accessible to those living with dementia. This can be anything from being more patient with a customer as he or she pays, or communicating more clearly over the phone, and this makes a huge difference to people living with dementia. I'm pleased to see places like Solva and Haverfordwest as being registered as dementia-friendly communities, and it's encouraging to see organisations such as Dyfed-Powys police and the fire and rescue service in mid and west Wales also being promoted as being dementia friendly.

I'm aware from previous discussions that the Welsh Government is supportive of the dementia-friendly communities. But perhaps in responding to the debate, the Deputy Minister could give us an update on what outcomes have been achieved since the Welsh Government gave its support to this campaign. I appreciate that there is no one-size-fits-all solution to dementia, because people are affected in different ways, and also what works in urban areas won't necessarily work in more rural areas.

I'd like to thank Luke Fletcher for proposing this debate, and the level of interest indicates that we are all aware of just what an important subject this is. We face a veritable epidemic of dementia—that's not my assessment, but that of a leading expert in older people's medicine. We need to do research as a matter of urgency into the link between air pollution and dementia. We need to understand—. We know that chronic obstructive pulmonary disease is caused by air pollution, but what about the impact of particulates inhalation into the bloodstream, ending up in the brain? Last week, the Deputy Minister for Mental Health and Well-being spoke about our obesogenic environment, and the dominance of junk-food advertising, which means people are not eating enough of the things that nourish their brain, rather than clogging up their arteries.

During the lockdown, we've seen a huge impact on people with dementia, but particularly those who are caring for people with dementia, because all the normal support services that were previously there have simply been collapsed, in most cases. This has been confirmed by research done both in Wales as well as in other parts of Europe. This has been a really terrible time, and of course has caused levels of stress both to people with dementia and their carers. I'm aware that, since the pandemic struck, Swansea Council has had to withdraw two key dementia care and support services, admiral nursing and the dementia service support team. So, there's now a significant gap in provision for carers and those living with dementia there. Carers report the impact of the severe domiciliary care staff shortage in the area, which means that their care packages are also being reduced or cut completely. So, families are having to fall back on other family members, or neighbours, to get any sort of respite at all, and this is really, really serious.

Amidst this perfect storm, I was devastated to be told that the Alzheimer's Society was choosing, just last month, to decide that they would not be reopening the day-care centre in Oldwell Court in my constituency, which had been closed since the beginning of the pandemic. This was just terrible timing, for the carers and for the people who used to enjoy going there. There's been no opportunity to discuss what the alternatives are, and indeed, at the moment there are no alternatives. Cardiff, at the moment, is confined to one day centre, where they are assessed as being safe to take seven service users on any given day. That's for the whole of Cardiff, and the place to which people with the most acute problems go—those who wander, those who occasionally become violent because they are so confused—that's closed because there's asbestos in the building. You couldn't make it up. This is just so terrible, and the burden on carers and the boredom and lack of stimulation, particularly for those with the most profound confusion, is really terrible. It is not just language that's so important to grab hold of, but also food is incredibly important. When I visited the Minehead day centre in Llanrumney recently, there was a wonderful chef there. The service users were actually writing these letters of appreciation because of the wonderful home-cooked food they were getting. So, that's wonderful too, but also music is such an important part of what people don't lose. Why is it not possible to do music sessions over the phone, over video, even if we can't yet have services back in person?

I thank Luke for bringing this debate before us today, and I'm very pleased to take part in the debate.

Dementia is a cruel, cruel disease that has a huge impact on thousands of families across Wales. I know about its devastating impact through my own family as my great aunt had dementia. We will hear many personal and powerful stories shared during this debate, so to complement that, I wanted to focus on what the third sector organisations had to say about what could be done to help improve people's lives and soften the blow that dementia delivers.

The Alzheimer's Society Cymru estimate that there are around 50,000 people in Wales living with dementia, and this is only a best guess since the current diagnosis rate, as we've heard, is only 50 per cent. That figure is expected to double by 2050. Having such an inaccurate picture of dementia in Wales means many people are not receiving the support they need or deserve. It also means that many who are receiving support are receiving it later than they should, resulting in poorer outcomes for all those concerned.

Anecdotal evidence suggests that around 4,000 people in Wales are waiting for an assessment by the memory assessment service due to the COVID backlog. As well as improved and earlier diagnosis, Alzheimer's Society Cymru are in favour of a national dementia data observatory, as we heard from Luke earlier, to collect, analyse and disseminate information on dementia to all those agencies and service providers that need accurate data to help them plan and deliver dementia services across Wales.

Many families with experience of dementia know that the burden of care often falls upon them. We know from the first coronavirus lockdown that family and friends spent an extra 92 million hours caring for loved ones with dementia. Since the pandemic began, it is estimated that unpaid carers have provided £135 billion-worth of care across the UK. Unpaid carers have been taken for granted, but at what cost to them? It cannot continue.

Existing difficulties in accessing appropriate support services, carers' assessments and respite care have been magnified by the pandemic. The chronically underfunded social care system left many with nowhere to turn. Dementia symptoms worsened for many due to the lack of expert help during the pandemic. It is vital that we learn the lessons from the pandemic. The pandemic exposed the flaws in the system, and it is incumbent on those with the responsibility and the power to rebuild the system be better equipped to deal with the kinds of extreme stresses and strains that we have seen over the last 18 months.

I will now turn to the social care system in Wales—a matter I have raised already this week with the First Minister, during First Minister's questions, due to the actions of the Labour-controlled Caerphilly County Borough Council and the devastating plans for social care for disabled adults. There is so much to improve on, and until we see some radical policies in this field, patients, their families and the staff that work in this sector will continue to suffer. That radical change should be in the form of a merger between social care and healthcare. We have been calling for this for the best part of a decade, yet we seem no closer to it. If care was free at the point of need and if there was a culture change that saw care workers respected and valued in terms of pay and conditions, then there would be a step change for workers in the sector, and also the patients that need this vital service. A merger would not just benefit those with dementia, but everybody in need of social care. I urge this Government to do what is right for the people in Wales. Diolch.

I would like to declare an interest, as I am the chair for Brynawel Rehab Wales.

I am pleased to have signed this motion for debate and thank you for calling me to speak this afternoon. Dementia is a cruel disease: cruel for the individual and for their families. It is also one that is going to place more pressure on public services to reform to meet people’s needs, where higher quality, more adaptable care will be needed as more people face this illness.

We are ageing. Dementia is on the increase, and to live a good life becomes a big challenge—a challenge we must meet. Our motion rightly calls for the need to ensure an accurate diagnosis of someone's condition and the right package of support to be identified quickly. We must also recognise that around one in 10 people with dementia have some form of alcohol-related brain damage—that is called ARBD—especially in younger people under the age of 65, where ARBD affects about one in eight people. It is reversible and has a better prognosis if diagnosed early.

The Welsh Government's dementia action plan for Wales expires next year, and whilst I welcome many of the sentiments and the commitments from here on in, we need to be more ambitious in how we provide a good quality of life for those with dementia. The plan said that because of the actions contained within it, more people would be diagnosed earlier, enabling them to plan and to access early support and care if needed. I look forward to the Minister outlining how this plan has worked for individuals and what evidence there is that more people have been diagnosed earlier.

When people are diagnosed, some experience a fear of what it might mean for them. Many people want to be cared for at home, close to their families and neighbours, remaining part of the community. This is something we all value, and for those older people with dementia, we can never underestimate the importance of family and familiarity with surroundings and locality. Sadly, many people end up in a care home, not because their condition cannot be responded to in their own homes, but because it becomes a matter of finance. For some people it's not about what is best for them, but best for the state and the convenience of others. That saddens me and we need to think more creatively in helping people to remain at home for longer.

Our care sector is struggling, and the pandemic has exposed weaknesses in our ability to sustain a sector based on high quality. The First Minister has previously campaigned on a policy of shifting care provision towards the not-for-profit sector, to realise more investment. This is sensible, but we need to think about what types of homes we build, how they are designed, located, and connected.

It's also about the service we provide, the lives and daily experiences we can support. The Government's plan rightly talks about developing links between homes and the community, but we need to pause and reimagine what these homes should look like in the future, and the environment that they provide. It is also about the way that families can remain involved in their loved ones' care and in their lives.

Clearly, there is real resonance across the Chamber in term of what people are saying. I've been here with my pen, actually, striking out quite a bit of what I'm going to say, you'll be very pleased to hear, Dirprwy Lywydd. I also want to acknowledge that many of us in this Senedd have been directly affected by dementia. My mother actually died of dementia and my father died of Alzheimer's. I want to pay tribute to all of those who cared for all of our family, and my mum and dad, up in north Wales; thank you—diolch yn fawr iawn ichi gyd.

It is extremely complex, attempting to reduce the number of cases of dementia. Many of them are undiagnosed, due to those challenges right now as well in COVID, so I do welcome this debate that, Luke, you've brought forward—thank you—as an opportunity to reaffirm our collective commitment to this important issue.

I would also welcome clarification from the Deputy Minister, as has been said, as to whether the further dementia action plan will be extended beyond 2022, and look forward to that, as has been said, being more ambitious, in terms of focused improvement in dementia care in Wales.

I want to say a little bit as well about dementia in rural areas. Support in rural areas for dementia is particularly challenging.

Will you take an intervention?

Of course I will; thank you.

Thank you very much indeed. On Monday, Darren Millar and I visited the Carers Trust North Wales Crossroads Care Services at their new north Wales dementia centre in north Wales. We heard that this is unique in Wales, contracted and funded via Betsi Cadwaladr health board but run on a charitable basis. We heard about their plans to create a best-practice hub in central Wales, hopefully with satellite hubs in the east and west. Will you join me in urging the Welsh Government to look at this as a best-practice model?

Thank you, Mark; thank you for that intervention. Of course I will join with you; anything that improves and enhances the delivery of services to both those who suffer from dementia and their carers in a rural area such as Mid and West Wales—I'd be very happy to join with you and others in supporting that moving forward.

Over 17,000 people are affected by dementia in rural Wales, yet there are huge difficulties in accessing specialist support. Poor public transport networks in rural areas lead to social isolation and loneliness for those affected, as they are unable to access those specialist services.

As we've also heard, it's really important that carers must not be forgotten as part of this debate too. Difficulties in accessing respite care, especially, once again, in rural areas, makes carers' lives more challenging as they struggle with the pressures of caring responsibilities and a shrinking support network after COVID. And there is the embarrassment and sometimes shame that can come with a diagnosis or the potential of a diagnosis of Alzheimer's and dementia, and I can speak about that as somebody personally affected.

The work that our unpaid carers do is underestimated, and it's important that we properly support their work. My party has proposed a £1,000 increase in the carers allowance in order to ensure that we recognise their contribution, and I'm sure that others also want to ensure that that contribution is recognised.

I finish once again by thanking Luke—diolch yn fawr iawn ichi—for bringing forward this debate, and I hope that we can all work across parties to ensure that there is dignity for those we love, for their carers, and continued gratitude and the right rewards and recognition for the staff who look after them so expertly. Thank you—diolch yn fawr iawn.

I am pleased to contribute to today's debate, and I thank my fellow Member from Plaid Cymru for South Wales West, Luke Fletcher, for raising this important issue about the need to develop and improve diagnostic approaches and to fund support in order to support the tens of thousands of people in Wales affected by all kinds of dementia. I say tens of thousands, because, as we've heard, rather than a specific figure, the truth is we don't know the exact number. According to the Alzheimer's Society Wales, more than half of the 50,000 people suffering from dementia are undiagnosed. My father died of Alzheimer's six years ago. He was one of the ones who didn't get a diagnosis or the medical or practical support for too long, and, indeed, even after he was diagnosed, my mother had to cope with what she described as a very difficult process—such a difficult process, too difficult—in terms of finding information and having access to clinical support and practical support. The expectations and the requirements of unpaid carers in this sense, people who are often vulnerable and at the end of their tether emotionally and physically, are unreasonable and create great frustration and concern. We need to create a much better system of providing dementia services and the correct support for people living with dementia and those who care for them.

Knowing what my parents went through, the difficulties that we experienced as a family in terms of having access to support services and the assessments that were needed to access that support, I can imagine entirely how terrible the COVID period is and the impact that it has already had on an unacceptable situation for too many people. Four thousand people, according to the Alzheimer's Society, are waiting for a vital memory assessment that opens the door to treatments and support. I support the call of the Royal College of Psychiatrists in Wales that specific funding is needed to increase capacity and to ensure equitable access to diagnostic infrastructure and to create a clinical pathway that's much better in terms of access to treatments.

During the pandemic as well there were great demands on unpaid carers, as Jenny Rathbone and others said, and the lockdown has exacerbated the symptoms of dementia and the terrible lack of investment in our social care system, leaving people without the support that they needed. Our care homes, where so many people who live with dementia live, they were left wide open to the pandemic. That is a scandal that the Welsh Government will need to account for. But we need action now to try and light the flame of hope in this very dark period, which has had a disproportionate impact on people with dementia.

Due to the complex nature of dementia, the need for quality, long-term data is high, and I am therefore glad to support the call in the motion for the Welsh Government to establish a national dementia data observatory to improve the planning and delivery of dementia services. As a former staff member, I'm proud that Swansea University in my region is playing a key role in world-leading multi-disciplinary dementia research. We have expertise here in Wales that we can and must develop further. Unfortunately, too many of you will, like me, know first hand why this motion is important. You can never ever be prepared for the effect dementia will have on you when it strikes your family, but we as a nation can be more ready, armed with knowledge, with proper support and with care.

When I was elected, I told Beti George, who lost her husband, David Parry-Jones, to dementia, that I would do everything possible to improve the support for people like her and her husband. 'There's been plenty of talk in the Senedd, Sioned', she said. 'We need action.'

I would like to place on record my thanks to Luke Fletcher for going around seeking support for this debate today, and I was really proud to co-submit.

Now, there is no denying that the COVID-19 pandemic has had a massive detrimental impact on people living with and affected by some form of dementia. Ninety-five per cent of carers, in a survey conducted by the Alzheimer's Society, reported a negative impact on their mental or physical health. And really sadly—you know, it's hard to read these statistics out, but over a quarter of people who died with COVID-19 from March to June 2020 in the UK had dementia. So, it does bother me when the dementia action plan for Wales states:

'We need to further develop the links between care homes and community services and will expect the dementia "teams around the individual" to provide specialist and regular in-reach support to care homes. We are also encouraging GP practices to offer a new enhanced service for residential and nursing care in Wales.'

Now, that stemmed from—. Seventy-five per cent of care homes surveyed said that it's difficult because GPs are reluctant to actually visit residents there. So, the evidence indicates that care homes have not been receiving an enhanced service from GPs. So, I will be pleased to learn what steps the Welsh Government will take to address this.

This month, Meddyg Care has become the first care home group to establish an admiral nurse service in Wales. So, while other organisations have dementia advisers, who offer valuable guidance to people with the condition and their families, admiral nurses go beyond advice—they offer comprehensive specialist support and expertise for families and those living with the complexities of dementia. And reading on, I was further surprised to find that there are no admiral nurses in north Wales. So, Minister, I just wonder what review you could do as a Government to maybe help registered nurses become admiral nurses. This would be in line with the following outcome in the dementia action plan that says:

'Staff have the skills to help them identify people with dementia and to feel confident and competent in supporting individual's needs post-diagnosis.'

Admiral nurses can also help unpaid carers, as such nurses can equip them with stress-management techniques and coping strategies that can then help to make contact with respite services and provide specialist carer education and training. In fact, really, we shouldn't be seeing any delays now in implementing any steps that might see greater support offered to unpaid carers.

The sad thing is that 40 per cent of those feel unable to manage their caring responsibilities. Seventy-two per cent have not had any break during the COVID-19 pandemic, and 73 per cent have reported being exhausted as a result of caring during the pandemic. So, I agree with Carers Wales, Age UK, Carers Trust, Motor Neurone Disease Association, Oxfam GB and Rethink Mental Illness, who have called on the Welsh Government to ensure that our unpaid carers providing significant hours of care to patients with dementia—that they get the breaks they need.

The human mind is a precious and vulnerable thing. We live with our memories and when we are robbed of them and a condition like dementia takes hold, it can be cruel and debilitating. As we've heard, it's estimated that 50,000 people in Wales are living with dementia, but it affects not just individuals, but entire families who have to deal with grief and loss every day, even though their loved one is sitting in front of them.

My grandma, Doreen, had dementia. She lived into her hundred-and-first year, but the final years of her life were taken from her gradually, piece by piece. She'd been a keen cook and baker and she was baking Welsh cakes on her baking stone well into her ninety-eighth year, but she'd forget to add the sugar or the salt or leave them on the bakestone a moment too long. Those were some of the first signs.

She used to sew and crochet and she'd delight in telling people that when my father was little, she'd made his entire school uniform, even down to the grammar school blazer, with the barathea material she'd bought in Pontypridd market, and she'd bought the school badge and sewed it on. But that solace of sewing and using her hands had escaped her more and more in her final years. The postman would see her in the window, sitting there, no longer sewing, but looking out and watching the world go by.

My grandma loved to walk. When my sister and I were little, we'd go on walks on Nelson mountain, picking blackberries and blueberries, but more and more, as she got further into her 90s and the dementia was firming its grip, she'd think that she could walk further than she could, and would keep on walking on the uneven paths near her home, being totally oblivious to the danger of falling. I remember her calling my parents' house one day and I'd answered it and she asked me, 'Why is it that I can't do all of the things that I used to do?', and she wished that she could walk and walk. She'd get frustrated and she'd be lonely, and even though my parents visited her every day, as well as carers, she'd feel sad and forget that they'd been.

When her condition deteriorated, she agreed that she'd be more comfortable and more safe in a home, though she did still fall, and after one fall, she went to Prince Charles Hospital with my mother and she was kept—a lady in her nineties; 99 years of age—on a trolley in a corridor for nine hours. This was not the fault of the doctors or the nurses or the ambulance crew; it was the fault of the system that underfunds its health service to the extent that a lady of 99 was left without specialised support in the middle of the night. We need dementia services across primary care and for hospitals and care homes to be integrated and properly funded. We need to invest and research into how to diagnose dementia more accurately and we desperately need more support for patients and their families after diagnosis so that they aren't robbed of yet more agency.

I call on the Deputy Minister for Mental Health and Wellbeing, Lynne Neagle.

Thank you, Deputy Presiding Officer. Can I thank Luke Fletcher for tabling this very important motion today and for engaging with me so constructively ahead of this debate? Luke has spoken with such courage about his own family experiences of dementia. I hope that he won't mind me saying that, in my personal experience, true champions are rarely drawn from the ranks of the unscarred, and I know that people living with dementia will have a powerful champion in you in this Chamber, Luke.

I'd also like to thank everyone else who has spoken today and I recognise that these have been difficult contributions to make and painful for Members and very important it was for everybody to hear them.

These last 18 months have been incredibly tough for everyone, but for no-one more so than people living with dementia. The loss of routine, changes to support, uncertainty and the restrictions on care home visiting have made a challenging situation even more difficult. That's why I was pleased, last week, on World Alzheimer's Day, to be able to launch the 'Dementia action plan: strengthening provision in response to COVID-19' document. This document was developed with our partners to supplement the 'Dementia Action Plan for Wales', and reflects the priorities that came to the fore during the pandemic.

Several of these priorities align with the focus of the debate today, for instance, equity of access and evidence-based approaches, research and development and learning and development. We will be reporting against our progress as part of our update against the action plan. Colleagues will know that our dementia action plan was co-produced with people living with dementia, and likewise, our recovery plan was co-produced with members of our dementia, delivery and oversight board, which includes those living with dementia as well as third sector partners, and I'd like to take this opportunity to thank everyone involved in this vital work.

This motion before us today recognises the crucial role played by unpaid carers in the pandemic; I couldn't agree more. Welsh Government's new strategy for unpaid carers, launched by my colleague Julie Morgan on 23 March, reaffirms our commitment to support all unpaid carers in Wales to have a life alongside caring. This work has never been more important. Work is ongoing with members of the carers ministerial advisory group and carers engagement group to develop a detailed plan to be published this autumn, and this will be accompanied by a new carers charter. We established the carers support fund during the pandemic. This is managed by Carers Trust Wales and aims to support unpaid carers with financial pressures, and I can confirm that, to date, this support has already been accessed by almost 6,000 unpaid carers. We are also allocating £3 million in this financial year to meet the anticipated spike in demand for both traditional and innovative respite services as lockdown restrictions are eased.

Luke is absolutely right to be particularly concerned about the need for an accurate dementia diagnosis. Again, I couldn't agree more. I know from my own personal family experience just how vital getting prompt, accurate diagnosis is if families are to access the support they need. This, for me, is also a fundamental rights issue. We wouldn't just tell a cancer patient that they have cancer without telling them what sort they have, and the same should absolutely apply to those living with dementia.

I call on Rhys ab Owen to reply to the debate.

Deputy Presiding Officer, as many in this Chamber will know, reforming the care sector is very important to me. Like for many others, it's a personal thing too. It was said yesterday in the Chamber that the word 'crisis' is overused. That's true, perhaps, but there certainly is a crisis in the care sector, and that crisis is just going to get worse. This is one reason why I am so proud to close this crucially important debate today.

As everyone else has done, I thank Luke for pursuing this, for tabling this debate. It was a hard debate to listen to—a very hard debate to listen to—you must have a very hard heart if you haven't been touched by the debate today, but I'm heartened to see cross-party support, to see us all willing to work together to tackle this important matter.

Paul Davies mentioned people with dementia not feeling like part of their community, and that's true even in an area like Preseli Pembrokeshire, where there are so many close-knit communities. I'm sure things are even worse in certain other areas. Paul mentioned the need for people to receive training on dementia. I've experienced on too many occasions responses that have been negative to people suffering dementia—people don't understand, people don't show patience, people ignore people with dementia, and people are treated as though they're stupid. Paul and many others—and Janet also—mentioned good practice in some areas. We must have a national strategy here. We have talked too much over the years about good practice here and there; we now need a national approach. Things shouldn't rely on individuals or individual organisations.

Jenny Rathbone mentioned the need for more research—in this case, into air pollution and junk food. I can only give anecdotal evidence here, but out of three siblings, my father and his sister who lived throughout their lives in Cardiff had dementia, and their elder sister who is nearing 90 now and lived most of her life in a rural location did not. I think there's something in it, Jenny, in the link with air pollution, and it's something that needs to be looked into.

Again, respite should not be dependent on the kindness of individuals or the work of some organisations; we need a national approach. Peredur said that the situation will only be getting worse. It's true. We need to do things right now. Adam Price, who also comes to this from a personal perspective, put a free national social care system at the heart of the Plaid Cymru manifesto. I hope other parties will do the same. That is what we need. Altaf Hussain again mentioned the need for research, and the need for quality of life. Dementia should not signal the end of a good-quality life. People can still have a good life with dementia.

Jane Dodds paid tribute to the carers who assisted her parents. I can also attest to that, Jane. The work that they've done, especially during this pandemic, has been absolutely incredible, and they need to be valued so much more. You mentioned loneliness, and that is so true of the sufferer and also the unpaid carer—the wife, or the husband, or the child. They often feel lonely, they often feel, as Sioned mentioned, vulnerable without any support. Mark Isherwood, in his helpful intervention, again mentioned good practice in other locations, but that's not good enough, is it? It's not good enough.

Delyth mentioned the frustration and the loneliness, about not being able to do what they used to do. Yes, I saw that frustration, I experienced that frustration. She mentioned her mother singing; I can well remember my grandmother singing Welsh hymns well into the advancement of her dementia, and reciting like the old lady in Wythnos yng Nghymru Fydd psalm 23,

'The Lord is my shepherd, I shall not want.'

Sioned Williams, it's true that there is huge pressure on people like your mother as she cared for your father. I remember reading a diagnosis letter for my father in 2013, and I had no idea what the future held. And that's entirely true; you are entirely right that nothing prepares you for life with dementia. We need early support, and we need to increase capacity, as you said, Sioned, in order to create that.

Can the Minister, in the future, outline to us how she will address this, the increase in the capacity and the calls by the Royal College of Psychiatrists for this to be done? I am glad that the unique work in Wales aiding early dementia diagnosis is being spread out nationally. I'd like to know when that will take place.

As mentioned by Sioned and by Luke, charities like the Alzheimer's Society would welcome further detail, would welcome the national dementia data. It's incredible that, in 2021, we don't have basic answers to basic questions about dementia, like how many people live with dementia, how many people provide unpaid care for people with dementia, how can these people be supported, how many people are diagnosed with different forms of dementia, how many people have early onset dementia, as Altaf hinted in his speech. These are basic answers, and we need to develop a plan for the future—an accurate plan, an evidenced plan, and a long-term plan. Unfortunately, as one who has experienced three grandparents, my father, and his sister with dementia, I can tell you, Dirprwy Lywydd, as Luke Fletcher stressed, that every case is completely different. We need a truly person-centred approach to this for policy making in Wales. To do that, we need as much data as possible.

Dirprwy Weinidog, I am pleased that you are in this role; more pleased than you can ever imagine, genuinely pleased, because I know for you, like others, this is personal, and there's drive behind what you're doing. I look forward to working closely with you, Luke and others within this Chamber to tackle this important issue, because truly, this needs cross-party co-operation, and it needs action now.

Because this is the forgotten sector, the care sector—defunded, undervalued, and its workforce and the carers being underpaid. As Members of the Welsh Parliament, we must send a clear message to people out there today. What's the purpose of us otherwise, unless we can tell families, carers, residents in care homes and everyone living with dementia that we are going to change things, that we are listening to you, and that we are willing to take action on your behalves? Too many Governments, here and in Westminster, and of different political hues, have neglected this important issue for too long. They've cast it to one side, kicked it into the long grass. I made a similar pledge to Sioned in speaking to Beti George and she regularly gets in touch to ensure that we're doing something. We have to take action now for people like Sioned's mother, for people like my mother, and for people like Beti George and those who they cared for, for the families represented here today and for families the length and breadth of Wales. Today, friends, we remember that forgotten sector, and we will take action on their behalves. Thank you.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer voting on the motion until voting time.

The next item on the agenda is the Welsh Conservatives debate on COVID passes. I have been notified that the motion under this item will not be moved. I call on Tom Giffard to confirm that is the case.

Diolch, Dirprwy Lywydd. In light of the Government's stated intention to bring this matter to a vote in the Senedd next week, we will not be moving this debate today.

We move on the item 7, the Welsh Conservatives debate on transport. I call on Joel James to move the motion.

Thank you, Dirprwy Lywydd. The abolition of the Severn bridge tolls has proved to be a massive benefit to the people of Wales. As the stranglehold of tolls was released by the UK Government in 2017, businesses and commuters were relieved of massive financial burdens, with some motorists saving as much as £1,400 per year. Removing the Severn bridge toll road will have undoubtedly opened up south Wales to many businesses that would have seen a toll road as a barrier to conducting commerce. As a result, axing of the tolls has generated an estimated annual boost of over £100 million to the Welsh economy. The technology sector has seen unprecedented growth in Cardiff, leading the UK's major cities at 7 per cent, on par with Manchester and ahead of London and Bristol. I believe—and indeed, my party believes—that introducing new toll roads would only serve to suffocate that growth.

As the Deputy Minister and many here will be aware, surveys commissioned by the Welsh Government have asked road users about paying to use parts of the M4 and A470 in a bid to tackle poor air quality. We understand that this is part of the Welsh Government's legal responsibility to survey for other possible actions that could help improve air quality. I asked a written question during recess, and I can also thank my colleague Tom Giffard for his question to the First Minister regarding this issue, and to the First Minister for his response yesterday. I am sure it would have gone some way to reassuring the wider public that toll road proposals were not part of the Welsh Government’s current forward plan.

However, it is without question that the Welsh Government must recognise that surveying people about toll roads and being very specific about the M4 and A470 as possible locations will put into people’s minds that this is a course of action that the Government are considering. I hope the Government can acknowledge the considerable concern among motorists and businesses that this would have caused. Therefore, the point of this motion today is that we want to rule out completely toll roads as a measure to address poor air quality in future.

In south Wales particularly, we face an air quality problem. A recent BBC article highlighted how the World Health Organization now believes that the effects of poor air quality are far worse than previously thought. This debate is therefore timely in that we get the opportunity to discuss the issue of poor air quality, which is at crisis point. We have proposed the further motions to try and address these concerns.

I would like to go on record to say that I, and my party, would oppose any introduction of tolls as a solution to poor air quality on the grounds that they will have a devastating impact on the lowest-paid workers, who will have to pay a disproportionate amount of their income to use the roads, and are those most likely to have older vehicles. Moreover, the introduction of tolls would undoubtedly push drivers to go around them and onto smaller roads. This would of course cause an increase in traffic and ultimately reduce air quality in other places. We have seen this with the pedestrianisation of Castle Street in Cardiff, a concern that the First Minister has raised himself in this Chamber.

The issue exists that electric vehicles are being welcomed as a major solution to poor air quality. However, Wales as a nation has very little provision when it comes to electric charging points. Many of those who currently use electric vehicles are able to have charging points fitted at their homes, but many people in Wales live in flats and terraced houses, where they need to park some distance from their homes and would struggle to use electric charging points.

While Scotland has 7.5 rapid charging points per 100,000 people, Wales only has 1.8. We are calling for the Welsh Government to deliver a more rapid roll-out of electric charging points, because this will be a key driver in encouraging people to invest in electric vehicles as a valid alternative to diesel and petrol vehicles. The Welsh Government says at least 55,000 publicly accessible charging points will be needed in Wales by 2030 in order to support sufficient electric vehicles. We really need to understand, without politicising the issue, whether this target is likely to be achieved, because the lack of charging points is fast becoming the limiting factor for electric vehicle ownership.

I have selected the four amendments to the motion. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected. I call on the Deputy Minister for Climate Change, Lee Waters, to formally move amendment 1 tabled in the name of Lesley Griffiths.

Formally.

I call on Delyth Jewell to move amendments 2, 3 and 4, tabled in the name of Siân Gwenllian.

Thank you, Dirprwy Lywydd. I move those amendments.

When the Welsh Government declared a climate emergency in 2019, many of us expected radical action, and in some policy areas we've seen strong ambition on homes, energy, forestry—the list goes on—all tied together by a bold net-zero target for 2050, but we all know that more radical ambition is needed, and more action to underpin it. Today's debate concerns transport, an area of policy where the Welsh Government, I'm afraid, has fallen short despite the fact that 17 per cent of Wales's emissions derive from this area.

Let's talk about tolls, what's already come up. The Welsh Government has floated the idea of motorists in Wales paying to use roads in a bid to tackle air pollution. Obviously, a clean air Act is something that I very much champion, but the Welsh Government has not gone further so far than consulting the public on the issue, suggesting tolls around the M4 around Newport and the A470 around Pontypridd. Following criticism—and I know that this has already come up in the previous contribution—the Welsh Government has said that there aren't any concrete plans for these tolls. And this is difficult—I recognise this is a difficult issue. We all want to get to grips with the climate emergency, it's a very difficult situation, but these tolls, if introduced, would hurt the poorest in society.

We know that tackling both the climate crisis and the pollution crisis requires integrated thinking and ways of encouraging people to change their habits in ways that will bring them with us. Even with tolls in place with the Severn crossing, for example, over several years traffic typically increased by about 4 per cent year on year. Often, what tolls would actually do is drive people to avoid the charges by taking an alternative route through communities, leading to more congestion and air pollution in small towns and villages.

But the problem remains as well that the removal of tolls on the Severn crossing also increased traffic, and therefore increased carbon emissions and air pollution. Data from Highways England has illustrated that following the scrapping of those tolls, there was an 18 per cent increase in crossings over the Severn crossing itself, and a 34 per cent increase over the old Severn bridge. So, tolls or no tolls, emissions go up. Our habits, it seems, are hard-wired.

Now, many people and businesses are still dependent on roads, and a dramatic shift is required to reach net zero by 2050. I would welcome comments from the Deputy Minister about plans to invest in electric vehicles, in charging infrastructure, R&D to improve existing technologies and to develop the technologies of tomorrow. The Welsh Government could explore ideas like electric-only highways and tunnels in areas of high air pollution and congestion. Crucially, Dirprwy Lywydd, we believe that Wales should be an interconnected community of communities, and people across Wales need to be connected to each other by a truly integrated public transport system with a greater reliance on environmentally friendly modes of travel. I recognise that this is an area where the Deputy Minister feels very passionately, but I'm sure that he will agree with me that it will require an even greater investment for the ambition to be met with action. Why not task Transport for Wales with creating an all-Wales rail network connecting the north and the south and enabling rail traffic between the major centres of population? Why not combine rail with a regulated bus service, and why not give local authorities the power to establish their own municipal bus companies? And, of course, we must see the full devolution, with adequate funding, of all rail services in Wales. The current situation for railways just has not worked. Can we really trust Westminster to deliver vital changes in Wales? I think we already know the answer to that.

Peter Fox.

Diolch, Dirprwy Lywydd. Sorry, I didn't hear you introduce me there.

I absolutely support the motion put forward by Joel James and I agree with a lot of what Delyth Jewell has just said, as well. When you have a bridge with a toll across it, it is a restriction on economic activity. That was a stark warning, not from a politician but from a respected lecturer at a business school in Wales—simple but wise and insightful words. Conservative-run UK Governments can see these things, and indeed have seized the hour in removing hindrances to the Welsh economy, because they understand what a thriving economy needs. One of those, as we've already heard from Joel James, was the abolition of those choking tolls on the Severn crossing. The lessons learned from this should not be forgotten. Removing the tolls unlocked the south of our country, where two thirds or more of the population resides. The UK Government invested in Wales that day by removing them. They wanted our economy to be set free and they did it. The axing of tolls saved the average commuter, as we've heard already, and businesses, an estimated £1,400 annually, as well as providing a huge boost to the Welsh economy.

We must be under no illusion, Members: road tolls would have a huge negative consequence on the economy here. They would only act as another tourniquet on our economy's windpipe. Investors and industry need a Government that pulls with them, helps to oil the wheels of success here, not the opposite. Whilst the Welsh Government proposals may be well meaning, they come at a time when every sinew in the Welsh Government's arm should be pulling to help our economy grow and thrive like never before. We have seen how fragile our supply chains can be at times, and that can only be made worse by poorly connected infrastructure and additional drag anchors such as tolls. There is no getting away from that.

And after more than two decades, it's scandalous that the Welsh economy is still the most underperforming in the whole of Britain. That is a terrible economic legacy that the consecutive Labour Governments here are leaving to our children and grandchildren. More tolls and the potential congestion charge would be the final straw that breaks the camel's back, which would undoubtedly cause an avalanche of potential investors in existing businesses to go elsewhere. We need to be tearing down barriers that are hindering economic growth, not putting them up. Eliminating barriers to inward investment and future economic growth whilst promoting green transport now needs to be the key priority. R&D in Wales has been pitifully low in comparison with our UK neighbours and this needs to be reversed, so the alternative fuels of the future, such as green hydrogen, to power our future freight movement, can be accelerated, meeting our carbon reduction targets as an additional result. Embracing and promoting green transport in the future needs to recognise all types of transport, including HGVs. Wales is lagging behind much of the United Kingdom in moving this all forward, especially when it comes to fast-charging points for electric vehicles. This needs to change, Ministers. Wales can be well and truly open for business if action is taken now to prevent disastrous decisions being imposed as well as the promotion of greener transport. Diolch yn fawr.

I'm very pleased to speak in this debate today. Looking at the Welsh Government amendment pointing out the significance of transport in the challenges of climate change and reducing emissions, and the UK Climate Change Committee's advice on reducing car journeys and making sure that more people make that modal shift to public transport and active travel, I'm very much reminded that we face those challenges to a great extent here in south-east Wales. Of course, that's why there was the inquiry into a possible M4 relief road; the Welsh Government's decision not to proceed; the setting up of the Burns commission; and now, of course, we have the implementation group, tasked with taking the recommendations of the commission forward.

So, in south-east Wales, around Newport, the challenges are there. The decisions have been made and the structures set up to meet those challenges. What we now await very keenly, and what people in Newport East and around await very keenly, is that actual implementation of the Burns recommendations.

There is some frustration at the moment that we're not seeing implementation at the pace and on the scale that is necessary. I've met with the commission and had discussions with various bodies with responsibility, and we really do need to find ways forward. There are some obvious possible early wins, as it were. We've seen some developments around active travel and we need to see more, because I agree with what has already been said about the importance of active travel in getting more environmentally friendly, healthy and progressive ways of moving people around.

We need to see some early developments in terms of better bus routes and ways of getting more people onto buses. There's an interesting fflecsi bus service in Newport now, which I think is gaining more support from passengers as we come out of the worst, I hope, of the pandemic, as restrictions are eased and we're getting more close to life as it was before the pandemic. But, we need to do something on a much greater scale, really, in Newport to get people back onto our buses in far greater numbers.

Of course, train services and infrastructure for trains do take quite some time to build and to develop, and it's quite difficult, perhaps, to have those early wins as far as rail is concerned. But, we're fortunate, I think, in Newport East in having in Magor a very good example of where we could make early progress in getting more people onto our trains and off the roads, and that is because there's a very committed group there that has been working towards a Magor walkway station for several years. They've had countless meetings with the UK Government, the Welsh Government, local authorities, Network Rail and many others in putting forward their proposals and seeking support and partnership. So, there is there, in Magor, the possibility to use a lot of work that's already taken place and a lot of process that's already been undergone to, perhaps, take forward an early example of how we can really meet that challenge of getting people off the roads and onto public transport.

It’s a pleasure to take part in this debate this afternoon. Road-use charging schemes aren't the answer to congestion, nor the air pollution created as a result of stationary traffic. We have heard Members bemoaning the daily traffic chaos along stretches of the M4 in south Wales. For many of my constituents in the Vale of Clwyd, the misery of congestion on the A55 is equally frustrating and a barrier to growth.

The daily misery faced by commuters has grown as a direct result of a lack of investment by Welsh Government in our transport infrastructure. For 22 years, Welsh Labour have run our public service infrastructure into the ground. We have seen a massive decline in the number of local bus journeys. This is particularly bad news for my constituents, as 21 per cent of households in the north Denbighshire locality do not have access to a car or van.

The situation on the trains isn’t much better, unfortunately. The Welsh Government can’t blame private operators for the mess we face on our rail network—they’ve been running our trains since 2018. Yet, despite big promises, it has been an even bigger failure. The lack of services in north-east Wales is astounding. Many trains don’t run at peak times—which has led to many of my constituents wishing for the Arriva days back—even to the point where there is no service running west from Chester between 5 p.m. and 7 p.m. on a weekday, and that’s staggering, seeing as it’s rush hour. Things might have been bad then, but at least they were consistent. For those who do have access to a private vehicle, it’s little wonder that they would rather sit in a queue on the A55—at least they know they will get to their destination eventually.

We all accept the need to tackle air pollution as well as the need for action on climate change. However, punishing road users is not the way, nor will road-use charging force modal shift. People rely upon the car because there is no other choice, particularly in my part of the world. The way we will deliver clean air is by improving roads, not by restricting their use. Roads are the vital link between communities. We can tackle pollution and carbon dioxide emissions by improving the vehicles that use these vital links. Yet, once again, the Welsh Government is failing in this regard. Two London boroughs have more electric vehicle charging points than the whole of Wales. The A55 has a severe lack of charging points along its route, making it extremely difficult for individuals and businesses to abandon the internal combustion engine. Denbighshire council are piloting a green taxi scheme, but unless we see a massive increase in charging infrastructure, such schemes are doomed to remain as urban-only ventures. We need charging infrastructure, not charging schemes, if we are to truly decarbonise transport and deliver air quality improvement, and I urge Members to support our motion this afternoon. Thank you very much.

I've listened carefully to everyone's contributions this afternoon, and I hear many arguments that are contradictory. One challenge for the Tories is the lack of investment from the UK Government before this Senedd came into existence, because this has been a problem that's been with us over many decades, and although I do have some criticisms of the Welsh Government since the inception of the Assembly, there is a responsibility on the UK Government too, and I think we all have to recognise that.

It's a complex debate, isn't it, because it's about transport on the one hand, but also, as we see, the climate emergency is at the heart of all this, as is public health—they are all inter-related. And although I've expressed concerns earlier in terms of tolls on the A470, I'm not opposed to the concept of tolls or radical action if it is in a broader context. For me, when residents received surveys over the summer, they got in touch with me not to complain that they would have to pay to use the A470—they were concerned about the impact that that would have on communities and air pollution. And their question to me was: 'Well, we live in an area now where everyone says that air pollution is a problem and it's dangerous, so you're going to bring more traffic through our communities?'

The Deputy Minister will be aware that I've written to him recently, asking about the most recent evidence as to how effective 50 mph zones are in terms of that area between Pontypridd and Upper Boat. You brought forward a statement earlier this week, mentioning that there had been a reduction of 47 per cent in nitrogen dioxide levels in these areas, but I can't actually find that data anywhere at the moment, and I would be delighted if I could see that data. Because, for me, seeing the impact of 50 mph zones actually making a difference would actually ease the concerns of those communities currently suffering high levels of pollution. It would alleviate their fears. So, if this data is available, I would appreciate seeing it.

During an earlier debate, the possible link between dementia and air pollution was mentioned. But, in 2018, the World Health Organization published a report on air pollution and child health, and that showed clearly how air pollution can impact on neurodevelopment and cognitive abilities and lead to asthma and cancer in children. Also, children brought up in areas with high levels of air pollution can be at greater risk of chronic diseases, such as cardiovascular disease, later in life.

Therefore, for me, all of this issue around transport is about so much more than the issue of how we travel from one place to another. I would hope that we would all agree, although some arguments have been made today in terms of motorists' rights and the rights of people to use their cars. But shouldn't we all be working towards getting rid of as many cars as possible from our roads? After all, there is a climate emergency. We saw radical action in terms of the COVID crisis; we saw that it was possible to reduce traffic on our roads, that there are alternative ways of living.

A pleasure to be taking part in this debate. I just want to refute one or two of the things that the Conservatives have already said. I just want to question this holy grail of the positive impact of the removal of the Severn crossing tolls. Perhaps Peter Fox might remember how much it increased the pressure on housing in the areas around Monmouthshire, next to our border with England, because, obviously, it was more attractive for people who were living in the Bristol area to come and live in cheaper housing in Wales. So, obviously, that potentially increased a lot of the commuting traffic, which obviously increases our carbon emissions. Clearly, I respect the fact that it, obviously, had a reduction in the costs for people who had to go and work the other side of the border because they weren't able to get suitable work in Wales, but, nevertheless, there has been considerable cost to the removal of the tolls on the Severn bridge, which is fully recognised in the report of the West of England Combined Authority, of which Cardiff is a member. It talks about the major cost to the region of the increased congestion, which they regard as £300 million a year, and that removing the Severn bridge tolls is likely to have worsened the problem. So, they are now considering demand-management measures, such as charging on both sides of the Severn to raise revenue for sustainable transport alternatives.

I'd also just like to correct Joel James on the idea that, somehow, Cardiff has become the biggest growing city in the UK as a result of the reduction in the tolls. It was already the fastest growing city in the UK before the tolls, and, hopefully, we will have a slightly reduced growth, because of the impact that all this traffic is having on illegal levels of air pollution. Why on earth would we want to rule out tolls as a policy lever if we discover that air pollution is a major cause of dementia? I'm referring back to the debate we had earlier. We have to have it in the armoury in case we need it, because we cannot go on submitting our population to illegal levels of air pollution.

I'd just like to remind you of a quote from your very own leader. 'Humankind needs to grow up and come of age', said Boris Johnson. Well, I think the Welsh Conservatives need to grow up and come of age. We have a climate emergency, and that means we have to change our ways. Let me just spell out to you what that means. Evidence to the climate change and environment committee from Sustrans reminded us that the switch from diesel and petrol vehicles isn't going to be sufficient to meet our carbon emissions reduction targets, which you, the Tories, have voted for. So, even if all new cars are ultra-low emissions by 2035, we are still going to have to reduce our actual car mileage by 58 per cent between 2016 and 2035 if we are going to avoid the disaster of not meeting our carbon reduction targets. So, we are going to have to do things differently.

At least he travelled here.

Well, that's a good idea; that's why he's able to lead on the—. But the point is, if we want to extend free bus passes to 16 to 25-year-olds—which I don't discount as a great idea—we have to work out how we're going to pay for it. I just want to, equally—. I do question the idea from Gareth Davies that people would rather sit in a queue on the A55. Would they rather do that than pay for a toll to improve the public transport services—really?

And I think, finally, I just want to—[Interruption.] I just want to remind us that one of the other people who's looking at tolls is your very own Chancellor of the Exchequer. And quite rightly too, because the fuel excise duty is currently worth £40 billion to the Treasury, and that pays for all the important services we all love—

Can the Member start concluding, please?

—and cherish. So, how are we going to replace that £40 billion when people no longer are buying petrol and diesel and are simply using cars that are charged up on renewable energy, otherwise it won't be worth a candle?

Will the Member conclude now, please?

So, if the UK Government is considering charging as a mechanism, which is widely used in places like France—and the world hasn't stopped going round in France—and is widely used on the Dartford tunnel east of London, why on earth could it not be a policy tool in this country, if we need it to be? Why is it that—

Can the Member conclude now, please?

—car drivers think that they have a God-given right to travel for free on our roads when we all have to pay when we go on the train or the buses?

Just as a reply to Jenny Rathbone, the reason there are pressures on Monmouthshire is because your Government never built houses to start with, that was the problem.

Minister, as we all know, our roads throughout Wales and the United Kingdom are the vital arteries that connect us all. Mankind has skilfully created an intricate network of roads that connect communities right across Wales and have brought us all closer together. And it has made those local rugby and football derbies a lot easier for people to attend.

We must never forget the sacrifice, time and effort that went into connecting our country. We use our road network to transport goods and services across long and short distances to grow our economy here in the United Kingdom. The road network also, for the first time in human history, gave people who had a vehicle or other modes of transportation the opportunity to travel across our great country and visit places that only, at one time, were seen as a dream. The freedom we all enjoy today on our roads must never be underestimated.

However, times have changed. We understand the real pressures on our environment. We have moved to more sustainable methods of transport. The rise of the electric car has been a great invention of modern times, and now we're in a place to move to a greener source of transportation, using hydrogen power, and more must be done by this Government to invest in the green technologies and kick-start that green revolution. And I just want to pay a quick tribute to Riversimple, who are leading the way in Wales in terms of this technology.

In my constituency of Brecon and Radnor, the road network is vitally important for my constituents who travel mostly out of the county for work due to the poor public transport that serves our communities. The schemes that are dreamt up by Welsh Government around active travel are great if you live in a city, but if you live in rural Wales, your access to public transport is greatly diminished, and the Government forget this time and time again. This is why I am so concerned about the calls by Welsh Government to introduce a road tax and road tolls in Wales, under the guise of protecting the environment. If this Government wants to protect the environment, maybe you should stop taxpayer funding for an airport, or maybe you should move the fleet of ministerial cars away from diesel and all to green energy, but I can't see you doing that. You've got a few Nissan Leafs, so you're going some way to sort the problem out. And maybe you could also deliver the clean air Act that you like to talk an awful lot about.

We need to see this Government investing more money in electric charging points and providing more funding for the research and development of hydrogen power. The reality is that road taxes will prevent the poorest in our society from being able to travel and enjoy their lives in the way they currently do, and I am sure Labour Members do not want to do anything to harm the poorest in our society. I believe that the Welsh Government should be transparent and produce a paper showing us who those road tolls and taxes will hit the hardest. It'll be the poor working people of this country who you like to quote that you represent—[Interruption.] No, I'm not taking an intervention, you wouldn't take one earlier.

I call on the Deputy Minister for Climate Change, Lee Waters.

Diolch, Dirprwy Lywydd. Members are going to have to answer their grandchildren's questions one day as to what they did when the United Nations issued a red alert for the state of the planet, and based on their contributions this afternoon, all we've heard are attempts to look for wedge issues. That's what we've heard this afternoon. Time and again, trying to divide based on falsehoods. We heard Joel James open the debate saying there's considerable concern amongst motorists. That concern has come from Conservatives powering Facebook algorithms over the summer, getting themselves very excited based on false facts.

James Evans says there are calls from this Government to introduce road charging. He just said that. He produced no evidence for that at all. There are no calls from this Government to introduce road charging, as Joel James acknowledged in the First Minister's answer yesterday to Tom Giffard. He made it very clear what was behind the questionnaire that was circulated over the summer. It's the same evidence gathering the UK Government are doing that we're obliged to do by court order on looking at different options. This is an option we are obliged to look at as part of the evidence base we are gathering for the clean air Act. We made it very clear that this is not part of the policy toolkit we intend drawing upon. So, they know that and yet they persist in waving this flag to try and create divisions at a time when we are facing a climate and nature emergency.

These are serious times, they require serious politicians to give serious thought and serious responses, and the Conservative benches have shown yet again this afternoon they are not serious about this problem. And as Jenny Rathbone quoted, we've had Boris Johnson just this week saying that humanity needed to get serious about this situation, and the Welsh Conservatives have no interest in tackling the difficult choices ahead of us. And I think it is deeply disingenuous of them to come before this Chamber again and again, signing up to targets, urging us to go faster, urging us to be bolder, but when it comes down to the things you actually need to do to bring about change, they run for the hills every time, behind the same old cliches, and it is becoming tiresome, as Julie James and I are, every day, grappling with the complexities of the change we have to go through, listening to the advice of the Climate Change Committee the UK Government themselves have set up, which runs counter to what you have all been saying. So, the time is coming, I would suggest to Welsh Conservatives, when they've got to face up and grow up, otherwise they should shut up, because this is not constructive to the challenge we face as a Government in trying to address these difficult problems. [Interruption.] If Members think that's unparliamentary language, I could say a lot worse, frankly. [Laughter.]

The Member will not say worse. [Laughter.]

Now, there was a series of points made that I will try to address in turn. I was struck by Joel James's argument. He said he's in favour of a clean air Act but he's against disincentives, and his account of what cycling was like left me quite puzzled. We heard about people ending up in verges surrounded by dead animals and litter, which, I must say, has not been my experience of riding a bike, and that's fairly untypical, I would suggest. I did see that he was out with Sustrans over the summer, which I was encouraged to see, but I'm not sure if he actually got on the bike. But I would say in all seriousness, adult cycle training is a really important part of what we have to do, because lots of people have got perceptions of what it's like to ride short journeys that are not grounded in reality, and those false perceptions are real barriers to people taking up behaviour change. So, one of the things we are looking at through our record investment in active travel, the most per head in any part of the UK, is how we can enable adults to retrain, to ride a bike safely and comfortably, so that the myths that Joel James has been spouting can be put to bed.

It also became clear from Gareth Davies's remarkable contribution that his conception of a clean air Act, which they keep telling us they want to introduce, is that we should build more roads as a result. So, that is a very interesting set of proposals, because more roads produce more carbon and produce more nitrogen dioxide from the induced traffic they unleash. I'd be delighted to hear more.

The argument is about the vehicle itself. If we improve the quality of the vehicles from diesel and petrol to electric on an increased volume of roads, that's the point I'm getting at, rather than the existing roads with diesel cars.

I understand the argument, I also understand the evidence, and the evidence from the UK Climate Change Committee shows that is not the case, because if you are building more roads, you have embodied carbon in the roads themselves, which are considerable generators of emissions. The production of the extra cars that'll come from the extra road space in themselves generate carbon. And even if you had 100 per cent electric cars, which is many years off, you're still requiring extra energy to be generated to power them, on top of all the other negative benefits we have from car domination in our towns and cities, with the sprawl of out-of-town shopping threatening and throttling town centres being one, which I also hear them bemoaning. So, I'm afraid the argument just does not withstand the scrutiny of the facts.

But I don't think they're interested in the facts; they're interested in winding people up instead of confronting the hard choices that we, as a society, have to face to make progress against this societal existential challenge. And, again, I tell Members that in order to reach the climate change targets we've all signed up to, we need to make more cuts in the next 10 years to emissions than we managed over the whole of the last 30 years. I've not heard a single serious proposal from the Conservatives as to how they would do that, and I would ask them to go away and reflect, and make a constructive contribution to the challenges ahead of us.

Turning to some of the other contributions that deserve more serious responses, I couldn't have agreed more with Delyth Jewell that what we need to be doing is improving public transport before we start thinking about tolling. But as Jenny Rathbone rightly pointed out, it is the Conservative Government who have said that by the end of this decade, diesel and petrol cars will not be allowed by law to be sold, and that means the whole method of the tax base will need to be changed. If you do not have petrol cars, you cannot charge petrol tax; you therefore need to find another way of generating the £40 billion that Jenny Rathbone cited.

I really like to hear the ideas from the Conservative benches, because they really are an engine of innovative ideas this afternoon so far of how to generate that revenue. But charging people for the amount they drive is probably a sensible idea; it's certainly one their own Government's Treasury is looking at as we speak. But again, this isn't about a serious debate with a serious engagement of ideas; this is about clickbait and trying to put leaflets out amongst people who are concerned about the choices that we all have to face as a society. We do have serious plans for modal shift, for improving public transport, for giving people real and realistic alternatives along with a campaign of behaviour change, to give people the incentives and the information to try and encourage them into different behaviours.

I call on Russell George to reply to the debate.

Thank you, Presiding Officer. Can I thank Members who took part in this debate today? My colleague Joel James opened the debate today, calling on the Government in a number of areas, but first of all, Joel set out the positive impact of the removal of the Severn crossing tolls. I genuinely thought that this might be something that all Members would be agreed on, but that's not the case. I appreciate Jenny Rathbone's comments in her contribution today; I don't agree with much of what was said, but I appreciate the points that were made. I genuinely think that there is a positive impact from those Severn crossing tolls being removed.

Also, Joel James set out our concern as well about the proposals from Government in terms of the potential tolls on the M40, the A470, the A55, and other trunk roads. The Deputy Minister said that they're not proposals; it's a survey suggesting that this could take place. So, I think there is some difference of opinion on what is 'a proposal'.

Also, my colleague Joel James set out positive suggestions from us as Welsh Conservatives in terms of promoting greener transport, in terms of supporting the provision of electric charging points, which is something I'm passionate about myself. I think there is a role for Government here in terms of support for electric charging points across Wales, because we've got to break that chicken-and-egg cycle. Electric charging points aren't going to be built until we've got electric cars, and electric cars are not going to move forward at the pace we want to see unless we have those charging points in place. So, there's a role for Government to step in here until the commercial sector can take its part in that provision.

Also, the further promotion of active travel; I appreciate other Members who spoke well in this debate today, John Griffiths and others, talking about initiatives in their own areas, as they have before, previously. And the extension of free bus passes to those aged between 16 and 25, as well; I think there was some mention about the cost of that. I think it could have been Jenny that mentioned that. Well, it is costed, because that was a proposal in the Welsh Conservatives manifesto; that was something that was costed within that manifesto as well.

I thank Delyth Jewell for moving Plaid's amendment today, and also Heledd Fychan for talking to those points as well. I think, in terms of Plaid's amendment, there's general agreement from us on the points made in those contributions and in the amendment put forward. I think the only question we would have is there are some possible high potential costs in some of the areas that Plaid outlined in their amendment, so I think we as Conservatives want to know more about those costings before we could support. But there's a general principle of support, I think, for Plaid's amendments today.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there is objection. Therefore, I defer voting on the motion till voting time.

That brings us to voting time. We'll take a short break to make the preparations for voting. So, we'll take a break now.

That brings us to voting time. The first vote this afternoon is on the Member debate under Standing Order 11.21(iv) on dementia. I call for a vote on the motion tabled in the name of Luke Fletcher. Open the vote. Close the vote. In favour 40, 14 abstentions and none against, and therefore the motion is agreed.

The next vote is on the Welsh Conservatives debate on transport. I call for a vote on the motion tabled in the name of Darren Millar. Open the vote. Close the vote. In favour 14, no abstentions, 40 against, and therefore the motion is not agreed.

Our first amendment is amendment 1. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected. I call for a vote on amendment 1 tabled in the name of Lesley Griffiths. Open the vote. Close the vote. In favour 28, no abstentions, 26 against, and therefore the amendment is agreed.

Amendments 2, 3 and 4 have been deselected.

The next vote is on the motion as amended.

Open the vote. Close the vote. In favour 40, no abstentions and 14 against. Therefore, the motion as amended is agreed.

That concludes voting time, but we will now move to the short debate, so if any Members are leaving, please do so quietly and quickly.

Any Members leaving to do so quietly and quickly.

I call on Llyr Gruffydd to speak to the topic he has chosen. Llyr Gruffydd to begin, once the Chamber is quiet. Llyr Gruffydd.

Thank you very much, Llywydd. It's my pleasure to introduce this short debate this afternoon on the subject of the Holden report on mental health services in north Wales. I've agreed to give a minute of my time, first of all, to Rhun ap Iorwerth, and then Mark Isherwood, and then Darren Millar, and then Mabon ap Gwynfor.

Mental health services present one of the greatest challenges for our NHS, and sadly it is a growing challenge. That's why it's important that we learn lessons from previous experiences and that we're honest in acknowledging mistakes and failures when they occur. Mental health services in north Wales, of course, were identified as one reason why Betsi Cadwaladr health board needed to be taken into special measures, more than six years ago, by the then health Minister—now, of course, Wales's First Minister. That was a clear statement and an acknowledgement of previous failings and mistakes, and in that respect the move was to be applauded, even though, of course, it might have been inevitable, but it was certainly very disappointing. But what concerns me now is that, six years on, we're not seeing progress in this sector. Instead, I fear, we're seeing a culture of cover up and a refusal to accept responsibility at the very highest level of both Government and the health board. The focus of this debate is the failure to date to release the Holden report by the health board, and that, I feel, is symptomatic of a wider problem.

The report was compiled back in 2013, after dozens of health workers came forward to blow the whistle on poor practice at the Hergest mental health unit in Bangor. Their testimony amounted to 700 pages of damning evidence that mental health patients were not getting the treatment they needed and that they deserved. In addition, vulnerable elderly patients with mental health issues were being placed side by side with drug addicts and people with other severe needs, in a wholly inappropriate way. Staff were unable to complete Datix forms—the internal forms for reporting problems—because of time constraints, so the problems were being allowed to fester by senior management. It was a recipe for disaster, and of course that disaster ultimately involved patients taking their own lives because ligature risks that shouldn't have been there were there.

You would imagine that a report into this kind of problem would be able to identify solutions and responsibility. I'm hoping it did, but of course I can't be sure because the report has never seen the light of day. To this day, Betsi Cadwaladr health board is refusing, despite requests, and, more recently, demands from the Information Commissioner's Office to release the report. To my knowledge, not one manager has been directly disciplined, although last week it was revealed that two managers were moved. This failure to take accountability for any failings has been a symptom of this whole sorry affair. And instead of demanding managers take responsibility, what we've seen, of course, is that whistleblowers have been scapegoated. Crucially, the same risks that sparked the Holden report eight years ago have not been eliminated from the unit, and this has consequences—serious consequences.

Earlier this year, a woman from Caernarfon took her own life on the unit, and she was able to do so because the same ligature risks that were present a decade ago had not been eliminated, despite being identified in the Holden report. This would be an internal health board issue were it not for two things, and this is why it is important that this issue is raised in this debate in this Senedd this evening. Firstly, as I mentioned, mental health services in north Wales were already a subject of sufficient concern six years ago for that to be cited as one of the reasons for the Welsh Government to take the health board into special measures. So, the Government was aware that there were problems. More specifically, last year, the then Deputy Minister for mental health, the now Minister for health, who will be responding to this debate today, gave me assurances in this Chamber that she would read the report and give the matter her attention.

On 4 November last year, in this Chamber, Minister, in response to a question from me, you said that you hoped that I would give you some time to look at the report and understand more about the background. I quote you—your words were,

'I will look at the Holden report and see exactly what the situation is here.'

Those were your words on 4 November. Since that pledge, nearly a year ago now, we've had nothing further from the Minister and nothing further from the Welsh Government. But what we do know, of course, is that deaths are still happening on the mental health units in north Wales and that the number of serious incidents and patients coming to harm have increased year after year. Twenty-five cases in these last three years alone. Each one a scandal, each one a tragedy, and many of them, I'm sure, could have been avoided, while your Government is sitting on its hands on this issue.

So, you told us in the Chamber that you would read the report, and I've no reason to doubt whether that has happened, but now, Minister, this evening, you need to explain to us, firstly, why the Holden report has still not been made public; secondly, why the recommendations of the report have not been carried out; and, thirdly, you need to explain why people are still dying on mental health units in north Wales when those risks should have been eliminated.

This is a tragic, avoidable scandal. It's a scandal because nobody has been held to account for these failings. And these aren't the failings of overstretched front-line staff. These are the long-term failings of senior managers who have continued to be employed by the health board, some of whom have very senior roles in Betsi Cadwaladr. It was avoidable because staff, families and Holden had raised the alarm many, many years ago. And the tragedy is that no action was taken, or that not sufficient action, at least, has been taken to date, and that means that vulnerable people are still dying on mental health units in north Wales. And I use the plural, because, in the past year, we've seen deaths on Hergest and also on the Ablett unit in north Wales.

We've seen glacial progress in terms of getting the facts out into the open, and it's time this Government showed some leadership, and it's time you held your hands up to Holden. Let's have this report out in the open so that we can all see for ourselves what needed doing back then, and what needs doing now, so that we can start to deliver the mental health services that the people of north Wales deserve.

I thank Llyr for bringing this issue before us today and, indeed, for his work in this area over a period of years. Let me speak quite openly: the Betsi Cadwaladr health board is still facing very grave problems with its mental health services. The Hergest unit is still facing very serious questions around patient safety. And, yes, it was too soon to bring the board out of special measures. Despite the efforts of staff to blow the whistle in order to bring about improvements, despite campaigns from patients and families, we, once again, over the last few weeks, have been talking about loss of life in Hergest and about fundamental questions on the circumstances. Robin Holden listened to staff who wanted to voice their concerns, but I can't overemphasise the damage that's been done, and the doubts confirmed, as the board fails to publish the report and fails to be seen to be transparent.

We're talking about serious, deep-rooted issues affecting patient safety, resulting in tragic losses of life. We're also talking about impacts on hard-working front-line staff, desperately worried about the care they can offer due to problems with underinvestment and under-resourcing. Responsibility, finally, must be accepted and acted upon for the years of failings in mental health care in north Wales. The debate today focuses on how releasing the Robin Holden report is surely a vital step towards addressing the wider problems and getting to the root causes of these tragic problems once and for all.

Four years after I first raised concerns with the Welsh Government, the 2013 Holden report, commissioned after patient deaths and complaints by 42 staff, warned that the Hergest psychiatric unit at Ysbyty Gwynedd was in serious trouble. I understand that Betsi Cadwaladr University Health Board asked staff criticised in Holden for putting lives at risk to write the paper to the board. After Betsi Cadwaladr University Health Board refused to disclose the full report, the Information Commissioner's Office ruled that the health board should disclose a full copy with only the names of individuals subject to the grievances redacted. However, the North Wales Safeguarding Adults Board say that they can't take any action because of an absence of specific details and information.

We must not allow this to be dismissed as ancient history. As we heard, two patients in north Wales mental health units have died from hangings and attempted hanging over the last year alone. Families identify a categoric failure of the regulatory framework by all statutory bodies to react to Holden. The onus is now on the Welsh Government to ensure transparency and to show that it is not complicit in a cover-up.

I'm very disheartened to know that we have a Welsh Government here that has failed to intervene so far to ensure that the antiseptic of sunlight can be spread abroad on the particular report—the Holden report—that we're discussing. We know that there are deep-seated problems in our mental health services in north Wales, and I want to ask the Minister, along with the chorus of voices that have already spoken, and the further speakers to speak: how many more people have to die? How many more vulnerable people need to suffer harm unnecessarily? How many more families need to lose their loved ones before we will see the radical action that is necessary in order to resolve the fundamental problems that we still have in our mental health services in north Wales some six years after they were identified as failings sufficiently to the extent that the health board was put into special measures? It simply isn't good enough. And we look to you, as a new health Minister, to step up to the plate, to hold people who were responsible for these failings to account in order that we can get some justice for those families who've lost their loved ones and those patients who've been so tragically let down.

Thank you very much, Llyr, for bringing this debate before us today. I want to start my contribution by paying tribute to a constituent of mine in Dwyfor Meirionnydd, David Graves—the son of the late Jean Graves, who died in June 2016. David has been very determined in his campaign for a number of years in trying to ensure that this report is released fully. Jean was admitted to the Hergest unit because of her mental ill health. She had early onset dementia. Unfortunately, she also suffered in Hergest. Her care needs as an older woman with mental ill health were very different from those of other residents who were younger, some with drug problems. Unfortunately, it wasn't just Jean who suffered in Hergest, and the fact that there are ligature points still in units where patients are at risk of suicide show that the lessons have not been learned. And that comes as no surprise, because there has been a deliberate campaign to try to conceal the Holden report. Someone has to take responsibility for the terrible failures that emerged from Holden and, indeed, Ockenden. But, more than that, if we are to have confidence in our mental health services once again and learn the lessons fully, then we have to see that report being published in its entirety. Thank you.

I now call on the Minister for health to reply to the debate.

Diolch, Llywydd. Thanks for the opportunity to respond to this debate and to put on record my recognition of the commitment of the Betsi Cadwaladr health board to continue to improve mental health services.

Now, whilst both I and the Deputy Minister for Mental Health and Well-being are challenging the health board to increase the pace of change in relation to mental health services—and both of us have brought this up with the health board on several occasions—I do recognise the impact that this level of scrutiny over so many years will have on staff morale. At the outset, I want to say on record that I recognise the efforts of all the staff at the health board and appreciate the work that they do.

In 2013, Robin Holden was commissioned by Betsi Cadwaladr health board to undertake a review of the Hergest psychiatric unit following complaints by staff, and I am familiar with the content of the report, and I must say it does make uncomfortable reading. Now, the call for the publication of the full, unredacted version of the Holden report is a matter for the health board, and some will be aware that there is currently a live case with the Information Commissioner’s Office. It’s therefore not appropriate for me to comment on this particular aspect in the debate. What I can say is that I expect the health board to fulfil its statutory obligations to both the people of north Wales, in terms of openness and transparency, and also, importantly, to its staff, by protecting the anonymity of people who raise concerns. The health board must also, of course, ensure it meets its legal obligation around data protection.

It’s always important to note that, following the review, a summary report was published by the health board in 2015, which included the recommendations made by Robin Holden. The executive medical director and executive director of nursing and midwifery subsequently commissioned a piece of work to ensure that the Holden report’s recommendations have been implemented, and this work was submitted for executive scrutiny and was reported to the health board’s quality, safety and experience committee in January 2021. Now, this provided assurance that action was taken and remains in place against each of the recommendations of the report, and my focus now is on ensuring the health board continues to act on those recommendations.

Now, as we’re all aware, the Holden report was one of a number of independent reviews commissioned by the health board in response to concerns about the quality of mental health care in north Wales in recent years, and which led to its placement in special measures in 2016. Now, since that time, much has happened, and the health board made progress against the milestones set out in the special measures framework, particularly including improved governance and quality, and improvements in mental health services. However, I am clear that there is still a long way to go, and that’s why the health board remains in targeted intervention. We must remember that targeted intervention is a high level of intervention with ongoing scrutiny by Welsh Government that recognises that the health board remains on an improvement journey. A new chief executive has been appointed to steer the health board on its improvement journey, and it’s clear that there is much greater oversight and scrutiny of mental health services now at board level.

Thank you, Minister. That brings today's proceedings to a close.