Petitions Committee

We move on to new petitions, agenda item 2. We have item 2.1, which is P-06-1444, 'Women of North Wales have the right to have a Menopause Services/Clinic in Ysbyty Gwynedd'. I would like to lead on this one.

The main issues are that not everyone can afford to travel to Wrexham, where the main services are being provided; not everyone can afford to pay privately to go to a menopause clinic; not everyone has the time to travel all that way, or maybe, sometimes, they have caring responsibilities for children and family members; everyone should have the choice; and this should be on the doorstep, for example Ysbyty Gwynedd is in Bangor, so they would like to have more specialist services there, local to people in north Wales.

The petitioner herself lives in Ynys Môn in north Wales. Most of the services are based in Wrexham, and it can take an hour and a half to travel there, which is a long way to go if you do have those caring responsibilities. The petitioner also goes on to say that we need more specialist services local to people living across north Wales, including regular updates for GPs, gynaecologists, practitioners and employers supporting them on menopause and the benefits of hormone replacement therapy.

I think education is really important, not just for employers, but also for women who are actually going through menopause, as well, to ensure that they understand what is available to them. Women often struggle to stay in employment, along with sometimes having these caring responsibilities, so they leave work as they cannot cope with some of the symptoms.

The Welsh Government acknowledges that improvements are needed to menopause care and support and the consistency of services across Wales. They are working on an NHS 10-year women's health plan, which is under development. I understand that this is due to be published in December 2024. Betsi Cadwaladr University Health Board says that the majority of women access advice on menopause-related symptoms through primary care services—so, most often, they're through primary care services—and that all gynaecology specialists across north Wales hospital sites also see women with menopause-related symptoms in general clinics.

I was reading the response from Eluned Morgan to the previous Chair of the committee, Jack Sargeant, dated 3 July, relating to specialist menopause clinics, which are run by the three menopause specialists, but these clinics are based at Deeside and Wrexham Maelor Hospital. She goes on to say that a mix of face-to-face and virtual slots are available, based on patient choice, and that this is in addition to e-advice for women via their GP practices, and that the health board is reviewing job plans to enable specialists to increase capacity to respond to demand, and are also exploring pilot virtual sessions with GPs to help provide specialist advice for women closer to home without the need for referral into secondary care

The petitioner notes the Government response is very similar to one sent from Ysbyty Gwynedd to Rhun ap Iorwerth in February and says it’s unacceptable. She says services should be delivered to women in their community and questions whether the health board has surveyed women using the service to assess the quality of their experience and whether they actually feel listened to. The petitioner welcomes the review of job plans, but questions how long this will take. She hopes that any review means that jobs will be based in Ysbyty Gwynedd in Bangor. She also questions how the duty to provide these services in Welsh will be met. Many women there use Welsh as their first language, in north-west Wales, so that’s really important.

There are also a range of petitions relating to women’s health, which is an ongoing scrutiny subject for the health committee. We very often debate women’s health issues in the Senedd, and on Wednesday we have a debate taking place, scheduled for 3.25 p.m. approximately, on women’s healthcare. I note that one of the calls to the Welsh Government is to establish a legal requirement for healthcare providers to regularly collect feedback from female patients about their experiences and satisfaction with the care they receive, especially in relation to gynaecological appointments, midwifery and postnatal services, perinatal mental health and menopause. I think that’s a really good recommendation that picks up here what Delyth, the petitioner, is asking.

Sorry, it was remiss of me, I didn’t mention before that Delyth is the petitioner, and this petition has 1,347 signatures. I’ll be taking part in the health debate on Wednesday, and I will be mentioning this petition then. As the petitioner says, women don’t often complain about health, it’s often expected that women live with issues that they have to go through in their life, from periods to childbirth to menopause. So, she raises a really good point here, you know, that we need more education, more awareness. And I do believe that the First Minister mentioned that women’s healthcare will be a priority in the last 18 months of the Senedd.

So, possible actions going forward: we could write to the Cabinet Secretary for Health and Social Care for more information about the timescales for the review of menopause service provision in north Wales, and more specific information on current and planned provision in Ysbyty Gwynedd, rather than Wrexham—I think as well as Wrexham would be good—including how much provision is available through the medium of Welsh, which is really important for women in that area. Would anybody else like to come in on this subject? Vaughan Gething.

Thank you, Chair. It seems to me that the questions that are being suggested are really operational matters for the health board. Because what will happen is, if we write to the Cabinet Secretary, the Cabinet Secretary will ask the health board what they’re doing. We might as well write directly to the health board, who are responsible for operational matters. They don’t need the permission of the health Secretary to do any of the work that’s been asked for.

I think as well as the clarity in the ask, what isn’t clear to me are the specialist cases where you need secondary care provision, that is currently in north-east Wales, how many of those cases are there, what’s the current demand, what’s the expected demand, and how they expect to meet them. Because as the moment, it’s really general. Most cases of menopause support and care will be provided from primary care, but I don’t know the specialist parts. It would be useful to know that, because that will affect the plans that they’re undertaking.

The second part of the point is around the quality of experience. I’m not sold on whether we need a legal duty, but I’d be interested in what currently takes place. Because every health board has a patient experience form of literature and questionnaires. I don’t know how much is provided in north Wales, what sort of feedback they get in terms of the numbers, or indeed the feedback about the quality. So, I think there would again be a question for the health board to answer about what they currently do, and what they expect to do, based on the feedback they've already got. Because they must have feedback from women about the provision that's there, and if the feedback is literally two or three people, then they might want to ask themselves about why they don't get more feedback.

And the final thing is, on the Welsh language provision, there's a real operational issue here as well in how do you provide provision, so that people are comfortable in talking about their experience, and then how do you make sure you have the staff required. Because the responses note there are three consultants, and they could all be Welsh, or none of them could be Welsh. So, there is an issue about having the staff who can provide the care, and have the ability to provide the care, and the specialism, but then also the ability to communicate. And that may not always be the consultant, actually. In lots of provision around this it won't just be the doctors.

So, I think, in each of those, I think there are questions, really, for the health board, and for the health board to respond to, because these are really operational matters for them to deal with what is an obvious need. And it's not as if women are going to stop having the menopause. So, this is an ongoing service provision issue.

Okay. Thank you, and thank you for your wealth of experience that you're bringing to this committee. [Laughter.] Peter.

Thank you. And welcome to you in your position as Chair. It's with some trepidation I try to even talk to any of this, especially with a past Cabinet Secretary, and obviously not being a woman to experience these things. However, my wife is in a situation where she does access and needs access to this sort of advice—advice on HRT and things like that—because for quality of life, access to the appropriate treatment at the right time is fundamental to her well-being, and that of many thousands of women across Wales.

So, whilst this is focused very much on its specific health board, I think it raises a general point: how are we consistently delivering services across all health boards to meet the needs of the people who need access? So, whilst it's a very specific question in itself, and I think Vaughan is right in getting clarity from the health board, I think it raises that desire to inquire how we are raising that profile across all health boards. Because I wouldn't know; I wouldn't know what it's other like in other health boards, and that we've got to wait for a petition for each case, before we stimulate a bigger discussion. So, I thank the petitioner for bringing it forward and raising the issues, which I absolutely recognise, as just a husband, and wish you well. I think there is merit in all of those actions there, possibly with the additional action of directly going to the health board.

Thank you.

Sorry, Chair—

Yes, Vaughan, you'd like to come back.

Thank you. Sorry. Just on the point that's been raised about the wider issue across Wales, our papers say that women's health is a regular scrutiny subject for the health committee, and there's a women's health panel that's coming up. Does it make sense for us to want to go further into that, or to actually want to see what the Health and Social Care Committee are doing, and point out we have a petition on north Wales, but we know there'll be an issue in every health board area? Because I'd expect that they're covering it, and I'd expect that this will feature in the longer term women's health plan. There's not a problem with us asking those, but, again, we don't want parallel inquiries into ones that I would be very surprised if they're not already ongoing. And if they haven't thought of it, I'd expect they'd fairly rapidly correct themselves, and that's part of the point about having a petition, and then making sure that other committees are doing—

So, a letter to the Chair of the health committee as well on this issue—

Yes, to point out that this is where we are, but—. And it might help us to go back to the petitioner to say that the health committee is undertaking this as part of its own scrutiny for the whole of Wales.

Okay. Well, from my personal experience, and that of my friends as well, I think that women often don't make time to have health checks, or think about them, because they lead busy lives, and there is that expectation that it's normal—it's normal to feel not right because every woman has to face it, I guess. I would like women to be invited to have a health check, maybe once a year, and to go through these things, so you can understand what's on offer, as part of an education programme even. Because I personally avoid going to the doctors whenever possible and put up with things, so I just think that education side of it is really important, not just for employers, but also for women, to know what is available to make their lives better and easier, maybe.

So, we have a few suggestions here, then. So, if we just quickly go through them and see what’s agreeable. So, to write directly to the health board to see what provision is already available and ask—. We need to know when they're looking at providing more quality of service, particularly in north-west Wales.

I mean, how they expect to do that. How much do they need to do face-to-face, in person, and how much they might be able to do remotely? But I think we need to understand what their plan is, and how they've taken into account women's voices within that as well. That's what I think the point is around the quality of the experience matters.

Yes, because remote has been mentioned, but sometimes you need to that have that one-to-one, so when are they looking to do that, and have that in place, that one-to-one? Which is why I think an idea of actually having an in-person health check would be so useful as well. Welsh-medium provision was really important. And consistent delivery of services across all boards has been raised by Peter. And then writing to the Chair of the health committee to see where they're up to with this subject as well. And could I just thank Delyth as well for bringing this to our attention and submitting the petition? Did that capture everything? Are we okay? Thank you, everyone.

So, if we move now on to 2.2, petition P-06-1435, 'We’re calling on the Welsh Government to commit to implementing targeted lung cancer screening'. So, the summary is:

'Lung cancer claims 1,800 lives each year, more than any other cancer in Wales. This must change. We can do things to reduce this impact. One of these is targeted lung cancer screening, which would invite people aged 55-74 to be screened if they have a high-risk of lung cancer. This screening can catch lung cancer at an earlier stage: and can save lives from lung cancer'

developing, or becoming worse. And

'By taking 2 minutes to sign, you can aid calls for the Welsh Government to commit to implementing this screening in Wales.'

That was the final point there. Luke, would you like to take this?

Diolch, Cadeirydd. In terms of lung cancer itself, it's the leading cancer in terms of cancer-related deaths, so it’s quite an important petition to consider. We know that Welsh Government actually is already doing a lot of work around this and you have the lung cancer screening programme in Wales. I think that's something we can all welcome. From my perspective, one thing that I'm both interested and alarmed at is that those who are living in deprived areas are more likely to develop lung cancer, and of course those people as well who are living in areas where there's high traffic or even where there's heavy industry in operation. So, it's something we really do need to get on top of.

Can I suggest that we first write to Cwm Taf health board around the lung cancer screening pilot that they have ongoing at the moment and get an update on that pilot? And as well, then, write to the Cabinet Secretary to ascertain and work out how quickly they would be looking to roll out such a screening programme, if the pilot proves to be successful, across other health boards, as well as what has been done in the meantime or in the short term to try and resolve some of these issues—like, for example, we know that encouraging people to stop smoking plays a big part, but also stuff around air pollution as well is a big contributing factor to whether someone develops lung cancer.

Thank you, Luke. We had a cross-party group on air pollution earlier on today in the Senedd, didn't we? Thank you for those suggestions. Would anybody else like to comment on this? Vaughan.

On timing, I think we should seek an update on the outcomes of both the pilot and the subsequent work in 12 months. The correspondence plainly says that the pilot that is being conducted is due to conclude in autumn 2025, and there's not much point in writing in six months' time because we'll just get told that in another six months or so we'll have an answer, but to be clear that we'll take an interest. And again, I'd be very surprised if the Health and Social Care Committee isn't taking an interest, as it's a big issue in terms of screening issues and what you do in the preventative space as well. And I think Cwm Taf has been deliberately chosen because of relative mortality rates. But I think it's a fair point that Luke raises about asking them what they're doing in the evaluation, and if there are learning points they've already got; I think that would be helpful too. And there'll be a big coalition of interest, because I note that the petitioner is a constituent, although they are writing in their role as a professional advocate, working for Cancer Research UK. So, I'd have thought that that time frame makes more sense than six months, because I think it won't be a very useful piece of correspondence otherwise.

Okay, thank you. Sorry, I didn't name the petitioner: Simon—.

Scheeres.

Scheeres. Simon Scheeres. Thank you, Vaughan. And he collected 5,339 signatures for this. So, I'd like to thank him for submitting this petition, a really important petition. So, actions going forward: to write to the health board regarding the pilot. We needed some targets there as well of what they plan to do, basically, going forward. And, again, writing to the Chair of that committee to keep them informed as well of this issue, and raise it with them.

Sorry. Pardon me, Chair. Can we check when the pilot concludes and when the evaluation concludes?

Okay.

Because after the pilot, there'll be an evaluation that will take the learning points and what needs to happen, and that would give us a better idea about how quickly you'd need to roll out and what the issues are. So, is it about the redesign of the service? How much value will there be in trying to integrate smoking cessation with the pilot in Cwm Taf? And then, if you need new staff or you need your staff to work in a different way, how do you go about doing that? Because you can guarantee those staff aren't sat back in the office scratching their backside waiting for something to do. So, if you're moving staff around, how do you do that in a way that adds to value? But the pilot concluding will tell us one thing, and in the correspondence to Cwm Taf it might be useful to ask if they'll have an interim evaluation, because there are lessons you'll learn as you go along. And that might be useful for us, but we need to know when the pilot concludes and then when the evaluation will be available. Otherwise, you're likely to get a letter from the Cabinet Secretary saying, 'The pilot has concluded and now it'll take three months, or however long, to do the evaluation', so ask now when we can expect that. [Interruption.]

Thank you both again.

I have a constituency as well. [Laughter.]

Thank you once again to Vaughan Gething for your lived experience. [Laughter.] But no, you're right, we need to have targeted deadlines, don't we, to measure this. So, dates of when the trial will be finishing and the deadline of when the evaluation will happen, and what they're going to basically do with it, I think. Okay, agreed. Thank you very much. Thank you, Vaughan, and thank you, Luke, for leading on that.

So item 2.3, petition P-06-1450, 'Welsh Government to take action to protect people from airborne infections in health care settings'. So, this has been submitted by Anna-Louise Marsh-Rees, and there are 330 signatures. So, this calls for:

'Improve air quality in health & social care settings through addressing ventilation, air filtration and sterilisation;

'Reintroduce routine mask-wearing in those settings (as per WHO recommendation 20 Dec 2023), particularly respiratory masks;

'Reintroduce routine Covid testing—it is asymptomatic;

'Ensure staff manuals fully cover preventing airborne infection;

'Provide public health information on the use of respiratory masks & HEPA air filtration against airborne infections.'

So, could I ask Rhys if he'd like to just take us through this a bit more?

Thank you, Cadeirydd, and llongyfarchiadau on your election. I look forward to working under your chairmanship. You've read out the five key elements of this petition. The former Cabinet Secretary for health has provided detailed responses to each point. The petitioner has met with Welsh Government officials. The petitioner has raised some further issues, which I think are probably worth raising—that's the whole point of the committee, to raise concerns by petitioners. So, two suggestions, perhaps: that we respond to the new Cabinet Secretary for health with the additional matters raised by the petitioner's response to the former Cabinet Secretary, and also write to the Senedd COVID committee, to see whether this falls under their consideration, under their work. So, those are my suggestions, Chair.

Thank you, Rhys. Vaughan.

I don't know if it's a disqualifying interest, but I think it would be sensible if I don't take part in trying to guide the committee either way, because I will continue to give evidence to a variety of modules of the UK COVID inquiry, and I think it is inevitable that, if the Senedd COVID special purpose committee wishes to examine matters, I'll be giving evidence to that. So, just to put that on the record, and make clear that I won't seek to sway the committee either way in terms of the potential action.

Okay. Thank you. We've made a note of that, Vaughan. Thank you for that. Peter.

Thank you. It's clearly a very important petition. I'd like to put on the record my thanks to Anna-Louise Marsh-Rees for the work she constantly does in this regard and on behalf of the COVID-19 bereaved families. They clearly have many concerns, which many other people probably share. That's not to say—. I'm no health specialist at all, or would not be able to—. I don't know what the science says around all of these elements, but very clearly there are still clear concerns for many people, especially those who have been affected so profoundly. So, I think I agree with Rhys, that there are still some options we could do. So, I think the options that Rhys suggested I would be supportive of, certainly before we consider that there's no more we can do here.

Okay. I would like to mention the petitioner and all the work that she has done on behalf of the COVID-19 bereaved families. She's also written to the then health Secretary, also wrote an article on it, and the fact that she keeps raising the issue. So, action going forward: we can write to the Cabinet Secretary for Health and Social Care, the new Cabinet Secretary, to seek a response to the petitioner's further queries and for an update on the NHS Wales trials of the effectiveness of the HEPA air filtration, copying in the co-Chairs of the Senedd COVID-19 special purpose committee for information as well, and we could keep the petition open, pending a response from them. Are we agreed on that, going forward? Okay. We need to also share the Cabinet Secretary's response and the petitioner's comments with the co-Chairs, to keep them informed of all the information that we have as well, and ask that the matters be considered as part of its work plan, following up on any gaps in the work, possibly, that they have. This might help fill in those gaps. Okay. Does committee accept that? Okay, that's great. Thank you very much.

So, if we move on to 2.4, P-06-1458, 'Stop the Welsh Government from using Phil Jones Associates (PJA) to review the 20 mph scheme'.

'PJA were instrumental in advising on the 20mph scheme. They have been long time supporters of the Active Travel / cycling lobby. I believe that asking PJA to review the hugely unpopular scheme is a clear conflict of interest—they cannot provide an unbiased opinion of the negative effects that this is having on motorists and be sympathetic to the huge body of public objection—evidenced by the 467k+ signature petition opposing 20mph. An independent body must review this.'

The petition was submitted by Carl Jones, and there are 724 signatures captured in the petition. Peter, would you like to come in on this?

Thank you, Chair. Yes, as you said, 724 signatures submitted, and the petition closed in the middle of July. Initial views were sought from the Welsh Government, and we know we have those. The petitioner has not put any further comments forward with regard to the ministerial advice.

So, the crux of the issue was, as you read out, that there is a concern that Phil Jones Associates may not be independent enough when reviewing any guidance. We know, following the outcry about 20 mph, that, at that time, the Deputy Minister for Climate Change, Lee Waters, did announce a new review of guidance on 20 mph limits. And as part of that review, Phil Jones Associates, together with a professor of transport for sustainability and development from University College London were engaged to take some of that work forward. We know that the current Cabinet Secretary for transport, Ken Skates, has launched, as he calls it, a listening exercise through the summer, and we're pleased that he has done that and listened to a lot of people. It's been made very clear, from the Cabinet Secretary, that Phil Jones Associates submitted a report in May 2024 and have had no further involvement in reviewing the implementation of the 20 mph speed limits in Wales. The letter outlines the wider and ongoing process of reviewing the implementation of the policy at a local level.

So, I think it's fair to say that things have overtaken events, and that, actually, we are where we are—the guidance has come forward, and now it's about working with local authorities to do the best we can, to right some of those things that people feel weren't right. So, I don't believe there is much else that we can do but to thank the petitioner and close this petition.

Thank you, Peter.

Can I just say, after the papers went out, we did receive a response from the petitioner, who said more or less the same thing, that we've been overtaken by events and—?

He felt the same. Right. Thank you, Gareth.

I believe that, going forward, the County Surveyors Society are involved, working with local authorities, the Welsh Local Government Association, on the new guidance. And I really welcome that there is good partnership working now, going forward, working with local authorities, who are the highway authorities, and we need to make sure, whenever any new legislation is created, that it's in partnership with the delivery bodies, so—

Three cheers for Ken Skates. [Laughter.]

So, again, I'd like to thank the petitioner, but I agree, now we can close this petition. Is everybody else in agreement with me and with Peter? Thank you. Okay.

So, now we move on to agenda item 3: updates to previous petitions. Item 3.1, P-06-1350, 'Re-open Dyfi Ward at Tywyn Hospital now', which is in Dwyfor Meirionnydd in north Wales. This was submitted by Jane Eleanor Seddon Barraclough, and there were a total of 5,528 signatures.

So, this goes back to June 2023. On 11 September 2023, the petition was considered for the first time. So, lots of correspondence but not a lot happening. Luke, could I bring you in on this—your experience of this?

Diolch, Cadeirydd. This has come to committee about five times now, from what I gather. I wouldn't mind a bit of a steer or some thoughts from other Members on where we take this, because, obviously, we keep writing to the relevant people, we get the same answers back, the assurances that they want to do this, that they want to move things forward, but then we're still 18 months down the line and nothing's happened. One thing that comes to mind, obviously, is that we contact local Members, because I think the pressure needs to be put on in the Chamber, perhaps, but I have no doubt that local Members are already aware of that.

In terms of what we can do as a committee, though, we could, of course, write again—I know, for the umpteenth time now—but I think we need to go a bit beyond just writing letters at this point, so I would appreciate some steer from fellow committee members, and maybe I'm unfairly looking to one in particular.

With experience in this matter. [Laughter.] It's very useful having—.

[Inaudible.]—leader of a party and knows how difficult—[Inaudible.]

I think that's a prime example of advocating—. I think there's something clearly wrong here. There's something clearly wrong on a communication level, if nothing else, and a respect level for what we are asking and not receiving appropriate responses. So, just on those points alone, I don't think we should leave this at all. I think we need to write again and challenge them as to why they don't feel it's appropriate to respond.

I think I spoke to this on the fourth time, and I think we agreed that we would write a final letter, and we really thought that that would be it, but it's been the same position months afterwards.

The question for me is how we, as a committee, spend our time in the right way. We can of course write again, but if we're going to get the same answer back, well, we don't want to waste committee time nor the petitioner's time, we want to try to—

I think this is cue Vaughan Gething.

Vaughan Gething.

But there's a question here not just about our time, but also about the answers that are being provided. The health board say they want to recruit staff, and they had some staff who have then moved on. So, actually, this is about recruitment and retention and the model of care, and if you can't recruit staff to go into that model of care, then it doesn't matter how many letters we write—if the staff won't stay to provide the service, you don't have a service, or, even worse, you have an unsafe service that people think they should be able to rely on and it doesn't provide the outcomes of care that any of us would want for our families, let alone our constituents.

There is something about not just—. I've read the letters from the chief exec, Carol Shillabeer, and the previous chief exec of Powys—used to providing different and changing models of care to a rural community and understands the difficulty and the challenge in how you get people to buy into that, both locally, the population, and staff as well. What I haven't really seen is an explanation of not just, 'Here's what we've done to try to recruit staff', but what they think the challenges are in getting staff and whether they actually need to change the model of care or actually whether the health board want to say upfront, 'We don't think we can provide that service there. We'd ideally like to, but given the current state of recruitment and retention, we can't do that.'

And the challenge always is if we say, 'Just put more money at it', well, that money will need to come from somewhere else, and then Members in different parties will stand up in the Chamber and say, 'Why oh why is this health board spending lots of money?' And actually, you often end up spending money because you're providing a model of care that actually costs more than you'd want it to. And it's not straightforward. The easiest thing is for us to say, 'Just make it happen', but that won't necessarily change anything. So, I think there's a question around, 'What is the current model? Is it simply about needing more staff to go and work there if you think the model of care itself is fundamentally the right one, or is this actually something where this type of care isn't going to be made available in the same way?'

And, look, it's the easiest thing in the world to demand a bigger, bolder and brighter recruitment campaign, but if the staff don't want to go there, it doesn't matter. We recruit lots of nurses internationally and we train lots of nurses; our rates of not just getting people into nurse training but keeping them there compared to England in particular is much better. And the reason I say England in particular is that that's where most of the cross-border flow goes. There's no point pretending that actually we could go and grab nurses from Scotland—that's not a helpful comparator—and because the English system is actually looking for more staff itself, you don't have stability across the England and Wales part of it, and that means that we catch a cold as well. So, there is something there about what we're trying to do and deliver, the test we're asking the health board to meet, and whether actually it's one that they can realistically meet or not. It's not very comfortable, but it's a much more honest way of dealing with it.

I think that's hitting it on the head there, and it's about honesty and clarity. What upsets people, because they don't see a light at the end of the tunnel, is they don't know what milestones that need to be reached, so what the barriers are in the way of getting where they are. People, generally, are very reasonable if they understand the facts. They recognise things might not happen overnight, but need to know what journey the health board's on to get to where it needs to be. And I think that's half of the trouble. People get so frustrated about things. There's no clarity. And I think that applies to health boards, it applies to Government, it applies to local government. We just expect people to believe us, and sometimes we need to lay it out and explain, 'Well, actually—.' I remember my own chief executive telling me one day, when we were talking about social care and the unmet need in Monmouthshire of 2,000 hours a week. He said, 'Peter, you could give me £30 million tomorrow and I couldn't solve the problem, because I can't get the staff.' So, that was really easy to comprehend.

I think Peter's point is important there, and it follows on from Vaughan’s point. The health board is not in a unique position. Attraction and retention is an issue across the board in many other professions too. You speak to legal firms these days, and there's a huge issue with attracting and then training, and then, after training, retaining staff. So, I agree with Vaughan's comment about the honesty and just the rationale behind it would make things much easier for people and, following Peter's point, much more palatable for the petitioner and others.

The other part is how the service used to be provided here and where it's currently being provided and how. Because it's not as if people who currently go there are being left at the door or in tents. So, the service that used to be provided on this ward, where and how is that being reallocated, and what is the stability and the quality of that care that is being provided, and is there a long-term plan that is realistic to recruit staff into this model of care and to keep them there on a longer term basis?

Okay. But it appears to me there seems to be a desire to keep this still going here, where they've tried to recruit, struggled to retain. I was on another committee where I think Audit Wales did a review of Betsi, and there were discussions about the survey of staff, and they said they thought they had a good response from staff, but, actually, the response rate was really quite low. So, it's expanding this a bit further, but it's really important regarding retention. When I talk to people in that area, they say, 'We need to have more jobs in the area.' When we talk about jobs, they expect we need industry to employ people, and businesses, but health, the public services—it goes back to that these are jobs, these are jobs in the local community that you need to have investment in.

We've got the new medical school that's been built in Bangor, but that's looking at GPs, isn't it? But we do have Bangor, who recruit allied health professionals and nurses, so it would be interesting to see how many places there are there and how they're getting on with recruitment and retaining and training there, and if more could be done regarding offering more places. That's something we could ask the health board. And then we have these new safe levels of staffing now, don't we, that have been introduced as well, which is important, but, when you're struggling to recruit as well, it's—

Sorry, Chair. All those things rely on being able to recruit and retain the right numbers of staff and the mix of training your own staff. That's not just in nurse, therapist and doctor training, and it's a really good thing there's been the first intake this autumn in Bangor for the new medical school, but you're still going to need to recruit nationally and internationally, and that takes money, and you’ve got to have a way and a service that people find attractive to want to buy into, and also somewhere they want to live as well. And, actually, there are lots of people who just won’t want to live in this part of Wales. That’s because they’d rather be in a city. There are other people, though, who would positively want to live in a part of Wales like this, because they want what you can get from that life. And so there is something there about the job and the model of care, but it’s also about all the rest of it as well. So, the provision that used to exist, where and how is that being provided? What’s the feedback from people who are now receiving that care somewhere else? And then, if the health board want to do this, is it their thinking that there is a sustainable model of care, and they just basically need to keep going until they get the staff, or do they think that, actually, this model of care needs to change to be sustainable?

I think we have spent a lot of time in Wales running campaigns around healthcare that are almost about a sense of loss for a place if a service doesn’t exist, whereas, actually, if the quality of care being provided isn’t the sort of quality that we would want to receive ourselves, why are we fighting for poor care that is local? And you’ve then got all the tension of how far you need to travel for really good care that’s sustainable as well.

But it’s an honest engagement with the challenges we have, and I can’t see in the health board’s correspondence whether they’re saying it’s just about recruitment, or whether it’s more than that, and I think that that would be helpful to know.

Part of the response is—. You’re asking where are they providing an alternative. It says here that the health board has increased work in the community, enabling patients to be cared for at home where possible, but, for a small number of patients needing more intensive care, additional beds at Dolgellau have been made available.

Sorry, the reason I ask my point, Chair, sorry, is that—. And when I read that part, I know the petitioner came back and said, ‘We don’t agree that these are small numbers.' Well, how large are the numbers? How many people a year still require in-patient care that would have otherwise have gone to Tywyn, and how many people are getting their care in a community-based model of care? And the reason I think it’s important to understand that is, if you’re seeing more of the people who had previously been in a hospital bed in Tywyn three years ago—well, let’s take it five years ago, pre-pandemic—well, how many of those people are now having their needs met in a different way? Because, most people, when they get community-based care, are much happier with it. But, actually, the numbers of in-patients that are still required, what are those numbers? Are they adequately provided for? Are we talking about 10 people a month or 100 people a month? The difference between the two is quite important. And we don’t get that from the correspondence. That’s why I think asking about the model of care is important. But it could be that the community-based care deals with 10 per cent of the previous need, or it could be that it deals with 70 per cent, and that changes everything about what’s then sustainable.

And, again, I think, Peter’s point, if you were to say to the public, 'It's not just what we're doing, but we're going to do more of this’, but if you’re saying a large percentage of people who had previously gone there now receive their care in the community, and that almost always leads to better outcomes as well, actually—.

Well, I feel like, because we’re a petitions committee—. We’re discussing the merits of trying to deliver a health service as well, but I want to—. So, this has been submitted by somebody who feels the need to have Tywyn opened again, working again. It seems that there is a desire there. So, we need to respond to the petition in particular, and to get some targeted, real responses back from the health board for her to have the reality of do they really intend, going forward, to reopen it, what are they doing regarding retention—they had two nurses working there, retention was difficult—so, how have they dealt with that retention of staff, how are they working with their staff, going forward, and just regarding what courses, available locally for nurses, are being offered at Bangor as well, or, generally, locally.

This is just a suggestion, and it might be rubbish, so, if it is, just say. But, when we are writing to whomever on this particular point now, is it not worth seeing if the Chair of the health committee will also sign that letter, so it's a joint letter, to give it a bit more weight and give it a bit more prominence as well, in terms of that this isn't just something now that we're dealing with, but the health committee is beginning to take an interest as well? I don't know if that will have an effect, but you know, it's—.

Yes, we could ask. Recruitment and retention in rural areas, especially north Wales, is such a big issue. Many people will, like has been mentioned, work in Cardiff, Swansea, big city centres, and transport is more of an issue, isn't it, in rural areas as well. We've discussed it many times, haven't we, recruitment and retention in rural north Wales.

This is such a specific issue, the health committee may not want to get involved. They may be more interested in the more strategic point around recruiting and retaining the right numbers of staff in the health service and all the different factors that go into it, including its relationship with social care and how community-based models work. But that's a much bigger topic, isn't it? This is, on a micro level, what is happening here.

Actually in that space, yes. Okay, is there anything else? Are you okay, going forward? You've got enough there to work on. So, again, I'd just like to thank the petitioner and we'll follow up those actions.

So, item 3.2, P-06-1409, 'Cease all further planning for road charging in Wales'. This is from Daniel Healey-Benson; 10,183 signatures—a lot of signatures there. There was a lot of publicity, at one time, wasn't there, about possible charging for roads. I think that was probably what increased the numbers for this petition. I don't know what was actually factual, or whether it was just publicity in the press. I don't know. Peter, would you like to come in on this?

Yes. Thank you, yes. We received this on 10 June, and that was when it was considered for the first time. We looked to get some clarity from the Cabinet Secretary for transport. Now, I think this one probably came up at a time when, on the back of 20 mph and everything else, there seemed to be this anti-motorist feeling that people were perceiving across Wales, and that was probably some of the reason in driving this, plus the fact that we know that at the time Cardiff were considering this as a way forward; we know that there are many people who believe that this is a tool that can be used to move us away from private cars and try to encourage and reduce pollution and things like that, and I'm sure some people don't like that idea. We know that there are about—. Well, there are seven clean air zones in England, and we know there are four low-emission zones in Scotland. However, we know that, in Wales, the WLGA were consulted, following our last meeting, to find out what the general view was, because the Government here, or we, the Senedd, are looking to put in place opportunities for local authorities to consider this, if they wanted to.

However, as I said earlier, there is only Cardiff who currently are considering something. We know that the leader of Newport came out only in the press a couple of days ago saying that he wasn't considering anything in Newport. However, the leader of the WLGA, Andrew Morgan, is very clear that whilst there may not be authorities other than Cardiff looking at this seriously at the moment, that's not to say in the future there won't be more authorities considering this.

Now, the petitioner is concerned that there is still work going on and that the Government is almost abdicating responsibility to local authorities to make these difficult decisions, but we are where we are, and I don't see that there is anything else we can do about this at the moment, and there is a split set of different views on this at the moment. We only have, like I say, Cardiff considering implementing these sorts of things, and we're not seeing it anywhere else. Julie James, in the Stage 4 debate on the Environment (Air Quality and Soundscapes) (Wales) Bill, made it very clear that these sorts of things would be used only as—what did she say—a last resort to tackle localised air quality issues. So, there doesn't seem to be an immediate appetite by the Government to say that these should be put in place. However, the petitioner is more sceptical. However, I don't believe there's more we can do.

Thank you for that summary, Peter. I tend to agree with you as well. Ken Skates has said that he has no plans to introduce road charging and, as you said, the WLGA has confirmed that only Cardiff, possibly, are looking at road charging. So, the petitioner could write to Cardiff Council, but otherwise I think that there's nothing, really, more for us here to work on.

Maybe, if there is suddenly a whole pile of local authorities deciding to do this and a new petitioner comes forward, it will open up a wider debate.

Yes, okay. So, are Members in agreement? Yes. Okay. Vaughan.

I don't agree with all of these characterisations, but I don't think there's any point—. And it's worth pointing out, I think—I'm a Cardiff Member—that, actually, I think Cardiff Council have been upfront that road-user charging would come after they have made improvements to public transport around the city as well. And that's part of the bargain, I think. If you were going to do this, you would need to demonstrate that there are alternatives. And I think it's also worth noting what was contained in the WLGA letter, that, as more of us move to low-emission or zero-tailpipe-emission vehicles—and that will happen, and you can see lots of buses in different parts of Wales, as Newport, Cardiff and others have got zero-emission buses, as well as individual vehicles—the emissions dialogue will shift and change. So, there are different points then around what scheme would be appropriate. And I personally think that it is appropriate for local authorities to make choices. I don't think it's the Government passing the buck. I think it's for local authorities, with responsibility for what the highways network looks like, to make an appropriate choice. There is only a handful of local authorities in Wales that are likely to have the scale and the volume for this to be a real option, and I don't think the Government should require people to introduce road-user charging or actively prevent them.

Thank you. Okay. So, we're going to close that petition and move on. Thank you.

So, 3.3, P-06-1428, 'Stop the flooding in Caenant Terrace, Skewen NOW!' This was submitted by Susan Martin Kerslake, and 776 signatures were collected. Okay, could I invite Vaughan to discuss the petition and any actions you think the committee should take?

Okay. Thank you, Chair. I know that the committee has previously considered that and that it wrote to the local authority, urging them to speed up action and expressing concern about not enough being done. There's a letter from the leader of the council, Steve Hunt, detailing the work being done and the range of anti-flooding schemes being undertaken. I think it is interesting that the leader says that, even if there were more funding tomorrow, he couldn't guarantee that the work would be done, because, I'm sure as a number of us know, undertaking a flood alleviation or defence scheme does take some time and there is a funding challenge for it. I understand why the petitioner thinks they're being fobbed off again by the council.

For us, though, I think the challenge would be, given that they're reworking the potential flood defence or alleviation scheme and they aren't going to have anything back for us until summer next year, we can either close the petition or seek an update in autumn next year, once the work has been done. Given that it's specific, I don't think there's any harm in us writing to the local authority in autumn next year to understand where they are. And we'll all have a bit of say in some of this, because we're all going to be making budget choices, and lots of this will be about the available budget to undertake a number of schemes, not just in Skewen but around the rest of the country as well.

Thank you. Yes, some funding was made available, wasn't it, recently, for local authorities to do schemes—

Yes.

—such as this, which is really good. But, many statutory bodies are involved, and it takes a while to draw up plans and implement them, I understand that. Luke.

Diolch, Cadeirydd. Last time this came up, I spoke on it. I think the situation really is unacceptable, and I completely understand why, as Vaughan has already referenced, the petitioner might feel like they're being fobbed off. I think the thing that we should try to do here is to make sure that we put a watching brief on what's going on, and I would agree with what Vaughan has suggested, that we write to the local authority to seek an update further down the line. But, of course, it's important that local Members are raising this themselves as well, not just the committee, and, as one of those Members, I will be doing it myself as well.

[Inaudible.]—budget round as well, it's worth pointing out, both at local authority and Welsh Government level.

The council notes that it's a high priority, that they're working on a number of anti-flooding schemes and have to comply with a range of statutory processes, and notes the complexity. So, like you said, it is urgent, and we are here to work on behalf of the petitioner. So, we'll keep it open and seek an update from the local authority in September 2025, or do we need to send just a holding letter?

Can I suggest that the committee sticks to the 2025 date?

Yes.

And that, perhaps, the committee also writes to the local Members to raise with them that this petition has come forward. I think a lot of the legwork between now and the Petitions Committee intervening again needs to be done by local Members.

Yes. I think you're right; they're probably best placed. I think they are best placed, actually, yes. Yes, Rhys.

I think I'd led on this the last time the petition was mentioned, and I think Luke then came in in supplementary. I think. The importance of this committee is that people feel that they can be heard. I'm sure the petitioner would be very disappointed on hearing the response from the local authority and they'll be looking in real trepidation at the autumn and winter months. If we can write to the petitioner, saying, 'As a committee, we're taking it seriously and we are not washing our hands of this, and we will be taking specific actions and we will be going back to the local authority', just to make sure that we keep them in the loop, because, from that point of view, this committee is very, very important, isn't it, because people feel that they can approach their Parliament.

That they've got a voice, yes.

I thought we'd agreed to do that.

We had. I was just stressing that we went back and specifically make the petitioner aware that we are taking it very seriously, because this will be a real disappointment to them. They will be very worried, they will be very concerned, and I don't want them thinking, 'Everyone's going to abandon me.' And I know, in the point that Vaughan is making, the pressures and that these things take time, but if you live in that street, and if you're facing hard winter months and bad weather, some reassurance from us could go a long way.

Is it standard, when follow-up action is being taken, that the petitioner is informed of the follow-up action that the committee is taking?

Yes.

So, they'll get the correspondence from the committee and they'll know that this is going to return.

Yes, so we can write to them to point out what actions we're taking.

They also get sent a transcript of this meeting, so all of what's been said will be a part of that.

The point I'm making is I don't want them thinking that we're fobbing them off too.

No.

I want them to be reassured that we are taking this very seriously.

People in communities do get extremely frustrated over the time frame, because it's very easy for us to say, 'Well, it takes a long time and it won't happen till next year.' Of course, when you're faced with a potential one day of heavy rain and nothing's happened for the last three years—I've seen it in my own village of Skenfrith, for instance, where we're flooded multiple times—and then we're slow getting schemes in place, and people don't see it, they don't understand, perhaps. Again, it's about clarity of what has to be gone through. Sometimes people think that bureaucracy just gets in the way of pragmatism and just acting quickly when something needs doing, and something that is often missing in government at all levels is pragmatism, because it has to hit the dots at the right time so that it's fair and everything, but sometimes it's not very transparent how we do these things, which causes huge frustration to people. So, I think it's an absolutely right point you make, Rhys, about actually helping people understand that we're not abdicating our responsibility as a committee here—there's nothing more we can do at the moment, but we are following it through.

Yes, as somebody who regularly gets flooded as well, I totally understand. So, thank you to everybody for your contributions to this. I think it's really important. We will be writing to the petitioner so that she knows what we're doing. We'll write to the local authority and the local councillors so that they're aware that we've received this petition, that it's a huge concern, and we ask them to monitor what's happening through their local authority to actually monitor progress, really. The design work will be completed by summer 2025, and then will be submitted to the Welsh Government to release funding for the work. That's another time frame, isn't it, and we'll keep a watching brief on it. Okay. Thank you.

Item 3.4, petition P-06-1445, 'Change Land Transaction Tax for First Time Buyers in Wales to be in line with the UK Government'. Taylor Reynish is the submitter, and she collected 268 signatures. So, Rhys, would you like to take us through this?

Thank you very much, Chair. This is the second time we've considered this matter. This is a matter we hear people raising with us from time to time. I've heard friends complaining to me about it, but this is a policy decision that the Welsh Government has made, and it's clear that there is a difference of opinion between the petitioner and the Welsh Government with regard to the policy approach. However, the petitioner has raised some specific points that I think are worth us going back to the Cabinet Secretary with. They raise the point about further assessment of targeted relief. I think we can raise that, and also, perhaps, whilst we're doing that, we could ask when will be the next review of the impact of the land transaction tax.

All right. Thank you. Would anybody else like to come in on this?

[Inaudible.]—we could all find things to say about this, because we do get people constantly feeling this, especially if you live right on the border where it is so much more beneficial, advantageous to buy a house just over the border.

Surely it's better to buy in Monmouth. [Laughter.]

Absolutely, if you can afford it.

There are benefits in both areas, shall we say?

[Inaudible.]—representation.

But it is a real challenge for first-time buyers. As the father of a daughter who is embarking on her first house purchase now, she's fortunate—they won't get caught in this because it's a relatively cheap house. However, for those young people who've got a family growing, want to make that next step and need another bedroom, suddenly they're in these realms, because you will not find hardly a house generally across Wales under £225,000, and not average price, and then they're going to be hit by significant additional costs on top of everything they're already facing, these often young working families.

Okay, so—

Chair, I don't agree with that. There are lots of houses in Wales where you can buy them for less than £225,000—

You won't buy find them in Monmouth.

There aren't very many in border areas. In some parts, in my constituency, Penarth is almost always immune to reductions in property values, and you can buy the same house just down the road in Barry and it costs a lot less. So, the variations in property are part of the issue. I accept that, in Monmouth, the property value will be different to buying something in a wide range of other areas in the country. But that's the challenge we have. It's such a localised issue, where property values are high in some parts of Wales, and really not that high at all in others, and we come back to the challenges over supply and, really, the bigger issue is the housing bubble we have and the ability of first-time buyers to get a mortgage. To save for a deposit and to get a mortgage is the biggest barrier by a long distance for most first-time buyers. I think there was something about the additional variations on how many more times your salary you can expect to get a mortgage for.

When I bought my first home, I bought it jointly with my sister, because actually, it made more sense to combine our incomes and we could buy a fairly modest terraced house in Cardiff. A lovely place, though. But actually, going on and on and on, it's the challenge of how far property values keep on accelerating beyond your income, and I think that and supply are the much bigger issues. I don't take issue with people having different views on this, by the way, but there is a clear difference in policy and I don’t think the petition is going to change that, but I do think there's value in asking the current Cabinet Secretary for finance about when he expects to review the impact of LTT and what that means. And then we can all make our own choices.

I think the wider issue is that generally across Wales, the average price is more than £225,000. But what we advocate is—. I'll use Monmouth as an example, where the actual median salary is very low, one of the lowest in Wales, but the average house price is £325,000 or more. So, what we're saying is that we alter the social fabric of our counties by expecting our young people to leave and go to areas they can afford. In Monmouth, we're already seeing it: the median working age is getting older and older, an older demographic. So, actually, you are altering the social nature of your communities. There needs to be a far cleverer approach to retain the fabric of our communities and allow people to live in their communities. And we'll only do that by creating more housing that is affordable, or more social housing, so that we can address those immediately for people who are looking to get their first home.

There's been—

Yes, but that goes into supply and it goes into tenures—so, your point about tenure, about the mix of shared home ownership and social home owners, as well as private sector homes and how you persuade people to build them in different places. It's the same in Cardiff. You go to Cardiff or the Vale and you ask young people if they can afford to buy a home in the communities they live in and most people can't.

But if you look at the—

We're having—. Through the Chair—

Sorry, Chair.

Apologies, Chair.

We're having little discussions at the side here.

But it's an interesting debate; it really is. Because Monmouthshire, for instance, thought originally that it needed 7,000 houses in its new LDP and that was cut back by the Welsh Government, because the Welsh Government did not want to see so many houses being built in Monmouthshire, they wanted to see more houses built along the M4 corridor, up the Valleys. So, there is an aspiration to build houses in some areas, but if we talk about subsidiarity and where things should happen, we have—

We're kind of slipping into the inquiry of the Local Government and Housing Committee, actually, where we've been having an inquiry into the provision of housing and making sure there's adequate provision of housing. We discussed rural housing enablers, calculating where houses are needed, et cetera. So, we could actually write to them, as well, regarding this petition, as part of it, but this seems to be—

You're creating work for my wife, Chair. [Laughter.]

We should write to the committee and say, 'Peter Fox believes that more council housing should be built in Monmouthshire'.

Yes, you need to build more houses—[Laughter.]

We've sort of gone off the remit a little bit here. So, possible actions are that we can write to the Cabinet Secretary—[Interruption.] Committee. Committee.

Sorry.

We can write to the Cabinet Secretary before closing the petition to share the petitioner's response further to the letter, as it calls for further assessment to be made of the possible benefits of targeted relief. We also want to know when a further review of the impact of the LTT might be planned. We want to know when the review of the impact is happening. So, again, a date, please. Okay. Agreed? Good. Thank you. That was a good discussion, though.

Moving on to agenda item 4, we've got two papers to note: P-06-1346, 'Provide free and accessible public transport for under 18s in Wales to lower carbon emissions and boost growth' and P-06-1335, 'Welsh Government should take steps to ensure vulnerable adults without bank cards can pay with cash'.

These are the Welsh Government responses that we received over the summer. Both of these petitions, or the reports, are due to be debated in Plenary over the next few weeks.

We've got scheduled for debate on 9 October our report on free bus travel for under 18s. And then the other one, we will discuss later on.

Agenda item 5 is a motion under Standing Order 17.42 to resolve to exclude the public from the meeting for the remainder of today's business. That concludes the public business. I propose that the committee resolves to meet in private for the remainder of this meeting. Have we got agreement? Thank you. We will meet again on 14 October 2024. Thank you.