Children, Young People, and Education Committee

Thank you. Welcome, again, to today's meeting of the Children, Young People and Education Committee. The public items of the meeting are being broadcast live on Senedd.tv, and a Record of Proceedings will be published as usual. The meeting is bilingual and simultaneous translation from Welsh to English is available. We have received apologies from Buffy Williams MS and Vaughan Gething MS. Jenny Rathbone MS is substituting for Buffy Williams. Welcome to the committee meeting. Are there any declarations of interest from Members? No declarations of interest.

We'll move on now to agenda item 2, which is a scrutiny session with the Cabinet Secretary and Ministers—the final scrutiny session of Senedd 6. So, can I introduce the Cabinet Secretary for Health and Social Care, Jeremy Miles, and thank you for your written evidence? I'd also like to introduce Dawn Bowden, the Minister for Children and Social Care, and, online, Sarah Murphy, the Minister for Mental Health and Well-being. Could I ask officers to introduce themselves, please?

Bore da. Albert Heaney, chief social care officer for Wales.

Bore da. I'm Alex Slade. I'm the director of primary care, mental health and early years.

Bore da. Abigail Philips, deputy director, quality and nursing.

Thank you very much. Welcome to the meeting today. We're going to move on now to questions. I'll start off with the first questions. These are to the Cabinet Secretary for Health and Social Care. Looking back over the last five years, to what extent has children's health in Wales improved against your key indicators, and in which areas of children's health has progress been strongest and weakest?

Thank you, Chair, and thank you for the opportunity to give evidence this morning. I think it varies between elements of children's health. So, for example, I think the area where we've seen strongest progress, probably, is in relation to oral health. It's an area where there's been significant investment. We have very effective programmes, including Designed to Smile, but others as well. We've seen, at both the five-year and the 12-year age point, a reduction in both severity and prevalence of tooth decay. So, that's been, I think, a very positive story, if I can use that term.

I think there are, of course, challenges in oral health, and I think what we will all be aware of is the gap between the most and least deprived in terms of oral health outcomes. That's still too large. It is closing, and, obviously, the programmes that we have are designed specifically to do that. We have a new general dental services contract coming in shortly and that has a clear focus on prevention. So, I would anticipate that will help close that gap even further, but that's still a persistent difference, as you will appreciate.

I think in terms of vaccination, we have seen very high levels of infant scheduled uptake in Wales around—. It compares very favourably within the UK and globally. We've made some quite significant changes in that space as well, whether it's in relation to the respiratory syncytial virus vaccination or, most recently, the introduction of the chickenpox vaccination in January. So, I expect that will make a significant difference as well into the future. We already vaccinate for human papillomavirus in adolescence, and we know that has a long-term benefit as well, which the committee will be familiar with.

There are, of course, in those areas as well challenges in terms of equity. I know the committee is very familiar with those issues, and we have, through Public Health Wales, a number of interventions in place. Colleagues may have watched the public accountability meeting last week with Public Health Wales. We discussed that very issue in that discussion.

I think it's probably worth drawing attention specifically as well to the Healthy Child Wales programme and the introduction of the newborn and infant physical examination Cymru standards. I think that is positive. However, I think in terms of the underlying data there, we will all be concerned at the persistent extent of overweight and obesity in very young children. Around a quarter of children in Wales are living with overweight or obesity, and we all will be familiar with what that means, both at that age but also through the life course. There is significant work going on to address that in the new delivery plan, but also in relation to infant feeding support and other interventions.

Okay, thank you. And how confident are you that the data you require health boards to collect provides a robust, consistent picture of child health outcomes across health boards and between different groups of children, including those most affected by inequalities? You mentioned inequality earlier.

In each of those—in each of the three areas that I've touched on broadly in answer to your first question—there is a significant level of data gathering, as the committee, I know, is aware. I think we would say that, from an overall point of view, we have a high level of confidence in the quality and consistency of the data across those three areas. Looking at oral health, we have, as I mentioned briefly, data sets at the five-year and 12-year point. They give us, I think, a very clear picture. That is why we know where to target our interventions to tackle that gap in deprivation that I referred to at the start. So, I think that gives us a high level of confidence, and supports very specific interventions as a result.

In relation to the child measurement programme, obviously, that's crucial. It provides, I think, one of the strongest population data sets that we have in Wales across the whole range of data that we collect. That's a very robust set of data that enables us to monitor obesity and overweight. I would say that data completeness in that data collection programme is strong. I think the area where that needs more work in the future is in linking that data set with other data sets that we have. So, digital health visiting records, and the Health Child Wales programme data sets as well. I think there is more that one could do to link those up in a way that would help us meet some of those broader goals that we have.

The child measurement programme measures children only once at reception age. That provides very valuable data. But, in that sense, it is a limited data set, and we are working on how we can strengthen that data on healthy growth in later years as well. So, there's, I think, more work that could be done in that space.

In relation to early years development, so the Healthy Child Wales programme, there are nine universal contacts that that captures. There is a piece of work, which I think the committee is aware of, to review that data set. I'm sure the committee will be aware of the report in 2024 that was saying at that point that there was still too much use of paper-based systems. None of us want to see that. None of us think that is the right way of doing things. That clearly limits accuracy inherently, and in fact it may lead to some under-recording of contacts as well. So, there's a review under way in relation to that programme, and I guess the two areas of that review that I'm certainly most interested in are what more we can do in the digital space and how we can make sure that data is captured consistently across all health board areas.

Okay. Thank you. And digital is being rolled out, isn't it, across health board areas now?

Yes.

When will the integrated quality statement be published? And can you outline exactly how it will lead to enforceable, measurable improvement and not simply remain a policy document without clear delivery mechanisms or accountability for health boards?

Well, we were hoping to have issued it, as you will be aware, by now. I'm very much hoping that we will—. Well, we're certainly working hard to get it issued before the end of this Senedd term, but there's a real possibility that won't be manageable, which is disappointing. However, if it doesn't happen, the reason will have been the extent of consultation with partners, but children and young people as well.

The areas that you mentioned in your question were about accountability, I think, and ensuring enforcement and monitoring and so on. Those are actually the areas where partners have said to us the quality statement needs—. I think it's regarded already in the draft form that it's in as a robust and coherent piece of work, which is positive, obviously, and the fruit of a lot of co-development, actually. But the areas where I believe, and partners are also saying to us, we need to strengthen are in the areas that you've touched on—so, making sure that we have a clear way of monitoring that, of evaluating it, being transparent about what it's telling us.

As part of the accountability arrangements we already have in place, obviously, we've strengthened those over the last couple of years in particular. I'll be making a statement in the next few weeks on where we have got to in that accountability work, and this will be one of the areas, obviously, that will benefit from that strengthened approach to accountability. Generally, it's part of the monitoring arrangements that we already have, and I think the committee, hopefully, when they see that statement, will be able to see the work that's ongoing to strengthen accountability more generally. If it isn't published before the end of the Senedd term, obviously I will be disappointed, but it would certainly be ready to be published, I think, no later than the end of the first quarter. So, I would expect the new Government to be able to be in a position to publish that before the summer recess, certainly.

Okay. Thank you. I was going to say we've got just two weeks left, I think, now, isn't it?

Could I just welcome students from Cardiff Met who are here to listen to the committee today? Welcome.

Could we move on now to questions from Russell?

Thank you, Chair. Morning. Cabinet Secretary, can you set out what the latest position is on children referral-to-treatment waiting times, including over-two-year waits?

Certainly. There's been a significant reduction, is the summary, I suppose. So, if you look at the figures at the point where we started our planned care recovery programme, which was in April 2022, so a year into the Senedd term, we had, my note here is telling me, 57,640 paediatric pathways. Of those, 6,800-odd were waiting for more than a year for their first out-patient appointment, and 5,040-odd pathways were waiting over two years. So, there were quite a number of long waits that we had at that point. We've discussed elsewhere what the interventions have been for the number of years in that space, and we've changed that mix in the last 18 months or so. Where we are now, or December, in fact, when the last data was published on this, we've seen a 53 per cent reduction in the numbers waiting for more than 52 weeks for the first out-patient appointment, so that's down at 3,200-odd. The biggest reduction, which I'm very pleased that we've been able to manage, and which has taken a huge amount of effort, obviously, across the health service, is a 92 per cent, almost a 93 per cent, reduction in the numbers waiting for more than two years. They've gone from 5,000-odd to 366. So, that's positive.

I will choose my words carefully in saying that nobody who is waiting for treatment from Powys health board or Swansea bay health board is waiting for more than two years for treatment, or 52 weeks for an out-patient appointment, and in both Hywel Dda and Cwm Taf Morgannwg there are fewer than 20 people in that category.

Thank you. I was going to ask if you know how many children are waiting for treatment. You've just given the times, with 57,000, 6,000, 4,000, 400—I was jotting them down—'in total', 'over one year' and 'over two years'. Have you got that data for how many children are waiting for treatment in total, including those who are waiting for treatment outside of Wales as well, because some, of course, will be because it's for specialist treatment?

So, you mean not just over two years; you mean the entire size of the list for children.

I mean the data, yes, but it's particularly in—. You've given the data for 'in total', 'over one year' and 'over two years'. Did you have that corresponding data as well? I was particularly interested in 'over two years'.

On the number of pathways, I don't have the number of individuals here, but we can provide that to the committee Chair. The number of pathways is at 54,400 and something, so that's an 8 per cent reduction, I think it is, roughly from the highest point at which we saw that, which is obviously positive. There are still some areas where there are ongoing challenges. So, for those 366 who are waiting for more than two years, ear, nose and throat waits are the highest, and then the others are ophthalmology, oral surgery, dentistry and orthopaedics, but each of those last four have under 50 people waiting in each of them. It's still too many, but that's quite considerably less.

You may have misunderstood my question. What I was asking is: are those 366 you just mentioned children waiting over two years in Wales for treatment? I was asking what is the data for children in Wales that are waiting for treatment outside of Wales by other providers.

I don't have that data, but I'm happy to share that with the committee if we have it, certainly.

It would be helpful to have that data for 'in total', 'one year' and 'over two years' as well, so that we can compare that data against those who are waiting in Wales and outside Wales as well. Okay. Thank you.

You've mentioned the significant improvement in two-year waits since April 2022, I think you said, which is, as you said, good progress. Obviously, we don't know who's going to form the next Government, so I'm asking this question with that in mind, but what are your expectations about that continuing into the next Senedd—the continuing progress being made in that area?

Well, I certainly won't be the health Minister in the new Senedd, for reasons which you'll be aware. But I would say that, in this area, as in a number of other areas, whoever is fortunate to be in that position will be inheriting a system that is getting back into balance. So, as the committee, I know, will be aware, when the health service is spending so much time, so much of its energy, as it needs to, in tackling the backlog in this and in other areas, then that is less time, energy and resource available to it to be recalibrating the way it delivers services so that it can deliver those in a more effective way. That's inherent in all health services. So, what we have been able to achieve is to get the system back into balance by reducing the overall size of the waiting list very dramatically, by bringing down the long waits very dramatically. And so, I'm confident that progress will continue into the term of the Government in the new Senedd. We are seeing a much more sustainable position.

I mentioned to you those areas where there are particular challenges, which still need to be addressed. ENT is the main one. In the others, there are challenges, but they are at a much, much lower level. There's obviously a geographic challenge as well in terms of where the longest waits are still to be found, and they are very largely in north Wales. Those challenges remain to be resolved, but the overall picture is of a system getting back into balance, which will then mean that the progress we have seen will be able to continue without the additional funding that we've been able to provide and have needed to provide to give that capacity for those reforms to take hold.

What are the specialties with the greatest pressures?

Give me a second. So, there are five specialties that represent 95 per cent of the longest waits. These are the bulk of them. ENT waits are the highest, and then the four other areas where there are waits of under 50 individuals are in ophthalmology, oral surgery, dentistry and orthopaedics. For treatments for out-patients, it's a slightly different mix, which is dermatology, ENT, ophthalmology, orthodontics and dentistry. So, that's the out-patient mix—just slightly different.

I've heard that the north Wales health board have just appointed two new ENT professionals, which is a relief, so hopefully that will impact there. Has the pandemic caused an issue and they're trying to still recover from that?

Chair, I don't have the data in front of me, but, in some areas, we are now back to a place where—and some of these are in out-patients—we are now outperforming the performance at which we went into the pandemic. So, we've been able to recover and, in fact, improve on performance in some areas, but, clearly, the legacy that we have in Wales, and that other health systems have, is one of resolving some of the persistent challenges that have been caused by the pandemic.

Okay. Russell, would you like to continue?

Yes, there are a couple more. I wonder what steps the Government's taken to improve the data availability in community child health services in particular.

Some of the points I mentioned in my earlier question. So, we're doing the review of the HCWP. There are some elements that I touched on in my previous answer, which I won't repeat, Chair. I suppose the one big change in the landscape coming up shortly is the Connecting Care system for health and social care—it's in procurement at the moment—and that will make a big difference.

Yes, okay. I suppose that's important, though, because you want to try and shift as much work as you can into community healthcare. That's what your aim is, isn't it?

It is, and the clinical network has been looking at what more we can do in order to make sure services are provided firstly in the community, which, for children, is particularly important for obvious reasons, but also to look at how pathways can be redesigned to better reflect developmental stages for children. So, there are recommendations that the clinical network are making about how we can refocus some of our interventions and our pathways. Obviously, how those interventions and how those recommendations are addressed will be a matter for the Government in the new Senedd, obviously.

The question is, though, I suppose, it's important to have that data available and being transparent with that data as well, as the context.

I think we are transparent with it. I've mentioned to you some areas where I think there are problems with inconsistency and what we're doing about that. We've published more and more data over the course of the last two years in particular around all elements of healthcare. From a targets point of view and a waiting list objectives point of view, but that has a data dimension, obviously, one of the things that the network are saying to us is, 'We might need to look differently at how we measure waiting times for children, given the greater impact that being on a waiting list has the younger you are, obviously.' So, there are opportunities there for those choices to be made in the future as well.

What are the factors driving community paediatric waiting times?

We don't have specific waiting times for community paediatrics. We don't have specific targets for those. I think the key issue has been the quite significant increase in demand over the last two or three years in particular in the demand for services generally, which I think has left services a little out of kilter with that level of demand, frankly. I think the resources that we have made available to reduce waiting times, where there's a community dimension, have so far been focused on reducing mental health waiting times. I'm not the Minister directly responsible for that, but you will know that's had a very significant impact in terms of reducing waits for mental health both in the community and in acute settings.

Do you think you should have specific waiting time targets?

My personal view is—. The context of this, I suppose, when I became the Minister—. There are hundreds of targets. Everywhere you look in the health service, there's a target. There's a serious challenge, I think, in focusing the efforts of the system on improvement when everyone's chasing a bewildering plethora of targets. The health service, absolutely understandably, was saying, 'Please give us a sense of where you want, for the next period, as it were, the most effort to be focused', and some of those are paediatric targets and child health, and we did do that exercise and it's had a beneficial effect. In that context, I don't think it would have been consistent to be looking for other targets to set for the system. However, what I would say is that there are targets for community service provision and they will be available to children, as well as for adults. It's just that this particular category hasn't got its own specific target.

Okay. Thank you. We move on to Jenny.

Thank you. I want to just look at the paediatric workforce. The Royal College of Paediatricians and Child Health says that there's chronic underinvestment in community child health in their report published last June. In your evidence, you talk about three different workforce plans, and I just wondered how all this joins up, because what we're looking for, surely, is the team around the child that's needed to deliver the service that that particular family needs. So, how does, for example, prudent healthcare come into all this? And what do you think the next Government should do to really—? Because these paediatricians and the Royal College of Nursing and all the other professional bodies, they all say, 'What we need is more of X', the ones that they represent, without understanding that these take years to train up, these people, and we need—. So, I just wondered what your approach would be, or your advice to the next—.

Well, I think I do understand why royal colleges ask for further recruitment in the area that they are closest to, because that is the lever most immediately at hand, from their perspective, and that's a perfectly legitimate challenge to Governments everywhere and a perfectly legitimate world view. But as you say, there are a number of separate areas where there's work already under way. So, we have the perinatal workforce plan, we have the nursing workforce plan, we have the allied health professions workforce development plan. So, we have workforce recruitment and retention strategies where success in those areas will deliver a larger workforce for paediatric and child health. So, the task is obviously to make sure those are all aligned, and the clinical network is helping us with that. The integrated quality statement, when that's published over the next few weeks, will provide, I think, a more robust framework for that workforce planning, because it brings those strands together. And I think the point you make is absolutely correct, which is, obviously, looking at it from the child's point of view, the key intervention and organising your workforce in a holistic way around that.

In terms of the overall level of recruitment for paediatrics specifically, we've seen, over the last 10 years, which is the last two Senedd terms, a 48 per cent increase in the number of paediatric consultants. So, that's a very significant level of recruitment by any standard. And we've been able to use our funding specifically to expand training capacity for paediatrics with an extra 18 new training posts, which have come onstream over the course, mainly, of this Senedd term. So, we are seeing that there are clearly challenges; they're not challenges that are unique to Wales—sadly, for everybody, really. But there are programmes and plans in place.

Okay. But I go back to my challenge about prudent healthcare. Are the people who are seeing the child and their parents qualified sufficiently to see that child, but no more? You know, you don't need a fully fledged consultant paediatrician to make that first contact.

No, I agree with that, and that isn't always delivered in that linear way, either; there's a wider range of support available. The clinical network is helping us with understanding how we can make sure that that works in that more holistic way. There have been some new appointments to that space recently, and I think we are seeing quite a lot of change coming as a result of that. So, I'm confident that, going into the next Senedd term, we will have the levers available to help us make progress in this area.

Okay. So, moving away from doctors, health visitors and midwives also are in short supply. You know, we always need more of them, and we definitely need more of them for different reasons, which we don't go into here. But how many of them have assistants who are able to do specific roles—you know, the maternity care assistant who's an expert in breastfeeding, or the health visiting assistant who's going to help that family understand how they have to play with their child, or anything? You know, there's a whole range of things that you could do. I don't hear a lot about that, and I certainly don't see it in some of these reports.

Okay. I don't have the numbers in front of me, Chair, but the maternity and neonatal assurance assessment that we published last week has some very interesting things to say, specifically on recruitment and retention of midwives and assistants in that context and what work needs to be done to make sure those teams work in the kind of integrated way that you're talking about now. It talks specifically as well about consultant midwifery and the balance of teams in order to deliver those services. So, I'd recommend the committee, if it has an interest, look at the elements of the report that deal with that. There are some interesting things for us to learn from in there. I'm happy to provide the numbers to the committee, to the extent we have them, Chair.

All right. I haven't read that report. Moving on to Flying Start, I find it really difficult to understand how health visitor contact levels have fallen to a record low of 2.9 visits that a particular child will have contact with a health visitor in a single year. I hope I'm reading that right.

I'll deal with this, Chair, if that's okay. So, you're right, Jenny, in 2024-25, we did see the contact rate be lower than in previous years and that was due to a general shortage of health visitors. We did have a shortage during that period, the immediate post-COVID period, and we also saw a significant increase in the number of children and families with particularly complex needs arising from a range of issues—the cost-of-living crisis and various other things. Really, what we saw was that that developed the need to be able to work with multiskilled professionals, so not just health visitors, but other health professionals that would need to work with those children and families as well, so that we had that wider skill mix.

What's also important to note, I think, is that the outreach Flying Start programme reaches a lot of people that are not actually contained in the data. So, the local authority data for the provision of outreach Flying Start, as opposed to the core Flying Start, is actually quite inconsistent.

What do you mean by outreach?

So, outreach, with Flying Start—. So, Flying Start was initially set up—

I do know what Flying Start is.

Yes, so it was initially set up—. It's important to say this so that you understand what the outreach does. It was targeted in particular postcode areas, those areas with the greatest need. You will know, I'm sure, from your constituency work—

So, we're expanding the Flying Start—

Absolutely. You will know from your constituency work, as I do, I'm sure, that there are a number of families that sit outside of those postcode areas that also have those needs. So, the outreach facility is for the local authority to be able to identify people that might need Flying Start support that live outside of those postcode areas. So, that's what the outreach service provides. Every local authority has the ability to provide outreach Flying Start, so that sits outside of the key Flying Start areas.

Okay. So, are you suggesting that these outreach visits are not counted in the number of visits?

Potentially—and we don't know for a fact—but only because the recording of outreach is quite inconsistent by local authorities. It's relatively small in number, shouldn't be difficult to record, and it is one of those areas that I think we probably do need to follow up with the local authority, because having that data is really important. That can be one of the reasons why we're not getting the full picture about health visitor contact.

What we know is that the actual number of children that are benefiting from the Flying Start programme is probably higher than the nearly 41,000 that are actually recorded in official statistics.

But even so, it's incredibly low and quite disturbing.

Jenny, can I just come in? I was very interested to hear that, that there's the outreach Flying Start, because people say very often, 'We're not in a Flying Start area', but there are little pockets, aren't there, of deprivation that should be included. So, it would be good if you could provide a little more information on that to us.

It's fairly straightforward. As part of previous expansions of Flying Start, that was something that was brought to our attention—and I think it wasn’t news to any of us, because we all have casework around this—that there were families that were in need of this Flying Start support, and we weren’t supporting them, because this was a very targeted programme. But the outreach programme does allow the flexibility for every local authority to be able to offer that Flying Start provision for families outside of those core Flying Start areas. So, every local authority has that flexibility, and, to my knowledge, every local authority is utilising that to a greater or lesser extent.

But to come back to Jenny’s point about the health visitor contact, we have, since those figures—so, we’re talking 2023‑24, 2024‑25—now seen an increase in the number of health visitors in the system. So, I think that was a particularly poor year for us, and those immediate years after COVID. But we have now seen an increase in the number of full‑time equivalent health visitors providing those Flying Start services, and an increase in the number of the wider health team and other staff groups in Flying Start. We’ve seen something in the region of a 5 per cent increase on the 2024‑25 year. So, I would expect that we are now getting back to the level of contacts that we would expect to see in the Flying Start provision.

Okay. So, when I visited a stay and play in St Mellons, which had breastfeeding support attached to it, I was hearing stories about health visitors who were just going round and round in their cars, knocking on the door, not getting entry because people didn’t want to let them in because they hadn’t done any housework. And if you’re a single parent, obviously the housework goes out the window if you’ve got a baby. And instead, people were coming to this stay and play because they didn’t have to expose the state of their home. And I’m just concerned, because you can see in the evaluation that was published recently that there are a lot of people who are just falling through the cracks, absolutely. Some local authorities don’t even seem to be doing the outreach; they’re waiting for people to come to them. Well, that will definitely exclude the people who are having postnatal depression, won’t it?

I mean, no system is perfect; we absolutely accept that. We are very clear about what the expectation is. When there are staff shortages, that obviously creates difficulties, it creates challenges, and we have sought to address that through the recruitment of more health visitors. And what I’m saying to you, acknowledging the data that were produced for 2024‑25—we’re now two years on, and we do have more health visitors in the system. We really need to see what the evaluation is now that we have more in the system.

What I was trying to probe with the Cabinet Secretary was: how many other people are in the team around the health visitor?

Yes.

Because the health visitor can’t do everything all the time—

No, no.

—and they need other people too.

Yes, absolutely. And as I said, I think in my initial answer to you, there is a wider skill‑mix team around Flying Start; it’s not just health visitors. The Cabinet Secretary referred earlier on to the Healthy Child Wales programme, and there’s a minimum set of key interventions to all families within that programme, and it is enhanced in the Flying Start programme. So, all children up to the age of seven years will have some form of intervention. Increased intervention is what we will see in some of our Flying Start areas, of course, because that was the nature of the programme and the purpose of us introducing that in the first place.

And I would say, any system can do better, any system can improve, but Flying Start—and all the evaluations show this—does make a real difference. It absolutely makes a real difference in some of our most disadvantaged communities. And the Flying Start health teams have achieved over 117,000 health visitor contacts in the 2024‑25 year where we had that shortage of health visitors. So, even acknowledging that there was a shortage, there were still nearly 120,000 contacts, and more than 98,000 contacts were made with the wider health team that I was talking about. So, I think supporting the point that you’re making about it can’t just be about health visitors, there’s got to be a wider intervention.

Absolutely. Okay. Just briefly, there's a lot of emphasis being put, in Plenary and elsewhere, on expanding the childcare aspect of Flying Start and there's some reflection of concern in that national evaluation of Flying Start that it's undermining the other aspects of support that new parents need. And so I wondered how you—? What's your response to that?

Well, I think that's a matter of opinion. I don't think that is substantiated by the facts. I think the facts are that over 40,000 Flying Start children and families can access an enhanced level of visiting support from the dedicated Flying Start health visitors and the wider team. And we have different elements of Flying Start, of which childcare is one element. And the expansion has primarily been around the childcare element, but those enhanced areas for those in those targeted areas of deprivation remain and absolutely are core to what we are seeking to deliver within Flying Start. And I see absolutely no dilution of those core enhanced services as we're looking to expand general childcare.

Okay. We're going to move on now to Natasha's set of questions, please. Thank you.

Thank you. My questions are mainly for the Cabinet Secretary for health, if that's okay. I'd just like to know how is the Welsh Government assuring itself that health boards are meeting their statutory duties to both provide information and also to support local authorities regarding the identification of additional learning needs and to deliver health provision as part of the individual development plans that come about from whatever they receive from school or anywhere else.

Yes. So, Chair, it's a complex area, as the committee, I know, is very well aware, and I'm assuming that you'll have discussed this with the education Minister—

We have.

—presumably on many occasions previously. So, she and I meet biannually, I think it is. We most recently met to agree a set of actions to try and provide clearer guidance in this space. So, what we wanted to do, firstly, is to clarify some of the complexity in this space around section 20 referrals—when the timescales apply, how they're to be discharged. So, the task is to get the guidance into a clearer place. So, that's one of the actions that we committed to as part of that. And then the key performance indicators that are around performance against that will provide both assurance to us, but also assurance to the system about how that clearer guidance is being discharged.

We had a spotlight event in December, which was helpful, I think, in identifying some of the things that are working well, but also areas where, clearly, there needs to be further work. I'd be very happy to share with you the report of that spotlight, if you haven't had it already. And we are writing out, as joint Ministers, to the system to share the findings of that spotlight event, but also to spell out some of the points that I've just made about some of the actions. So, if it's helpful, Chair, some of it will be around how we are better able to embed the needs of children and young people with ALN and health and care needs in the regional partnership board agenda to give that more prominence; reviewing the 'Supporting learners with health care needs' guidance; I think, crucially, given the point that we've just been talking about, a mapping exercise of how we can share data more effectively, where the workforce is, both within the health system but also in the education system, to make sure—. Again, putting the needs of the child at the heart of it, looking at that mapping on a holistic basis to understand where that is and where it needs to get to and mapping where the 'No wrong door' interventions or opportunities are at the moment. So, there's a piece of work to be done in that space, which I think is really important, before we can get to grips with some quite challenging requirements from a six-week perspective that you touched on in your question.

Obviously, there's a statutory requirement in that space, which, clearly, must be met, but, actually, in order to meet the needs of the child, you've got questions around patient safety, clinical governance, clinical prioritisation, clinical need—all of those have to be reconciled, essentially, or brought together, aligned, in order to provide the best care for the needs of the child, and that involves quite complex judgments in the health space around education benefit, where the system is, bluntly, designed to meet clinical need. So, there are some challenges there, clearly, but that's the plan: actions going out to the system; clarification of the guidance; KPIs, then, to measure compliance against that.

I'm really glad you mentioned KPIs, Cabinet Secretary, because I like KPIs. I think everybody in this committee knows how much I like them.

I was waiting for you to say that, Natasha. [Laughter.]

Yes. I like my KPIs. I wanted to ask you—. Obviously, there are numerous health boards across Wales, and we all appreciate that some perform well; some don't, unfortunately, for whatever reasons. But, in this particular area of ALN, the IDP element, the support that young people are provided with specifically, is there a particular health board that you could say, 'Do you know what?'—? We appreciate that there are struggles, we appreciate that there are issues, but is there one that you could say that they're leading the way or they're doing better than the others?

I don't think I'd want to specifically draw attention to one health board, Chair. We all recognise that there's variation in this area, as in, I think, almost all areas of healthcare provision. Our task as a system, and my challenge to the system, is to make sure that we eliminate variation that isn't otherwise justified. There clearly is variation that is what you would expect to see and is appropriate, but where we see differences of approach that aren't justified by circumstances, where we see differences of priority, of delivery, the task is to make sure that that is reduced—the point that Jenny was making earlier about prudent healthcare, that having a system where the value-based approach to healthcare is more embedded, where we aren't doing things that don't add value, bluntly, and we are looking at things more holistically, that that should be embedded, the way of working for all health boards. We aren't there yet, and this is an example of that, I think.

Okay. My next question is going to be around designated education clinical lead officers. It's a topic that we've spoken a lot about in this committee as well, and you'll be aware that this committee has consistently taken the position that each health board should have their own DECLO in place in order to fully comply with the spirit of the requirements of the ALN legislation. Now, five health boards have chosen to share two DECLOs between them, with only Aneurin Bevan and Betsi Cadwaladr appointing their own. Informed by your experience, obviously, within this committee in a past life, and also in the current position that you're in as well, I'd really like to know: do you believe that this is sufficient to ensure the desired closer and more effective collaboration between health and education?

So, in this sense, it obviously isn't sufficient, but it's not the only thing that's happening. I am absolutely clear that all health boards are compliant with their statutory duties, because they all have a DECLO in place. I don't, myself, share—. I'm not persuaded by the committee's view, if I can put it like that, that there needs to be a separate DECLO for each—

Can I ask why?

You can. So, the point that you've just been making to me about variation—we have different approaches in different health boards, different approaches, if I may say, in different local authorities. We have a quite complex system for quite a small nation. That's my personal view. And I don't think that any of us would argue that we're not able to fulfil the needs of social care by having anything other than 22 directors of social services, that we can't meet the education needs by having anything other than 22 directors of education. It's quite a complex landscape, isn't it? My own view is that joint appointments are a positive thing, where they're justified, because that enables consistency to develop. And there's quite a wide range of support for this view, I think, probably around this table, for wanting to deliver more services along a regional footprint, because we recognise, firstly, that some things we do are just more effectively delivered on a regional basis. Sometimes, services are fragile and therefore have to be done on that basis. But also that's the best way to ensure that we eliminate the differences in the experience of a patient based on where they live. And we would all want to support that. So, my own view is that, if we set the task of saying, 'You cannot deliver your needs without having one person doing this in each area', we are definitely not going to meet that agenda of consistency. Well, that's too strong a way of putting it—it makes it harder to meet that agenda of consistency, and it cuts across that regionalisation of services that I think is a positive thing for us to achieve.

Okay. Thank you very much.

Okay. Thank you very much. We'll move on to Cefin now.

Yes. Bore da. I'm going to be asking questions about perinatal mental health. The first question is about stakeholders. Having made it absolutely clear that national co-ordination is essential to making progress in perinatal mental health, how will the proposed community of practice model maintain the national oversight equity and momentum currently provided by the perinatal clinical implementation network and the national clinical lead?

Thank you very much for that question. So, firstly, let me just set out that we have made changes, and part of that has come along, then, with the £2.2 million in the strategic programme for mental health, which is part of what NHS Performance and Improvement use to be able to carry out this work for us. So, this is going to ensure that we have a strengthened clinical leadership.

As you know, this was part of the 10-year mental health and well-being strategy, and so this has also meant then that NHS Performance and Improvement have decided to change some of those clinical structures, so that, fundamentally—

Minister, your screen has frozen, and—

As you'll know, we have—

Minister, we have an unstable connection to you at the moment.

Right.

We'll just take a little pause. Okay. It seems to be okay again. Could you just repeat that last sentence for us?

Yes, of course. I was just saying that this has been part of the process of rolling out the new mental health and well-being strategy. It means that NHS Performance and Improvement have been allocated money now to be able to ensure that everything is performing as it should be, and part of that is perinatal mental health. And that will come under, now, the mental health clinical leads, who will be in those rooms when the decisions are being made.

So, I have to say I'm very happy with the progress that is being made in developing these perinatal services, and I do want to thank everybody who is playing a part in that.

Okay, thank you. Jenny, did you want to come in on this?

Yes, I did, if you don't mind. The national evaluation of Flying Start highlighted that there was a need for clearer and more consistent procedures for assessing postnatal depression, and I wondered how the arrangements you're putting in place are going to support that, because, clearly, a lot of that should be being identified antenatally.

Yes, absolutely. So, in terms of the ethos that we have around perinatal mental health, the whole focus, really, should be on it being in the community. I obviously have to kind of oversee and work on, sometimes, women and babies needing to be able to have that in-patient support, but, fundamentally, everybody should be having that in the community.

I think that a lot of this starts, like you said, before you even have the baby. I've met with some of the health board teams, particularly, for example, in Betsi Cadwaladr; I've met with the team there. And a lot of the work that they do is really kind of talking to mothers before they even give birth, going through, maybe, some of their triggers and their concerns. And ensuring that they have the best birth possible is a huge part, then, of preventing any kind of trauma or mental health issues that may arise afterwards.

But when that does arise, what we know—and, obviously, you'll be aware that we commissioned a report into perinatal mental health through the joint commissioning committee and the Royal College of Psychiatrists, which came out last year—what we do know is that being able to see somebody very, very quickly, and being able to be having that support in your home, is what mothers prefer.

Okay. So, you're satisfied that the system you're putting in place is actually going to improve the identification of postnatal depression. Because, clearly, this is one of the most devastating things, for both the mother and the child.

Yes, I think, again, if I come back to the mental health and well-being strategy, the purpose of it is that—. We have this single session, open-access model, so it means that health boards now will have a single point of referral, so that you don't have to necessarily even go to a GP; you would be able to see somebody very, very quickly who will be able to have that single session with you. The whole point is that we want that prevention, and then we want that early intervention, and then we want people to be able to stay in their communities. And I have to say that health visitors, midwives, are very well trained in these areas.

Okay, thank you. Cefin, would you like to continue?

Yes, if I can, thank you. So, key stakeholders report, Minister, that they weren't consulted on the proposals to disband the perinatal clinical implementation network, and you've not yet set out what other options were considered. Now, the committee has written to you about this many times in the past. So, could you explain to us what formal options, appraisals, were undertaken before deciding on this course of action, and why was no structured consultation carried out with these stakeholders? And what engagement process will now take place as the proposals move forward?

Thank you. Yes, of course, I did receive and respond to the letters from the committee, as well as letters that came directly from health boards and perinatal groups as well. So, just to be clear, this is not something that I have undertaken or was my decision. The format and running of NHS structures to support the implementation is for the NHS performance and improvement work plan, and it's for them to then engage with stakeholders and set out the internal processes that have been followed. But I do want to say that it absolutely has recognised that we've made significant progress, and I want to thank, like I said, absolutely everybody involved. This was never to undermine the work that's been done up until this point. The intention is to actually strengthen the clinical leadership at a senior level across the programme. So, the programme now has four permanent clinical lead roles, which will cover areas of mental health, and that will include perinatal mental health.

I also wanted to say that, from what I've been told, colleagues in NHS performance and improvement undertook considerable engagement with stakeholders who raised specific issues in order to address any concerns that have resulted in these structural changes. And also then the work will continue to support that perinatal mental health service and provide assurance on delivery. So, I believe that there is a meeting that is imminent where all of this will be discussed once again. So, I do think that by flagging it, raising it—I welcome and thank the committee for writing to me—that this has meant now that, going forward, hopefully, there has been that explanation, that further engagement, and that in no way was this to undermine the work that has happened up until now. It's just that in rolling out a large, long, 10-year mental health and well-being strategy, perinatal mental health now will absolutely be a considerable part of that. But it will be structured in a different way for the governance.

So, in achieving the intention of the community of practice model, in hindsight, do you think that you should have consulted better with the key stakeholders and discussed option appraisals with them?

Well, as I said, this would not have been out of my role to undertake. This would have been for NHS performance and improvement, who have assured me that that was absolutely done.

Okay, thank you. So, can I just, finally, go on to a question that is slightly different? So, can you provide a clear timetable for Welsh access to the Chester mother and baby unit, and confirm the long-term future of Uned Gobaith, including implementation of its one-year review recommendations?

Yes, absolutely. I'm really proud to say that we are now able to provide in-patient care for mothers from north Wales much closer to their homes. I'm also really pleased that this was, obviously, a joint commissioning with NHS England. I have not been able, due to my pregnancy, to make it up there to see with my own eyes, but I am very much assured it is a state-of-the-art Seren Lodge unit, where we are able to commission two beds, and also have potential for more if needed. However, since the unit has been opened, so far, two mothers in north Wales have already received care at the unit. We have not needed to expand that.

I also wanted to say, again—I've previously mentioned this, but I do think it is really important to note—that our focus is always on prevention, and that is why we have invested in our community perinatal teams. We really know that, ultimately, mothers want to receive support in their own homes and, alongside now the development of those beds in Seren Lodge, Betsi health board has also strengthened its community mental health teams.

And then in relation to Uned Gobaith, this was originally agreed as an interim solution while further options were looked at. That's why, when I came into this role, one of the very first things that I did with the team is that I commissioned a report by the joint commissioning committee and the Royal College of Psychiatrists into what we thought the requirements currently were across Wales, but also what they would be in the future. I'm sure the committee has seen this report, so I won't go into too much detail about it. Ultimately, I believe that what we will need now is, potentially, an additional bed in Uned Gobaith, but, ultimately, looking at some of the case studies, my personal view is that we would begin by expanding out of hours, a more rapid response. So, again, we don't really want mums and babies needing to go into in-patient units if they don't need to, and that's probably where I would start. But, ultimately, and this goes for the whole of the mental health estate, we just, as you know, haven't had hardly any capital to be able to do that. Again, for the future, my personal belief is that we need a 10, 20-year mental health estate strategy. That would obviously then include the perinatal mental health.

Okay. Thank you.

Okay. Thank you.

Thank you very much. Natasha, over to you, please.

Thank you, Chair. Minister, you said that the goal for young people is to receive equitable same-day access to mental health support wherever they seek help. What measurable progress has been made towards this, and what practical arrangements, such as clear pathways, defined roles, and accountability across all the services, are now in place to ensure that this works consistently and actually does do what it says on the tin?

Thank you. So, again, just to clarify, I guess, what we mean by open-access mental health. This means that people can self-refer, so access is absolutely key; you don't have those lengthy waiting lists, you don't necessarily have to have a GP referral, and there's no strict eligibility criteria. So, it focuses, really, on that 24/7, community-based support, walk-ins, maybe crisis cafes, online single sessions. So, that's what we mean when we're saying that we want this open-access model. As you know, the 10-year mental health and well-being strategy is all ages. We are less than one year into the delivery, and, again, that additional investment now in the NHSPI should drive this forward.

We've seen tremendous progress. So, we've already had workshops and surveys that the health boards are undertaking; we have three waves of demonstrator projects, with one wave agreed. What I wanted to say about the demonstrator projects, and the reason why this is a really crucial part of rolling out the whole of the strategy, is that there is, potentially, some kind of nervousness sometimes within health boards and within teams that, once you start saying 'open access', 'self-referral', you're going to be flooded and overwhelmed. But, as we always say, the fact is that people are coming to the NHS needing mental health support, and children in particular, anyway, so let's just get them to the right place as early as possible, so that they can get the support that they need. So, the lovely thing is that we originally intended to have three demonstrator sites to do exactly that, so that we could evaluate them, demonstrate to the other health boards that this works, that this is the way to go, and we were really pleased with the enthusiasm of every single health board that came back and said, 'Do you know what? We're kind of already doing something like this', or, 'We've had this idea that we'd really like to scale up.'

So, just now, these demonstrator projects will begin. I'm really pleased to say that, for example, Aneurin Bevan is going to be testing a model within their child psychology services, which will be that one-at-a-time session. Cardiff and Vale University Health Board have a wonderful project that is actually going to be supporting the four universities in Cardiff with that as well. So, they'll be reducing the number of sessions needed and then reducing the waiting time until you can see somebody. Betsi are going to have the Body project, which is going to be early intervention for young people at risk of eating disorders. Cwm Taf Morgannwg are going to have single-session therapy for children and families. Then Swansea have got loads going on: they've got enhancing early access to child and adolescent mental health services through same-day support pilots, as well as pre-surgery single session psychological support for paediatric plastic surgery patients. So, I have to say, within less than a year to get to this point, where we have health boards coming forward with really exciting proposals, and a lot of them to do with children and young people, is fantastic.

Thanks, Minister. I just want to follow up on what you've just said. You've covered a number of health boards there, and different projects that they're doing, and you said that they're going to be starting soon. Is there a particular time frame, or are these going to be permanent, set in stone now, from now till forever beyond?

No, these will be demonstrators. So, it will be similar to what we're doing in women's health, to be honest. It's similar in terms of, like, it's pathfinders, it's seeing what works, there'll be an evaluation, there'll be a sharing of best practice. So, this is the first step as we go forward. Also, just to say, because you asked about how we measure all of this, we have established a very robust governance structure now, with a joint ministerial advisory group. That was done within the first six months, and there will be an outcomes framework and theory of change that will come through, which will be an independent evaluation at the end of year one. Then of course, as you know, annually then we will publish an update against the actions in the plan.

Okay. Great. Thank you very, very much for your response, Minister. You highlighted early signs that sanctuary pilots for 11 to 18-year-olds may be reducing CAMHS referrals. When will the full evaluation be published, for the benefit of the committee, and what assurance can you give that the evidence base, funding and practical arrangements will be in place to scale these models, so that all young people across Wales can access this type of early crisis-preventing support?

Yes, of course. The Royal College of Psychiatrists are finalising the report, and we expect that in the next few weeks, and then I will absolutely share a copy with the committee as soon as that's available. To support this transition, though, I've also agreed the same level of revenue funding to health boards for 2026-27, and officials now will work with them to agree how provision can be sustained in the longer term and informed by the evaluation.

I think it's important to say that we can provide the models to the health boards to demonstrate to them that if they move funding further towards the prevention space, that it is best for the patients, best for the workforce, honestly, and also the most efficient way of being able to provide care. I will emphasise, though, it is very much like—. We obviously gave over £800 million to mental health services. That has to include children and young people as well, and so I would expect then the health boards, the regional partnership boards, the local authorities to be working with officials to ensure that this is prioritised.

But, yes, I think the—. Like I said, I've visited a number of them; a number of them are in your area, Natasha, in Barry and Cardiff. I've talked to young people directly who have said it's really transformed their lives and their futures. I have heard anecdotally, as I've said to the committee before, that CAMHS are saying that they're getting fewer referrals, and that's what it was meant to be. It was meant to be an alternative to admissions, and it very much aligns with what the Welsh Youth Parliament's 'Young Minds Matter' report was requesting.

I hope it alleviates some of the pressure on schools, because these are, obviously, after school, on the weekends, and it's allowing young people to have, again, a lot of the time, single sessions with an adult just to have a chat, but also just that safe space. Safe spaces are so important as places to connect, places to ask for help if they need it.

Thank you very much, Minister. I do have to clarify that I cover south-east Wales; Barry doesn't come underneath me.

Sorry.

No, it's just in case I start getting an influx of casework from Barry. [Laughter.] I just want to set the record straight for everyone's benefit right now, while we're here in committee.

When the committee last examined transitions to adult mental health services in 2022, young people in Mind Cymru actually reported gaps in preparation, support and continuity. So, I'd like to ask you: what measurable progress has been made since then to ensure consistent implementation of the national transition guidance across all health boards in Wales?

Thank you. I was actually on the Health and Social Care Committee when 'Sort the Switch', the Mind Cymru report, came out, and I had the opportunity, along with members of this committee, to sit down and meet with the young people who had fed into that, and hear first-hand their experiences. And they were incredibly brave. I still, to this day, think that report was absolutely seminal. It really demonstrated the trauma of the switch, honestly—the trauma of feeling like you needed to prove that you were unwell enough to be able to continue to receive care and treatment. It was very, very eye-opening.

So, following implementation of the transition and handover from children to adult health care services guidance, we do monitor compliance through usual health board quarterly reporting mechanisms. We obviously have the integrated quality, planning and delivery meetings. But also, in July 2024, the CAMHS service specification was issued and embedded expectations on those transitions. And it states that all services must provide transition support and transition leads, and refers to the guidance.

So, all health boards have been benchmarked against the implementation of the CAMHS service specification in September 2024, and then again in February 2026. They are due to return the February 2026 information very shortly. So, I just want to say we are continuing to work to remove any existing barriers between children and adult services for those young people who need adult secondary care mental health services. It's partly why we've done an all-ages mental health and well-being strategy. But it also just confirms that we do need to keep exploring, really, the need for young adult-specific approaches.

I appreciate your response, Minister, and you mentioned barriers. It's an interesting word, but I'd like to know: do you feel that there are any barriers in place at the moment that are actually preventing progress?

Yes, like I said, I think—. Well, to be honest, I will need to see what comes through in the reports from February. I don't want to be too—. I don't want to make assumptions until I see that. But, as I said, if I refer back to the switch, the barriers there were that you had to go for another assessment to see if you can continue to receive your care and treatment, and feeling like you needed to meet this threshold, and that shouldn't be the case anymore. That, for me, was the key barrier that seemed to come through in that report, and that's what we're doing to prevent that. But we'll know more, I think, once we hear back from the health boards and actually are able to assess them.

Okay, great, thanks for that. The Welsh Government has reported eliminating four-year waits for children with neurodevelopmental—with needs for neurodevelopmental assessments—I do apologise; I will get my words out—while acknowledging that many families are still waiting for far too long. What is the longest wait time you're currently aware of that we have here?

We still have three of the health boards at the moment that are just over the three years. So, there are no over four years. So, when I first came into this role, the First Minister said to me that this was one of my key delivery targets that I had to reach, which was to get them as low as we possibly can in the amount of time that I've had, with the funding that I have as well. At the time, we had children and young people who had been waiting in some of the health boards for over six years. So, we were able to invest that initial funding and bring those down pretty quickly, and then the goal for this year, then, has been to get them all under three years. So, that work is still continuing until the end of this financial year. I have weekly meetings and spreadsheets and discussions about any issues that we might be having in order to reach that target, but, at the moment, we're on track to reach that target. Although I would say that this is for some of the health boards—this is for three of the health boards, really. Aneurin Bevan is under the 52 weeks. Some of the others are already under the two years.

So, again, if I look into the future, I would continue to do this. It takes an awful lot of focus and prioritisation, and that includes the funding for this as well. I think it's the right thing to do. We've started with children and young people. I've always said that I would like us to get to a place in Wales where everybody has their assessment when they're a child or young person, and we don't have people then going into adulthood still needing that assessment. I think that we're on track to do that, and I think, if you compare what we're doing here in Wales to other nations, we've got a really good record and story to tell.

Okay, thank you for that. A final part of my question now. I appreciate you mentioned that you've got reports that are coming into you in the next couple of—well, couple of weeks, couple of months. What further action do you feel is needed to ensure that improvements are sustained and accelerated across all health boards in the next Senedd term? To what extent—how confident are you, in fact—that children will receive consistent, need-led support whilst they wait for their assessments?

Yes, we've seen huge improvement in that aspect, and I will give a shout out in terms of the waiting well. The RPBs are really, really fantastic in this space. I'm actually due to have a report today from my neurodivergent officials team around this, about what we should do going forward. Now, it's difficult because I am aware that, again, as the Cabinet Secretary said, I will be starting my maternity leave; I will not be continuing in this role. But it's about, now—. Personally, I would say that we should keep on this trajectory. We've done so much work with the health boards, and the health boards themselves have done so much work as well in reaching their targets—under three years; some of them have individual targets. I would now say, ‘Let's go for it and get it under the two years. Let's continue this momentum.’ It takes quite a long time sometimes to get the systems in place to be able to do these assessments, and they're in place now, so let's keep going—that's what I would say.

But, alongside that, we also need to be able to do the transformation of the service. I have the neurodevelopmental ministerial advisory group, and, ultimately, people don't want to just be doing assessments 24/7. They actually want to be able to get to a point where they're spending much more of their time actually helping the child and young person once they've had their assessment. So, it's a bit of a balancing act at the moment. I think that we should keep up the momentum. Let's head for that under-two-years target, but alongside that I would suggest that we give some more flexibility to the health boards to continue to do that transformation work alongside, so that we actually have a service that's fit for the future, once all the assessments are at the target that they need to be.

Okay. Thank you, Chair.

Thank you, Natasha. Thank you, Minister. I'll be bringing Cefin in now for the final set of questions. There are quite a few, so can we have concise answers as well, please, going forward? You've got six questions here, Cefin.

Diolch yn fawr iawn, Gadeirydd.

Yes. So, my next question is to you, Minister.

I'm going to ask the question in Welsh. We have the Health and Social Care (Wales) Act 2025 coming into force in April 2026, and there's a commitment in that Act to reduce the number of for-profit accommodation providers, and that was part of the co-operation agreement, if you remember, that that aim was delivered. But Care Inspectorate Wales notes that they're not seeing any significant change in registration tendencies currently, and note that about 58 per cent of the 43 new services are private for-profit providers. So, what's your assessment of this situation, and why, perhaps, haven't we seen more of a change in that space?

Diolch for that question, Cefin. I think it's important to say at the outset that the Act is being implemented in a phased way. That was always the intention. It was never the intention that we would start from April 2026 with an immediate move to not-for-profit. We knew that that would take us some time. It's just the framework that comes into place in April 2026. But, moving forward, we do expect to see a very clear shift away from for-profit provision and a steady increase in the not-for-profit capacity. It's probably worth pointing out that the Care Inspectorate Wales figures that you quote are absolutely correct, of course, but what we also see is that 40 per cent of the new registrations are actually in the not-for-profit area, and that's a significant increase on the previous six months. So, we are still seeing private for-profit providers coming in, and I suspect that's largely because that cut-off date is in April this year. So, anybody that still wants to operate in the system needs to register by 1 April this year.

What I would say—just to reassure the committee—is that, as a Welsh Government, we are absolutely committed to delivering this. We've provided somewhere in the region of £70 million between 2022 and 2025 to local authorities and regions to support delivery of the agenda, and we committed a further £75 million up until 2028. And, of course, there's separate capital funding for new builds through Welsh Government's integration rebalancing capital fund and the housing with care fund.

But the key element, I think, that is worth reiterating—and I know that you understand this, Cefin, because you were part of the co-operation agreement—is that you can't look at this in isolation. This is one element of a much wider transformation of children's services. And what we are seeing already in relation to the wider elements of the transformation of children's social services is a downward trend in the number of children that are coming into care. So, we're seeing around 200 fewer children that are coming into care now than we saw maybe a couple of years ago, and that's very much down to the work that we're doing, working with children on the edge of care and their families, to prevent as many children going into care as we saw previously. So, that's the general direction of travel, and I would like to think that we will be in the position that we want to be in by the cut-off date of April 2030.

Thank you very much. My next question is again about care-experienced children. This committee called for a statutory entitlement of parent advocacy, and that that is available for all parents across Wales who are at risk of entering child protection receiving care and support from social services. Now, National Youth Advocacy Service Cymru recently wrote to us reiterating the need for this change. So, with more than one in every 100 children in care in Wales, and no signs of a change in that upward trend, what is the rationale for not providing a legal basis for the advocacy services for parents which would be funded by Welsh Government?

Okay, diolch. Can I start by saying that we absolutely recognise the importance of parental advocacy, helping families to navigate the child protection system? It's absolutely vitally important. Parental advocacy is available nationally across Wales. We've recently enhanced the funding for parental advocacy by £800,000 and we recently announced the expansion of Parent Advocacy Network Cymru's parent cafe peer advocacy services, which are absolutely phenomenal. If you get the chance to go along to one of those peer advocacy cafes, you really should; it's quite inspirational. But, rather than placing the services on a statutory footing at this stage, our priority has been to work closely with the existing four advocacy providers and to co-produce clear national guidance that will ensure that all parents in the child protection arena can access independent, high-quality advocacy.

The rationale is not a lack of commitment. It really reflects on us building that robust, sustainable framework. We feel that we need to get that right, get the framework right, ensure that we're taking the right approach to parental advocacy, and when we're satisfied that we're in that space then it may be that looking at placing it on a statutory footing becomes something that we would consider. But we do feel that we need to get the foundations right first. We need to get the model right, and we need to make sure that we evaluate that the way in which it is being rolled out is being rolled out in a way that's effective. Then we would be open to a further discussion about putting that on a statutory footing.

So, you wouldn't rule it out?

We certainly wouldn't rule it out, but I think we need to get a robust, evidence-based framework in place first.

Okay. So, just to carry on on the theme of children in care, this committee called for a statutory entitlement of parent advocacy for all parents across Wales who are at risk of entering child protection receiving care and support from social services. Now, you've covered most of that by saying that the advocacy is there. So, in terms of the 'Radical reform' report, we made recommendations and expressed concerns about the fragility of the children in social care workforce—including the turnover of staff, vacancy rates and the use of agency staff—and emphasised how workforce issues have a significant and negative impact on care-experienced children. Yet your oral statement supporting the social care workforce on 24 February this year appeared to make no reference at all to any of these issues, focusing on the workforce to support adults instead. Why is that?

To be clear, my statement was not focused on adult social care; it was about the whole of the social care workforce. I don't know why the committee or you have the impression that I was only focusing on adult social care. If I gave that impression, I apologise, and I'm quite happy to clarify that. The key announcement that I made in that statement was the establishment of a national social care academy. I made it very clear that one element of that is that we look to those local authorities that currently have their own social care academies, that have the grow-your-own schemes, a number of which are focused on children's services and children's care. In fact, of the two grow-your-own schemes that I have visited directly, one of those was around children's services. There's one in RCT and one in Wrexham that I visited.

I also referred to the implementation of the fair pay agreement and made a very clear statement about the fact that what we have negotiated for Wales is the implementation of a fair pay agreement to cover children's services as well as adult services. The fair pay agreement in England, part of the employment Bill—the fair pay agreement in England—will only cover adult services. In Wales, we've negotiated that this will include children's services. I thought I was very clear in the oral statement, and I apologise if I wasn't, but I can absolutely guarantee you that what I was talking about was the improvement of social care recruitment and retention right the way across the sector, including children's services. Albert.

Thank you, Minister. I can support the fact that our approach is around children and adults, and I think that is different from some of the discussions that have taken place in England. I just think what's probably important for the committee, really, is the announcement the Minister made around the national care academy and the approach—I think that's a really good example of development in Wales. You'll be very aware of the establishment of the National Office for Care and Support, and I know that you inputted into that creation. It's now in its second year, but that's a really good example. The national office holds good practice events, and in the good practice events, actually, it was local authorities in some areas who were piloting care academies to improve their workforce recruitment and retention of children and adult care staff. And, I think it's great to see that, actually, as a good traveller now, we've been able to take it from what was good initiatives at a local level into a national approach, and that's been, I think, very creative of the work of both local partners, but also the new national office as well. Thank you.

Thank you for the clarity on that particular point.

Another question for you, through the medium of Welsh, and that's to do with Flying Start childcare. During our recent draft budget scrutiny, you told us that you had not been able to fully achieve the programme commitment to deliver a phased expansion of early years free child provision to include all two-year-olds. But you said you were 'pretty close' and gave written information noting that this provision was provided to 66 per cent of children. What do you anticipate that percentage to be by the dissolution, in your opinion? And on reflection, what more could have been done to get an offer to the remaining 34 per cent of children?

Okay. Thank you for that question. Well, the number of children that are reached by the end of this financial year depends on take-up. So, we can put the offer out there; what we can't determine is how many people actually decide to take it up. We expected to support more than 9,500 additional two-year-olds across Wales in 2023-24 and 2024-25, and the phase 2 delivery well exceeded that target. The latest statistics showed that, in that period, we offered childcare places to over 13,400 children. So, our target was around 9,500. We actually got to 13,400 children, and over 10,000 of those have benefited by taking up the Flying Start offer. So, that's the point I'm making. We offered it to 13,500; 10,000 took it up. So, 80 per cent of children took up their Flying Start childcare place.

Now in 2025-26, we started the phase 3, which is the universal roll-out, and we're investing a further £25 million for that. We would expect to reach more than 4,000 additional children on that particular phase, bringing us roughly to the 66 per cent that you've referred to. But as mentioned, this figure could change depending on the take-up levels. I can't tell you exactly what that figure will be. But, again, I'll refer us back to the conversations that we would have had during the co-operation agreement, Cefin, when it became apparent, during the discussions around the expansion of Flying Start, that the capacity constraints were what was was going to prevent us from reaching that full 100 per cent by the end of this Senedd term. So, there were capacity constraints in terms of staffing and there were capacity constraints in terms of funding. And you'll remember, in those early days of the co-operation agreement, that we had the most challenging financial position that this Senedd has found itself in in many a year, when we had budgets that were allocated in 2021 that were worth some billion pounds less because of inflation and so on by the time we were getting to the discussions about how we were going to roll this out. So, that ambition, actually, became increasingly challenging to deliver, but what we think we've done is we have reached a position where I think we are now in a better place. We've committed the funding to roll out as far and as wide as we can, and we're working very, very closely with our local authority colleagues to develop the childcare workforce that will enable all local authorities to roll it out.

Interestingly, we have two local authorities that have been able to reach the 100 per cent roll-out, and that's Merthyr Tydfil, of course, and Swansea. In Merthyr, I think what we saw was there was an infrastructure in place, because the whole of Merthyr was a Flying Start area, so they were able to upscale relatively quickly. In Swansea, we saw a significant commitment from that local authority to put additional investment in themselves, over and above what Welsh Government were putting in, to deliver the 100 per cent roll-out of Flying Start across Wales. So, I'm hoping that that commitment will continue. Of course, it won't be for me or the Cabinet Secretary to take that forward in the next term, but that's certainly our ambition, and I hope that will be the ambition of the incoming Government.

We have run out of time. We have one important question to ask, if that's okay? Would that be all right? Just regarding local authority safeguarding—could we just ask that question?

Sure.

Cefin, would you come in on that one, please?

Yes, okay. Well, as we know, Neil Foden was convicted of 19 counts of sexual activity—it's horrific, truth be told—with a child, while he was headteacher, and the subsequent child practice review found more than 50 missed opportunities, with nine of those being referrals to children's services. So, as the Minister responsible, what is your explanation for the repeated failures, time and time again, to provide that most fundamental safeguarding and protection to children, and also that inability to listen to their voices?

Thank you for that very important question. I'll place on record again that my thoughts always remain with Neil Foden's victims in all of this and with the bravery of those children that came forward to expose what was happening in plain sight for a number of years. The starting point here, I think, is important. Jan Pickles OBE, who led the review, was very clear that Welsh Government policies and procedures were robust, and the problems arose because these were not applied in practice. And it's also important to note that Gwynedd Council have accepted full responsibility for those failings and those missed opportunities. And in this case, the Welsh Government assurance around that going forward now is through the ministerial oversight board that we established. So, myself, the Cabinet Secretary for Education and the Cabinet Secretary for Local Government and Housing are meeting with Gwynedd local authority members and officers to scrutinise their responses to the recommendations of the child practice review, to ensure that we have the assurance that what we have put in place, in terms of Welsh Government policies and procedures, to deliver safeguarding in our schools and elsewhere are actually being applied in practice.

We remain absolutely committed to actively listening to children and to children's voices being at the heart of everything we do around safeguarding, and that applies to all agencies that work with children. This is not just in schools. This could be any organisation that works with children. They have to make sure that the voice of the child is there, front and centre. It was quite shocking to me to read that report and to see how many times children were not even spoken to when concerns and suspicions were being raised, and we cannot—we cannot—allow that to continue.

The Cabinet Secretary for Education and I have written to the regional safeguarding boards. We did that immediately following the publication of the CPR, asking them to provide assurance that they were embedding the learning from the report, particularly, as I said, around ensuring that the voice of the child is heard. And the safeguarding boards were given until 2 March to provide an overview of progress to date on that work. We have received the progress reports, and our officials are currently analysing them. So, I’m not in a position to tell you any more about that today, but we're happy to provide that information to the committee once we’ve had the opportunity to see that and to analyse it.

Quite rightly the focus is on Gwynedd, but how can we be absolutely clear that all local authorities now are embedding those clear guidelines on listening to the voice of children?

That is absolutely right, and one of the things that I said when I saw this report and I read what had happened was that, but for the grace of God, this could have been anywhere, because these people—. The point I made right at the outset—Neil Foden was operating in plain sight for decades, and that is what these people do, and we have to be alert to that, and we have to understand more effectively how these people operate and what grooming and sexual abuse actually looks like.

Now, I am going to be publishing the Welsh Government’s 10‑year strategy on the prevention of child sexual abuse in the next week or so. And it is very clear within that strategy that that element will be a very clear part of it—that anybody and everybody who is working with children will have to have training and development to understand what happens in these circumstances, what to look out for and how we respond to it.

Okay. I’ve got one more question, but we can send that in writing to you.

Yes. We’ve kept you almost 10 minutes over. I’d like to thank you for coming along today. You will be sent a transcript for checking as usual. I’d like to wish you well in whatever you choose to do. Jeremy, I think you’ve been here many times in your role covering education as well as social healthcare. So, good luck with whatever you do, and thank you to everybody.

That was our last scrutiny session of the sixth Senedd, so—.

Thank you very much.

Thank you very much, Chair. Diolch yn fawr.

I'll move on to item 3, which is papers to note. We have 14 papers to note today, full details of which are set out in the agenda and in the paper pack. Are Members happy to note the papers? Okay, thank you.

That takes us on to item 4, so, in accordance with Standing Order 17.42, that the committee resolves to meet in private for the remainder of today’s meeting. Are Members content to meet in private? Okay, thank you. Could we move to private?