:00:23. > :00:27.I think professional sport is looking strong in Newport at the
:00:28. > :00:33.moment and I wondered if you would join me in paying tribute to all of
:00:34. > :00:37.those people involved in making that a reality and particularly the
:00:38. > :00:41.grassroots support? Absolutely. I saw the scenes at the
:00:42. > :00:46.end of the game, the scenes of joy when the second goal went in against
:00:47. > :00:51.Notts County so I am more than happy to congratulate Newport county. The
:00:52. > :00:58.dragons have a bright future as well. The financial stability seems
:00:59. > :01:04.to be coming together and I fully recognise the importance of sporting
:01:05. > :01:08.development. The FA W over the past two years has been transformed, an
:01:09. > :01:12.organisation that now has a training facility in place. In terms of the
:01:13. > :01:17.importance of individual physical activity, I know how important this
:01:18. > :01:22.is and I know indeed that the member has spent the last 18 years telling
:01:23. > :01:33.me how important it is and I failed to follow his advice! We continue to
:01:34. > :01:37.take a broad range of actions to support the manufacturing industry
:01:38. > :01:41.against Wales. UK industrial output shrank for a third month in a row
:01:42. > :01:51.with the manufacturing industry falling by 5.6%. As a country, in
:01:52. > :01:54.Wales, with a proud manufacturing and industrial past, it is sad that
:01:55. > :02:03.the proportion of apprenticeships in manufacturing fell from 6% in 2006
:02:04. > :02:06.to a dismal 2% in 2014 and those are stats Wales figures, including the
:02:07. > :02:10.First Minister wants to accuse me again of misrepresenting the facts.
:02:11. > :02:14.Does he agree with me that it is acceptable to did for over a year
:02:15. > :02:18.with a new economic and industrial plan for this country and what hope
:02:19. > :02:21.is there for a future in industry in Wales on a global level when we're
:02:22. > :02:30.not providing the next generation with the skills to deliver? We will
:02:31. > :02:34.fund 100,000 apprenticeships in this Government, something we think is
:02:35. > :02:39.very important. He is right to put out manufacturing is of greater
:02:40. > :02:44.importance to the Welsh economy than it is to the UK as a whole. I do not
:02:45. > :02:52.accept what he says about dithering. We brought Aston Martin into Wales,
:02:53. > :02:56.we brought Qatar Airways into Wales. We currently work with 88 companies
:02:57. > :02:59.looking to expand or locate in Wales. We have been hugely active
:03:00. > :03:10.and investment figures speak for themselves. Question ten, Russell
:03:11. > :03:22.Jones. Superfast Cymru scheme in Montgomeryshire.
:03:23. > :03:34.It will be rolled out. We are now eight months away from the job dead
:03:35. > :03:39.date when the superfast Cymru projects, it seems to have
:03:40. > :03:45.continuing issues with residents. We were contacted by one constituent
:03:46. > :03:50.who complained that even though he had confirmation of superfast
:03:51. > :03:54.broadband via fibre to the premises technology in February this year, he
:03:55. > :03:57.also confirmed in writing by the Minister, he has now been told the
:03:58. > :04:04.situation has changed and the technology to be used is eager for
:04:05. > :04:09.the Cabinet and now he is too far away from the Cabinet to benefit
:04:10. > :04:13.from the upgrade. That situation is unacceptable and one minute he is
:04:14. > :04:16.told he will receive up to 330 megabytes and then the goalposts are
:04:17. > :04:21.changed and he finds he will not benefit at all. In February, they
:04:22. > :04:25.could have been other solutions but they are no longer available. Would
:04:26. > :04:29.you agree that it is important people are given the right
:04:30. > :04:32.information in the first place. Absolutely, perhaps if the member
:04:33. > :04:38.could write to me with the details of a problem I will of course
:04:39. > :04:41.investigate. The next item is the business statement and announcement
:04:42. > :04:50.about Korber Leader of the House, Jane hunt. The business committee
:04:51. > :04:52.has agreed to table a motion to suspend standing orders immediately
:04:53. > :04:54.after the business statement to allow tomorrow's short of eight to
:04:55. > :05:13.take place after today. I recently visited my GP and I had
:05:14. > :05:19.to go very early in the morning, 8am, and what I saw is unthinkable,
:05:20. > :05:25.I had to go past a couple of surgeries and people were waiting,
:05:26. > :05:32.7:30am to 8am, outside with children, able and disabled and
:05:33. > :05:34.senior people, with of course sickness. You have to make an
:05:35. > :05:41.appointment to see the doctor before 8am and the surgery door never
:05:42. > :05:44.opens. That is a surprisingly 21st-century. People waiting outside
:05:45. > :05:48.and not getting into it in this weather earlier in the morning and
:05:49. > :05:55.the surgery staff are already inside. So would you kindly make a
:05:56. > :06:00.statement about GP appointments in Wales, that includes, it will
:06:01. > :06:04.definitely have many surgeries in this country that all stood outside
:06:05. > :06:09.without shelter in this weather, could not some matter allow these
:06:10. > :06:15.patients to wait inside the surgeries and possibly a use of
:06:16. > :06:21.ticketing or numbers to be given and they can have a lot of numbers to
:06:22. > :06:26.see the nurses or the people who are inside give the appointments for the
:06:27. > :06:31.doctors. I think it would be great help for sick people, young and old,
:06:32. > :06:37.to make sure that statement is made on doctor appointment surgeries in
:06:38. > :06:41.Wales. The member raises an important question and it gives me
:06:42. > :06:47.the opportunity to say that our GPs in Wales provide a first class
:06:48. > :06:52.service to the population, the national survey continues to show
:06:53. > :06:58.high level of satisfaction, patients satisfied with GP services. We are
:06:59. > :07:06.continuing to invest new money in private care, 42.6 million this
:07:07. > :07:09.financial year alone. In terms of GP practices working together,
:07:10. > :07:16.collaboratively, we are investing 64 primary care clusters across Wales.
:07:17. > :07:22.That all means that in terms of access to GP surgeries, this Welsh
:07:23. > :07:23.Government is not only investing, supporting, but also patients
:07:24. > :07:32.increasingly satisfied with those services. Play-offs for a Government
:07:33. > :07:38.statement in the importance of universities and what the Government
:07:39. > :07:54.is doing to support the university sector. The importance as you say of
:07:55. > :07:56.universities is quite clear. The higher education sector makes a
:07:57. > :08:01.substantial contribution to the economy of Wales. University of
:08:02. > :08:05.Wales contributes more than ?3 billion a year in gross expenditure.
:08:06. > :08:11.Employee over 20,000 people and turnover in excess of 1.5 billion.
:08:12. > :08:16.Of course also contributing to sustainable, economic growth in many
:08:17. > :08:21.ways. Developing a highly skilled workforce through engagement with
:08:22. > :08:24.local communities. Clearly, there are examples the university sector
:08:25. > :08:33.can learn from across the world but I think we have real opportunities
:08:34. > :08:36.as the diamond review recognises, investment in higher education can
:08:37. > :08:47.bring those benefits for the economy. Thank you, if I can ask the
:08:48. > :08:53.Cabinet secretary for two statements. The first is quite
:08:54. > :08:56.simple, we have just announced that all parties in Wales are in favour
:08:57. > :09:01.of scrapping the Severn Bridge tolls. I look forward to that but it
:09:02. > :09:13.does leave one bridge in Wales which does have a toll and that is the
:09:14. > :09:23.Thamwong -- that is the Cleddau bridge and that is wholly in the
:09:24. > :09:28.hands of the Welsh Government. What is the Government's intention in
:09:29. > :09:33.terms of scrapping the Severn Bridge tolls and I believe the only bridge
:09:34. > :09:37.in Wales where it a bridge goes from one part of an enterprise to another
:09:38. > :09:42.so let's make sure Wales is free of tolls following, realising the
:09:43. > :09:48.dreams of the daughters of Rebecca at last. The second statement is a
:09:49. > :10:01.little more complex, relating to a planning application for a cabin
:10:02. > :10:07.holiday part in Bedd Gelert. The campsite in Bedd Gelert is to be
:10:08. > :10:11.done away with and there is a planning application for holiday
:10:12. > :10:16.cabins in the place which includes hot tubs and also some things, as
:10:17. > :10:22.well as a shop and visitors centre. The plan under pinning this is part
:10:23. > :10:25.of something that has emerged from the old Forestry Commission and
:10:26. > :10:33.therefore, I want a statement from the Government on the role of an RW
:10:34. > :10:40.in this application, as I understand it, NRW as the successor body to the
:10:41. > :10:45.Forestry Commission, has a 20% stake in this scheme and if it does
:10:46. > :10:53.proceed and is successful, in terms of its planning application, NRW
:10:54. > :11:00.will receive ?48,000 per annum in rent for 16 holiday cabins. That is
:11:01. > :11:08.3000 per cabin. The problem here is that NRW is also a regulator for the
:11:09. > :11:15.site and NRW as a regulator, has raised any objections of the
:11:16. > :11:22.development. -- has not raised any objections of the development. I
:11:23. > :11:27.would like to hear from the Government how exactly they expect
:11:28. > :11:30.NRW the balance that position and to make sure everything is done
:11:31. > :11:33.properly to make sure local people can be assured they are doing the
:11:34. > :11:40.proper work and safeguarding the local environment. It is a
:11:41. > :11:45.breakthrough that the Welsh Labour Government and indeed your cells
:11:46. > :11:49.have been crying out for, the Severn Bridge tolls to be removed and now
:11:50. > :11:56.the Tories are responding to our calls here from the Welsh Government
:11:57. > :12:02.and from parties in this chamber. It is very important therefore, we look
:12:03. > :12:07.at how this can progress. Your point about Cleddau bridge is well made
:12:08. > :12:12.and I am sure the Minister will want to update you about. Your second
:12:13. > :12:17.question, it draws attention to a whole range of issues which touch on
:12:18. > :12:22.powers and responsibilities of NRW. You have put it on the record now in
:12:23. > :12:29.terms of this application which does crossover issues relating to Tories
:12:30. > :12:35.and forestry and planning which the Minister has two reserve comment on
:12:36. > :12:41.but you have put it on record. Could I call for two statements, firstly
:12:42. > :12:50.on an issue I first raised 14 years ago and possibly earlier. That is
:12:51. > :12:55.deaf school pupils in Wales. In this UK deaf awareness week 2017, the
:12:56. > :13:00.latest Welsh Government figures have shown deaf school pupils are
:13:01. > :13:03.underachieving at every key stage with the national deaf children
:13:04. > :13:08.society for Cymru saying these pupils are being left behind without
:13:09. > :13:12.urgent action. The figures suggesting the attainment gap having
:13:13. > :13:17.temporarily fallen, has widened again at GCSE level. Having launched
:13:18. > :13:23.to close the gap following a poor set of results four years ago, the
:13:24. > :13:27.society has said the latest figures are unacceptable. Deafness is not a
:13:28. > :13:30.learning disability or difficulty and there is no reason why these
:13:31. > :13:34.people should be underachieving unless and only because they are not
:13:35. > :13:40.access in the appropriate support. As we call for 14 years ago, that
:13:41. > :13:46.means raising deaf awareness, improving acoustics in the classroom
:13:47. > :13:49.and making sure deaf children are supported from the start. I hope the
:13:50. > :13:53.Welsh Government will respond with a statement on this very serious
:13:54. > :14:00.issue. Having given it deep and serious consideration and considered
:14:01. > :14:04.how we might now move forward. Secondly, could I call for a
:14:05. > :14:15.statement on the Health Secretary on rare conditions in Wales, once he
:14:16. > :14:21.has read the spring 2017 edition of vasculitis UK's magazine. An article
:14:22. > :14:29.within it entitled what's up with Wales? This article says we have a
:14:30. > :14:35.really good relationship with all the leading medical vasculitis
:14:36. > :14:39.people in England but in Wales it is a different situation. Having been
:14:40. > :14:44.given diagnosis by the leading people in England, over the border,
:14:45. > :14:49.the advice seems to be ignored. There are various problems in
:14:50. > :14:51.England for people with rare diseases but this seems to be a last
:14:52. > :15:04.century attitude in Wales. Even if that is not 100% accurate,
:15:05. > :15:07.the fact that these people hold that as their experience of treatment in
:15:08. > :15:10.Wales and put it into a national magazine merits attention and hope
:15:11. > :15:15.it will justify a statement accordingly. I am grateful that Mark
:15:16. > :15:20.Isherwood has kept faith, as you do, with these very important issues you
:15:21. > :15:24.have raised with me, I am sure not just 14 years ago, an issue not just
:15:25. > :15:31.for health ministers and responsibilities, but also education
:15:32. > :15:39.ministers and responsibilities as well. Our mission is to raise
:15:40. > :15:43.standards and improve attainment at all levels. We do aim to achieve
:15:44. > :15:47.this through the range of educational reforms that are
:15:48. > :15:51.currently under way. Our ambitious additional learning needs Bill, if
:15:52. > :15:55.passed, will completely overhaul the system for supporting pupils with
:15:56. > :15:59.additional learning needs, including learners with hearing impairments. A
:16:00. > :16:03.20 million package of funding will support implementation and build on
:16:04. > :16:08.our wider plans, including developing workforce, but I do
:16:09. > :16:15.recall again, and I'm sure the Cabinet Secretary for will be able
:16:16. > :16:20.to update us on this, on the ways in which we ensure that in our capital
:16:21. > :16:24.investment programme, 21st century schools will particularly be looking
:16:25. > :16:28.at these issues, when we were developing that ambitious programme,
:16:29. > :16:34.to ensure that we can take this on board in terms in the ways those
:16:35. > :16:40.buildings could assist that and that is very much part of raising deaf
:16:41. > :16:44.awareness for policy makers, as well as for those who are delivering the
:16:45. > :16:50.services. On your second point, in terms of where conditions... I have
:16:51. > :16:54.certainly over the vet met -- over the years met with groups, as you
:16:55. > :16:57.will have done, and with professionals who were delivering in
:16:58. > :17:05.terms of addressing the needs of people with rare conditions and I
:17:06. > :17:09.don't recognise that statement that was given, I know that the Cabinet
:17:10. > :17:12.Secretary will be taking very serious consideration of how we are
:17:13. > :17:21.progressing in terms of meeting those needs. Some six weeks ago,
:17:22. > :17:24.Julie Morgan and I wrote to the Cabinet Secretary for the
:17:25. > :17:30.environment and planning about the threat to the most vibrant live
:17:31. > :17:36.music venue in Cardiff, which is at one in the street, because of the
:17:37. > :17:49.threat of planning applications for a hotel and residency applications
:17:50. > :17:53.-- Womanby Street. I am is ??DELETE alleged she is back after the life
:17:54. > :17:59.changing injuries she suffered in the accident but now she is back, I
:18:00. > :18:03.wonder with a she is able to tell us if it is able to introduce new
:18:04. > :18:06.planning guidelines so it is absolutely clear to any developers
:18:07. > :18:12.that the agent of change in any development has to be met by the
:18:13. > :18:17.person who's making the applications, because under the
:18:18. > :18:22.current planning laws, the whole of Womanby Street could be put out of
:18:23. > :18:28.business if these applicants are successful, and they could then
:18:29. > :18:32.insist that the live music venue has to pay the soundproofing, etc, which
:18:33. > :18:34.in any case is likely to be ineffective because people on the
:18:35. > :18:39.street will cause noise whether they are inside or outside of a venue.
:18:40. > :18:46.There is over nearly 1,000 jobs at risk here, as well as many millions
:18:47. > :18:51.of pounds from music tourism, so I wondered if we could envisage an
:18:52. > :18:54.early statement on how we can change the law to ensure that any new
:18:55. > :18:59.development has to make it clear that they are going to have to pay
:19:00. > :19:05.for the costs of any mitigation that is resulting from a new development.
:19:06. > :19:09.I thank Jenny Rathbone for raising this very important issue, again,
:19:10. > :19:15.this important campaign that Julie Morgan also raised with you. Lesley
:19:16. > :19:21.Griffiths is back in business, certainly wanting to meet with you
:19:22. > :19:26.to discuss this issue. She certainly is very concerned to make sure that
:19:27. > :19:31.the principle of making agents of change responsible for managing the
:19:32. > :19:39.impact of new development is made very explicit in any future revision
:19:40. > :19:43.to planning policy in Wales. It is already there, already contained
:19:44. > :19:48.within planning policy Wales, but clearly needs to be more explicit
:19:49. > :19:51.and I think the Cabinet Secretary, now of course for environment and
:19:52. > :19:57.rural affairs, is willing to meet with you to discuss how it can be
:19:58. > :20:03.taken forward. TRANSLATION: Thank you. I was very
:20:04. > :20:14.pleased a few days ago to see the Welsh Government noting can guess
:20:15. > :20:21.the station is one that could be reopened if in the future, the work
:20:22. > :20:29.my predecessor did on the feasibility study on opening the
:20:30. > :20:33.line through Llanelli which would bring huge benefits to Anglesey and
:20:34. > :20:36.I know that we would be more than happy to discuss this issue further
:20:37. > :20:41.with Government, but would it be possible to have a statement from
:20:42. > :20:46.the Cabinet Secretary for transport on the additional work that needs to
:20:47. > :20:53.be done now in order to transform this exciting idea into reality? The
:20:54. > :20:56.Cabinet Secretary, as you have acknowledged, recently announced the
:20:57. > :21:01.prioritisation of 12 new railway stations across Wales. That decision
:21:02. > :21:05.was made assessing a number of proposals against the well-being
:21:06. > :21:11.goals set out at the well-being and future generations act. And clearly
:21:12. > :21:17.now, it is about working with local authorities, partners and all those
:21:18. > :21:21.who can progress proposals for those stations, including the station in
:21:22. > :21:25.your constituency, with a view to future considerations, so I know the
:21:26. > :21:31.Cabinet Secretary will want to update the Assembly on this matter.
:21:32. > :21:36.Can I call the two statements, please? One in relation to the
:21:37. > :21:40.regulation of drones and light aircraft. I've received a number of
:21:41. > :21:44.complaints recently from residents in my own constituency about the use
:21:45. > :21:48.of drones in residential areas hovering over people's back gardens,
:21:49. > :21:54.filming local residents and invading their privacy and in addition to
:21:55. > :22:00.that, there have been complaints about the use of light aircraft on
:22:01. > :22:04.beaches which are right adjacent to the rail infrastructure and indeed
:22:05. > :22:08.the trunk road network and, of course, if any of those microlights,
:22:09. > :22:13.etc, had an accident, that could cause a serious problem on those
:22:14. > :22:16.particular pieces of infrastructure, so I would appreciate a statement
:22:17. > :22:20.from an appropriate Cabinet Secretary about the way we can best
:22:21. > :22:24.regulate these whilst still allowing people to use them for leisure
:22:25. > :22:28.purposes. Can I also call for a statement on access to GPs. I know
:22:29. > :22:35.my colleague has also raised this as an issue but the National pensioners
:22:36. > :22:40.a report recently on access to GP services in Wales and it found there
:22:41. > :22:46.was significant problems with accessing some appointments in some
:22:47. > :22:49.surgeries and it was largely due to the inconsistency around appointment
:22:50. > :22:54.arrangements. So it reported that while some surgeries were offering
:22:55. > :22:58.same-day appointment only, others were allowing people to book in
:22:59. > :23:03.advance and offering a more flexible approach, which seemed to be much
:23:04. > :23:06.better for patients in terms of their patient experiences, so I do
:23:07. > :23:11.think it is about time we had a statement on GP access and how to
:23:12. > :23:19.improve that overall and I would appreciate it if one could be
:23:20. > :23:21.scheduled. I think the importance of access to GPs, I've already
:23:22. > :23:31.commented on that in response to an earlier question, but I think the
:23:32. > :23:37.changes to the GP contract for 2017-18 is important in terms of the
:23:38. > :23:43.ways in which you can provide for new, enhanced services and also to
:23:44. > :23:47.take forward the quality and outcomes, which is where ready to
:23:48. > :23:53.see the consistency in terms of delivery. That's going to free up
:23:54. > :23:57.more capacity for GPs and also access to practice nurses, which we
:23:58. > :24:04.must of course remember is equally important in terms of the primary
:24:05. > :24:10.care team and services provided. And also, it means patients can be seen
:24:11. > :24:14.by the most appropriate professional for their needs. This is an issue
:24:15. > :24:17.that in terms of GP surgeries, we are addressing. On your first
:24:18. > :24:24.question, I will obviously take back and identify which Cabinet Secretary
:24:25. > :24:28.is appropriate to answer your important question. Indeed, if we
:24:29. > :24:36.have powers at all in terms of the use of drones and the impact in
:24:37. > :24:46.terms of invasion, if you like, of Private space and the use of them as
:24:47. > :24:48.well. Could we find time for a statement on the detrimental impact
:24:49. > :24:55.on Welsh Government policies of well-being and promoting prosperity
:24:56. > :24:59.of cuts, existing cuts and possible future codes to disability benefits
:25:00. > :25:05.in the South Wales valleys and throughout Wales? A ?30 a week cut
:25:06. > :25:09.to some new claimants of the employment and support allowance
:25:10. > :25:13.came into effect last month, so disabled people put in the
:25:14. > :25:17.work-related activity group will now receive ?73 a week. I will just
:25:18. > :25:21.repeat that, ?73 a week. I wouldn't be able to live on that and also
:25:22. > :25:25.cope with the additional challenges and costs that people with
:25:26. > :25:30.disabilities have. The Prime Minister Theresa May says this lower
:25:31. > :25:37.rate of support will, in her words, "Encourage disabled people to find
:25:38. > :25:40.work." Yet over 30 disability charities, authoritative disability
:25:41. > :25:44.charities, said the cuts do not incentivise work at all but they do
:25:45. > :25:48.make life harder for disabled people who face extra costs of living and
:25:49. > :25:53.they mean some people will be unable to afford basic necessities. Last
:25:54. > :25:59.week, the Prime Minister refused to rule out further cuts for people
:26:00. > :26:03.with disabilities, so if things are bad now, we can only imagine what
:26:04. > :26:06.things might be if a Conservative Government is elected for the next
:26:07. > :26:13.five years. So can we have a statement to shine the light on
:26:14. > :26:19.effect of these prove who you delete -- of these punitive decisions and
:26:20. > :26:22.the communities they live in. I am very grateful it has been brought to
:26:23. > :26:28.our attention in the chamber today and I have to say that in my
:26:29. > :26:31.constituency capacity, I am being approached by people who are now
:26:32. > :26:38.suffering directly as a result of the further cuts to welfare benefit,
:26:39. > :26:47.particularly affecting disabled people, the 1st of April. People who
:26:48. > :26:55.are struggling and are losing access to notability, for example, and then
:26:56. > :26:59.having contradictory expectations, which, of course, cannot be
:27:00. > :27:04.delivered, and all reducing their income levels. We Remain deeply
:27:05. > :27:09.concerned about UK Government's changes for employment support
:27:10. > :27:13.allowance claimants assigned to the work-related activity group, which
:27:14. > :27:16.started in April this year. It will see new claimants receive
:27:17. > :27:23.approximately ?29 per week less, existing claimants -- than existing
:27:24. > :27:27.claimants and it is the cuts on new claimants, we have to remember that,
:27:28. > :27:31.the DWP estimate 500,000 families in Great Britain will be affected and
:27:32. > :27:37.in the longer term, 35,000 affected claimants will be in Wales and it is
:27:38. > :27:40.the local authority areas in the South Wales valleys, particularly
:27:41. > :27:48.those claimants, affected on the higher PSA rates. And as a Welsh
:27:49. > :27:55.Government, we are taking action to help people to manage the effects of
:27:56. > :28:00.the UK Government's welfare benefit changes and we will continue to
:28:01. > :28:04.analyse the impacts of such cuts and monitor those impacts, putting more
:28:05. > :28:10.money into our advice services, credit unions and support services
:28:11. > :28:18.is crucial. It would be very helpful is crucial. It would
:28:19. > :28:22.for us to bring to the wider for us
:28:23. > :28:23.discussion a statement by the Cabinet Secretary, it would be very
:28:24. > :28:30.helpful to this chamber and disassembly. Three brief areas, if I
:28:31. > :28:36.may. Firstly, can I support Mark Isherwood's earlier call for a
:28:37. > :28:40.statement of support given by the Welsh Government for rare diseases.
:28:41. > :28:44.You mentioned vasculitis, an area of concern close to my heart. Many of
:28:45. > :28:50.these sufferers of the rarer diseases do often feel left out. It
:28:51. > :28:54.is natural for large diseases, cancer, heart disease, to get the
:28:55. > :28:58.lion's share of funding but over time, it is important that we do
:28:59. > :29:01.send a signal to sufferers of rare diseases that they are being taught
:29:02. > :29:07.about and policy is filmed around them too. Secondly, I think it is
:29:08. > :29:12.six months now since the Cabinet Health Secretary made a statement
:29:13. > :29:20.giving the go-ahead for the specials and critical care centre income
:29:21. > :29:27.bran. I think 2022 was the date given for a solution backstreet
:29:28. > :29:32.completion for that project. Can we have an update -- was the date given
:29:33. > :29:36.for completion of that project Chris Watt can we have an update on that?
:29:37. > :29:42.Finally, I drove along the heads of the valleys road on the weekend and
:29:43. > :29:45.it is good to see that coming on. That's a fantastic piece of road and
:29:46. > :29:53.there are many economic potential benefits, I can see the member
:29:54. > :29:59.nodding vigorously at that. However, just down the road, you have got the
:30:00. > :30:04.a 40 that links Abergavenny to Raglan and Monmouth in my
:30:05. > :30:08.constituency, which is an ageing concrete road causing hassle for
:30:09. > :30:11.commuters and people living in adjacent areas, so if we are going
:30:12. > :30:15.to have this fantastic piece of road kit up at the heads of the valleys,
:30:16. > :30:18.it doesn't make any sense to have a poorer piece of road infrastructure
:30:19. > :30:21.feeding into it, so I wonder if we could have a statement from the
:30:22. > :30:24.Cabinet Secretary of the transport are Harry intends to build on the
:30:25. > :30:27.development of the heads of the valleys and make sure the
:30:28. > :30:33.surrounding network is also build up to standard.
:30:34. > :30:38.The Cabinet secretary for health and well-being and sport is sitting here
:30:39. > :30:41.listening to your first two questions, one of which I did
:30:42. > :30:48.respond to in terms of rare diseases and the importance of the priorities
:30:49. > :30:56.we give to that. But also to the state of play in terms of critical
:30:57. > :31:00.care centre. Wonderful new heads of the valleys roads with more funding
:31:01. > :31:08.coming through innovative finance to complete it. Also, seeing the sign
:31:09. > :31:13.which you will have seen, saying, funded by the European Union, I
:31:14. > :31:19.think strikes me as a back road would not be built without us being
:31:20. > :31:27.a member of the European Union. As well as Welsh Government funding as
:31:28. > :31:32.well. That has made a huge impact in terms of the Welsh economy and
:31:33. > :31:36.access to your constituency and then of course, nick Robinson, you
:31:37. > :31:41.mentioned the roads that came up to be a full 65 and that is a matter of
:31:42. > :31:49.our work and partnership together with your local authority. Thank
:31:50. > :31:53.you, Leader of the House and the next item is the motion to
:31:54. > :32:00.temporarily suspend standing orders, to allow the short debate scheduled
:32:01. > :32:04.for the 17th May to be debated as the last item of business today. I
:32:05. > :32:11.call a member of the business committee to move motion. The
:32:12. > :32:19.proposal is to suspend standing orders. The motion is therefore
:32:20. > :32:24.agreed in accordance with standing order 12.36 and the next item is a
:32:25. > :32:29.statement by the Cabinet secretary for health, well-being and sport on
:32:30. > :32:35.end of life care. I call on the Cabinet secretary. On 27th of March
:32:36. > :32:39.this year, I published the updated palliative and end of life care
:32:40. > :32:43.delivery plan. This plan reaffirms our commitment to make sure people
:32:44. > :32:48.have a realistic, healthy approach to diet and can plan appropriately
:32:49. > :32:53.for the event. We want people to be able to end their days in the
:32:54. > :32:57.location of their choice. Be that home, hospital or hospice. And we
:32:58. > :33:03.want them to have access to high-quality care wherever they live
:33:04. > :33:06.and die, whatever the underlying disease or disability. This plan
:33:07. > :33:11.covers all aspects of palliative and end of life care. Delivered by both
:33:12. > :33:17.primary and secondary sectors and involving specialist palliative care
:33:18. > :33:26.by the NHS and third sector providers. To build on the success
:33:27. > :33:30.of the first plan, it has been updated to reflect the latest change
:33:31. > :33:35.and has strengthened children and young people and research sections.
:33:36. > :33:37.We no care at the end of life has improved greatly since the
:33:38. > :33:43.publication of the first delivery care plan in 2013. Consultants in
:33:44. > :33:47.palliative medicine are now available on call 20 47 across Wales
:33:48. > :33:52.to provide advice and support to other professionals and visit
:33:53. > :33:55.patients where required, enhancing the service provided by clinical
:33:56. > :34:02.nurse specialist at weekends. The support is now in place for
:34:03. > :34:06.specialist teams the work seven days a week. This provides front line
:34:07. > :34:12.staff with valuable support at weekends, enabling patients with end
:34:13. > :34:15.of life care needs to avoid hospital admission where appropriate and
:34:16. > :34:24.patients with complex needs to remain at home. Also we are
:34:25. > :34:28.improving hospice at home provision. All general practices have a ratio
:34:29. > :34:35.of patients with supportable palliative care needs. We have
:34:36. > :34:41.established a 24 hour out of our telephone advice service which is
:34:42. > :34:46.now available across Wales. Dying is of course an inevitable event. I
:34:47. > :34:50.fully appreciate it is not a subject many people are comfortable talking
:34:51. > :34:54.about but it is vital people let their loved ones know how they wish
:34:55. > :34:58.to end the days when the time comes. Planning for the end of life through
:34:59. > :35:01.open conversations can result in a better death and certainly help the
:35:02. > :35:06.grieving process for those left behind. Last week, I attended a
:35:07. > :35:12.conference and was pleased to launch the new website for advanced care
:35:13. > :35:15.planning. Today, you can find most of the information online and it
:35:16. > :35:21.will be useful to have that resource on the internet at their fingertips.
:35:22. > :35:26.We have provided ?150,000 to train staff in end of life care. This
:35:27. > :35:30.enables colleagues to begin and manage serious illness conversations
:35:31. > :35:34.with parents, families and carers. The end of life care implementation
:35:35. > :35:39.board provide strong leadership and oversees the delivery of the plan.
:35:40. > :35:42.As is the case with all major health conditions, the board sees ?1
:35:43. > :35:47.million annually to support the priorities. The Welsh Government
:35:48. > :35:52.allocated an additional million pounds to further enhance end of
:35:53. > :35:58.life care provision. The board has identified provisionally this
:35:59. > :36:03.funding will be used in a compassionate community approach for
:36:04. > :36:08.palliative care. Supporting the development for an all Wales
:36:09. > :36:14.development record and take research priorities and the poor GP clusters
:36:15. > :36:18.in Wales. The Government provides also ?6.4 million in funding support
:36:19. > :36:22.specialist palliative care services provided by hospices and health
:36:23. > :36:24.boards throughout Wales. This significant investment is a
:36:25. > :36:29.reflection of the importance of this Welsh Government places on end of
:36:30. > :36:33.life care. It is vital individuals receive the best possible care in
:36:34. > :36:37.the location of their choice at the end of the days. Direct feedback
:36:38. > :36:44.from patients and their families about specialist palliative care
:36:45. > :36:46.services in Wales have shown that year, these services make a huge
:36:47. > :36:53.difference to people's quality of life in the closing days. 93% of
:36:54. > :36:58.responses to the patient evaluation of the experience of palliative care
:36:59. > :37:02.was positive and the average score was 9.5 out of ten across all
:37:03. > :37:07.domains. This would not be possible of course without the dedication and
:37:08. > :37:11.professionalism of our workforce. I do want to take a moment at the
:37:12. > :37:15.stage to acknowledge the work of our clinicians, nurses and other staff
:37:16. > :37:19.providing care for people at the end of their lives. They can be fewer
:37:20. > :37:24.jobs, more or mostly demanding yet more necessary. I'm sure you'll all
:37:25. > :37:30.join me in recognising and thanking our staff for work. Dying is a
:37:31. > :37:35.social matter. How well we care for people who were dying reflect on how
:37:36. > :37:39.we care as a society. Advances in modern medicine and treatment have
:37:40. > :37:46.resulted in a growing population living longer with incurable
:37:47. > :37:49.diseases. It is vital good end of life in palliative care is made
:37:50. > :37:53.available across Wales. The delivery plan was developed through effective
:37:54. > :37:58.partnership working, that continued cooperation between the Government
:37:59. > :38:02.of Wales, implementation board, NHS, professional bodies at the third
:38:03. > :38:06.sector is key to delivering outcomes at a greater pace and with greater
:38:07. > :38:09.impact. We should recognise the challenges ahead are many other
:38:10. > :38:18.significant but we can look forward to the future with a sense of shared
:38:19. > :38:23.direction and confidence. This week is dying matters awareness week
:38:24. > :38:28.2017, placing the importance of talking about dying, death and
:38:29. > :38:33.bereavement firmly on the Welsh and UK agenda. I very much welcome as
:38:34. > :38:37.chair of both the cross-party group on hospices and palliative care at
:38:38. > :38:42.the cross-party group on funerals and bereavement, with an estimated
:38:43. > :38:46.32,000 people dying in Wales each year, that is affecting somewhere
:38:47. > :38:52.between 160,000 and one third of a million people directly. In Wales
:38:53. > :38:57.each year. Many vulnerable to serious additional problems,
:38:58. > :39:02.suicide, lonely dice, social isolation, anxiety, depression and
:39:03. > :39:07.social problems. The majority of end of life care in Wales is provided by
:39:08. > :39:14.hospices across a range of settings including inpatient units and
:39:15. > :39:18.hospice and home services. There are lessons the NHS could learn from
:39:19. > :39:23.hospices, especially about the integration of care services in the
:39:24. > :39:27.home Community Hospital and hospice. I've been asking successive health
:39:28. > :39:36.ministers and our Health Secretary for many years, to start asking or
:39:37. > :39:39.making sure NHS will start asking our wonderful community, hospice
:39:40. > :39:46.movement, how it can help them deliver more for the resources
:39:47. > :39:50.available in modern Wales, delivering services with them. And
:39:51. > :39:57.too many still feel that is not the case. I wonder if you could respond
:39:58. > :40:03.to that point. Hospices Cymru, as you will be aware, are receiving
:40:04. > :40:07.Welsh Government funding on a ring-fenced basis through health
:40:08. > :40:13.authorities over three years period. That period finishes in 2018. Can
:40:14. > :40:19.you provide assurance to them whether that funding will continue
:40:20. > :40:23.to be ring fenced when the existing funding expires because they need to
:40:24. > :40:28.go for the forward planning, and if not, can you indicate when you might
:40:29. > :40:34.be able to provide that assurance or at least information? 16 to 20%
:40:35. > :40:37.hospices in Wales still receive far less Government funding, that's
:40:38. > :40:43.Welsh Government and Welsh NHS funding, than the English and
:40:44. > :40:47.Scottish counterparts. They also highlight a postcode lottery of
:40:48. > :40:52.hospice services with the disparity of care available between different
:40:53. > :40:59.parts of Wales. When will the Welsh Government finally in the context of
:41:00. > :41:03.my previous question, recognise that by discussing and designing and
:41:04. > :41:11.delivering with them on a more balanced funding basis, it is win-
:41:12. > :41:16.win for everybody and a means of delivering in a strict budget
:41:17. > :41:19.environment? At the end of life implementation board, as you
:41:20. > :41:24.indicate, has been allocated an extra million pounds in 2017-18 and
:41:25. > :41:30.one of the provisional areas identified for that is developing a
:41:31. > :41:36.compassionate community 's approach the end of life care. To a half
:41:37. > :41:39.months ago, I went to a lecture on a compassionate community approach the
:41:40. > :41:43.end of life care. Highlighting the need to provide people near the end
:41:44. > :41:48.of their lives with the support they need to remain in their communities
:41:49. > :41:50.by providing health, promotion and community development principles,
:41:51. > :41:56.and providing support to those who are dying and those who are
:41:57. > :41:59.bereaved. How therefore do you respond, not just in terms of a
:42:00. > :42:04.provisional part of ?1 million for one year, but to the call by married
:42:05. > :42:08.here for Wales to become a compassionate nation following the
:42:09. > :42:12.lines of the compassionate community model, that has successfully been
:42:13. > :42:19.developed in numerous towns and communities in the UK, including
:42:20. > :42:23.Somerset. It is not about more money but using the existing money wisely
:42:24. > :42:29.to improve outcomes and lives. How would you respond to the calls by
:42:30. > :42:32.age Cymru on end of life care for the Welsh Government to provide
:42:33. > :42:35.direction on effective collaboration between local health boards and
:42:36. > :42:40.local authorities, to make sure equal access for all the people in
:42:41. > :42:43.hospice care and for the Welsh Government to carry out a robust
:42:44. > :42:49.monitoring of the fermentation, delivery and outcomes of it end of
:42:50. > :42:53.life care delivery plan to determine whether it is delivering real
:42:54. > :42:58.improvements in palliative care and end of life care for older people in
:42:59. > :43:03.Wales is to mark how do you respond to Macmillan's calls for people
:43:04. > :43:08.approaching the end of their life, who will benefit from the support of
:43:09. > :43:10.palliative care services, to be identified said that earlier
:43:11. > :43:16.discussions may start about their care. For people's preferred place
:43:17. > :43:24.of death to be recorded early and for health and social care services
:43:25. > :43:30.to be coordinated so that people can die well in the place of their
:43:31. > :43:36.choice? Are you coming to the end? Thank you for allowing this.
:43:37. > :43:46.Hospices Cymru is supporting the ambitions for palliative and end of
:43:47. > :43:52.life care framework... This has ambitions for each person seen as an
:43:53. > :43:57.individual, to have the access to care and coordinating care and much
:43:58. > :44:00.more. How would you respond to the call for this model to become more
:44:01. > :44:08.integrated into the Wales end of life care delivery plan, so that we
:44:09. > :44:14.can all learn from each other and benefit together? Thank you for the
:44:15. > :44:19.series of questions which I'm aware the member has raised on a number of
:44:20. > :44:23.occasions in the past. He is consistently interested in this
:44:24. > :44:27.area. It was dying matters week last week which is when I attended a
:44:28. > :44:31.conference. I spoke to them about their work and recognise what they
:44:32. > :44:35.have done in promoting this as a more national and natural
:44:36. > :44:40.conversation to have. There is more work to be done with them but also
:44:41. > :44:44.among all of us and the community we represent. I certainly don't
:44:45. > :44:50.underplay the contribution of the hospice movement. And the variety of
:44:51. > :44:52.hospices around the country which was the main focus of the questions
:44:53. > :45:02.and comments made. Most members in this chamber Wardle
:45:03. > :45:08.the local hospice their constituents attend, if not having hospices in
:45:09. > :45:12.constituencies oral regions and I have regularly visited a number of
:45:13. > :45:15.hospices in this role but have two in my own constituencies, so I
:45:16. > :45:19.understand perfectly well the role they play in engaging with
:45:20. > :45:22.clinicians and the public and designing the care that better meets
:45:23. > :45:27.a person's needs. One of the significant steps forward in the
:45:28. > :45:30.last plan and carrying on in an Exxon is promoting the hospice at
:45:31. > :45:35.home movement, so people don't need to go into a hospice but can run
:45:36. > :45:45.their hospice care at home, there have been real strides made forward.
:45:46. > :45:48.In the way the carers commission and boards do, hospices are very much
:45:49. > :45:53.part of the design and delivery of this plan and I don't necessarily
:45:54. > :45:59.share the member's rather pessimistic approach and assessment
:46:00. > :46:04.of the contribution designing this strategy, but also understand the
:46:05. > :46:10.success its impact on palliative end of life care. And in terms of the
:46:11. > :46:16.financial matters raised, well, as I've indicated, the million pounds
:46:17. > :46:21.goes to each of the major conditions, each has ?1 million
:46:22. > :46:27.allocated and I mentioned the 6-4p spent recurrently in this area. I am
:46:28. > :46:32.aware of the issues in fruit that he mentioned about the pastoral
:46:33. > :46:37.community approach and approaches have been made to see what happens
:46:38. > :46:40.in that particular community and it is something to build upon here in
:46:41. > :46:44.Wales and I look forward to having the ongoing concession I will have
:46:45. > :46:51.with the end of life care board and all of its members and supporters,
:46:52. > :46:55.for us to be a more compassionate notion. And I will end with your
:46:56. > :46:59.point about outcomes and delivery, because part of the strength of the
:47:00. > :47:05.delivery plan approach that we take is that we take an issue of major
:47:06. > :47:08.significance. We bring together people from Government, from the
:47:09. > :47:13.health sector and the third sector and leading clinicians in the field,
:47:14. > :47:17.and there is a constructive and helpful tension created both an
:47:18. > :47:21.understanding and agreeing priorities and the priority is being
:47:22. > :47:25.carried forward and of the dialogue is open and honest and there are
:47:26. > :47:27.times when the delivery plans, there are times when the delivery plans,
:47:28. > :47:33.their associated delivery wards, recognise they haven't made all the
:47:34. > :47:40.approach is needed. I look forward to honest reporting on how we have
:47:41. > :47:44.not done and priorities in the future. TRANSLATION: May I thank the
:47:45. > :47:49.Cabinet Secretary for his statement and for all of work done by staff
:47:50. > :47:54.and volunteers in the Health Service and the third sector in providing
:47:55. > :48:03.end of life care and palliative care across Wales. I don't think there is
:48:04. > :48:06.much new, if truth be told into Dave's statement, although it is
:48:07. > :48:13.always useful to have an update, so may I refer perhaps to what should
:48:14. > :48:17.happen in the mind of one of the organisations involved in this area
:48:18. > :48:21.and I will list some of the requirements they have set out. They
:48:22. > :48:26.want palliative and end of life care to be an entirely central part of
:48:27. > :48:29.care planning for those with chronic and long-term conditions. They want
:48:30. > :48:34.better coordination between local authorities and health boards in
:48:35. > :48:40.order to give equal opportunity for everyone in the population to have
:48:41. > :48:44.access to hospital care. They want end of life care commissioned by
:48:45. > :48:50.local health boards to include comprehensive care for people in
:48:51. > :48:53.care homes. They want every institution and professional work to
:48:54. > :48:58.get the necessary training and ensure continuity of training
:48:59. > :49:08.throughout their working lives. They want to see or rather, they want the
:49:09. > :49:13.orders to not attempt resuscitation or ceasing to provide food and drink
:49:14. > :49:17.not to be put in place without full consultation with family or other
:49:18. > :49:22.carers and finally, they want an assurance of very careful monitoring
:49:23. > :49:28.on the implementation and delivery of end of life care plans, so that
:49:29. > :49:31.it does deliver better care, so we are in a situation where some steps
:49:32. > :49:36.have been put in place by Government, there is clearly more to
:49:37. > :49:41.be done in the eyes of those involved in this area, so three
:49:42. > :49:44.questions emerging. One, do you disagree with any of those
:49:45. > :49:48.recommendations and if you don't, when can we be given an assurance
:49:49. > :49:55.that those will have been implemented. Secondly, the annual
:49:56. > :49:58.report mentions improvements in palliative care for children and
:49:59. > :50:03.naturally, that is something that we welcome, but there are far too many
:50:04. > :50:10.children who can't spend their last days in their own homes. Would you
:50:11. > :50:15.agree that there is some work to be done in that area and do you
:50:16. > :50:24.acknowledge that we need to strengthen services to support the
:50:25. > :50:29.siblings of those who have suffered bereavement. And finally, minority
:50:30. > :50:33.ethnic groups are particularly identified by Marie Curie as an area
:50:34. > :50:39.where services need to improve, so what are the Government intend to do
:50:40. > :50:46.about that specifically? Thank you for the series of questions and
:50:47. > :50:48.comments and in terms of the priority that age country
:50:49. > :50:51.identified, it is in the work I outlined of the board is taking
:50:52. > :50:57.forward. Part of the strength of the work we are doing is having that
:50:58. > :51:01.cross-section of people with a genuine interest in the area setting
:51:02. > :51:11.a list of priorities. We often get different bids and not having a
:51:12. > :51:19.cohesive approach. But the things you mention, they are priorities for
:51:20. > :51:21.the board in the year ahead. The second particular issue, paediatric
:51:22. > :51:27.palliative care. There was a concern about whether this had been properly
:51:28. > :51:33.taken account of in moving forward and I met a group of paediatric
:51:34. > :51:38.palliative care conditions and it was a very constructive conversation
:51:39. > :51:41.and I think they have moved forward and her understanding that their
:51:42. > :51:46.issues are properly taken account of and there is a definite step forward
:51:47. > :51:51.in this iteration of the plans, progress has been made, but in
:51:52. > :51:54.almost every area which I attend this chamber to speak, there is
:51:55. > :51:59.always more to be done and there has to be an essential honesty about
:52:00. > :52:02.that as well. That includes bereavement support, again
:52:03. > :52:05.identified in my opening contribution, as an area for
:52:06. > :52:10.improvement, for the family left behind. That is part of our
:52:11. > :52:13.challenge and it is also why having a national conversation is somewhere
:52:14. > :52:17.where we should take time in this chamber to do that. If we don't
:52:18. > :52:24.normalise a conversation in this place about the importance, we are
:52:25. > :52:27.unlikely to have a national conversation in the wider part of
:52:28. > :52:29.society, so that is a normal conversation that takes place about
:52:30. > :52:34.what we want. It is also why the advance care plans website has been
:52:35. > :52:38.launched, so people have that conversation at a time when they can
:52:39. > :52:42.make choices, much more active choices, about what they want, it is
:52:43. > :52:47.really important because of people know they are coming to end of life
:52:48. > :52:50.care. All those people on the end of life care registers and receiving
:52:51. > :52:54.palliative care and primary care, there should be efforts to improve
:52:55. > :52:57.the number of people that have come forward and had an advance care plan
:52:58. > :53:02.drawn up that they have contributed to. We made real progress leisure to
:53:03. > :53:06.improve the numbers of people who have a plan like that but we
:53:07. > :53:09.understand it is only just over a third of people are primary care
:53:10. > :53:14.register who have an advanced care plan in place. So significant
:53:15. > :53:17.progress last year but lots more to do to get people into a place where
:53:18. > :53:22.they can receive the care they want at the end of their life. On black
:53:23. > :53:24.and Asian communities in Wales, there is a real challenge about some
:53:25. > :53:30.of the care they want to receive. Some of this is a vote to differing
:53:31. > :53:33.nature of family support that exists in those communities and the way
:53:34. > :53:38.they feel about looking after relatives but also the work that
:53:39. > :53:41.Marie Curie themselves have done. I attended the launch both of the
:53:42. > :53:44.consultation stage and the final Report Stage and they recognise that
:53:45. > :53:50.the hospice movement, as well as the Health Service, need to promote the
:53:51. > :53:53.opportunities that exist for end of life care and different choices.
:53:54. > :54:01.Something about the Health Service and hospice that provide care going
:54:02. > :54:03.out and be more proactive with the committees that don't take
:54:04. > :54:06.palliative care in the wake other communities do to say this is an
:54:07. > :54:10.option and I am pleased to see they recognise they had a problem and
:54:11. > :54:15.want to do something about it and certainly interested to see whether
:54:16. > :54:18.that does take place. Over the time of this plan, you will see more
:54:19. > :54:21.people in different communities having more access to palliative
:54:22. > :54:28.care and making active choices about their end of days. I declare an
:54:29. > :54:32.interest in the subject, as I'm the vice president of George Thomas
:54:33. > :54:37.Hospice care based on the grounds of a hospital in Cardiff North that
:54:38. > :54:41.delivers specialist palliative care to allow people to live in their
:54:42. > :54:44.homes and maintain independence for as long as possible and I think it
:54:45. > :54:49.is a good example of partnership working between the voluntary sector
:54:50. > :54:53.and the statutory sector, written the Welsh Government and the local
:54:54. > :54:57.authority and also, I think we would all want to pay tribute to the
:54:58. > :55:01.long-standing investment of the voluntary sector in the hospice
:55:02. > :55:06.movement from which you screw. I think that this plan is a very
:55:07. > :55:12.important plan, the palliative and end of life care delivery plan, and
:55:13. > :55:16.a crucial plan and I would like to play show view to professor and
:55:17. > :55:21.Baroness Laura Finlay who has been so instrumental in this plan and is
:55:22. > :55:25.standing down as a national clinical lead for end of life care in July. I
:55:26. > :55:28.have worked for many years with Laura and I think she has made a
:55:29. > :55:35.tremendous contribution to this area of work. One of the issues I am very
:55:36. > :55:40.concerned of, which the Cabinet Secretary did referred to in his
:55:41. > :55:47.introduction, was the really crucial issue of people when they are very
:55:48. > :55:51.ill being moved into hospital for treatment when, basically, it would
:55:52. > :55:55.be better if they were to stay at home if the support services there
:55:56. > :55:59.could be given for them to Remain at home and this does happen with many
:56:00. > :56:04.seriously ill people who have been receiving this report but when the
:56:05. > :56:08.situation becomes much worse, they then go into hospital, so it is
:56:09. > :56:12.fairly managed to keep people in that situation at home and I have
:56:13. > :56:16.had several examples of that in my own constituency where, actually, at
:56:17. > :56:21.a weekend, someone who was very near the end of their life was taken into
:56:22. > :56:26.hospital AMD because the on-call doctor was so concerned about their
:56:27. > :56:29.condition, whereas I think with a bit more collaboration and working
:56:30. > :56:34.together, they could have remained at home with a bit to increase
:56:35. > :56:37.support. So I think that is one of the crucial areas and I don't know
:56:38. > :56:43.if the Cabinet Secretary can save a bit more about that? I welcome the
:56:44. > :56:48.point made that we need a review of the capacity of existing bereavement
:56:49. > :56:56.services. I think these are a vital part of planning for end of life
:56:57. > :57:01.care. And in George Thomas Hospice care, the consultant has described
:57:02. > :57:04.to me about how they are providing free bereavement counselling, the
:57:05. > :57:08.children who have a parent or grandparent or perhaps a sibling who
:57:09. > :57:13.is dying, and she says that this helps enormously if you do it before
:57:14. > :57:19.the loved person dies and that that does mean you tend to need less
:57:20. > :57:25.frequent follow-up sessions afterwards. So I wondered if the
:57:26. > :57:31.Cabinet Secretary had any news about that and whether this was something
:57:32. > :57:35.that was happening to any extent throughout Wales. And then of
:57:36. > :57:39.course, there is the whole issue of Children's Services for the small
:57:40. > :57:49.but very important group of children who do need palliative care and I'm
:57:50. > :57:53.sure is aware of the work of the Short-lived body, which has put
:57:54. > :57:59.forward several proposals. And then the final point I wanted to make was
:58:00. > :58:02.in terms of advance planning. We have to take account now the number
:58:03. > :58:08.of people diagnosed with dementia who will lead end of life care and
:58:09. > :58:16.we're having a on that later on in the afternoon, about dementia, but
:58:17. > :58:19.in George Thomas Hospice care, 75% of their patients have cancer and up
:58:20. > :58:25.until now, the next group that they were working with other people with
:58:26. > :58:30.heart disease. But now, the next biggest group is people who have
:58:31. > :58:34.dementia and I think that is something we have really got to take
:58:35. > :58:40.into consideration in planning for palliative care, if people do have
:58:41. > :58:44.dementia, and I do note that, I think it was Macmillan, has said we
:58:45. > :58:48.need to do a lot of preplanning with older people and I think we have got
:58:49. > :58:53.to take into account the fact that a large number of people have
:58:54. > :58:57.dementia. And then I just want to say that I do agree with all of the
:58:58. > :59:03.issues about trying to learn from the compassion of communities
:59:04. > :59:10.movement and we do need been conversation and to move onto make
:59:11. > :59:20.that much more part of life. -- to make death much more part of life.
:59:21. > :59:23.Just took speak on the pivot adventure and advanced planning,
:59:24. > :59:27.people can make choices to actively do so and decide what they want,
:59:28. > :59:30.rather than leaving it for other people to second-guess what they
:59:31. > :59:34.might have wanted at a different time in their life and actually,
:59:35. > :59:40.supporting people with dementia is politically difficult. The process
:59:41. > :59:44.of going through and losing someone losing the personality, or parts of
:59:45. > :59:47.it and then to lose them physically, it is a particularly challenging
:59:48. > :59:52.time for the individual who is going that and their families as well. I
:59:53. > :59:56.already mentioned the progress on paediatric care but what I haven't
:59:57. > :59:59.mentioned is the additional work we have had done on a transition
:00:00. > :00:02.between paediatric and adult services. It can be really difficult
:00:03. > :00:06.time for the individual young person, as well as their family and
:00:07. > :00:10.this can be particular difficult when relations are built up through
:00:11. > :00:14.paediatric service and how it is transferred on but we have a
:00:15. > :00:18.particular post within Wales which is a first base in the Children's
:00:19. > :00:18.Hospital in Wales that looks of the transition from paediatric
:00:19. > :00:30.palliative medicine into adult. It is recognised, that the earlier
:00:31. > :00:35.the conversation, the better prepared people are for the
:00:36. > :00:38.bereavement. Your point about George Thomas hospice, you are right,
:00:39. > :00:42.individual and community investment and sustaining it is a huge
:00:43. > :00:47.important part of what keeps the hospice movement special and well
:00:48. > :00:53.funded. I want to recognise a point you made about Laura Finlay, much
:00:54. > :01:00.respected right across the UK as a clinician. She says that Wales has
:01:01. > :01:05.much to be proud of but also much more to do and I think it is a fair
:01:06. > :01:08.reflection of where we are. The final point I make is the point you
:01:09. > :01:17.make about maintaining support for people on the last months and year
:01:18. > :01:19.of life. We know too many of those people have unnecessary hospital
:01:20. > :01:24.admissions and so it is something that is part of the focus for
:01:25. > :01:29.improvement. The latest figures show 65,000 admissions of people in the
:01:30. > :01:38.last year of life, 65,000 emissions into hospitals. -- 65,000 admissions
:01:39. > :01:42.into hospitals. Those people can sometimes be cared for in their own
:01:43. > :01:46.homes that is a large part of the improvement for the year ahead.
:01:47. > :01:48.Hopefully next year we will be able to report back on progress that has
:01:49. > :01:55.been made for people across the country. Caroline Jones. Thank you
:01:56. > :02:00.for your statement, the sad fact is that while everyone will eventually
:02:01. > :02:05.die, we don't all die well. Because of the latter, it is essential we
:02:06. > :02:09.have excellent end of life care. I welcome the Welsh Government's
:02:10. > :02:13.palliative and end of life care plan and the commitment to improve the
:02:14. > :02:18.care given to those approaching the end of their lives and those they
:02:19. > :02:23.leave behind. If current trends continue, the number of people dying
:02:24. > :02:27.in Wales will increase by 9%. We know that around 6200 people die
:02:28. > :02:33.each year, do not get the palliative care they need but these figures
:02:34. > :02:36.come from Marie Curie and they are not coming from the NHS. Therefore,
:02:37. > :02:43.they don't feed into the workforce planning. We need an all-round
:02:44. > :02:48.approach to palliative care as for the whole family are involved.
:02:49. > :02:52.Therefore, it is essential staff are properly trained to deal with
:02:53. > :02:59.sensitive situations such as this and it is pleasing to see that
:03:00. > :03:05.?150,000 is provided to train staff in advanced communication skills and
:03:06. > :03:08.end of life care. Although this is a start, a good start in recognising
:03:09. > :03:15.the specialist skills needed, could you provide more information on how
:03:16. > :03:22.many staff you anticipate? And what area will be covered in Wales? Some
:03:23. > :03:29.may be more than others due to logistic situations? Funding to
:03:30. > :03:33.provide access to hospice at home provision is welcome, along with
:03:34. > :03:38.palliative care registered for all GPs who have a register of all
:03:39. > :03:44.patients with supportive palliative care needs. Could you also tell me
:03:45. > :03:48.how these registers are, child because there are some people
:03:49. > :03:52.obviously without families who go unnoticed and become ill and they
:03:53. > :03:58.are reluctant to visit their GPs. I wonder how we can reach these people
:03:59. > :04:02.who sometimes and very often actually, die at home and are
:04:03. > :04:09.discovered days or weeks later. Can we do more to make sure people like
:04:10. > :04:16.this are included? Also, to bring back something said earlier, a Marie
:04:17. > :04:21.Curie report has highlighted, as I indeed highlighted in the last
:04:22. > :04:29.statement, additional barriers faced by bereaved LGBT communities beyond
:04:30. > :04:33.the universal pain experienced after losing a partner. Despite this,
:04:34. > :04:38.there are no specific actions outlined in the delivery plan aimed
:04:39. > :04:44.at addressing these issues. Cabinet secretary, do you agree with me that
:04:45. > :04:49.if we are to improve the end of life care for LGBT and BME communities,
:04:50. > :04:55.we must address the shortcomings in this plan? In England, the NHS
:04:56. > :05:00.conducts a survey of bereaved called Voices, and this shows the level of
:05:01. > :05:05.care and support given to families at the end of their loved ones'
:05:06. > :05:09.lives. We don't conduct such a survey in Wales and if we are to
:05:10. > :05:14.make sure that everyone who needs specialist palliative care gets it,
:05:15. > :05:17.and we are going to make sure that an individual needs and priorities
:05:18. > :05:24.and preferences for end of life care can be identified, documented,
:05:25. > :05:29.reviewed, respected and acted upon, then we must conduct a survey of the
:05:30. > :05:34.bereaved also in Wales. I see there is no privilege for this in the
:05:35. > :05:39.statement. Rather than relying on data collected through the
:05:40. > :05:46.programme, which many patients are unaware of, does your Government
:05:47. > :05:53.have plans to introduce a comprehensive survey of bereaved
:05:54. > :06:00.families in Wales? The website launch is welcome and definitely is
:06:01. > :06:05.the way forward. However, we must not depend on this statement that
:06:06. > :06:10.nowadays, most people find most of the Reformation online. Although
:06:11. > :06:13.this is true, there are many people without access to online services
:06:14. > :06:20.and therefore, we need to be inclusive. It is important this plan
:06:21. > :06:26.is inclusive and beneficial to all. I note consultants and palliative
:06:27. > :06:31.care are now available on-call 24/7. Can you tell me how people will
:06:32. > :06:42.become aware of this service? And the work with the children's
:06:43. > :06:48.hospice, Ty Hafan, and an out of hours telephone service is essential
:06:49. > :06:52.and is very welcome. I thank all hospital staff involved in this
:06:53. > :06:59.extremely sensitive area, whilst also acknowledging the dedication of
:07:00. > :07:02.families to their loved ones. I recognise the positive ongoing work
:07:03. > :07:05.and the commitment shown by the Welsh Government and the Cabinet
:07:06. > :07:10.secretary in this statement, however, I look forward to working
:07:11. > :07:16.with you positively and constructively to further improve
:07:17. > :07:22.the services in palliative care. Thank you for the series of
:07:23. > :07:25.questions and comments. On the point about serious illness conversations,
:07:26. > :07:29.I'll happily provide an update for members about how many staff have
:07:30. > :07:33.gone under trading in the last year and how many more we expect to have
:07:34. > :07:37.that trading over the next year. And more as a result of the additional
:07:38. > :07:43.resources we are putting into it. On your point about the survey, of
:07:44. > :07:48.bereaved families and all patients, I would be happy to consider whether
:07:49. > :07:54.there is a better way forward but in this point in time, no one has
:07:55. > :07:58.suggested to me, it has not been asked from the board, that we have
:07:59. > :08:01.to have a different means of understanding feedback from people
:08:02. > :08:05.directly involved in the care, people involved in receiving the
:08:06. > :08:10.care as well. I would have expected if there was a real call for that,
:08:11. > :08:14.that would have come through the board both from clinicians who are
:08:15. > :08:19.still champions for the patients, as well as for the campaigning third
:08:20. > :08:22.sector as well. If there is real evidence, there is a need to do
:08:23. > :08:26.something different, I am open-minded about it but I would
:08:27. > :08:32.need to be persuaded we don't currently have an adequate way of
:08:33. > :08:35.understanding the quality of the care provided. The point you made
:08:36. > :08:38.about the organisation of palliative care, we have got more people
:08:39. > :08:42.available at different times in the day. We have a service enabled
:08:43. > :08:46.throughout the week. I would need to be persuaded there is a different
:08:47. > :08:50.way in which that should be accessed. Part of the challenge of
:08:51. > :08:56.calls is what happens to those people who die alone. In their own
:08:57. > :08:59.homes. Those people are few and far between but there is a broader
:09:00. > :09:13.challenge as to how we as a society engage...
:09:14. > :09:25.Thank you for coming to join us today, our very distinguished and
:09:26. > :09:28.honourable guest the Prime Minister the reason may. She will just say a
:09:29. > :09:35.few words and an open the floor to the general questions. Can we give a
:09:36. > :09:44.big welcome to the Prime Minister Theresa May. Thank you very much
:09:45. > :09:45.indeed, a great pleasure to be with